Osteoprotegerin and 25-hydroxy vitamin D levels in patients with diabetic foot.

OBJECTIVES: This study aims to compare the levels of osteoprotegerin (OPG) and 25-hydroxy vitamin D (25(OH)D) in patients with diabetic foot and patients with newly diagnosed type 2 diabetes mellitus (DM) and to investigate the prevalence and severity of 25(OH)D insufficiency in patients with diabetic foot. PATIENTS AND METHODS: This prospective study was conducted on 105 patients including 58 patients with diabetic foot (42 males, 16 females; mean age 63.6 years; range, 31 to 90 years), who applied to our hospital between June 2014 and May 2015, and 47 newly diagnosed type 2 DM patients (27 males, 20 females; mean age 51.4 years; range, 29 to 85 years) (control group). 25(OH)D and osteoprotegerin serum levels in both groups were measured and compared. RESULTS: Osteoprotegerin levels in diabetic foot group were significantly higher than the control group (p<0.05). The 25(OH)D levels in diabetic foot group were significantly lower than the control group (p<0.05). There were positive correlations between OPG levels and C-reactive protein (CRP) and creatinine levels in patients with diabetic foot. CONCLUSION: Elevated levels of OPG in patients with diabetic foot may display the severity of the clinical status due to its positive correlation with CRP and creatinine. We detected severe 25(OH)D deficiency in the majority of diabetic foot patients. Vitamin D supplementation may be required in diabetic foot patients to prevent unfavorable immunologic alterations.

Is FGF23 effective on insulin resistance in individuals with metabolic syndrome?

Purpose Metabolic syndrome (MetS) is a polymetabolic syndrome has high morbidity and mortality rates. Insulin resistance (IR) plays a key role in the increasing frequency of this situation and has been cited as being an important etiologic factor in MetS. In this study, the relationship between IR and fibroblast growth factor-23 (FGF23), was investigated in a population with MetS. Materials and methods Forty patients with diagnosis of MetS and 40 healthy volunteers with an equal number of males and females were included in the study and classified as patient group and control group. Blood samples were obtained after 12-h fasting period to study FGF23 and other parameters. MetS, defined according to the International Diabetes Federation (IDF) guidelines, FGF23 was studied by Enzyme-Linked ImmunoSorbent Assay (ELISA) method and IR was calculated using the homeostatic model assessment-insulin resistance (HOMA-IR) formula. Results There was a statistically significant difference in HOMA-IR between the patient and control group as expected, while levels of FGF23 were similar. According to gender, levels of FGF23 was statistically significantly higher in male patients compared with controls (p = 0.037). A relationship was not detected between HOMA-IR and FGF23 in the correlation analysis. Conclusion Although there are many studies suggesting the correlation between FGF23 and IR in different populations, we did not find any statistically significant relationship between IR and FGF23 levels in MetS in this study.

Serum α-Hydroxybutyrate: A Candidate Marker of Insulin Resistance Is Associated with Deterioration in Anthropometric Measurements in Individuals with Low Diabetes Risk.

BACKGROUND: α-Hydroxybutyrate (α-HB) is a marker of insulin resistance (IR) and lipid oxidation, both of which precede the development of diabetes and cardiovascular disorders. We aimed to analyze the relation of α-HB levels with anthropometric measurements in individuals without metabolic risk factors. METHODS: A total of 82 nonobese individuals [body mass index (BMI) <30 kg/m2] without an accompanying chronic disorder were enrolled into the study. The entire cohort of participants underwent physical examination. Biochemical and hormonal parameters were analyzed. The BMI was calculated as weight/height2 (kg/m2). An ELISA method was used to analyze serum α-HB level. The relation of variables was analyzed by correlation analysis. RESULTS: The mean age, BMI, body fat ratio, and waist/hip ratio of participants were 36 (9) years, 24.9 (2.2), 39.2 (3.9), and 0.82 (0.06), respectively. The mean fasting glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) levels, total cholesterol, triglyceride, HDL, and LDL levels were 90.7 (5.1) mg/dL, 9.8 (1.5) IU/mL, 2.2 (0.3), 193.2 (32.6) mg/dL, 119.3 (60.3) mg/dL, 54.6 (12.2) mg/dL, and 114.2 (30.4) mg/dL, respectively. Serum α-HB level was significantly correlated with age, BMI, body fat ratio, waist circumference, waist/hip ratio, fasting glucose, insulin, HOMA-IR, HDL, total cholesterol, and triglyceride. CONCLUSIONS: Serum α-HB, a strong marker of insulin resistance, is well correlated with deterioration of anthropometric parameters such as an increase in BMI and body fat distribution in patients with low diabetes risk.

