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Caro Editor, A iniciativa internacional KDIGO (Kidney Disease: Improving Global Outcomes) publicou recentemente as importantes conclusoes de uma conferencia de consenso intitulada genericamente “Nomenclature for kidney function and disease”. O principal objetivo era a padronizacao da nomenclatura nefrologica para artigos cientificos escritos em ingles, seguindo como principio fundamental o melhor entendimento por pacientes (anglo-saxoes)1,2. Como nefrologistas, devemos levar essas recomendacoes em consideracao em nossas publicacoes internacionais. Do ponto de vista latino, foi surpreendente que uma das principais recomendacoes tenha sido [...]

Background: Current guidelines recommend assessment of 25-vitamin D status in patients with chronic kidney disease (CKD). Although significant differences among assays have been described, the impact of CKD on this variability has never been tested. Methods: We tested the variability between two 25-vitamin D assays in patients with CKD (eGFR < 60 mL/min/1.73m2) who had consecutive 25-vitamin D measurements in 2015 (Assay 1 - Diasorin LIASON 25 TOTAL - D assay®) and 2016 (Assay 2 - Beckman Coulter Unicel Xl 800®). The cohort consisted of 791 adult patients (122 with normal renal function and 669 with CKD - 33, 30, and 37% in stages 3, 4, and 5 on dialysis, respectively). Results: Levels of 25-vitamin D were lower and the prevalence of hypovitaminosis D using assay 1 was higher than using assay 2 in patients with CKD, regardless of similar levels of calcium, phosphate, and parathyroid hormone. As kidney function decreased, the percentage of disagreement between the assays increased. Conclusion: There is a noteworthy variability between assays in patients with CKD such that the diagnosis of hypovitaminosis D is modified. The mechanism behind this result is still unclear and might be due to a possible interference in the analytical process. However, the clinical significance is unquestionable, as the supplementation of vitamin D can be erroneously prescribed to these patients.

Background: Current guidelines recommend assessment of 25-vitamin D status in patients with chronic kidney disease (CKD). Although significant differences among assays have been described, the impact of CKD on this variability has never been tested. Methods: We tested the variability between two 25-vitamin D assays in patients with CKD (eGFR < 60 mL/min/1.73m2) who had consecutive 25-vitamin D measurements in 2015 (Assay 1 - Diasorin LIASON 25 TOTAL - D assay®) and 2016 (Assay 2 - Beckman Coulter Unicel Xl 800®). The cohort consisted of 791 adult patients (122 with normal renal function and 669 with CKD - 33, 30, and 37% in stages 3, 4, and 5 on dialysis, respectively). Results: Levels of 25-vitamin D were lower and the prevalence of hypovitaminosis D using assay 1 was higher than using assay 2 in patients with CKD, regardless of similar levels of calcium, phosphate, and parathyroid hormone. As kidney function decreased, the percentage of disagreement between the assays increased. Conclusion: There is a noteworthy variability between assays in patients with CKD such that the diagnosis of hypovitaminosis D is modified. The mechanism behind this result is still unclear and might be due to a possible interference in the analytical process. However, the clinical significance is unquestionable, as the supplementation of vitamin D can be erroneously prescribed to these patients. Resumo Antecedentes: As diretrizes atuais recomendam a avaliação do estado da 25-hidroxivitamina D em pacientes com doença renal crônica (DRC). Embora significativas diferenças entre os ensaios tenham sido descritas, o impacto da nesta variabilidade DRC nunca foi testado. Métodos: Testamos a variabilidade entre dois ensaios de 25-hidroxivitamina D em pacientes com DRC (TFGe < 60 mL/min/1,73 m2) que realizaram medidas consecutivas de 25-hidroxivitamina D em 2015 (Ensaio 1 - Diasorin LIASON 25 TOTAL - D assay® ) e 2016 (Ensaio 2 - Beckman Coulter Unicel Xl 800®). A coorte consistiu de 791 pacientes adultos (122 com função renal normal e 669 com DRC - 33, 30 e 37% nos estágios 3, 4 e 5 em diálise, respectivamente). Resultados: Os níveis de 25-hidroxivitamina D foram menores e a prevalência de hipovitaminose D foi maior utilizando o ensaio 1 do que com o ensaio 2 em pacientes com DRC, independentemente dos níveis similares de cálcio, fosfato e paratormônio. Quando a função renal diminuiu, a porcentagem de discordância entre os ensaios aumentou. Conclusão: Existe uma notável variabilidade entre os ensaios em pacientes com DRC, de modo a modificar o diagnóstico de hipovitaminose D. O mecanismo por trás desse resultado ainda não está claro e pode ser devido a uma possível interferência no processo analítico. Entretanto, o significado clínico é inquestionável, pois a suplementação de vitamina D pode ser erroneamente prescrita a esses pacientes.

Introduction: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD) constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an increased risk of cardiovascular disease. However, it is not known whether or not smoking impacts the cardiovascular risk in CKD- MBD. Objective: To analyze the relationship between smoking and CKD-MBD markers. Methods: We evaluated 92 patients divided into: 1) Control Group: non-smokers without CKD; 2) CKD group in stages III and IV under conservative treatment (20 non-smokers and 17 smokers); 3) CKD group on dialysis (21 non-smokers and 19 smokers). Clinical, demographic, and biochemical markers were compared between the groups. Results: FGF-23 and Klotho levels were not different between smokers and non-smokers. Patients in the CKD group on conservative treatment had higher serum P than non-smokers (p = 0.026) even after adjusted for renal function (p = 0.079), gender (p = 0.145) and age (p = 0.986). Conclusion: Smoking confers a higher cardiovascular risk to CKD patients under conservative treatment as it is associated with higher levels of P. Further studies are needed to confirm and better elucidate this finding. RESUMO Introdução: Os distúrbios do metabolismo mineral e ósseo da doença renal crônica (DMO-DRC) constituem uma síndrome definida por alterações do cálcio, do fósforo (P), da vitamina D e do paratormônio, do fator de crescimento de fibroblastos 23 (FGF-23) e de seu cofator específico, Klotho. Os DMO-DRC, assim como o tabagismo, estão associados a maior risco de doença cardiovascular. Porém, não se sabe se há influência do tabagismo no risco cardiovascular dos DMO-DRC. Objetivo: Analisar a relação entre o tabagismo e marcadores dos DMO-DRC. Métodos: Avaliamos 92 pacientes divididos em: 1) Grupo controle sem DRC não tabagistas; 2) Grupo DRC em tratamento conservador estágios III e IV (20 não tabagistas e 17 tabagistas); 3) Grupo DRC em diálise (21 não tabagistas e 19 tabagistas). Marcadores clínicos, demográficos e bioquímicos foram comparados entre os grupos. Resultados: Níveis de FGF-23 e Klotho não foram diferentes entre tabagistas e não tabagistas. Pacientes tabagistas do grupo com DRC em tratamento conservador exibiram maior P sérico do que não tabagistas (p = 0,026) mesmo após ajuste para função renal (p = 0,079), sexo (p = 0,145) e idade (p = 0,986). Conclusão: O tabagismo confere um maior risco cardiovascular adicional aos pacientes com DRC em tratamento conservador à medida que se associa com maiores níveis de P. Novos estudos são necessários para confirmar e melhor elucidar esse achado.

