Anemia is a frequent complication of chronic kidney disease, and its primary cause is erythropoietin deficiency. After diagnosis, treatment begins with administration of an erythropoiesis-stimulating agent (ESA). However, some patients present with resistance to ESA, which needs to be reversed, as it can increase the risk of death in patients with kidney disease. Therefore, we provide a discussion of the current literature regarding the factors that can modify the response to this class of drugs and the strategies that can be considered to optimize the benefits of treating anemia.

SUMMARY INTRODUCTION: Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE: To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS: We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS: We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION: Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION: Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.

SUMMARY The objective was to evaluate the association between nutritional status and the glomerular filtration rate (GFR) in remaining quilombolas. Cross-sectional study carried out on 32 remaining quilombola communities in the municipality of Alcântara-MA. The nutritional indicators (IN) used were: body mass index (BMI); Waist circumference (WC); Waist-to-hip ratio (WHR); Waist-to-height ratio (WHtR); conicity index (CI) and estimated visceral adipose tissue (VAT). GFR was estimated from the CKD-EPI creatinine-cystatin C formula. The Shapiro Wilk test was used to evaluate the normality of the quantitative variables. In order to compare the second IN sex, the chi-square test was applied. The Anova or Kruskal-Wallis tests were used to verify the association between IN and GFR. Of the 1,526 remaining quilombolas studied, 89.5% were black or brown, 51.2% were women, 88.6% belonged to economic classes D and E and 61.2% were farmers or fishermen. Clinical investigation revealed 29.2% of hypertensive patients, 8.5% of diabetics and 3.1% with reduced GFR. The BMI revealed 45.6% of the remaining quilombolas with excess weight. When compared to men, women presented a higher prevalence of overweight by BMI (56.6% vs 33.8%, p <0.001) and abdominal obesity CC (52.3% vs 4.3%), WHR (76,5% vs 5.8%), WHtR (82.3% vs 48.9%) and VAT (27.1% vs 14.5%) (p <0.001). Comparing the means of IN according to the GFR, it was observed that the higher the mean value of the IN lower the GFR (p <0.05). The GFR reduced with increasing mean values of nutritional indicators of abdominal obesity, regardless of sex.

Introdução: Recentemente vem sendo destacado o papel da inflamação em pacientes renais crônicos em hemodiálise e sua possível relação com estado clínico e nutricional.Objetivo: Avaliar a associação entre inflamação e parâmetros clínicos e nutricionais de pacientes em hemodiálise.Materiais e Métodos: Estudo transversal. Foram coletados dados demográficos, clínicos e nutricionais: idade; Kt/V; níveis séricos de creatinina e vitamina D; índice de massa corporal (IMC); circunferências da cintura (CC), quadril (CQ) e muscular do braço (CMB); prega cutânea tricipital (PCT); diâmetro abdominal sagital (DAS) e força de preensão manual (FPM). Para avaliação do estado inflamatório utilizou-se o Malnutrition Inflammation Score (MIS). Para comparação entre as médias das variáveis clínicas e nutricionais com MIS foi realizado o teste t de Student pareado.Resultados: Dos 73 pacientes avaliados, 54,2% era do sexo masculino, com média de idade de 44,5±15,4 anos. 81,9% tinham menos de 60 anos, eram negros/pardos (95,8%), com menos de 9 anos de estudo (70,4%). Observou-se grande variação na classificação de desnutrição (11,1 a 66,7%), prevalência de inflamação (57,7%), baixo risco cardiovascular (60,6%) pela CC; 52,9% pela RCQ, sem excesso de gordura visceral (84,7% - DAS). Níveis séricos adequados de creatinina e vitaminas D (69,4 e 83,8%, respectivamente) foram encontrados. Foi observada associação do estado inflamatório com idade, creatinina, vitamina D e FPM (p<0,05).Conclusão: Foi observada associação significativa do MIS com idade, creatinina, vitamina D e força muscular.

Background: Disorders of mineral metabolism occur in most patients with chronic kidney disease (CKD). The aim of this work was to correlate parathyroid hormone (PTH) levels with urinary magnesium excretion in patients with non-dialysis dependent CKD. Methods: Cross-sectional study. Concentrations of creatinine, magnesium, calcium, phosphate, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D] and alkaline phosphatase (ALP) were determined in blood samples. The assessment of urinary magnesium levels was performed by means of total daily excretion and by the excretion fraction (FEMg). Results: The study evaluated 163 patients with a mean age of 60.7 ± 11.7 years and 51.0% were male. In the highest quartile of PTH (> 89.5pg/mL), the mean levels of FEMg and ALP were higher (p< 0.05). In the unadjusted regression analysis, the following variables were related to serum PTH levels: FEMg (odds ratio (OR) = 1.12; 95% confidence intervals (CI): 1.02– 1.23), calcium (OR = 0.45; 95% CI: 0.22– 0.90), ALP (OR = 1.02; 95% CI: 1.00– 1.03) and eGFR (OR = 0.92; 95% CI: 1.00– 1.03). After an adjusted analysis, only one FEMg and ALP will remain correlated with PTH. Conclusion: In patients with non-dialysis dependent CKD, FEMg and ALP were some variables that remained associated with PTH.