Relação dos biomarcadores de lesão endotelial com a disfunção pulmonar em indivíduos com doença renal crônica hemodialítica com e sem Diabetes Mellitus

Abstract

Patients with Chronic Kidney Disease (CKD) on dialysis or with Diabetes Mellitus (DM) may develop dysfunctions in several systems, including the respiratory system. Aims: Relate the biomarkers of endothelial injury to pulmonary dysfunction in individuals with chronic hemodialysis kidney disease with and without Diabetes Mellitus. Methods: Cross-sectional study with a collection period between October / 2017 and August / 2018, composed of 60 individuals divided into three groups: Patients on hemodialysis (HD) without Diabetes Mellitus (DM) (NDM in HD = 30); Diabetics in HD (DM in HD = 15); Diabetics who do not undergo hemodialysis (DM without HD = 15) aged 40 to 60 years, regardless of gender. Lung function data were analyzed: maximum inspiratory and expiratory pressures (MIP and MEP); Lung capacities and volumes, Forced Vital Capacity (FVC) and Forced Expiratory Volume in the first second (FEV1). The biomarkers of endothelial lesions analyzed were Syndecan-1, Intercellular Adhesion Molecule-1 (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1), Angiopoietin-2. The statistical tests used were ANOVA or Kruskal-Wallis, Chi Square of Independence, univariate regression and multivariate models, Spearman's Correlation and the Student T-Test. Results: In the HD DM group: MIP, MEP, FVC and FEV1 showed significant differences (p = 0.008; and p = 0.000; p = 0.000; p = 0.000), respectively. In the HD NDM group: FVC MEP and FEV1 showed a statistically significant difference (p = 0.001; p = 0.000; p = 0.000), respectively. In the DM group without HD: MEP, FVC and FEV1 showed a statistically significant difference (p = 0.000; p = 0.008; p = 0.000), respectively when compared to their predicted. A significant difference was detected between groups in relation to VCAM-1 between DM in HD and DM without HD (p = 0.040). Plasma levels of Syndecan-1 and angiopoietin-2 showed statistical difference when compared between groups (p = 0.000) for the two biomarkers. In the univariate regression analysis, it was observed that patients with PEmax values below expectations had higher VCAM-1 values O.R = 1.708, (CI = 1.057-2.760) (p = 0.024). When the fact that the individual had DM was also added, there was a greater association O.R = 8.762 (I.C = 2.317 - 33.136) (p = 0.001). A weak correlation was observed between MEP and VCAM-1 (r = -0.287, p = 0.036). The FEV1 and FVC parameters obtained a statistically significant result when correlated with angiopoietin-2 (r = -0.309, r = -0.361; p = 0.007, p = 0.023), respectively. Conclusion: Inspiratory muscle strength is reduced only when DM and HD are present. The expiratory muscle strength is reduced in the three groups and this parameter is more affected in diabetic individuals undergoing hemodialysis. Lung function is similarly compromised in the three groups. Angiopoietin-2 and Syndecan-1 are increased mainly in individuals on hemodialysis. ED is evidenced in the HD DM group by the increased VCAM-1 levels. There is a relationship between not reaching the expected values of expiratory muscle strength and having high values of VCAM-1. When the fact of having DM is added, the relationship between high values of VCAM-1 and not reaching the predicted MEP increases. There is an inversely proportional correlation between expiratory muscle strength with VCAM-1 and between lung function with Angiopoietin-2.