BACKGROUND: Narcolepsy is a chronic neurological syndrome with prevalence between 0.018% and 0.040% without important ethnic differences. Narcolepsy is characterized by excessive daytime sleepiness and cataplexy. The pathophysiology of the illness is not known; even so it possesses genetic marker (allele HLA DQB1 *0602) and with abnormalities in the neurotransmission of hypocretin has been described in patients with narcolepsy. OBJECTIVES: Resume news discoveries in narcolepsy and show diagnoses and treatment options. METHODS: Bibliographic review. RESULTS AND DISCUSSION: The diagnoses of narcolepsy must be done with The International Classification of Sleep Disorders criteria. The hypocretin dosage is the best exam to confirm diagnose in narcoleptic patients with typical cataplexy. The treatment is carried through with behavior actions and symptomatic drugs that promote the vigil and control the cataplexy. Differential diagnoses as schizophrenia, epilepsy, depression and others sleep disorders need to be eliminated. CONTEXTO: Narcolepsia é uma síndrome neurológica crônica com prevalência entre 0,018% e 0,040% da população, sem diferenciações étnicas importantes. Caracteriza-se por sonolência e cataplexia. A fisiopatologia da doença não é totalmente conhecida, embora possua marcador genético (alelo HLA DQB1 *0602) e anormalidades na neurotransmissão de hipocretina descritos recentemente. OBJETIVOS: Resumir as recentes descobertas na narcolepsia e expor possibilidades diagnósticas e terapêuticas. METODOLOGIA: Revisão bibliográfica. RESULTADOS E DISCUSSÃO: O diagnóstico deve seguir os critérios da Classificação Internacional de Sono. A dosagem de hipocretina é o melhor exame para confirmar narcolepsia em pacientes com cataplexia típica. O tratamento deve ser realizado com medidas comportamentais e drogas sintomáticas que promovem a vigília e controlam a cataplexia. Diagnósticos diferenciais como esquizofrenia, epilepsia, depressão e doenças do sono devem ser descartados.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-27T22:18:55Z No. of bitstreams: 1 Maria Beatriz Cordeiro de Noronha Pessoa.pdf: 4983357 bytes, checksum: 1a1c8c0c85530fc6204f8474439ad244 (MD5) Made available in DSpace on 2022-07-27T22:18:55Z (GMT). No. of bitstreams: 1 Maria Beatriz Cordeiro de Noronha Pessoa.pdf: 4983357 bytes, checksum: 1a1c8c0c85530fc6204f8474439ad244 (MD5) Previous issue date: 2024-11-12 Introduction: Chronic Kidney Disease (CKD) affects a large percentage of patients worldwide. Renal replacement therapy keeps patients with CKD alive. Mineral and bone disease is a common complication of CKD (CKD-BMD) and includes changes in serum concentrations of phosphorus, parathyroid hormone (PTH), calcium (Ca), and vitamin D, in addition to vascular and soft tissue calcifications. Corneal and conjunctival calcification (CCC) is poorly studied in this population despite the eyes being the main site of metastatic calcification in patients with CKD. It is not known whether CCC correlates with coronary artery calcification and CKD-MBD biomarkers. Methods: this was a prospective observational study that included patients on dialysis for at least 3 months. Clinical, demographic, and biochemical factors (Ca, phosphorus, PTH, alkaline phosphatase, and vitamin D) were analyzed. CCC was evaluated by slit-lamp ophthalmologic examination and optical coherence tomography (OCT) by the same observer. Coronary calcium scores (Agatston) were assessed by tomography. Results: We included 34 patients [48.0 ± 15.2 years, 61.8% women, on hemodialysis for 5.7 (2.7- 9.3) years, 79.4% with hyperparathyroidism]. Laboratory tests were: PTH 731(336-1366) pg/ml, vitamin D 33.2 ± 13.7 ng/ml, alkaline phosphatase 148 (94-400) UI/L, ionized Ca 4.91 ± 0 .42 mg/dl, total Ca 9.3 ± 1.0 mg/ml, and phosphorus 5.3 ± 1.9 mg/ml. In the slit lamp ophthalmological examination, we obtained a median of CCC scores were 5 (1-12) and 9 (3-14.5), obtained from slit lamp and OCT, respectively. The scores obtained by the slit lamp tended to underestimate those obtained by the OCT, although they had a good correlation with each other. Hyperphosphatemia was more frequent in patients with moderate/severe CCC than in those with CCC mild. Hyperphosphatemia remained an independent risk factor for moderate/severe CCC [relative risk 5.33 (95% CI 1.02-27.76), p=0.047], even after adjusting for age and presence of diabetes. We found no correlation between coronary calcium scores and CCC obtained either by slit lamp or by OCT. Conclusion: CCC is frequent in patients with CKD on dialysis and does not correlate with coronary calcium scores. Hyperphosphatemia appears to independently contribute to CCC. Introdução: A Doença Renal Crônica (DRC) atinge um grande percentual de pacientes em todo o mundo. Em estádio avançado os pacientes dependem de terapia de substituição renal. A doença mineral e óssea é uma complicação comum da DRC (DMO-DRC) e cursa com alterações nas concentrações séricas de fósforo, hormônio da paratireoide (PTH), cálcio (Ca) e vitamina D, além de calcificações vasculares e de partes moles. Calcificação de córnea e conjuntiva (CCC) é pouco estudada nesta população apesar dos olhos serem o principal sítio de calcificação metastática em pacientes com DRC. Não se sabe se as CCC se correlacionam com calcificação coronariana e com os dados bioquímicos da DMO-DRC em pacientes com DRC em hemodiálise. Métodos: estudo prospectivo observacional que incluiu pacientes há pelo menos 3 meses em diálise. Foram analisados fatores clínicos, demográficos e bioquímicos (Ca, fósforo, PTH, fosfatase alcalina e vitamina D) e hiperparatireoidismo (PTH > 300pg/ml). CCC foi avaliada por exame oftalmológico na lâmpada de fenda e no tomógrafo de coerência óptica (OCT), pelo mesmo observador. Escores de cálcio de coronárias (Agatston) foram avaliados por tomografia. Resultados: foram incluídos 34 pacientes incluídos [48,0 ± 15,2 anos, 71,8% mulheres, em diálise por 5,7 (2,7-9,3) anos, 79,4% com hiperparatireoidismo]. Exames laboratoriais foram: PTH 731 (336-1366)pg/ml, vitamina D 33,2 ± 13,7ng/ml, fosfatase alcalina 148 (94-400)U/L, Ca ionizado 4,91 ± 0,42mg/dl, Ca total 9,3 ± 1,0mg/ml e fósforo 5,3 ± 1,9mg/ml. Escores de CCC pelo exame oftalmológico foram 5 (1-12) e 9 (3-14,5), na lâmpada de fenda e OCT, respectivamente. Os escores obtidos pela lâmpada de fenda tenderam a subestimar aqueles obtidos pela OCT, embora tenham tido boa correlação entre si. Hiperfosfatemia permaneceu como fator de risco independente para CCC moderada/grave [risco relativo 5,33 (IC: 95% 1,02-27,76), p=0,047], mesmo após ajuste para idade e presença de diabetes. Não encontramos correlação entre os escores de Ca da coronária e a CCC. Conclusão: CCC é frequente em pacientes com DRC em diálise e não se correlacionam com escores de cálcio da coronária. Hiperfosfatemia contribui de forma independente para a CCC.