BackgroundChronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life.Methods/DesignA prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height2; circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life.DiscussionCKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients.Trial registrationThe protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).
Introduction Approximately 80% of patients with chronic kidney disease complain about sleep disorders, which is a much higher percentage than in the general population. Excessive daytime sleepiness is the third most frequent complaint in these patients, and it is significantly associated with a higher risk of sleep apnea. The aim of this study was to assess the presence of daytime sleepiness in patients with end stage renal disease (ESRD) who were undergoing diurnal hemodialysis. Materials and methods The Epworth Sleepiness Scale (ESS) was applied to patients with ESRD who underwent diurnal hemodialysis in the Centro de Nefrologia da Zona Norte in Sao Paulo, Brazil. Results A total of 168 patients were included in the study. According to the ESS, 31% presented with a mild propensity to sleep, 22% with a moderate propensity, and 17% with a severe propensity. Conclusion Our study concluded that 70% of the sample of patients with ESRD who were undergoing hemodialysis presented with a propensity to sleep in inappropriate circumstances on the ESS. When excessive daytime sleepiness is associated with sleep apnea and other comorbidities, it is essential to carefully assess patients’ complaints.
Introdução: Pacientes com doença renal crônica (DRC) em fase terminal submetidos à terapia de substituição renal por hemodiálise (HD) apresentam uma complexa síndrome com efeitos em diversos sistemas, entre eles, o sistema músculo esquelético. Este estudo teve como objetivo analisar a força de preensão palmar e correlacionar com o tempo de tratamento de pacientes com DRC submetidos à HD. Métodos: Estudo transversal que avaliou pacientes com DRC submetidos à HD no Hospital São Vicente de Paulo em Passo Fundo (RS). As avaliações foram realizadas individualmente através de um questionário clínico e sócio demográfico. Para avaliação da força muscular, foi utilizado o dinamômetro de preensão manual (capacidade de mensuração de 5 a 100 kg resolução 0,05 kg precisão ±0,5%) sobre os músculos flexores dos membros superiores. O projeto foi aprovado pelo Comitê de Ética em Pesquisa e está de acordo com a Declaração de Helsinki. Resultados: A amostra final do estudo foi de 27 pacientes (58,5 ±13 anos, 89% homens). Comparando-se a força do membro superior esquerdo (MSE) com a força do membro superior direito (MSD) obtém-se, em newtons, (2,29±0,32 vs. 2,46±0,89 p=0,513), respectivamente. O tempo de HD com força do MSE não apresentou relação significativa (Pearson r = -0,316 p=0,109), porém houve uma correlação inversamente proporcional (Pearson r = -0,433 p=0,024) entre o tempo de HD com a força do MSD, demonstrando que os pacientes que há mais tempo estão em terapia renal substitutiva por HD tem menor força no MSD. As anormalidades músculo esqueléticas são numerosas e frequentes em pacientes doentes renais em particular daqueles mantidos por longo período de terapia de diálise renal. Sabe-se que pacientes em HD apresentam comprometimento na estrutura e na função muscular podendo manifestar pela atrofia e pela fraqueza muscular proximal. O aspecto que influência a diminuição da força muscular está associada às alterações no suprimento de energia das células musculares. As alterações nos sistemas metabólicos de produção de ATP diminuem a capacidade metabólica muscular basal em torno de 40 % em paciente com IRC. Conclusão: Este estudo demonstrou que não há diferença estatisticamente significativa entre a força do MSE e do MSD nos pacientes com DRC em tratamento dialítico. Entretanto, o tempo de terapia renal substitutiva por hemodiálise é inversamente proporcional à força no MSD. Estudos futuros são necessários para melhor verificar tal associação. Resumo 61
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