Kidney Failure, Chronic

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Editorial

Yellow Fever and Cardiovascular Disease: An Intersection of Epidemics

Gláucia Maria Moraes de Oliveira et al. Roberto Muniz Ferreira

Arboviral diseases are an important public health problem, especially in tropical and subtropical countries, such as Brazil, where viruses of the family Flaviviridae, responsible for dengue fever, zika and yellow fever (YF), and of the family Togaviridae, which cause chikungunya, predominate. In recent years, the number of cases has increased because of several factors, of which environmental changes, such as deforestation and climate changes, disorderly occupation of cities with low hygiene-sanitary conditions, in addition to the increased mobility of international travelers, stand out. Such factors have allowed the colonization of new areas by vectors, mainly Aedes aegypti, which can be found in 80% of the Brazilian territory.^,

Dengue virus, which has four different serotypes, has accounted for isolated epidemics or for co-infections in 1984-1985, 1997-1999 and 2004-2007. Chikungunya, whose virus originated in Africa, succeeded the dengue fever in Brazil in 2014, with similar clinical and laboratory presentation, hindering the differential diagnosis. In 2015, the first cases of zika were reported in Brazil. summarizes the clinical manifestations of those arboviral diseases.^–

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Original Article

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes

Mauro Alves et al. Nelson Albuquerque de Souza e Silva Lucia Helena Alvares Salis Basilio de Bragança Pereira … Paulo Henrique Godoy Emília Matos do Nascimento Jose Mario Franco Oliveira

Background:

End-stage kidney disease patients continue to have markedly increased cardiovascular disease morbidity and mortality. Analysis of genetic factors connected with the renin-angiotensin system that influences the survival of the patients with end-stage kidney disease supports the ongoing search for improved outcomes.

Objective:

To assess survival and its association with the polymorphism of renin-angiotensin system genes: angiotensin I-converting enzyme insertion/deletion and angiotensinogen M235T in patients undergoing hemodialysis.

Methods:

Our study was designed to examine the role of renin-angiotensin system genes. It was an observational study. We analyzed 473 chronic hemodialysis patients in four dialysis units in the state of Rio de Janeiro. Survival rates were calculated by the Kaplan-Meier method and the differences between the curves were evaluated by Tarone-Ware, Peto-Prentice, and log rank tests. We also used logistic regression analysis and the multinomial model. A p value ≤ 0.05 was considered to be statistically significant. The local medical ethics committee gave their approval to this study.

Results:

The mean age of patients was 45.8 years old. The overall survival rate was 48% at 11 years. The major causes of death were cardiovascular diseases (34%) and infections (15%). Logistic regression analysis found statistical significance for the following variables: age (p = 0.000038), TT angiotensinogen (p = 0.08261), and family income greater than five times the minimum wage (p = 0.03089), the latter being a protective factor.

Conclusions:

The survival of hemodialysis patients is likely to be influenced by the TT of the angiotensinogen M235T gene.

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Artigo Original

Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment

Fátima Aparecida A. Almeida et al. Felipe Carrhá Machado José Andrade Moura Junior Armênio Costa Guimarães

BACKGROUND: There is a high global and cardiovascular mortality rate among patients who need hemodialysis. OBJECTIVE: To assess global and cardiovascular mortality and to identify the risk factors in patients who undergo hemodialysis. METHODS: Observational, prospective study. A total of 334 patients were studied within three years. Primary outcomes: global and cardiovascular mortality. Survival was assessed through Kaplan-Meier method, and the risk variables were identified by means of bivariate and multivariate Cox regression. RESULTS: A total of 189 men (56.6%), aging 48.8 ± 14.2, majority non-white (295, 88.3%) and who did finished the elementary school (211, 63.2%). Global mortality rate was 21.6%, with a 50% rate of 146-month survival; cardiovascular mortality rate was 41.7% (30/72), with a 75% rate of 141-month survival. In the bivariate analysis, the relative risk (RR) for non-cardiovascular and cardiovascular death increased when age >60 years old was Hb126 mg/dl. Only non-cardiovascular death with low school grade and widow, Hb<11.0 g/dl, Ht100 mg/dl, Ca product x P9.2 mg/dl decreased with blood pressure (BP) >140/90 mmHg (before hemodialysis session) and Ht>36%; Obit due only to cardiovascular factors increased with creatinine >9.4 mg/dl. In the multivariate analysis, non-cardiovascular and cardiovascular RR increased with age >60 years old and Hb126 mg/dl, and non-cardiovascular death RR increased with urea removal rate in hemodialysis (Kt/V) 60 years old and Hb126 mg/dL, and for non-cardiovascular cause of death, Kt/V<1,2.

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Artigo Original

Oxidative stress and endothelial dysfunction in chronic kidney disease

Valeria Costa-Hong et al. Luiz Aparecido Bortolotto Vanda Jorgetti Fernanda Consolim-Colombo … Eduardo M Krieger Jose Jayme Galvão de Lima

BACKGROUND: Chronic kidney disease (CKD) is characterized by the high prevalence of atherosclerosis. Considering that endothelial dysfunction and oxidative stress are promoters of atherosclerosis, it is of interest to verify whether the two conditions are associated in CKD patients still free of clinical cardiovascular disease (CVD). OBJECTIVE: To evaluate the association between oxidative stress and endothelial function in end-stage CKD patients without clinically evident CVD. METHODS: We studied 22 nondiabetic, nonsmoker CKD patients without clinical CVD treated by maintenance hemodialysis and 22 healthy controls. Endothelium- dependent and independent vascular reactivity and oxidative stress, as determined by the plasma levels of thiobarbituric acid-reactive substances – TBARS, were evaluated in all subjects. RESULTS: Endothelium-dependent (6.0 ± 4.25 vs. 11.3 ± 4.46 %, p< 0.001) and endothelium-independent (11.9 ± 7.68 vs. 19.1 % ± 6.43 %, p< 0.001) vascular reactivity were reduced, while TBARS (2.63 ± 0.51 vs. 1.49 ± 0.42 nmols/mL) was increased in CKD patients when compared to controls. TBARS levels were significantly related to endothelium-dependent vascular reactivity (r= – 0.56, p< 0.001) and to systolic blood pressure (r= – 0.48, p= 0.002). CONCLUSION: Oxidative stress is increased in CKD patients free of CVD and is associated with endothelial dysfunction in patients and controls. The results suggest that oxidative stress and endothelial dysfunction may be involved in the increased susceptibility of CKD patients to CVD and cardiovascular complications.

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Yellow Fever and Cardiovascular Disease: An Intersection of Epidemics

Survival and Predictive Factors of Lethality in Hemodyalisis: D/I Polymorphism of The Angiotensin I-Converting Enzyme and of the Angiotensinogen M235T Genes

Background:

Objective:

Methods:

Results:

Conclusions:

Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment

Oxidative stress and endothelial dysfunction in chronic kidney disease

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