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-21T14:48:28Z No. of bitstreams: 1 Fernando da Silva Sant_Anna.pdf: 3017185 bytes, checksum: 8b1219efc26ba3f37af2d874ef2b1c24 (MD5) Made available in DSpace on 2022-07-21T14:48:28Z (GMT). No. of bitstreams: 1 Fernando da Silva Sant_Anna.pdf: 3017185 bytes, checksum: 8b1219efc26ba3f37af2d874ef2b1c24 (MD5) Previous issue date: 2021-10-05 The six-minute walk test (6MWT) has been widely used in patients with symptomatic peripheral arterial disease (PAD) to quantify disease severity, gait impairment and the effectiveness of different therapeutic interventions. However, the information provided by this test can go beyond the meters covered. The aim of this thesis was to expand the use of the 6MWT in patients with PAD, describing their relative values compared to peers without the disease and using the product of distance by body weight (DW) as a new way to interpretation 6MWT data. Furthermore, the second objective was to analyze the relationship of new interpretations with functional capacity and cardiovascular variables. Therefore, 227 patients with symptomatic PAD participated in the study. The 6MWT was performed and the onset claudication distance and the total walking distance in six minutes were obtained. The results of the 6MWT were then relativized and expressed as a percentage of a healthy individual without PAD. Additionally, from the obtained absolute distance, the DW was calculated. Functional capacity was objectively assessed using the Short Physical Performance Battery and the handgrip strength test, and subjectively using questionnaires (Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History). The indicators of the cardiovascular system were obtained by measuring brachial blood pressure (BP), central blood pressure and arterial stiffness indicators (pulse pressure, augmentation index itself and corrected by 75 bpm, and pulse wave velocity). The results of the 6MWT were compared between genders using the independent t test. To analyze the influence of different age categories (≤59 years, 60-69 years and ≥70 years), one-way ANOVA was applied. To test the relationship between the variables, Spearman's correlation was performed. Values with P0.072). The DW was higher in men than in women (P0,072). O DP foi maior nos homens do que nas mulheres (P

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-12T18:57:47Z No. of bitstreams: 1 Jéssica Santos.pdf: 4347035 bytes, checksum: d936ccbee014efaef73dffbc47a9147b (MD5) Made available in DSpace on 2021-11-12T18:57:47Z (GMT). No. of bitstreams: 1 Jéssica Santos.pdf: 4347035 bytes, checksum: d936ccbee014efaef73dffbc47a9147b (MD5) Previous issue date: 2021-06-24 Introduction: Chronic kidney disease has grown worldwide and has consequently been considered a public health problem. With the improvement of dialysis treatment, more patients with the aforementioned disease have had pregnancies. While the literature has focused on the pregnancies evolution, little attention is paid to the newborns (NB). The clinical condition of NBs can be affected by prematurity, which is frequent amongst mother in dialysis, as well as by uremia and by the renal replacement therapy itself. In this context, the objective of this research was to evaluate birth conditions and in-hospital complications of NBs from mothers on dialysis. Methods: This is a cross-sectional study with a quantitative approach, with data collected from medical records at the Hospital das Clínicas of the University of São Paulo. We compared 2 groups of patients, NBs from mothers on dialysis and NBs from mothers with high-risk pregnancies, but with normal renal function. Apgar scores in the 1st, 5th, and 10th minutes, birth and discharge weight, clinical complications, and length of stay were analyzed. Results: the comparison between NBs of mothers on dialysis (N=29) with NBs of mothers with normal renal function (N=21) showed that gestational age was lower among mothers on dialysis (32.4  3.7 vs. 38.0  1.2 weeks, p

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-18T22:01:41Z No. of bitstreams: 1 Renata Gomes.pdf: 2364841 bytes, checksum: 6d777d3679f09a885c9664da7d1b1964 (MD5) Made available in DSpace on 2021-11-18T22:01:41Z (GMT). No. of bitstreams: 1 Renata Gomes.pdf: 2364841 bytes, checksum: 6d777d3679f09a885c9664da7d1b1964 (MD5) Previous issue date: 2021-06-10 During the human aging process, there is an increased risk of developing diseases such as chronic kidney disease (CKD), a progressive, silent and irreversible pathology, that has been negatively affecting the entire population, including the elderly. About 30 to 40% of the elderly fall at least once a year, a risk that increases in individuals with CKD who undergone hemodialysis (HD). The calf circumference measurement (CC) is an easy, low cost and non-invasive measure, already used to check muscle mass in the elderly. A prospective study was outlined with the hypothesis that the CC measurement would be able to predict the risk of falls in elderly people in HD treatment. The objectives of the present study were: to assess the ability of the CC measure to predict the risk of falls and fractures in elderly people on HD. Specific objectives were: to assess the prevalence of decreased CC, to correlate the CC measurement with clinical, demographic, and biochemical factors, ankle-brachial pressure index (ABI) and handgrip strength (HGS), with other nutritional measures such as serum levels of albumin, cholesterol, and phosphorus, as well as the degree of physical fitness fall and fractures. This was a prospective study that included 91 elderly patients with