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Chan GCK, Ng JKC, Szeto CC, Chow KM. Effects on calcium phosphate homeostasis after sodium-glucose cotransporter 2 inhibitor in patients with advanced chronic kidney disease and type 2 diabetes mellitus. Diabetes Res Clin Pract 2024; 216:111818. [PMID: 39128564 DOI: 10.1016/j.diabres.2024.111818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/03/2024] [Accepted: 08/08/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on calcium phosphate homeostasis in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) remain uncertain. METHODS A retrospective observational cohort study of patients with T2DM at CKD stage G3b-5ND who received SGLT2i as compared to control from 1 January 2015 through 31 December 2021 was recruited. Propensity score assignment at 1:3 ratio by logistic regression was done. All patients were followed for 12 months. Outcomes were changes in phosphate level. RESULTS We analyzed 1,450 SGLT2i users and 4,350 control subjects. At the 12th month, SGLT2i users had a slower increase in phosphate levels (absolute change: -0.01 ± 0.28 vs + 0.14 ± 0.34 mmol/L; percentage change: -0.74 % ± 25.56 vs + 10.88 ± 28.15 %, P for both < 0.001). The proportion of patients with high phosphate was lower with SGLT2i (8.2 % vs 24.6 % increase). In the generalized estimating equation, SGLT2i was linked to a longitudinal reduction in phosphate (B -0.039, P<0.001). CONCLUSIONS SGLT2i can effectively slow down the progression of phosphate retention in advanced CKD with T2DM.
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Affiliation(s)
- Gordon Chun Kau Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jack Kit Chung Ng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Zlosa M, Grubišić B, Švitek L, Sabadi D, Canecki-Varžić S, Mihaljević I, Bilić-Ćurčić I, Kizivat T. Implications of Dysnatremia and Endocrine Disturbances in COVID-19 Patients. Int J Mol Sci 2024; 25:9856. [PMID: 39337343 PMCID: PMC11432667 DOI: 10.3390/ijms25189856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Sodium imbalance is a common electrolyte disturbance in COVID-19, often linked to disruptions in hormonal regulation. This review explores the relationship between sodium dysregulation and endocrine disturbances, particularly focusing on primary and secondary hypothyroidism, hypocortisolism, and the renin-angiotensin-aldosterone system (RAAS). Hypocortisolism in COVID-19, due to adrenal insufficiency or secondary to pituitary dysfunction, can lead to hyponatremia through inadequate cortisol levels, which impair renal free water excretion and enhance antidiuretic hormone (ADH) secretion. Similarly, hypothyroidism is associated with decreased renal blood flow and the glomerular filtration rate (GFR), which also increases ADH activity, leading to water retention and dilutional hyponatremia. Furthermore, COVID-19 can disrupt RAAS (primarily through its interaction with the angiotensin-converting enzyme 2 (ACE2) receptor), diminishing aldosterone secretion and further contributing to sodium loss and hyponatremia. These hormonal disruptions suggest that sodium imbalance in COVID-19 is multifactorial and warrants further investigation into the complex interplay between COVID-19, endocrine function, and sodium homeostasis. Future research should focus on understanding these mechanisms to develop management algorithms that address both sodium imbalance and underlying hormonal disturbances in order to improve prognosis and outcomes in COVID-19 patients.
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Affiliation(s)
- Mihaela Zlosa
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (M.Z.); (B.G.); (D.S.)
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Barbara Grubišić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (M.Z.); (B.G.); (D.S.)
- Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Luka Švitek
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (M.Z.); (B.G.); (D.S.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Dario Sabadi
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (M.Z.); (B.G.); (D.S.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, 21 Crkvena Street, HR-31000 Osijek, Croatia
| | - Silvija Canecki-Varžić
- Department of Endocrinology, Internal Medicine Clinic, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia;
- Department of Pathophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Ivica Mihaljević
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (I.M.); (T.K.)
- Department for Nuclear Medicine and Oncology, Faculty of Medicine, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
- Academy of Medical Sciences of Croatia, 15 Kaptol Street, HR-10000 Zagreb, Croatia
| | - Ines Bilić-Ćurčić
- Department of Endocrinology, Internal Medicine Clinic, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia;
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
| | - Tomislav Kizivat
- Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Centre Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia; (I.M.); (T.K.)
