Perfil clínico-epidemiológico dos pacientes em programa crônico de hemodiálise em João Pessoa -PBClinical and epidemiological profile of chronic hemodialysis patients in João Pessoa -PB Introdução: A doença renal crônica (DRC), considerada por alguns autores como uma epidemia deste século, relaciona-se diretamente com as doenças crônicas como diabetes (DM) e hipertensão arterial sistêmica (HAS) e ao aumento global da expectativa de vida da população. Objetivo: O objetivo deste estudo foi traçar o perfil epidemiológico dos pacientes em programa de hemodiálise (HD) em uma capital brasileira. Métodos: Foi realizado um estudo transversal de amostra aleatória de conveniência, utilizando um questionário aplicado em 245 pacientes entre agosto de 2011 e março de 2012. Todos pacientes entrevistados estavam em programa de HD nos três serviços de Nefrologia credenciados pelo Sistema Único de Saúde (SUS) em João Pessoa -PB. Resultados: Dos entrevistados, 61% eram do sexo masculino, 66% apresentavam união estável e 44,5% eram brancos. Aproximadamente 50% eram da faixa etária de 40 a 59 anos e 51% não moravam no município de João Pessoa. As etiologias mais prevalentes foram HAS (38%) e DM (13%). As comorbidades mais prevalentes foram retinopatia diabética (15,5%) e neuropatia periférica (13,5%). Noventa e dois por cento referiram algum episódio de internação hospitalar. O acesso vascular temporário foi usado em 100% dos pacientes na primeira diálise. Conclusão: Os resultados deste estudo sinalizam a importância do melhor acompanhamento pré-dialítico desses pacientes, o que poderia reduzir a morbimortalidade. ResumoPalavras-chave: acesso aos serviços de saúde; diálise renal; insuficiência renal crônica.Introduction: Chronic kidney disease (CKD), considered by some authors as an epidemic of this century, relates directly to chronic diseases such diabetes (DM) and high blood pressure (HBP) and increase the life expectancy of the population. Objective: The aim of this study was to delineate epidemiological profile of patients on hemodialysis (HD) in a Brazilian capital. Methods: We conducted a cross-sectional study of a random sample of convenience, using a questionnaire in 245 patients between August 2011 and March 2012. All patients interviewed were in HD program in three Nephrology services at the Unified Health System (UHS) in João Pessoa. Results: Of the respondents, 61% were male, 66% were married and 44.5% were white. Approximately 50% were aged 40-59 years and 51% were living out of João Pessoa. The main etiologies were HBP (38%) and DM (13%). Main comorbidities were diabetic retinopathy (15.5%) and peripheral neuropathy (13.5%). Ninety-two percent reported an episode of hospitalization. Temporary vascular access was used in 100% of patients in first dialysis. Conclusion:Results of this study indicate the importance of better monitoring of these pre-dialysis patients, which could reduce morbimortality.

Sirolimus, an antiproliferative immunosuppressant, induces hypomagnesemia and hypokalemia. Rosiglitazone activates renal sodium- and water-reabsorptive pathways. We evaluated whether sirolimus induces renal wasting of magnesium and potassium, attempting to identify the tubule segments in which this occurs. We tested the hypothesis that reduced expression of the cotransporter NKCC2 forms the molecular basis of this effect and evaluated the possible association between increased urinary excretion of magnesium and renal expression of the epithelial Mg2+ channel TRPM6. We then analyzed whether rosiglitazone attenuates these sirolimus-induced tubular effects. Wistar rats were treated for 14 days with sirolimus (3 mg/kg body wt in drinking water), with or without rosiglitazone (92 mg/kg body wt in food). Protein abundance of NKCC2, aquaporin-2 (AQP2), and TRPM6 was assessed using immunoblotting. Sirolimus-treated animals presented no change in glomerular filtration rate, although there were marked decreases in plasma potassium and magnesium. Sirolimus treatment reduced expression of NKCC2, and this was accompanied by greater urinary excretion of sodium, potassium, and magnesium. In sirolimus-treated animals, AQP2 expression was reduced. Expression of TRPM6 was increased, which might represent a direct stimulatory effect of sirolimus or a compensatory response. The finding that rosiglitazone prevented or attenuated all sirolimus-induced renal tubular defects has potential clinical implications.

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