CKD on maintenance HD from 2 dialysis services (age 73.7  5.4 years, 69.2% men, 56% with diabetes). The mean CC was 32.6  3.7 cm, with a high prevalence of low muscle mass measured by CC in the study population (61.5%). After the initial approach, the subjects were followed for six months. During this period of time, 13 fall patients were identified, one fall followed by fracture and death. It was observed that both advanced age and high weight were factors associated with falls. None of other variable was correlated to fall, including laboratory results, ABI, HGS pr DASI scores. A logistic regression model was applied to select covariates of interest. CC, age, and weight remained significant in the final model. Therefore, after adjusting for age and weight, the chance of falling in the elderly with decreased CC is 6.9 times greater than in the elderly with normal CC. It was concluded that an association with age and weight, the decreased CC was able to predict fall in elderly patients on HD. Durante o processo de envelhecimento humano há um maior risco de desenvolver doenças, entre elas, a doença renal crônica (DRC), uma patologia progressiva, silenciosa e irreversível da função renal que vem afetando a população de forma preocupante, inclusive idosos. Cerca de 30 a 40% dos idosos caem ao menos uma vez por ano e esse risco aumenta quando esse idoso tem DRC e faz tratamento hemodialítico (HD). A medida de circunferência de panturrilha (CP) é uma medida de fácil aplicação, baixo custo e não invasiva, já utilizada para verificar massa muscular em idosos. Delineou-se um estudo prospectivo com a hipótese de que a medida da CP seria capaz de predizer risco de queda em idosos com DRC em tratamento em HD. Os objetivos do presente estudo foram: avaliar a capacidade da medida de CP em prever o risco de quedas e fraturas em idosos em HD e avaliar a prevalência de CP diminuída. Objetivos mais específicos foram: correlacionar a medida de CP com fatores clínicos, demográficos e bioquímicos, com o índice de pressão tornozelo-braquial (ITB) e com a força de preensão palmar (FPP), com outras medidas nutricionais tais como concentração de albumina, colesterol e fósforo, além do grau de aptidão física, além de quedas e fraturas. Tratou-se de um estudo prospectivo com 91 idosos de dois centros de HD do estado de São Paulo (idade 73,7  5,4 anos, 69,2% homens, 56% com diabetes). A CP média foi de 32,6  3,7 cm, com alta prevalência de baixa massa muscular medida pela CP na população em estudo (61,5%). Após a abordagem inicial os sujeitos foram acompanhados por um período de seis meses. Durante este período foram identificados 13 pacientes caidores, uma queda seguida de fratura e óbito. Observou-se que tanto a idade avançada como o peso elevado se apresentaram como fatores associados à queda. Nenhuma outra variável se correlacionou com quedas, incluindo exames laboratoriais, ITB, FPP e escores de DASI. Um modelo de regressão logística foi aplicado para seleção de covariáveis de interesse. Permaneceram significantes no modelo final a CP diminuída, a idade e o peso. Dessa forma, após ajuste pela idade e peso, a chance de queda em idosos com CP diminuída é 6,9 vezes maior do que em idosos com a CP normal. Conclui-se que, embora não isoladamente, mas em associação com idade e peso, a CP diminuída foi capaz de prever queda na população em HD.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-21T19:25:42Z No. of bitstreams: 1 Vanessa Corrêa Fanchini.pdf: 1925167 bytes, checksum: 9f493348e83c689f748275fb0add308b (MD5) Made available in DSpace on 2022-07-21T19:25:42Z (GMT). No. of bitstreams: 1 Vanessa Corrêa Fanchini.pdf: 1925167 bytes, checksum: 9f493348e83c689f748275fb0add308b (MD5) Previous issue date: 2021-05-06 Introduction: Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function, with a consequent reduction in the production of erythropoietin, the hormone responsible for erythropoiesis. Therefore, loss of renal function can result in anemia and despite of treatment with the use of erythropoiesis stimulating agents (ESAs), some patients are hyporesponsive due to the state of micro inflammation caused by the accumulation of uremic toxins and hepcidin, a hormone that plays a central role in iron homeostasis. Hemodiafiltration (HDF) is a recent dialysis modality that, due to its higher convective rates, can purify a larger spectrum of molecules, reducing inflammation. Aims: To evaluate the serum concentration of hepcidin and inflammatory biomarkers by treatment with HDF in elderly patients with CKD. Material and methods: Thirty patients aged 65 to 94 years with CKD who were previously treated with conventional hemodialysis and started treatment with HDF were included. However, 19 patients completed the study and were evaluated at time zero and after 12 months of follow-up for hematimetric, biochemical, hepcidin and inflammatory cytokine parameters. Results: After 12 months of treatment, we observed a significant increase in hemoglobin, hematocrit, hepcidin, TNF-α, IL-10, β2-microglobulin and a decrease in C reactive protein (PCR). Discussion: The serum concentrations of hepcidin and β2-microglobulin were not reduced in follow-up in this elderly population of chronic kidney patients after 12 months with HDF treatment probably due to loss of residual renal function. The increase in hemoglobin and hematocrit levels observed may have been due to treatment withs ESAs (89%) and iron supplementation (74%), suggesting that there was no hyporesponsiveness or resistance to treatment in the patients of the present study. Conclusion: Hepcidin appeared to be more related as an iron biomarker regardless of the variations of inflammatory markers than associated with resistance to the use of ESAs. Introdução: A Doença Renal Crônica (DRC) é caracterizada pela perda progressiva e irreversível da função renal, com consequente redução da produção de eritropoetina, hormônio responsável pela eritropoiese. Portanto, a perda da função renal pode resultar em anemia e apesar do tratamento com uso de agentes estimulantes de eritropoiese (AEEs) alguns pacientes são hiporresponsivos devido ao estado de micro inflamação causado pelo acúmulo de toxinas urêmicas e da hepcidina, hormônio que tem papel central na homeostase do ferro. A