Influence of mild pulmonary congestion on diaphragmatic mobility and activities of daily living in chronic kidney disease: An experimental and clinical study
Bibliographic record
Abstract
Pulmonary congestion is a strong predictor of mortality and cardiovascular events in chronic kidney disease (CKD); however, the effects of the mild form on functionality have not yet been investigated. The objective of this study was to assess the influence of mild pulmonary congestion on diaphragmatic mobility (DM) and activities of daily living (ADL) in hemodialysis (HD) subjects, as well as compare ADL behavior on dialysis and non-dialysis days. In parallel, experimentally induce CKD in mice and analyze the resulting pulmonary and functional repercussions. Thirty subjects in HD underwent thoracic and abdominal ultrasonography, anthropometric assessment, lung and kidney function, respiratory muscle strength assessment and symptoms analysis. To measure ADL a triaxial accelerometer was used over seven consecutive days. Twenty male mice were randomized in Control and CKD group. Thoracic ultrasonography, TNF-α analysis in kidney and lung tissue, exploratory behavior and functionality assessments were performed. Mild pulmonary congestion caused a 26.1% decline in DM (R2 = .261; P = .004) and 20% reduction in walking time (R2 = .200; P = .01), indicating decreases of 2.23 mm and 1.54 min, respectively, for every unit increase in lung comet-tails. Regarding ADL, subjects exhibited statistically significant differences for standing (P = .002), walking (P = .034) and active time (P = .002), and number of steps taken (P = .01) on days with and without HD. In the experimental model, CKD resulted in increased levels of TNF-α on kidneys (P = .037) and lungs (P = .02), attenuation of exploratory behavior (P = .01) and significant decrease in traveled distance (P = .034). Thoracic ultrasonography of CKD mice showed presence of B-lines. The mild pulmonary congestion reduced DM and walking time in subjects undergoing HD. Individuals were less active on dialysis days. Furthermore, the experimental model implies that the presence of pulmonary congestion and inflammation may play a decisive role in the low physical and exploratory performance of CKD mice. La congestión pulmonar es un fuerte predictor de mortalidad y eventos cardiovasculares en la enfermedad renal crónica (ERC); sin embargo, aún no se han investigado los efectos de la forma leve sobre la funcionalidad. El objetivo de este estudio fue evaluar la influencia de la congestión pulmonar leve en la movilidad diafragmática (MD) y las actividades de la vida diaria (AVD) en sujetos en hemodiálisis (HD), así como comparar el comportamiento de las AVD en los días de diálisis y no diálisis. Paralelamente, inducir de forma experimental la ERC en ratones y analizar las repercusiones pulmonares y funcionales resultantes. Treinta sujetos en HD fueron sometidos a ecografía torácica y abdominal, evaluación antropométrica, función pulmonar y renal, evaluación de la fuerza de los músculos respiratorios y análisis de síntomas. Para medir las AVD se utilizó un acelerómetro triaxial durante 7 días consecutivos. Se aleatorizaron 20 ratones machos en el grupo control y con ERC. Se realizó ecografía torácica, análisis de TNF-α en tejido renal y pulmonar, comportamiento exploratorio y evaluaciones de funcionalidad. La congestión pulmonar leve provocó una disminución del 26,1% en la MD (R2 = ,261; P = ,004) y una reducción del 20% en el tiempo de caminata (R2 = 0,200; P = ,01), lo que indica disminuciones de 2,23 mm y 1,54 minutos, respectivamente, por cada unidad de aumento de las colas de cometa pulmonares. En cuanto a las AVD los sujetos mostraron diferencias estadísticamente significativas para estar de pie (P = ,002), caminar (P = ,034) y tiempo activo (P = ,002) y número de pasos dados (P = ,01) en los días con y sin HD. En el modelo experimental la ERC resultó en un aumento de los niveles de TNF-α en los riñones (P = ,037) y los pulmones (P = ,02), la atenuación del comportamiento exploratorio (P = ,01) y una disminución significativa en la distancia recorrida (P = ,034). La ecografía torácica de ratones con ERC mostró la presencia de líneas B. La leve congestión pulmonar redujo la MD y el tiempo de marcha en sujetos sometidos a HD. Los individuos eran menos activos en los días de diálisis. Además, el modelo experimental implica que la presencia de congestión e inflamación pulmonar puede desempeñar un papel decisivo en el bajo rendimiento físico y exploratorio de los ratones con ERC.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".