- Department for Nuclear Medicine and Oncology, Faculty of Medicine, J. J. Strossmayer University of Osijek, 4 Josip Huttler Street, HR-31000 Osijek, Croatia
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Eraslan Doganay G, Doganci M, Yurtseven G, Ozanbarci A, Kahraman A, Cirik MO, Ozturk Yalcin F, Hazer S, Ensarioglu K. Dysnatremia as a Mortality Marker in Intensive Care Patients with SARS-CoV-2 Infection: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1019. [PMID: 39064448 PMCID: PMC11278994 DOI: 10.3390/medicina60071019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may cause acute respiratory failure, but also remains responsible for many other pathologies, including electrolyte disorders. SARS-CoV-2 infection causes disorders in many systems and can disrupt water homeostasis with thirst and appetite abnormalities. Dysnatremia affects prognosis, and may be associated with mortality in patients admitted to an intensive care unit (ICU) diagnosed with SARS-CoV-2. Materials and Methods: The study included 209 patients admitted to the ICU between 12 April 2021 and 1 March 2022 who were over 18 years old and diagnosed with SARS-CoV-2 infection by clinical and thoracic tomography findings or with a positive reverse transcription polymerase chain reaction (RT-PCR) test result. The laboratory markers, treatment modalities, nutritional, and respiratory support also for outcome evaluation, length of stay in the ICU, total hospitalization duration, and mortality in the ICU were recorded. The laboratory marker comparison was made using admission with the final assessment performed before the time of mortality in the ICU or after discharge. Results: Inotropic requirements among patients were high, which reflected mortality in the ICU. Hypernatremia presence was associated with an increase in enteral support, the inotropic support requirement, and mortality. Hypernatremia was correlated with diabetes mellitus, chronic renal failure, and a longer duration under mechanical ventilation. Conclusions: Hypernatremia was an important risk factor in ICU patients hospitalized for SARS-CoV-2 infection, which was also affected by the treatment regimens given themselves. This complex relationship underlies the importance of proper electrolyte management, especially in patients who were under severe stress and organ failure.
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Affiliation(s)
- Guler Eraslan Doganay
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Melek Doganci
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Gulsah Yurtseven
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Azra Ozanbarci
- Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey; (A.O.); (A.K.)
| | - Abdullah Kahraman
- Anesthesiology and Reanimation Intensive Care Unit, Ministry of Health Ankara Etlik City Hospital, 06170 Ankara, Turkey; (A.O.); (A.K.)
| | - Mustafa Ozgur Cirik
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Fatma Ozturk Yalcin
- Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey; (M.D.); (G.Y.); (M.O.C.); (F.O.Y.)
| | - Seray Hazer
- Department of Thorasic Surgery, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey;
| | - Kerem Ensarioglu
- Department of Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, 06290 Ankara, Turkey;
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Ma Y, Zhang P, Hou M. Association of hypernatremia with mortality in patients with COVID-19: A systematic review and meta-analysis. Immun Inflamm Dis 2023; 11:e1109. [PMID: 38156387 PMCID: PMC10714304 DOI: 10.1002/iid3.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic worldwide has caused varying degrees of severity of lung damage in patients, with acute respiratory distress and death in severe cases. However, this is not directly caused by the virus itself, but by the production of inflammasome by monocytes in the body, leading to a systemic inflammatory response, which results in a very poor clinical prognosis for patients with COVID-19. OBJECTIVE The purpose of this meta-analysis was to look at the relationship between hypernatremia and mortality in COVID-19 patients. METHODS We searched the PubMed, Web of Science, Embase, and Cochrane databases for articles published from the inception of the database until August 27, 2022. Three researchers reviewed the literature, retrieved data, and assessed the quality of the literature, respectively. A meta-analysis was performed using State 17 software to assess the value of the effect of hypernatremia on mortality in patients with new coronavirus pneumonia. RESULTS A total of nine publications was finally included in this study, including a total of 11,801 patients with COVID-19, including 1278 in the hypernatremia group and 10,523 in the normonatremia group. Meta-analysis showed that hypernatremia was associated with mortality in patients with COVID-19 [OR = 4.15, 95% CI (2.95-5.84), p = .002, I² = 66.7%] with a sensitivity of 0.36 [0.26, 0.48] and a specificity of 0.88 [0.83, 0.91]. The posterior probability of mortality was 42% in patients with COVID-19 hypernatremia and 15% in patients who did not have COVID-19 hypernatremia. CONCLUSION According to available data, hypernatremia is associated with death in patients with COVID-19.
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Affiliation(s)
- Yongzhi Ma
- Qinghai University Affiliated HospitalXiningChina
| | | | - Ming Hou
- Qinghai University Affiliated HospitalXiningChina
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