hemodiafiltração (HDF) é uma modalidade dialítica recente que por apresentar maiores taxas convectivas pode depurar maior espectro de moléculas reduzindo a inflamação. Objetivos: Avaliar a concentração sérica de hepcidina e biomarcadores inflamatórios pelo tratamento com HDF em pacientes idosos com DRC. Material e métodos: Foram incluídos 30 pacientes com idade entre 65 a 94 anos com DRC que previamente faziam tratamento com hemodiálise convencional e iniciaram o tratamento com HDF. Entretanto, 19 pacientes finalizaram o estudo e foram avaliados no tempo zero e após 12 meses de seguimento para os parâmetros hematimétricos, bioquímicos, hepcidina e citocinas inflamatórias. Resultados: Após 12 meses de tratamento observamos significante aumento da hemoglobina, hematócrito, hepcidina, TNF-α, IL-10 e β2-microglobulina e diminuição da proteína C reativa (PCR). Discussão: As concentrações séricas de hepcidina e β2-microglobulina não se apresentaram reduzidas no seguimento nesta população idosa de doentes renais crônicos após 12 meses de acompanhamento do tratamento com HDF provavelmente devido a perda da função renal residual. O aumento dos níveis de hemoglobina e hematócrito observados podem ter sido decorrentes do tratamento com AEEs (89%) e suplementação de ferro (74%), sugerindo que não houve hiporresponsividade ou resistência ao tratamento nos pacientes do presente estudo. Conclusão: A hepcidina pareceu estar mais relacionada como um biomarcador de ferro independentemente da variação dos marcadores inflamatórios do que associada à resistência ao uso de AEEs.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-12T19:05:11Z No. of bitstreams: 1 Jorge Peres.pdf: 715163 bytes, checksum: c12d5682102bec2ec0c59e2b4df1266c (MD5) Made available in DSpace on 2021-11-12T19:05:11Z (GMT). No. of bitstreams: 1 Jorge Peres.pdf: 715163 bytes, checksum: c12d5682102bec2ec0c59e2b4df1266c (MD5) Previous issue date: 2020-12-17 Introduction: The identification of biomarkers linked to the etiopathogenesis of prehypertension, with adequate predictive value and good cost-benefit ratio, would contribute to the early diagnosis and prevention of more severe forms of hypertension, involving cardiovascular outcomes. Therefore, the aim of this study was to carry out a systematic literature review, to identify the main clinical evidence related to the use of biomarkers for the prehypertension stage diagnosis in adults. Methods: A systematic search was performed in the PUBMED database, using the following strategy: (prehypertension [majr] OR "pre-hypertension" [majr] OR "(pre) hypertension" [majr] OR "(pre-) hypertension" [majr]) AND (biomarkers OR markers) AND blood NOT (diet OR intake). The review was conducted according to the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyzes). Results: The search, carried out on June 30, 2020, returned 71 papers. After reading the titles and abstracts, 31 articles were eliminated according to eligibility criteria, especially for not effectively discussing the use of markers for prehypertension diagnosing in adults, that discusses only hypertensive individuals, for using samples with a different age range than that established for the present study, or even for not shown a clear division between patients with or without prehypertension. The remaining 40 studies, considered for review, totalized 70,967 patients. Conclusion: The most promising and reliable marker of prehypertension is serum uric acid, followed by serum gamma-glutamyltransferase. Based on these results, the evaluation of these markers, especially uric acid, can be used to complement the screening process of pre-hypertensive patients. Introdução: A identificação de biomarcadores ligados à etiopatogenia da pré-hipertensão, com valor preditivo adequado e boa relação custo-benefício, traria uma provável contribuição para o diagnóstico precoce e prevenção de formas mais graves da hipertensão, envolvendo desfechos cardiovasculares. Sendo assim, o objetivo deste trabalho foi realizar uma revisão sistemática da literatura buscando identificar as principais evidências clínicas relacionadas a utilização de biomarcadores para auxiliar no diagnóstico do estágio de pré-hipertensão em adultos. Métodos: Foi realizada uma busca sistemática na base de dados PUBMED, utilizando a seguinte estratégia: (prehypertension[majr] OR "pre-hypertension"[majr] OR "(pre)hypertension"[majr] OR "(pre-)hypertension"[majr]) AND (biomarkers OR markers) AND blood NOT (diet OR intake). A revisão foi conduzida segundo o protocolo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Resultados: A busca, realizada no dia 30 de junho de 2020, retornou 71 trabalhos. Após a leitura dos títulos e resumos, 31 artigos foram eliminados por não preencherem os critérios de elegibilidade, especialmente por não discutirem efetivamente a utilização de marcadores para diagnóstico de pré-hipertensão em adultos, por avaliarem apenas indivíduos hipertensos e não pré-hipertensos, por utilizarem amostras com intervalo de idade diferente do estabelecido para o presente trabalho, ou mesmo por não realizarem uma divisão clara entre pacientes portadores ou não de pré-hipertensão. Os 40 trabalhos restantes, considerados para revisão, totalizaram 70.967 pacientes. Conclusão: O marcador de pré-hipertensão mais promissor e fidedigno é o ácido úrico sérico, seguido da gama-glutamiltransferase sérica. Com base nestes resultados, entende-se que a avaliação destes marcadores, especialmente do ácido úrico, pode ser utilizada para complementar o processo de triagem de pacientes pré-hipertensos.