Seyyid Bilal Acikgoz

The Association of Vitamin D Status and Vitamin D Replacement Therapy with Glycemic Control, Serum Uric Acid Levels, and Microalbuminuria in Patients with Type 2 Diabetes and Chronic Kidney Disease

Objective: To evaluate the relationship of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid (SUA) levels, and microalbuminuria (MAU) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). Subjectsand Methods: A total of 1,463 patients with T2DM and CKD (aged 14-88 years), 927 females and 536 males, were included in this study. The serum data of 25-hydroxyvitamin D, i.e., 25(OH)D, level, SUA, hemoglobin (Hb)A1c, creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio (UACR) were obtained from the medical records. The Mann-Whitney U test, the χ2 test, the Mantel-Haenszel test, and linear regression models were used for data analysis. Results: Vitamin D deficiency and insufficiency were evident in 770 (52.0%) and 357 (24.0%) patients, respectively. Median HbA1c levels (7.3 [IQR 3.9] vs. 6.5 [IQR 2.3]%; p < 0.01) were significantly higher in patients deficient in vitamin D than in those with a normal vitamin D status. A significantly low level of vitamin D was noted with a high UACR (β −0.01; 95% CI −0.01 to −0.001; p = 0.017) and HbA1c (β −1.1; 95% CI −1.6 to −0.6; p < 0.001), but with low levels of SUA (β 1.3; 95% CI 0.5-2.2; p = 0.002). Vitamin D replacement was associated with a significantly low level of HbA1c (7.4 [2.7] vs. 6.7 [1.9]%; p < 0.001]. Conclusion: In this study, there was a high prevalence of hypovitaminosis D among T2DM patients with CKD, with a higher UACR, higher HbA1c, and lower SUA being noted as playing a role in predicting a decrease in vitamin D levels and potential benefits of vitamin D replacement therapy on glycemic control in T2DM management.

Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia

PURPOSE Several studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions. BASIC PROCEDURES This was a retrospective medical record review study in which patients who presented to the emergency department and had serum potassium levels ≥6mmol/L were included. Patients who did not have simultaneous potassium measurement by blood gas analyzer were excluded. We included all patients meeting potassium criteria irrespective of their underlying disease or comorbidities. We evaluated agreement between the measurement methods with Pearson correlation, Bland-Altman plot, and Sign test. MAIN FINDINGS A total of 118 blood sample pairs were included. The mean serum potassium level measured by biochemistry analyzer was 6.78±0.79mmol/L, whereas it was 6.16±0.86mmol/L by blood gas analyzer (P<.001, Sign test). There was a strong correlation (P<.001, r=0.864) between the 2 methods, but agreement was relatively poor. Blood gas analyzer tended to measure potassium significantly lower than measured by biochemistry analyzer. The mean difference between the methods was 0.62±0.43mmol/L. PRINCIPAL CONCLUSIONS In patients with moderate to severe hyperkalemia, blood gas analyzer and biochemistry analyzer gives significantly different serum potassium results which may be clinically important.

Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushings syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma.

Cutaneuos findings in patients with predialysis chronic kidney disease.

Several cutaneous findings are seen in dialysis dependent chronic kidney disease (CKD) patients. However, there are only a few small studies on cutaneous findings in predialysis CKD patients. We aimed to determine cutaneous findings in predialysis CKD patients.

First and only symptom of undiagnosed diabetes mellitus: eruptive xanthoma

Eruptive xanthoma (EX) is a very rare dermatosis mostly occurring due to high levels of serum triglycerides or uncontrolled diabetes mellitus. When EX is encountered, it is important to keep in mind that it could be a sign of severe underlying metabolic derangements. Early recognition can help avoid serious complications such as pancreatitis. After treatment of the underlying metabolic disorders, lesions mostly disappear without leaving scars. We present a case of a 55-year-old woman who presented with solely EX lesions and who was eventually diagnosed with diabetes mellitus and severe hypertriglyceridaemia.

Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients

Neutrophil‐to‐lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients.

“Angiography without contrast”: Severe vascular calcification in chronic kidney disease

phylaxis independently increases the risk of death by eightfold, with estimated cause-specific survival rate at 1 year of 45.8% in a retrospective study. The optimal treatment for calciphylaxis is not known. Recent evidence suggests that a multi-interventional approach consisting of early diagnosis with trigger-agent cessation, wound management, intravenous sodium thiosulfate, and oxygen therapy may alter the course of disease and improve survival. The benefit of surgical parathyroidectomy has not been convincingly demonstrated and there is an emerging trend that cinacalcet may represent a medical alternative to parathyroidectomy in cases of calciphylaxis with hyperparathyroidism. In summary, calciphylaxis is a complex and devastating mineral bone disorder associated with a high mortality rate in ESRD patients on RRT. Further studies are needed to aid better understanding of risk factors and management of this disease.

Single-Dose, Open-Label Study of the Differences in Pharmacokinetics of Colchicine in Subjects with Renal Impairment, Including End-Stage Renal Disease

We read the article by Wason et al. [1] with great enthusiasm. The authors conducted an elaborate study in which they investigated colchicine pharmacokinetics in subjects with different levels of kidney function. The authors administered colchicine to eight patients with end-stage renal disease (ESRD) in two periods 15 days apart. In each period, a single dose of colchicine 0.6 mg was administered (in period 1, post-dialysis; in period 2, pre-dialysis). Interestingly, the results of the study showed similar plasma colchicine concentrations between subjects with mildly diminished renal function and haemodialysis patients. This may be due to administration of only a single dose (0.6 mg) of colchicine to the study groups. Treatmentemergent adverse events were observed in four of the eight subjects with ESRD. These were diarrhoea and headache in one subject with ESRD. The authors also reported no laboratory abnormalities attributable to colchicine in these subjects, though what tests were implied was not clear. Although not cited in the current study by Wason and colleagues, the largest study in the current literature looking at the safety of colchicine in patients with ESRD undergoing haemodialysis was ours [2]. We evaluated the clinical and laboratory safety of colchicine in a case-control study in which 22 maintenance haemodialysis patients, along with 20 healthy control subjects, were recruited. Four of the 22 patients were using colchicine 0.5 mg/day, four patients were using 1.5 mg/day and 14 patients were using 1 mg/day. The mean duration of colchicine use was 8.9 ± 8.2 years. There was no difference between the groups in terms of myoneuropathic signs and symptoms and blood counts, except for the white blood cell count, which was significantly higher in patients on colchicine. Serum creatine kinase levels (56.3 ± 39.5 and 52.1 ± 36.1 U/L in the colchicine and control groups, respectively; P = 0.72) and myoglobin levels (191.4 ± 108.8 and 214.6 ± 83.5 ng/mL in the colchicine and control groups, respectively; P = 0.44) did not differ between the groups. Significant polypharmacy was also present for the subjects who were on colchicine treatment. Despite use of higher doses for long periods and the presence of polypharmacy, colchicine seemed rather safe for the haemodialysis patients. However, because of the study design, bias favouring selection of patients who tolerated colchicine well could not be excluded from our results. Considering the growing population of patients with gout and familial Mediterranean fever who require dialysis, further studies are needed to extend the findings of the aforementioned studies.