Systemic endothelial function measured by flow-mediated dilation is impaired in patients with urolithiasis.

Some in vitro and animal studies have shown endothelial dysfunction in hyperoxaluria models indicating its role in pathogenesis of urolithiasis and relation to CVD. The aim of this study was to investigate endothelial function in patients with urolithiasis in relation to urinary stone risk factors and metabolic parameters. A total of 120 subjects without any known CVD (60 with urolithiasis and 60 healthy subjects) were included into study. Fasting blood and 24-h urine samples were collected to study metabolic parameters (glucose and lipids) and urine stone risk factors (oxalate, citrate, uric acid, and calcium, pH). Endothelial function was assessed as flow-mediated dilation (FMD) at the brachial artery. Age, sex, and body mass index were similar in patients and controls. Of urine stone risk factors, oxalate and citrate were higher in patients than controls. Fasting blood glucose, total LDL cholesterol, and triglyceride were higher, and HDL cholesterol was lower in patients than controls. Although within normal limits systolic blood pressure was higher in patient group, patients with urolithiasis had a lower %FMD than controls. Percent FMD was negatively correlated with urinary oxalate/creatinine ratio (p = 0.019, r = -0.315), calcium/creatinine ratio (p = 0.0001, r = -0.505) age (p < 0.001, r = -0.694), BMI (p < 0.001, r = -0.838), total cholesterol (p < 0.001, r = -0.559), and triglyceride (p < 0.001, r = -0.529). Urine oxalate/creatinine ratio was positively correlated with age (p = 0.01, r = 0.327) and calcium/creatinine ratio with BMI (p = 0.001, r = 0.410). This is the first study demonstrating endothelial dysfunction in human subjects with urolithiasis. This indicates a possible predictive role of urolithiasis in future development of cardiovascular diseases.

Retinal Vessel Caliber, Choroidal Thickness and Ocular Pulse Amplitude Measurements in Essential Thrombocythemia.

PURPOSE: The choroid and retina receive most of the blood that enter to the eye, and this uptake may be affected by essential thrombocythemia (ET) in which thrombosis and hemorrhage is common. This study compares choroidal thickness, retinal vascular caliber, and ocular pulse amplitude (OPA) measurements between patients with ET and healthy adults. MATERIALS AND METHODS: Thirty-seven patients with ET and 37 age-sex-matched healthy adults were recruited in this cross-sectional and comparative study. Spectral-domain optical coherence tomography was used to measure the subfoveal choroidal thickness (SFCT) and retinal vascular caliber measurements. The Pascal dynamic contour tonometer was used for OPA and intraocular pressure (IOP) measurements. The independent samples t-test was used for comparison of measurements between the groups. Pearson's correlation coefficient analysis was used to detect correlations between the variables. A P < 0.05 was statistically significant. RESULTS: SFCT, OPA, and IOP measurements were not statistically significant differences between the study group and the control group (P > 0.05, all comparisons). Blood platelet counts were not associated with choroidal thickness, OPA, and IOP (P > 0.05). Retinal arteriolar and venular calibers were statistically, significantly thicker in healthy controls when compared to the study group (P < 0.05). CONCLUSIONS: Our results indicate that choroidal thickness and pulsatile blood flow are not significantly affected in ET and under high blood platelet counts. Retinal arteriolar and venular calibers are thinner in ET when compared to age-sex matched healthy controls.

Relation of Complementary-Alternative Medicine use with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage.

AIM: Complementary and alternative medicine is a broad field of health including all health care practices and methods, and their accompanying theories and beliefs. In the present study, we aimed to examine the frequency of complementary-alternative medicine use, and its relation with glomerular filtration rate and depression in patients with chronic kidney disease at predialysis stage. METHODS: A total of 1053 predialysis patients; 518 female and 535 male, that were followed up with chronic kidney disease for at least 3 months were enrolled into the study. Demographic features, biochemical parameters and findings of physical examination were recorded. Their compliance to diet, and knowledge about disease were questioned. Beck depression inventory and questionnaire regarding complementary-alternative medicine use were performed. RESULTS: The overall frequency of complementary-alternative medicine use was 40.3% . Total ratio of herbal products was 46%. Complementary-alternative medicine use was significantly more frequent in female or single patients, and patients that informed about chronic kidney disease or under strict diet (P = 0.007, P = 0.016, P = 0.02, P = 0.016, respectively). When glomerular filtration rate of participants were considered, complementary-alternative medicine use was similar in different stages of kidney disease. Depression was observed in 41.9% of patients and significantly frequent in patients with alternative method use (P = 0.002). Depression score was higher as creatinine increases and glomerular filtration rate decreases (P = 0.002; r = 0.093). CONCLUSION: We determined that complementary-alternative medicine use gradually increases at predialysis stage as glomerular filtration rate decreases and there is a strict relation between complementary-alternative medicine use and depression or female gender. Disorder related stressors may lead to seeking of alternative methods.

The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions.

INTRODUCTION: Mean platelet volume (MPV) is an indirect indicator of platelet activity that plays a major role in the pathogenesis of endothelial injury. Obese individuals have higher microalbuminuria which is the initial step of renal endothelial injury. We aimed to analyze the relation of microalbuminuria and MPV in obese individuals without metabolic risk factors. METHODS: A total of 290 obese individuals (body mass index (BMI)>30 kg/m2) without an accompanying chronic disorder, and 204 nonobese healthy subjects were enrolled into the study. All participants underwent physical examination. Biochemical, hemogram, and hormonal parameters along with urine albumin analysis were performed. Glomerular filtration rate (GFR) was measured by Cockcroft-Gault (GFRC&G), modification of diet in renal disease (MDRD). The BMI was calculated as weight/height2 (kg/m2). Logistic regression analysis was used to analyze relation of variables. RESULTS: The patient group consisted of 171 (59%) female (mean age: 37.15±8.05 years) and 119 (41%) male (mean age 38.98±10.68 years) obese individuals. 130 (63.7%) age matched female (mean age 36.18±8.26 years) and 74 (36.3%) age matched male (mean age 36.49±10.25 years) controls were assigned to the control group. There was a significant difference between groups with regard to BMI, spot microalbuminuria, spot urine microalbuminuria/creatinine ratio but not with to MPV and spot urine creatinine (p: 0.01, 0.004, 0.002; respectively). GFR measured by MDRD and Cockcroft-Gault formula were significantly higher in the obese group (p<0.001 for both). Correlation analysis revealed a significant correlation between BMI and spot urine microalbuminuria, spot urine microalbuminuria/creatinine ratio, GFR (Cockcroft-Gault Formula), Homeostasis Model Assessment of Insulin resistance (HOMA-IR), insulin, C-peptide, diastolic blood pressure, glucose, uric acid, total cholesterol, low density lipoprotein (LDL)-cholesterol, c-reactive protein (CRP), thyroid stimulating hormone (TSH), leukocyte count, platelet count. MPV was inversely and significantly correlated with spot urine creatinine, systolic blood pressure, triglyceride, C-peptide, and platelet count. Mean urea, creatinine, uric acid, triglyceride, total cholesterol, LDL-cholesterol, insulin, C-peptide, HOMA-IR were significantly higher in obese male individuals while obese female individuals had higher levels of mean high density lipoprotein (HDL), CRP, TSH, platelet count, spot urine microalbumin/creatinine rate, and GFR measured by MDRD. CONCLUSIONS: Obese individuals have higher microalbuminuria and nonsignificantly elevated MPV, however, urine albumin loss is independent of MPV.

Associations between apolipoprotein E gene polymorphism and plasminogen activator inhibitor-1 and atherogenic lipid profile in dialysis patients.

BACKGROUND: Apolipoprotein-E (ApoE) gene polymorphism has an important role in lipoprotein metabolism and could participate in the development of cardiovascular diseases (CVD). Plasminogen activator inhibitor-1 (PAI-1) is also regarded as a risk factor for CVD. The aim of the present study is to further investigate the possible link(s) between ApoE gene polymorphism and plasma PAI-1 antigen and serum lipid profile in peritoneal dialysis (PD) and hemodialysis (HD) patients. MATERIAL AND METHODS: We studied 72 PD patients (38 female, mean age 49.9 +/- 16.1 years), 72 HD patients (22 female, mean age 57.4 +/- 14.6 years), and 42 healthy subjects (21 female, mean age 50.1 +/- 18.6 years). Serum lipid parameters, plasma PAI-1 levels, and ApoE genotypes were determined in all subjects. RESULTS: The distribution of ApoE genotypes and alleles frequencies was similar in dialysis patients and healthy controls. In PD patients, total cholesterol (TC), low-density lipoprotein (LDL)-C, and ApoB levels were significantly higher than that of HD patients. HD patients with E3/4 genotype had elevated TC, LDL-C and ApoB levels compared with E3/3 genotype. TC and triglyceride levels were also higher in E3/4 genotype than that of E2/3 genotype. PD and HD patients showed a significantly increased PAI-1 levels compared with controls, whereas PAI-1 levels were highest in HD patients. There was no significant relation between ApoE genotypes and PAI-1 levels. CONCLUSIONS: The present study suggests that ApoE polymorphism significantly affects serum lipid profile in HD patients and epsilon4 allele carriers are more susceptible to have atherogenic lipid profile.