Background and objective: Diabetic kidney disease (DKD) is the most common microvascular chronic complication of diabetes mellitus. Hyperbaric oxygen (HBO2) therapy will increase the partial pressure of oxygen (PaO2) and may improve cell repair processes, which can lead to better renal function. The objective of this study was to quantify the efficacy of adjuvant HBO2 to increase the glomerular filtration rate and urinary albumin excretion in diabetic patients, as well as determine its effectiveness to modify the clinical course of DKD. Materials and methods: An experimental study was performed on patients with stage 3 and 4 DKD. Twenty sessions of HBO2 or ambient air in a hyperbaric chamber were administered. Estimated glomerular filtration rate, urine albumin:creatinine ratio calculation and clinical stage stratification were made prior to and after HBO2 administration. A descriptive, inferential and clinical efficacy analysis was performed. Results: Urinary albumin/creatinine (UACR) mean values prior to HBO2 were 1452.9 ± 644.3 mg/g and decreased to 876.1 ± 504.0 mg/g at the end of the study (p=0.06). The patients in the control group showed a UACR mean of 2784.5 ± 2128.6 mg/g and 2861.4 ± 2424.2 mg/g at baseline and at the end of the study, respectively (p=0.82). Patients in the experimental/HBO2 group showed an estimated GFR of 27.3 ± 9.5 mL/min /1.73m2 before HBO2, with a 34.4 ± 6.9 mL/min/1.73m2 after treatment (p=0.017); control group eGFR was 30.1 ± 9.2 mL/min/1.73m2, decreasing to 22.2 ± 6.8 mL/min/1.73m2 (p=0.004). Relative risk 0.00, relative risk reduction -100%, absolute risk reduction -71.4%, 95% CI (-104.9% to -38.0%), NNT 1, 95% CI (1 to 3). Conclusions: Management with HBO2 for DKD was associated with decreased excretion urinary albumin, improved GFR and clinical stage of patients in stages 3 and 4 of kidney damage unlike those receiving ambient air.

BackgroundAntimitochondrial antibodies (AMA) are autoantibodies directed against proteins of the outer and inner mitochondrial membrane. M2 antibodies stand out because of their high sensitivity and specificity for the identification of primary biliary cirrhosis.ObjectivesTo analyse the prevalence of AMA and M2 autoantibodies in a large cohort of Spanish patients with primary Sjogren syndrome (SS), and to correlate positive results with epidemiological, clinical and immunological expression of the disease.MethodsThe GEAS-SS multicenter registry was formed in 2005 with the aim of collecting a large series of Spanish patients with primary SS. The cumulated ESSDAI index (2010 EULAR-SS disease activity index) was retrospectively calculated at diagnosis. AMA were detected by indirect immunofluorescence in triple rat tissue and M2 autoantibodies by ELISA against M2 proteins (PDC-E2, BCOADC-E2, OGDC-E2).ResultsAMA were tested consecutively in 733 patients with primary SS (688 women, mean age at diagnosis of 54.65 yrs), of whom 63 (9%) showed positive results. No significant differences were found in the main epidemiological, clinical and immunological features according to the presence or absence of AMA, except for a higher frequency of anti-Ro/SSA antibodies (83% vs 68%, p=0.015) and leucopenia (33% vs 21%, p=0.038) in AMA+ patients in comparison with those with negative AMA. M2 autoantibodies were tested in 210 patients, of whom 19 (9%) were positive. Comparison of the main epidemiological, clinical and immunological features according to the presence or absence of anti-M2 antibodies showed a higher frequency of anti-Ro/SSA antibodies (95% vs 74%, p=0.049), leucopenia (53% vs 19%, p=0.002), neutropenia (48% vs 22%, p=0.025), low C4 levels (26% vs 6%, p=0.008) and biological activity measured by the ESSDAI (84% vs 50%, p=0.007). We have the paired determination of AMA and anti-M2 in 23 patients with positive results: 12 have concordant positive results and 11 discordant (7 had negative AMA with positive M2, and 4 positive AMA with negative M2). The mean value of M2 autoantibodies in AMA+ patients was twice than in those with negative AMA, although the difference was not statistically significant (85.67 vs 41.51, p=0.126).ConclusionsThe study showed three key messages: i) the prevalence of AMA/M2 in primary SS was of 9%; ii) AMA/M2 correlated with the coexistence of Ro autoantibodies but not with systemic Sjögren; and iii) nearly half the patients showed discordant results between AMA and M2 positivities. We recommend the use of M2-ELISA to test for AMA in patients with primary SS.Disclosure of InterestNone declared