Chronic kidney disease prevention campaign: relationship between proteinuria and elderly people

OBJECTIVE

To verify the relationship between the presence of proteinuria as a renal injury marker in elderly without history of systemic arterial hypertension and cardiovascular diseases. A cross-sectional study was developed from January 2014 to December 2019, through kidney disease prevention campaigns promoted by the Federal University of Ceará in the city of Fortaleza.

METHODS

The sample consisted of 417 elderlies. A questionnaire was used to characterize individuals and assess previous diseases, and urinalysis reagent strips were used to assess proteinuria.

RESULTS

Statistically significant differences (p < 0.05) and moderate effect sizes were found for blood pressure levels (CI 0.53-0.93), systolic blood pressure, and diastolic blood pressure (CI 0.21-0.61). Significant differences in capillary glycemia were also found between groups (p = 0.033), but with a low effect size (0.02-0.42). The group with comorbidities was 2.94 times more likely to have proteinuria than those without comorbidities (OR 2.94, CI 1.55-4.01; p < 0.05). In the group without cardiovascular disease/high blood pressure, a statistically significant association was found for previous diabetes and proteinuria (p = 0.037), presenting 2.68 times higher risk of proteinuria in those with diabetes mellitus (OR 2.68, CI 1.05-6.85). Significant association was also found between age groups, with the older group having 2.69 times higher risk of developing proteinuria (75 to 90 compared to 60 to 74 years) (CI 1.01-7.16; p = 0.045).

CONCLUSION

Even without systemic arterial hypertension or cardiovascular disease, diabetes and older age can be considered high risk factors for proteinuria.

Campanha de prevenção de doença renal crônica: relação entre proteinúria e idosos

Resumo Objetivo: Verificar a relação entre a presença de proteinúria como marcador de lesão renal em idosos sem histórico de hipertensão arterial sistêmica e doenças cardiovasculares. Um estudo transversal foi desenvolvido de Janeiro de 2014 a Dezembro de 2019, por meio de campanhas de prevenção a doenças renais promovidas pela Universidade Federal do Ceará, na cidade de Fortaleza. Métodos: A amostra foi composta por 417 idosos. Um questionário foi usado para caracterizar indivíduos e avaliar doenças prévias, e foram utilizadas tiras reagentes de urinálise para avaliar proteinúria. Resultados: Diferenças estatisticamente significativas (p < 0,05) e tamanhos de efeito moderados foram encontrados para níveis de pressão arterial (IC 0,53-0,93), pressão arterial sistólica e pressão arterial diastólica (IC 0,21-0,61). Também foram encontradas diferenças significativas na glicemia capilar entre grupos (p = 0,033), mas com um tamanho de efeito baixo (0,02–0,42). O grupo com comorbidades apresentou 2,94 vezes mais probabilidade de ter proteinúria do que aqueles sem comorbidades (OR 2,94; IC 1,55-4,01; p < 0,05). No grupo sem doença cardiovascular/hipertensão, foi encontrada uma associação estatisticamente significativa para diabetes anterior e proteinúria (p = 0,037), apresentando risco 2,68 vezes maior de proteinúria naqueles com diabetes mellitus (OR 2,68; IC 1,05-6,85). Também foi encontrada uma associação significativa entre faixas etárias, com o grupo mais velho apresentando risco 2,69 vezes maior de desenvolver proteinúria (75 a 90 em comparação com 60 a 74 anos) (IC 1,01-7,16; p = 0,045). Conclusão: Mesmo sem hipertensão arterial sistêmica ou doença cardiovascular, o diabetes e a idade avançada podem ser considerados fatores de alto risco para proteinúria.

MO410: Early Endothelial Glycocalyx Injury Damage Associated With Further Kidney Dysfunction in Hiv Patients: Five Years Follow-Up

BACKGROUND AND AIMS

HIV patients have an increased risk of chronic kidney disease (CKD) development. Endothelial dysfunction was previously associated with kidney dysfunction markers. This study aims to investigate the association between renal markers and renal dysfunction biomarkers among outpatient HIV patients.

METHOD

Cohort study carried out with HIV patients in chronic use of Antiretroviral therapy followed up at a public outpatient service located in northeastern Brazil. Clinical and laboratory parameters of HIV patients were evaluated annually between 5 years: 2015 and 2019. Kidney dysfunction markers were blood creatinine and estimated glomerular filtration rate (GFR). Urinary kidney biomarkers NGAL, MCP-1, KIM-1 and serum endothelial biomarkers Syndecan-1 (glycocalyx), ICAM-1 and E-selectin were quantified in first-year using ELISA assays.

RESULTS

In total 66 patients completed the follow-up. Most patients were male (77.3%), of mixed race/color (57.6%), aged 39.33 ± 9.04 years. No patient had CKD development. However, Syndecan-1 showed a significant correlation with maximum creatinine (P &lt; 0.001) and minimum GFR (P 0.003) over the years. Moreover, both creatinine and GFR in the last year had a significant association with syndecan-1 levels quantified 4 years ago. Multivariate linear regression with confounders showed a significant and independent association of syndecan-1 levels, current age and CD4 + count with minimum GFR.

CONCLUSION

HIV patients in chronic use of Antiretroviral therapy and glycocalyx injury may have an increased risk for long-term impacts on renal tissue. These data reinforce that endothelial impacts evaluation using biomarkers is a way to optimize the diagnosis and prognosis of kidney diseases, promoting the prevention of complications.