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-21T15:20:43Z No. of bitstreams: 1 Luci Carla Dias Carvalho.pdf: 1927365 bytes, checksum: bde7c8bdbbb093bc2bdd7715e29e050b (MD5) Made available in DSpace on 2022-07-21T15:20:43Z (GMT). No. of bitstreams: 1 Luci Carla Dias Carvalho.pdf: 1927365 bytes, checksum: bde7c8bdbbb093bc2bdd7715e29e050b (MD5) Previous issue date: 2020-12-17 Introduction: In view of the increase in life expectancy and the prevalence of diabetes and arterial hypertension, an increase in the elderly population with chronic kidney disease (CKD) has been observed. Vascular calcification is frequent in elderly and in patients with CKD. Some experimental studies have been observed a relationship between Klotho and vascular calcification. Thus, it is possible that Klotho is a risk factor for vascular calcification in patients with CKD. This study proposes the assessment of the association between intracranial vessel calcification and serum Klotho. Methods: This is a subanalysis of CTs performed in a study evaluating the association between cognition with markers of mineral and bone metabolism. We evaluated 60 CTs of patients with stages 4 and 5 CKD not on dialysis. Clinical, biochemical, and demographic data were collected. The CT was reported in a structured way, following the same sequence in all patients. Only vascular but not parenchymal calcification was evaluated. Results: Patients aged 81  7 years (65% men, 93% with hypertension, and 48% with diabetes). The median Klotho concentration was 783 (610, 994) pg/ml. Vascular calcification was observed in 18 patients (30%). Patients with intracranial vascular calcification were not distinguished from those without calcification regarding sex, age, body mass index, blood pressure, albumin, creatinine, cholesterol, calcium, phosphorus, and fibroblast growth factor 23. They had a slightly lower percentage of hypertension (83.3 vs. 96.6%, p = 0.042), and a lower concentration of Klotho [613 (509 - 805) vs. 824 (704, 1042), p = 0.009]. This difference remained significant even after adjusting for age, renal function, and classical cardiovascular risk factors such as diabetes, blood pressure, and cholesterol. Conclusion: Patients with moderate to severe CKD present intracranial vascular calcification in association with lower Klotho concentration. Introdução: Diante do aumento da expectativa de vida e da prevalência de diabetes e hipertensão arterial, tem-se observado um aumento da população idosa com doença renal crônica (DRC). Calcificações vasculares são frequentes em idosos e em pacientes com DRC. Estudos experimentais apontam a relação entre concentração da proteína Klotho e calcificação vascular. Este estudo propõe a avaliação de calcificação de vasos intracranianos e sua relação com Klotho. Métodos: Esta é uma subanálise de TCs realizadas em um estudo cujo objetivo é avaliar a relação de cognição com marcadores do metabolismo mineral. Foram avaliadas 60 TCs de pacientes portadores de DRC não dialítica (Estágios 4 e 5). Dados clínicos, bioquímicos e demográficos foram coletados. Resultados: A idade média foi de 817 anos (65% homens, 93% com hipertensão arterial e 48% com diabetes). A mediana da concentração de Klotho foi 783 (610, 994) pg/ml. Calcificação vascular foi observada em 18 pacientes (30%). Estes pacientes não se distinguiram dos demais quanto ao sexo, idade, índice de massa corporal, pressão arterial, albumina, creatinina, colesterol, cálcio, fósforo e fator de crescimento de fibroblastos-23. Eles tinham um percentual um menor de hipertensão (83,3 vs. 96,6%, p=0,042) e uma menor concentração de Klotho [613 (509 - 805) vs. 824 (704, 1042), p=0,009]. Esta diferença permaneceu significante após ajuste para idade, função renal e fatores clássicos de risco cardiovascular tais como diabetes, pressão arterial e colesterol. Conclusão: Pacientes idosos com DRC moderada a grave apresentam calcificação vascular intracraniana em associação com menor concentração de Klotho.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-12T19:33:25Z No. of bitstreams: 1 Luiz Guilherme Ramos.pdf: 581521 bytes, checksum: c24b8014ad8294a77a4417c8c5dabc2e (MD5) Made available in DSpace on 2021-11-12T19:33:25Z (GMT). No. of bitstreams: 1 Luiz Guilherme Ramos.pdf: 581521 bytes, checksum: c24b8014ad8294a77a4417c8c5dabc2e (MD5) Previous issue date: 2020-12-15 Introduction: Mineral and Bone Disease (BMD) is a frequent complication of Chronic Kidney Disease (CKD), called CKD-MBD. Among bone diseases, secondary hyperparathyroidism (SHPT) is common, and parathyroidectomy (PTX) can be indicated in cases of clinical intractability. There are few Brazilian data on the percentage of response to clinical treatment (cinacalcet and vitamin D analogs) and PTX. Methods: We retrospectively evaluated adults in follow-up at the CKD-MBD clinic between 07-07-2017 and 06-30-2018, with at least two consultations in the period. Demographic, clinical, and laboratory information (including total and ionic calcium, phosphorus, alkaline phosphatase, and parathormone - PTH) were collected from electronic charts. Two groups were evaluated: CKD and kidney transplant (Tx). HPTS was defined as PTH> 300 pg/ml in the CKD group and as PTH> 100 pg/ml or ionized Calcium> 5.3 mg/dL in the Tx group. Results: 268 patients with CKD (103 with SHPT) and 134 transplant patients (77 with SHPT) were included. We observed a reduction in the concentration of PTH with either clinical or surgical treatment in both groups. However, analyzing patients with severe SHPT (initial PTH> 800 pg/ml in the CKD group and PTH> 200 pg/ml and/or Total Calcium >11 mg/dl in the Tx group), we observed a better response in patients who were submitted to PTX during follow-up, represented by a more significant drop in PTH in the CKD group and in serum calcium in the Tx group. Conclusion: Clinical treatment with or without cinacalcet is effective in controlling SHPT. However, patients with severe forms should be referred for PTX. Introdução: A Doença Mineral e Óssea (DMO) é uma complicação frequente da Doença Renal Crônica (DRC), denominada DMO-DRC. Dentre as doenças ósseas, o hiperparatireoidismo secundário (HPTS) é frequente e a paratireoidectomia (PTX) pode ser indicada nos casos de intratabilidade clínica. Existem poucos dados brasileiros do percentual de resposta ao tratamento clínico (cinacalcete e análogos de vitamina D) e da necessidade cirúrgica. Métodos: Avaliamos retrospectivamente adultos em acompanhamento no ambulatório de DMO-DRC entre 01-07-2017 e 30-06-2018, com pelo menos duas consultas no período. Informações demográficas, clínicas e laboratoriais (incluindo cálcio total e iônico, fósforo, fosfatase alcalina e paratormônio - PTH) foram coletadas a partir de prontuário eletrônico. Dois grupos foram avaliados, com DRC e transplantados renais (Tx). HPTS foi definido como PTH > 300 pg/ml no grupo DRC e como PTH >100 pg/ml ou Ca ionizado > 5,3 mg/dL no grupo Tx. Resultados: Foram incluídos 268 pacientes com DRC (103 com HPTS) e 134 pacientes transplantados (77 com HPTS). Observamos redução na concentração de PTH com tratamento clínico ou cirúrgico nos dois grupos de pacientes. Porém, analisando pacientes com HPTS grave (PTH inicial >800 pg/ml no grupo DRC e PTH >200 pg/ml e/ou Ca Total >11 mg/dl no grupo Tx), observamos melhor resposta nos pacientes submetidos à PTX, representada por queda mais significativa de PTH no grupo DRC e de cálcio no grupo Tx. Conclusão: O tratamento clínico com ou sem cinacalcete é eficaz no controle do HPTS. Porém, pacientes com forma grave devem ser encaminhados para realização de PTX.