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- What is the role of apelin regarding cardiovascular risk and progression of renal disease in type 2 diabetic patients with diabetic nephropathy?Publication . Silva, Ana Paula; Fragoso, Andre; Silva, Claudia; Viegas, Carla; Tavares, Nelson; Guilherme, Patricia; Santos, Nelio; Rato, Fatima; Camacho, Ana; Cavaco, Cidalia; Pereira, Victor; Faisca, Marilia; Ataide, Joao; Jesus, Ilidio; Neves, Pedro LeãoAims. To evaluate the association of different apelin levels with cardiovascular mortality, hospitalization, renal function, and cardiovascular risk factors in type 2 diabetic patients with mild to moderate CKD. Methods. An observational, prospective study involving 150 patients divided into groups according to baseline apelin levels: 1 <= 98pg/mL, 2 = 98-328 pg/mL, and 3 >= 329 pg/mL. Baseline characteristics were analyzed and compared. Multivariate Cox regression was used to find out predictors of cardiovascular mortality, and multivariate logistic regression was used to find out predictors of hospitalization and disease progression. Simple linear regressions and Pearson correlations were used to investigate correlations between apelin and renal disease and cardiovascular risk factors. Results. Patients' survival at 83 months in groups 1, 2, and 3 was 39%, 40%, and 71.2%, respectively (P = 0.046). Apelin, age, and eGFR were independent predictors of mortality, and apelin, creatinine, eGFR, resistin, and visfatin were independent predictors of hospitalization. Apelin levels were negatively correlated with cardiovascular risk factors and positively correlated with eGFR. Patients with lower apelin levels were more likely to start a depurative technique. Conclusions. Apelin levels might have a significant clinical use as a marker/predictor of cardiovascular mortality and hospitalization or even as a therapeutic agent for CKD patients with cardiovascular disease.
- Gla-rich protein (GRP) as an early and novel marker of vascular calcification and kidney dysfunction in diabetic patients with CKD: a pilot cross-sectional studyPublication . Silva, Ana P.; Viegas, Carla; Mendes, Filipa; Macedo, Ana; Guilherme, Patrícia; Tavares, Nelson; Dias, Carolina; Rato, Fátima; Santos, Nélio; Faísca, Marília; Almeida, Edgar de; Neves, Pedro Leão; Simes, DinaVascular calcification (VC) is one of the strongest predictors of cardiovascular risk in chronic kidney disease (CKD) patients. New diagnostic/prognostic tools are required for early detection of VC allowing interventional strategies. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor, whose clinical utility is here highlighted. The present study explores, for the first time, correlations between levels of GRP in serum with CKD developmental stage, mineral metabolism markers, VC and pulse pressure (PP), in a cohort of 80 diabetic patients with mild to moderate CKD (stages 2-4). Spearman's correlation analysis revealed a positive association of GRP serum levels with estimated glomerular filtration rate (eGFR) and α-Klotho, while a negative correlation with phosphate (P), fibroblast growth factor 23 (FGF-23), vascular calcification score (VCS), PP, calcium (x) phosphate (CaxP) and interleukin 6 (IL-6). Serum GRP levels were found to progressively decrease from stage 2 to stage 4 CKD. Multivariate analysis identified low levels of eGFR and GRP, and high levels of FGF-23 associated with both the VCS and PP. These results indicate an association between GRP, renal dysfunction and CKD-mineral and bone disorder. The relationship between low levels of GRP and vascular calcifications suggests a future, potential utility for GRP as an early marker of vascular damage in CKD.
