Nota: Estas diretrizes se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

Despite considerable progress in understanding the pathophysiology of obesity, there are still no specific guidelines for the treatment of obesity hypertension other than weight reduction. Special considerations for obese hypertensive patients, in addition to controlling blood pressure, are correcting the metabolic abnormalities and protecting the kidneys from injury. This remains an important area for further research, especially in view of the current 'epidemic' of obesity in most industrialized countries.

Abstract-This study examined the importance of aldosterone (ALDO) in mediating changes in renal function and increased mean arterial pressure (MAP) during the development of dietary-induced obesity in chronically instrumented dogs. Mean arterial pressure, heart rate (HR), and cardiac output (CO) were recorded 24 hours per day in lean dogs (nϭ7) before and after administration of an ALDO antagonist, eplerenone (EP) (10 mg/kg twice daily), for 10 days. After 10 days of EP treatment, the dogs (nϭ7) were given a supplement of cooked beef fat for 5 weeks while EP was continued. An untreated group (nϭ6) was fed a high fat diet for 5 weeks and used as control (C). In lean dogs, EP decreased MAP from 89Ϯ4 to 84Ϯ4 mm Hg and glomerular filtration rate from 67.4Ϯ6.8 to 53.2Ϯ4.9 mL/min while inducing a small negative Na ϩ balance (Ϫ42Ϯ12 mEq). Plasma renin activity increased from 0.4Ϯ0.1 to 2.7Ϯ0.7 ng AI/mL per hour and plasma K ϩ increased from 4.8Ϯ0.1 to 6.1Ϯ0.3 mEq/L. After 5 weeks of a high fat diet, body weight increased 45% to 53% in EP and C obese dogs. In C dogs, MAP increased by 16Ϯ3 mm Hg, compared with only 7Ϯ1 mm Hg in EPLE dogs. Compared with untreated dogs, the EP dogs had smaller increases in CO (18Ϯ4.6% versus 43Ϯ1.5%), HR (33Ϯ5% versus 60Ϯ3%), glomerular filtration rate (19Ϯ5% versus 38Ϯ6%), and cumulative Na ϩ balance (138Ϯ35 mEq versus 472Ϯ110 mEq) after 5 weeks of a high fat diet. Thus, EP markedly attenuated glomerular hyperfiltration, sodium retention, and hypertension associated with chronic dietary-induced obesity. These observations indicate that ALDO plays an important role in the pathogenesis of obesity hypertension. Key Words: blood pressure Ⅲ renin-angiotensin system Ⅲ kidney Ⅲ sodium Ⅲ potassium Ⅲ glomerular filtration rate Ⅲ cardiac output Ⅲ obesity T he importance of obesity as a cause of hypertension is widely recognized, with experimental studies showing that excess weight gain raises blood pressure, clinical studies demonstrating that weight loss lowers blood pressure in most hypertensive patients, and population studies showing that overweight and obesity are major risk factors for development of hypertension. 1-5 Also, most patients with hypertension are overweight, and evidence from epidemiological studies suggests that 65% to 75% of the risk for human essential hypertension can be directly attributed to excess weight. 4,5 Although the importance of obesity as a cause of hypertension is well established, the mechanisms that link excessive weight gain with increased blood pressure are not as well understood. Previous studies suggest that obesity impairs renal-pressure natriuresis as the result of increased tubular sodium reabsorption. [5][6][7][8] These abnormalities of renal function may be due in part to activation of the renin-angiotensin-aldosterone system (RAAS).Studies in experimental animals and humans have shown that obesity activates most components of the RAAS. 9,10 A significant role for angiotensin II (Ang II) in stimulating renal sodium reabsorption and in contributing to ob...

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity.

Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease.

No abstract

Hypertension and cardiovascular diseases are highly prevalent in hemodialysis patients and are associated with the reduction of physical functioning and quality of life. We evaluated the effects of supervised aerobic exercise training on physical functioning, blood pressure, quality of life, and laboratory data in hemodialysis patients. Fourteen patients were evaluated at the beginning and after 12 weeks of stretching exercises (control phase) and at the end of 12 weeks of aerobic exercise training performed during hemodialysis sessions (intervention phase). Patients underwent a 6-min walking test (6MWT), 24-h ambulatory blood pressure monitoring, a Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) quality of life questionnaire, and blood sample collections. After the intervention phase, the 6MWT distance increased from 508.7 +/- 91.9 m to 554.9 +/- 105.8 m (P = 0.001), systolic and diastolic blood pressure decreased respectively from 150.6 +/- 18.4 mm Hg to 143.5 +/- 14.7 mm Hg and from 94.6 +/- 10.5 mm Hg to 91.4 +/- 9.7 mm Hg (P < 0.05), while hemoglobin levels increased from 10.8 +/- 1.2 g/dL to 11.6 +/- 0.8 g/dL (P < 0.05). Moreover, there was a significant increase in the physical functioning, social functioning, and mental health dimensions of the SF-36. Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patients with end-stage renal disease.

Palavras-chave: Doença renal crônica. Exercício físico. Hemodiálise. Sistema cardiovascular. Qualidade de vida. Keywords:Chronic kidney disease. Exercise training. Hemodialysis. Cardiovascular system. Quality of life. RESUMOPacientes portadores de doença renal crônica (DRC) submetidos a tratamento dialítico apresentam alterações físicas e psicoló-gicas que predispõem ao sedentarismo. Nesta população, a prescrição rotineira de exercícios físicos não é uma prática freqüente, especialmente no nosso país. No entanto, alguns autores têm demonstrado que um programa de exercícios para estes pacientes contribui para o melhor controle da hipertensão arterial, da capacidade funcional, da função cardíaca, da força muscular e, conseqüentemente, da qualidade de vida. Além dos benefícios relacionados ao sistema cardiovascular, a realização do exercício traz benefícios secundários, pois quebra a monotonia do procedimento, melhora aderência e pode aumentar a eficácia da diálise. Na presente revisão, os autores discutem aspectos da realização de exercícios físicos em pacientes portadores de DRC em diálise e apresentam dados iniciais de sua experiência com a aplicação de exercícios supervisionados durante as sessões de hemodiálise. ABSTRACT Physical exercise in dialyzed patientsPatients with chronic kidney disease (CKD) on dialysis present physical and psychological limitations that induce to a sedentary life stile. The prescription of exercise for this population has not been common, especially in our country. In the last few years though, some authors have shown that exercising for these patients improves hypertension control, cardiac function, muscular strength, functional capacity and, consequently, their quality of life. Besides the benefits related to the cardiovascular system, exercise training during hemodialysis reduces the monotony of the procedure, improves adherence and contributes to the increase of dialysis efficacy. In this review, the authors discuss some aspects of exercise training in patients with CKD on dialysis and present their preliminary data of supervised exercises during hemodialysis sessions. INTRODUÇÃOO número de pacientes com doença renal crônica (DRC) em todo o mundo tem aumentado em proporções alarmantes, ocasionando um importante problema de saúde pública. No Brasil, de 1994 a 2005, o número de pacientes em hemodiálise (HD) e diáli-se peritoneal elevou-se de 24.000 para 65.121(1-2) . Como conseqüência, do número crescente de doentes renais crônicos, os gastos do Ministério da Saúde com a terapia renal substitutiva são de aproximadamente 1,4 bilhão de reais por ano, quantia esta correspondente a cerca de 10% do orçamento global desse ministério (1) .Nessa população, as doenças cardiovasculares (DCV) representam a principal causa de morbidade e de mortalidade. Além disso, contribuem sobremaneira para a diminuição da capacidade funcional, para a baixa tolerância ao exercício e, conseqüentemente, para a dificuldade de realização das atividades da vida diária (3)(4)(5) . Além das DCV, também contribuem ...