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2021-11-18T21:02:59Z No. of bitstreams: 1 Maria Helena Mattos.pdf: 1828650 bytes, checksum: ccf22c7d3788822b6a5b8b8d859a395b (MD5) Made available in DSpace on 2021-11-18T21:02:59Z (GMT). No. of bitstreams: 1 Maria Helena Mattos.pdf: 1828650 bytes, checksum: ccf22c7d3788822b6a5b8b8d859a395b (MD5) Previous issue date: 2020-12-09 INTRODUCTION: Renal inflammation occurs early after AMI with a worst cardiovascular prognosis associated. The inflammatory process is modulated by the activity of the autonomic nervous system, and the parasympathetic efferent pathway has an anti-inflammatory role already recognized (anti-inflammatory cholinergic reflex). Previous studies have demonstrated improvement of the anti-inflammatory profile in the heart of normotensive rats after AMI. Information on the impact of cholinergic stimulation on acute renal inflammation after AMI is scarce. OBJECTIVE: Evaluate the effects of vagal stimulation, by administering pyridostigmine bromide (PY), on renal inflammatory response and morphofunctional parameters of the heart of SHR rats (spontaneously hypertensive rats) 7 days after AMI. METHODS: SHR male rats were randomized into three groups: SHAM (thoracotomy group), MI (infarcted group submitted to ligation of the left coronary artery) and MI+PY group (infarcted group and treated with PY at a dose of 40mg/Kg/day, for 7 days started on the day of AMI). All animals were submitted to cannulation of the left femoral artery at the 5th of after AMI, and on the next day direct blood pressure curves were made for subsequent analysis of hemodynamic variables and heart rate variability (HRV) in time and frequency domains. The Ecodopplercardiogram was performed on the 6th day to obtain morphofunctional parameters of the heart, and on the 7th day the rats were euthanized for tissue collection. RESULTS: The MI group, when compared to the SHAM group, showed significant changes (p

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-21T14:22:41Z No. of bitstreams: 1 Fernanda Aparecida Gonçalves.pdf: 1308392 bytes, checksum: 73d46a731ec82bf972beb82dc5b66870 (MD5) Made available in DSpace on 2022-07-21T14:22:41Z (GMT). No. of bitstreams: 1 Fernanda Aparecida Gonçalves.pdf: 1308392 bytes, checksum: 73d46a731ec82bf972beb82dc5b66870 (MD5) Previous issue date: 2020-04-16 Background: Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients. Methods: This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average, and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics and omeprazole were recorded. Results: We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 ± 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin (p=0.022), race (p=0.031) and omeprazole use (p=0.024). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric (p=0.001) and in use of furosemide use (p=0.0001). Conclusion: Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium. Introdução: A hipocalemia é um distúrbio eletrolítico bem descrito em pacientes em diálise peritoneal (DP). A hipercalemia, no entanto, ainda é negligenciada, embora também represente um fator de risco para mortalidade. Inibidores da enzima conversora da angiotensina e/ou bloqueadores dos receptores da angiotensina (IECA/BRA), diuréticos e inibidores da bomba de prótons (IBP) podem interferir nos níveis de potássio nesses pacientes. Métodos: Trata-se de um estudo retrospectivo que avaliou o potássio sérico mensal em pacientes em DP por um período de 5 anos. Os distúrbios séricos de potássio foram avaliados como tempo médio e número de episódios de hipocalemia e hipercalemia por paciente. Medicamentos prescritos como IECA/BRA, diuréticos e omeprazol foram avaliados. Resultados: Avaliamos 2025 medidas de potássio obtidas de 146 pacientes. O potássio sérico variou de 2,5 a 8,3 mEq/L com uma média de 4,72 ± 0,74 mEq/L. A hipocalemia foi encontrada em 59 medidas (2,9%) obtidas de 35 pacientes (23,9%), enquanto a hipercalemia foi demonstrada em 269 (13,3%) medidas obtidas de 74 pacientes (50,7%). A hipocalemia esteve associada à menor albumina sérica (p=0,022), raça (p=0,031) e uso de omeprazol (p=0,024). A hipocalemia associada ao omeprazol foi observada apenas em pacientes não anúricos e permaneceu como fator de risco independente mesmo após ajustes. Os pacientes que tiveram hipercalemia foram mais propensos a apresentar anúria (p=0,001) e estarem em uso de uso de furosemida (p=0,0001). Conclusão: Tanto hipercalemia como hipocalemia são muito frequentes em pacientes em DP e devem ser monitorados. Estudos intervencionistas devem abordar o impacto da interrupção do IBP nos níveis de potássio.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2022-07-21T19:02:14Z No. of bitstreams: 1 Shirley Ferraz Crispilho.pdf: 2672920 bytes, checksum: 44d3c60ad18e20fe0d7b3b39613a1327 (MD5) Made available in DSpace on 2022-07-21T19:02:14Z (GMT). No. of bitstreams: 1 Shirley Ferraz Crispilho.pdf: 2672920 bytes, checksum: 44d3c60ad18e20fe0d7b3b39613a1327 (MD5) Previous issue date: 2019-02-07 Chronic kidney disease (CKD) is defined by decreased glomerular filtration rate and changes in renal structure and function, irreversibly, over months or years. It is a decisive parameter in the diagnosis, and it is of great importance to monitor the progression of kidney disease. The main causes of mortality in patients with CKD are cardiovascular diseases. The association between CKD and bone mineral disease generates a high risk of hip fracture, associating physical incapacity, being an important mechanism for the indirect correlation of eGFR (glomerular filtration