- Resistin as a predictor of cardiovascular hospital admissions and renal deterioration in diabetic patients with chronic kidney diseasePublication . Bonito, Bruno; Silva, Ana Paula; Rato, Fátima; Santos, Nélio; Neves, Pedro LeãoBackground: High resistin levels have been associated with cardiovascular disease (CVD). Cardiovascular hospitalizations are common, especially in diabetic and renal impaired patients. The purpose of this study is to determine the role of serum resistin as a predictor of cardiovascular hospitalizations in type 2 diabetic patients with mild to moderate chronic kidney disease (CKD). Methods: We conducted a prospective, observational study. 78 diabetic patients with mild to moderate CKD and no previous CVD were included. The population was divided in two groups: G-1 with cardiovascular related admission (n = 13) and G-2 without cardiovascular related admission (n = 65). A Student's t-test was conducted to determine correlations between laboratory findings and hospitalization. We used logistic regression to assess predictors of cardiovascular events requiring hospitalization and Cox regression to identify predictors of end-stage renal disease (ESRD). Results: eGFR, albumin, HbA1c, phosphorous, PTH, IR, CRP, resistin and active vitamin D, were related to cardiovascular admissions. In a multivariate regression model, resistin (OR = 2.074, p = 0.047) was an independent predictor of cardiovascular hospitalization. Cox regression showed that resistin (HR = 1.931, p = 0.031) and UACr (HR = 1.151, p = 0.048) were also independent predictors of renal disease progression. Conclusion: Resistin demonstrated to be valuable in predicting hospital admissions and progression to ESRD. (C) 2019 Elsevier Inc. All rights reserved.
- Gla-Rich protein, magnesium and phosphate associate with mitral and aortic valves calcification in Didabetic patients with moderate CKDPublication . Silva, Ana P.; Viegas, Carla; Guilherme, Patrícia; Tavares, Nelson; Dias, Carolina; Rato, Fátima; Santos, Nélio; Faísca, Marília; de Almeida, Edgar; Neves, Pedro L.; Simes, Dina C.Accelerated and premature cardiovascular calcification is a hallmark of chronic kidney disease (CKD) patients. Valvular calcification (VC) is a critical indicator of cardiovascular disease and all-cause mortality in this population, lacking validated biomarkers for early diagnosis. Gla-rich protein (GRP) is a cardiovascular calcification inhibitor recently associated with vascular calcification, pulse pressure, mineral metabolism markers and kidney function. Here, we examined the association between GRP serum levels and mitral and aortic valves calcification in a cohort of 80 diabetic patients with CKD stages 2–4. Mitral and aortic valves calcification were detected in 36.2% and 34.4% of the patients and associated with lower GRP levels, even after adjustments for age and gender. In this pilot study, univariate, multivariate and Poisson regression analysis, show that low levels of GRP and magnesium (Mg), and high levels of phosphate (P) are associated with mitral and aortic valves calcification. Receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) values of GRP for mitral (0.762) and aortic (0.802) valves calcification were higher than those of Mg and P. These results suggest that low levels of GRP and Mg, and high levels of P, are independent and cumulative risk factors for VC in this population; the GRP diagnostic value might be potentially useful in cardiovascular risk assessment.
- A diálise peritoneal na actual crise pandémica: uma oportunidade de reflexãoPublication . Domingos, Ana; Guedes, A Malho; Neves, Pedro LeãoSão difíceis os tempos que se vivem, e tempos mais difíceis poderão estar por chegar. A actual pandemia do novo coronavírus obrigou a uma total reformulação da sociedade em geral e, em especial, dos cuidados que concernem à área da saúde.
