P0663RELATIONSHIP BETWEEN ENDOTHELIAL LESION AND PULMONARY DYSFUNCTION AMONG HEMODIALYTIC CHRONIC KIDNEY DISEASE PATIENTS WITH AND WITHOUT DIABETES MELLITUS
Authors: De Francesco Daher Elizabeth , Fortes Marizeiro Debora , Gardano Bucharles Mont'alverne Daniela , Cavalcante Meneses Gdayllon , Veras de Sandes Freitas Taina , Costa Martins Alice Maria , Bezerra da Silva Junior Geraldo 
Published: June 2020

Abstract

Background and Aims
Patients with Chronic Kidney Disease (CKD) on dialysis and Diabetes Mellitus type 2 (DM2) may develop dysfunction in several systems, including the respiratory system. The aim of this study is to investigate if there is a relationship between endothelial lesion and pulmonary dysfunction in patients with CKD in hemodialysis with and without DM2.

Method
This is a cross-sectional study, from October 2017 to August 2018, including 60 patients divided into three groups: patients on hemodialysis (HD) without DM2 (HD in NDM = 30); HD with DM2 (HD in DM = 15); Non-hemodialysis with DM2 (DM without HD = 15) aged 40 to 60 years, regardless of gender. Analyzed pulmonary function were: maximal inspiratory and expiratory pressures (MIP and MEP) and measures of lung capacities and volumes: Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1).

Results
In the DM group in HD: 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 without NDM group: only the MIP parameter showed no significant difference (p = 0.256), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.001; p = 0.000; p = 0.000), respectively. In the DM group without HD: only MIP showed no statistically significant difference (p = 0.491), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.000; p = 0.008; p = 0.000), respectively when compared to their predicted value. Significant difference was detected between the groups regarding VCAM-1 only between DM in HD and DM without HD (p = 0.040). Syndecan-1 and Angiopoietin-2 plasma levels were statistically different when compared between the groups (p = 0.000) for the two biomarkers, this difference was observed only between the dialysis groups and the diabetic group without dialysis. In the multivariate regression analysis, when the fact that the individual had DM was also added, there was a greater association of VCAM-1 with the fact that the patient did not reach the predicted MEP, this value increased to OR = 8.762 (CI = 2.317 - 33.136) times of chance of not achieving the expected (p = 0.001). However, no statistically significant difference was found when the fact that the patient underwent hemodialysis was included (p = 0.885). Regarding Spearman correlation between MIP and VCAM-1 / Syndecan-1 / angiopoietin-2 there was no significant difference. However, in the correlation between MEP and endothelial lesion biomarkers, there was a significant difference only when compared with VCAM-1 (r = -0.287, p = 0.036). The FEV1 and FVC parameters obtained statistically significant results when correlated only with angiopoietin-2 (r = -0.309; -0.361), respectively.

Conclusion
Inspiratory muscle strength is reduced only when DM and HD are present when compared to their predicted. Expiratory muscle strength is reduced in all three groups and this parameter is most affected in diabetic individuals undergoing hemodialysis. Pulmonary function is compromised in all three groups equally. Endothelial glycocalyx lesion biomarkers (Angiopoietin-2 and Syndecan-1) are increased mainly in subjects on hemodialysis. Endothelial dysfunction is evidenced in HD group DM by increased VCAM-1 levels. There is a relationship between the lack of expected expiratory muscle strength with high values of VCAM-1 and when added the fact of having DM this relationship increases, however when added the fact of being dialytic there is no significant relationship. There is an inversely proportional correlation between expiratory muscle strength with the adhesion molecule marker (VCAM-1) and between pulmonary function with the endothelial lesion marker (Angiopoietin-2).