Inflammation is a common feature in end stage renal disease (ESRD) that might contribute to increase DNA damage. ESRD patients present increased circulating cell-free DNA (cfDNA) and different types of DNA injury. The underlying inflammatory process in ESRD may be associated with increased genomic damage and cfDNA contributing to further enhance inflammation. We analyzed the degree of genomic damage in ESRD patients under hemodialysis therapy, using the comet assay and cfDNA quantification. ESRD patients presented significantly higher C-reactive protein (CRP) and cell damaged DNA. The cfDNA correlated with age and inflammatory stage. Nine out of 39 patients died during the one year follow-up period and presented significantly higher cfDNA, than those who persisted alive. At lower CRP values, the increased DNA damage is still within the cell, and at higher CRP the damaged DNA is released in to plasma. The higher degree of genomic damage in ESRD might be a consequence of inflammation and aging, and may contribute to increase cancer and cardiovascular mortality risk. Our data suggest that the comet assay is more sensitive for low-grade inflammatory conditions, while cfDNA appears as a good biomarker for more severe inflammatory conditions, and as a biomarker for the outcome of ESRD patients.
Part of the book: Genotoxicity
Medications are used as the primary approach to prevent and effectively manage the chronic conditions. Non-adherence to medication is recognized as a worldwide public health problem with important implications for the management of chronic diseases, which affects every level of the population, particularly older adults due to the high number of coexisting diseases and consequent polypharmacy. Estimated rates of adherence to long-term medication regimen are of about 50%, and there is no evidence for significant changes in the past 50 years. The consequences of non-adherence include poor clinical outcomes, increased morbidity and mortality and unnecessary healthcare costs. Factors contributing to non-adherence are multifaceted and embrace those that are related to patients, to physicians and to healthcare systems. Cognitive, sensorial and functional decline, poor social support, anxiety, depression symptomatology and reduced health literacy have been linked to medication non-adherence in the elderly patients. Many interventions to improve medication adherence have been described in the study for different clinical conditions; however, most interventions seem to fail in their aims. In this chapter, a revision of the implications of poor adherence as well as its predictors and available tools to improve adherence is performed.
Part of the book: Gerontology