rate) and physical function. Dialysis patients have a high rate of fractures in relation to the general population, and the prevention of fractures in this population is somewhat challenging. However, phosphorus retention occurs due to the reduction in the glomerular filtration rate observed at the onset of CKD, which results in an increase in the production of fibroblast growth factor 23 (FGF-23), which is secreted by osteocytes. However, secondary hyperparathyroidism is usually associated with increased bone remodeling and consequent loss of bone mass. Due to progressive loss of renal function there is a reduction in sodium filtration and inadequate renal tubular reabsorption occurring with volume retention, even in patients receiving conservative treatment. Hypervolemia is a risk factor for mortality in cardiovascular diseases. Dual-energy X-ray absorptiometry (DXA) analyzes bone fragility and measures the volume of cortical and trabecular bone, as well as soft tissue properties based on measurements at the molecular level of fat mass, lean mass, bone mineral content (BMC). However, Bioimpedance (BIA) is highly specialized to determine the water between the intracellular and extracellular spaces. The aim of our study was to evaluate the concordance between BIA and DXA for body composition measurements, specifically BMC, in patients with CKD, and to evaluate the relationship of BCA difference between BIA and DXA with BMD-CKD markers. The study included 28 patients with stage 5 CKD with secondary hyperparathyroidism who underwent hemodialysis treatment three times a week with indication of parathyroidectomy and patients with chronic non-dialytic chronic kidney disease of both sexes, aged between 18 and 75 years old, under conditions stable clinics upon presentation of medical authorization, who signed the Informed Consent Form. All patients underwent BIA and DXA. Patients in the hemodialysis group with secondary hyperparathyroidism were younger and lean, reflecting the BMI value. PTH, alkaline phosphatase and P were higher in relation to the group under conservative treatment. The hemodialysis group with secondary hyperparathyroidism presented lower fat mass, bone mineral content and bone mineral density of the left hip and greater percentage value of lean mass in DXA. The same group had lower fat mass and higher percentage of lean mass in BIA. When comparing the evaluation methods, we observed that the BIA underestimated the fat mass and overestimated the bone mineral content, mainly in the hemodialysis group with secondary hyperparathyroidism. There is a correlation between BAC difference between DXA and BIA with phosphorus, alkaline phosphatase and PTH. Since phosphorus and alkaline phosphatase presented a significant correlation with the difference in BMC in both methods. A Doença renal crônica (DRC) é definida por diminuição da taxa de filtração glomerular e alterações na estrutura e função renal, de forma irreversível, durante meses ou anos. Sendo um parâmetro decisivo no diagnóstico, e é de grande importância para monitorizar a progressão da doença renal. As principais causas de mortalidade em pacientes com DRC, são as doenças cardiovasculares. A associação entre DRC e doença mineral óssea, gera um risco elevado de fratura do quadril, associando a incapacidade física, sendo um mecanismo importante para a correlação indireta da eGFR (taxa de filtração glomerular) e a função física. Pacientes em diálise possuem alto índice de fraturas em relação a população em geral, sendo que a prevenção de fraturas nessa população é algo desafiador. Já a retenção de fósforo ocorre devido à redução na taxa de filtração glomerular observada já no início da DRC, que resulta no aumento da produção do fator de crescimento de fibroblastos 23 (FGF-23) que é secretado pelos osteócitos. Entretanto o hiperparatireoidismo secundário está geralmente associado ao aumento da remodelação óssea e consequente perda de massa óssea. Devido a perda progressiva da função renal, há uma redução da filtração de sódio e inadequada reabsorção tubular renal ocorrendo retenção de volume, mesmo nos pacientes em tratamento conservador. A hipervolemia é um fator de risco de mortalidade para doenças cardiovasculares. A Densitometria Óssea Absorciometria Por Raios X Com Dupla Energia (DXA), analisa a fragilidade óssea e mensura o volume de osso cortical e trabecular, além das propriedades dos tecidos moles baseando-se em medições no nível molecular de massa gorda, massa magra, conteúdo mineral ósseo (CMO). Entretanto, a Bioimpedância (BIA) é altamente especializada para determinar a água entre os espaços intracelular e extracelular. O objetivo do nosso estudo foi avaliar a concordância entre BIA e DXA para as medidas da composição corporal, especificamente CMO, em pacientes com DRC e avaliar a relação da diferença de CMO entre BIA e DXA com marcadores do DMO-DRC. Foram incluídos no estudo 28 pacientes com DRC estágio 5 com hiperparatireoidismo secundário submetidos a tratamento de hemodiálise três vezes por semana com indicação de paratireoidectomia e pacientes com doença renal crônica não dialíticos, de ambos os sexos, faixa etária de 18 a 75 anos, em condições clínicas estáveis mediante apresentação de autorização médica, que assinaram o Termo de Consentimento Livre Esclarecido. Todos os pacientes realizaram BIA e DXA. Os pacientes do grupo hemodiálise com hiperparatireoidismo secundário eram mais jovens e magros, refletindo no valor do IMC. O PTH, fosfatase alcalina e P foram mais altos em relação ao grupo em tratamento conservador. O grupo hemodiálise com hiperparatireoidismo secundário apresentou menor massa gorda, conteúdo mineral ósseo e densidade mineral óssea do quadril esquerdo e maior valor percentual de massa magra na DXA. O mesmo grupo apresentou menor massa gorda e maior percentual de massa magra na BIA. Ao compararmos os métodos de avaliação, observamos que a BIA subestimou a massa gorda e superestimou o conteúdo mineral ósseo, principalmente no grupo hemodiálise com hiperparatireoidismo secundário. Há correlação da diferença de CMO entre DXA e BIA com fósforo, fosfatase alcalina e PTH. Sendo que o fósforo e a fosfatase alcalina apresentaram significativa correlação com a diferença do CMO em ambos os métodos.