- Klotho levels: association with insulin resistance and albumin-to-creatinine ratio in type 2 diabetic patientsPublication . Silva, Ana Paula; Mendes, Filipa; Pereira, Luisa; Fragoso, André; Baptista Gonçalves, Rui; Santos, Nelio; Rato, Fátima; Neves, Pedro LeãoThe present study aimed at evaluating the relationship between Klotho levels and insulin resistance and albumin-to-creatinine ratio (ACR) in type 2 diabetic patients with CKD. We conducted an observational, cross-sectional study in our outpatient diabetic nephropathy clinic from 2014 to 2016, enrolling a total of 107 type 2 diabetic patients with stage 2-3 CKD, with a mean age of 59 years. Several clinical and laboratorial parameters were evaluated, including those related to mineral and carbohydrate metabolism. The mean eGFR at baseline was 53.2 mL/min, and the mean levels of ACR and Klotho were 181.9 A mu g/mg and 331.1 pg/m, respectively. In the simple linear regression model, Klotho levels were correlated with age, phosphorus, PTH, ACR, HOMA, IL-6, FGF-23, OxLDL, eGFR and vitamin D levels. Applying a multivariate linear regression model, only the ACR, HOMA-IR, FGF-23 and vitamin D independently influenced the Klotho levels. In the generalized linear model, only the Klotho groups were statistically significant as independent variable (p = 0.007). The results show that the group 1 (< 268) compared with group 3 (> 440) had higher odds in the higher ACR (ae181), ORa = 3.429, p = 0.014. There were no statistically significant differences between Klotho groups 2 and 3, and the HOMA-IR obtained showed that group 1 (< 268) had greater odds of HOMA-IR ae2 when compared with group 3 (> 440), ORa = 21.59, p = 0.017. Our results showed that Klotho levels are influenced by FGF23, vitamin D and insulin resistance. This suggests that Klotho levels might be affected by renal function as well as having a relevant role on insulin metabolism and ACR homeostasis.
- Etanercept in the treatment of ankylosing spondylitis and nephrotic syndrome in the context of AA amyloidosis: a 48-month follow-upPublication . Domingos, Ana; Vidinha, Joana; Osorio, Rui; Jerónimo, Teresa; Ribeiro, Célia; Mendonça, Catarina; Góis, Mário; Neves, Pedro LeãoDear Editor, Amyloidosis represents a family of diseases characterized by the deposition of proteinaceous material in the extracellular space that, by forming insoluble clusters on various tissues and organs, affects its function.
- Mineral metabolism and inflammation: factors related to left ventricular hypertrophy in patients with diabetic nephropathyPublication . Jerónimo, Teresa; Fragoso, Andr?; Mendes, Filipa; Silva, Ana Paula; Pimentel, Ana; Tavares, Nelson; Camacho, Ana; Neves, Pedro LeãoLeft ventricular hypertrophy (LVH) is an important risk factor for cardiovascular disease in patients with diabetic nephropathy (DN) and is an independent predictor of mortality in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the association of LVH with mineral metabolism and inflammation in a population of patients with DN. In an observational study were included 119 type 2 diabetic patients with CKD stages 3 and 4. The population was divided into two groups, according to the presence of LVH: group 1 (G-1) with LVH (left ventricular mass index (LVMI) > 125 g/m2 in male patients and LVMI > 110 g/m2 in female patients) and group 2 (G-2) without LVH (LVMI ? 125 g/m2 in male patients and LVMI ? 110 g/m2 in female patients). The patient characteristics of each group were compared regarding several biological and laboratory parameters. Patients with LVH displayed lower values of estimated glomerular filtration rate (eGFR) (p = 0.0001) and albumin (p = 0.046), and higher levels of phosphorus (p = 0.0001), intact parathyroid hormone (iPTH) (p = 0.0001), insulin resistance (HOMA-IR) (p = 0.0001) and interleukin-6 (IL-6) (p = 0.0001), compared with patients without LVH. In a logistic regression model, phosphorus (odd ratio (OR) = 1.825 (1.075-4.414), p = 0.038), iPTH (OR = 1.991 (1.098-3.000), p = 0.004) and IL-6 (OR = 3.538 (1.863-6.719), p = 0.0001) were independently related to LVH. In a multiple linear regression model, phosphorus (r = 0.602, p = 0.038), iPTH (r = 1.009, p = 0.044) and IL-6 (r = 1.264, p = 0.0001) were positively related to LVMI. Phosphorus, PTH and IL-6 were related to LVH in our diabetic population with CKD stages 3 and 4
- Pseudomonas mendocina: the first case of peritonitis on peritoneal dialysisPublication . Jeronimo, Teresa M.; Malho Guedes, A; Stieglmair, Sandra; Guerreiro, Raquel; Laranjo, Ceu; Bernardo, Idalecio; Neves, Pedro Leão
- One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factorsPublication . Moita, Bruno; Marques, Ana Patricia; Camacho, Ana Maria; Neves, Pedro Leão; Santana, RuiIdentification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation.