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1.
Med Sci Monit ; 30: e944314, 2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38865287

ABSTRACT

BACKGROUND Hyperuricemia, which is common in chronic kidney disease and diabetes mellitus patients, raises health concerns. Febuxostat, a first-line urate-lowering agent, prompts cardiovascular risk questions, especially in high-risk patients. This study compared the effects of febuxostat and allopurinol on cardiovascular risk in diabetes mellitus and chronic kidney disease patients. MATERIAL AND METHODS This retrospective observational cohort study, conducted using Taiwan's National Health Insurance Research Database, focused on patients diagnosed with chronic kidney disease and diabetes between January 2012 and December 2017. The study population was divided into 2 groups: allopurinol users (n=12 901) and febuxostat users (n=2997). We performed 1: 1 propensity score matching, resulting in subgroups of 2997 patients each. The primary outcomes were assessed using a competing risk model, estimating hazard ratios (HR) for long-term outcomes, including the risks of all-cause hospitalization, hospitalization for heart failure, and hospitalization for cardiovascular interventions. RESULTS Febuxostat users, compared to allopurinol users, had higher all-cause hospitalization (HR: 1.33; 95% confidence interval [CI]: 1.25 to 1.42; P<.001), hospitalization for heart failure (HR: 1.62; 95% CI: 1.43 to 1.83; P<.001), and hospitalization for cardiovascular interventions (HR: 1.51; 95% CI: 1.32 to 1.74; P<.001). Moreover, the adverse effects of febuxostat on cardiac health were consistent across most subgroups. CONCLUSIONS Use of febuxostat in patients with diabetes mellitus and chronic kidney disease is associated with higher cardiovascular risks compared to allopurinol. Prudent evaluation is essential when recommending febuxostat for this at-risk group.


Subject(s)
Allopurinol , Cardiovascular Diseases , Febuxostat , Gout Suppressants , Hyperuricemia , Renal Insufficiency, Chronic , Humans , Febuxostat/therapeutic use , Febuxostat/adverse effects , Allopurinol/therapeutic use , Allopurinol/adverse effects , Male , Female , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/drug therapy , Middle Aged , Aged , Retrospective Studies , Taiwan/epidemiology , Hyperuricemia/drug therapy , Hyperuricemia/complications , Gout Suppressants/therapeutic use , Gout Suppressants/adverse effects , Diabetes Mellitus/drug therapy , Risk Factors , Adult , Hospitalization
2.
World J Clin Cases ; 10(9): 2844-2850, 2022 Mar 26.
Article in English | MEDLINE | ID: mdl-35434103

ABSTRACT

BACKGROUND: Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterized by renal wasting hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. It is usually caused by mutations in the gene SLC12A3, which encodes the thiazide-sensitive Na-Cl cotransporter. GS is not usually diagnosed until late childhood or adulthood. CASE SUMMARY: Here, we report the case of a one-year-old girl who was brought to the emergency department due to persistent vomiting for two days. On admission to our hospital, generalized weakness was observed, and laboratory investigations revealed severe hypokalemia (1.9 mmol/L). However, persistent hypokalemia was observed during outpatient follow-up. Suspicion of the GS phenotype was assessed via the patient's clinical presentation, family history, and biochemical analysis of blood and urine. Further genetic analysis was performed for her and her family by exon-wide sequencing analysis of the gene SLC12A3. The genetic diagnosis of GS was established in the Taiwanese family with three affected individuals, two of whom were children (7 years/17 years) without obvious symptoms, with the youngest being only one year old (patient in our case). CONCLUSION: We successfully demonstrated the early diagnosis of GS using family genetic analysis. Any instances of hypokalemia should not be neglected, as early detection of GS with suitable treatment can prevent patients from potentially life-threatening complications.

3.
Med Sci Monit ; 25: 691-699, 2019 Jan 24.
Article in English | MEDLINE | ID: mdl-30674864

ABSTRACT

BACKGROUND Rapid shifting between extracellular and intracellular phosphorus can occur during dialysis sessions, which can cause aberrant intracellular signaling in long-term hemodialysis (LTHD) patients. However, the effect of these intra-dialysis fluctuations of phosphorus on clinical outcomes has not been examined. Therefore, we investigated the relationship between intradialysis serum phosphorus reduction ratio (IDSPRR) and mortality in LTHD patients. MATERIAL AND METHODS This was a retrospective, observational cohort study to assess the predictive power of IDSPRR (>0.63 vs. ≤0.63) on mortality in a total of 805 LTHD patients. All these fatal events were analyzed using the Cox proportional hazards regression model. RESULTS After multivariable analysis, baseline IDSPRR higher than 0.63 was significantly predictive of all-cause mortality (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.10-2.26), but not for cardiovascular (CV) mortality (HR: 1.41; 95% CI: 0.91-2.18). However, when time-varied IDSPRRs were applied, a value greater than 0.63 was not only significantly predictive of all-cause mortality (HR: 1.74, 95% CI: 1.16-2.63), but also CV mortality (HR: 2.04, 95% CI: 1.23-3.40). CONCLUSIONS High IDSPRR (>0.63) is independently associated with increased all-cause and CV mortality, which shows the negative effect of rapid intracellular phosphorus-shifting on LTHD patients.


Subject(s)
Phosphorus/analysis , Renal Dialysis/mortality , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Phosphorus/blood , Prognosis , Proportional Hazards Models , Renal Dialysis/adverse effects , Retrospective Studies
4.
Medicine (Baltimore) ; 97(37): e12416, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30213019

ABSTRACT

RATIONALE: Membranoproliferative glomerulonephritis (MPGN) can be induced by autoimmune diseases, chronic infection, chronic hepatitis, and paraproteins (including cryoglobulinemia). In addition, the mixed cryoglobulinemic MPGN is reported to be highly correlated with hepatitis C virus (HCV) infection. PATIENT CONCERNS: We reported a rare case of a 61-year-old woman without a history of viral hepatitis infection; she presented with bilateral leg edema and proteinuria. Renal pathology revealed MPGN with multiple positive immunofluorescent staining. The consequent serum survey revealed positive cryoglobulin and monoclonal gammopathy of kappa type of immunoglobulin M. However, bone marrow study showed no obvious plasma cell proliferation, indicating that multiple myeloma was less likely. DIAGNOSES: This patient's cryoglobulinemic MPGN could be related to monoclonal gammopathy of undetermined significance. INTERVENTIONS: Oral immunosuppressant. OUTCOMES: After steroid treatment, her renal function normalized and proteinuria kept in low level. LESSONS: We demonstrated a rare cause of cryoglobulinemic MPGN without HCV infection, which led to a favorable prognosis after receiving steroid therapy. Moreover, the diagnosis of monoclonal gammopathy should be considered when facing such case and aggressive steroid therapy might be beneficial.


Subject(s)
Cryoglobulinemia/etiology , Glomerulonephritis, Membranoproliferative/etiology , Monoclonal Gammopathy of Undetermined Significance/complications , Female , Humans , Middle Aged
5.
Am J Case Rep ; 18: 12-16, 2017 Jan 04.
Article in English | MEDLINE | ID: mdl-28050008

ABSTRACT

BACKGROUND Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. CASE REPORT Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. She presented with muscle weakness, nausea, vomiting, and diarrhea since one week. The initial diagnosis was TPP. However, biochemistry tests showed hypokalemia with metabolic alkalosis and renal potassium wasting. Moreover, a suppressed plasma renin level and a high plasma aldosterone level were noted, which was suggestive of primary aldosteronism. Abdominal computed tomography confirmed this diagnosis. CONCLUSIONS Therefore, it is imperative to consider other causes of hypokalemia (apart from TPP) in a patient with hyperthyroidism but with renal potassium wasting and metabolic alkalosis. This can help avoid delay in diagnosis of the underlying disease.


Subject(s)
Aldosterone/blood , Hyperaldosteronism/diagnosis , Hyperthyroidism/diagnosis , Hypokalemia/diagnosis , Paralysis/etiology , Potassium/blood , Renin/blood , Adrenergic beta-Antagonists/therapeutic use , Adult , Antithyroid Agents/therapeutic use , Biomarkers/blood , Diagnosis, Differential , Drug Therapy, Combination , Female , Humans , Hyperaldosteronism/blood , Hyperaldosteronism/complications , Hyperthyroidism/blood , Hyperthyroidism/complications , Hyperthyroidism/drug therapy , Hypokalemia/blood , Hypokalemia/complications , Hypokalemia/drug therapy , Paralysis/diagnosis , Propranolol/therapeutic use , Propylthiouracil/therapeutic use , Treatment Outcome
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