Potassium Levels Research Articles

Real-Life Experience on the Effect of SGLT2 Inhibitors vs. Finerenone vs. Combination on Albuminuria in Chronic Kidney Disease.

There have been several recent advances in the care of patients with chronic kidney disease (CKD), including the use of sodium glucose cotransporter 2 (SGLT2) inhibitors and selective mineralocorticoid receptor antagonists (MRAs). There are very few data reporting the outcomes of these treatments in real-world experience. The aim of this retrospective study is to report the effects of SGLT2 inhibitors, finerenone, and their combination in CKD patients in our community-based setting. Ninety-eight patients with CKD with an estimated glomerular filtration rate (eGFR) between 25 and 90 mL/min per 1.73 m2 and a urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g were included. Patients were divided into three groups: two monotherapy groups of SGLT2 inhibitors or finerenone and a third combination group of therapy with SGLT2 inhibitors for the first 4 months and SGLT2 inhibitors and finerenone subsequently. The primary outcomes were the timing and percentage of patients achieving a >50% reduction in UACR from baseline. Group 1 comprised 52 patients on SGLT2i, group 2 had 22 patients on finerenone, and group 3 had 24 patients on combination therapy. The baseline median UACR and mean eGFR were 513 mg/g and 47.9 mL/min per 1.73 m2 in group 1, 548.0 mg/g and 50.5 mL/min per 1.73 m2 in group 2, and 800 mg/g and 60 mL/min per 1.73 m2 in group 3. At baseline, 71 (72.4%) patients were on the angiotensin-converting enzyme inhibitor (ACEi) or the angiotensin receptor blocker (ARB), and 78 (79.5%) patients had type 2 diabetes. After 8 months of follow-up, a >50% decrease in albuminuria was achieved in 96% of patients in group 3, compared to 50% in group 1 and 59% in group 2 (p-values were <0.01 and <0.01, respectively). There was a statistically but not clinically significant change in mean potassium levels in group 2 (+0.4 mmol/L) compared to either group 1 (0.0 mmol/L with p-value: <0.01) or group 3 (-0.01 mmol/L with p-value: <0.01). However, there was no difference in potassium levels when comparing groups 1 and 3. At the end of the follow-up, the average difference in eGFR was -3.4 (8.8), -5.3(10.1), and -7.8 (11.2) mL/min per 1.73 m2 in groups 1, 2, and 3, respectively, without a statistically significant difference between groups. In this real-world experience in our community setting, the combination of SGLT2 inhibitors and finerenone in our adult patients with CKD was associated with a very significant and clinically relevant reduction in UACR, without an increased risk of hyperkalemia. Combination therapy of SGLT2 inhibitor and finerenone regarding background use of ACEi/ARB is feasible and should be encouraged for further albuminuria reductions in CKD patients.

Twice Weekly versus Thrice Weekly Hemodialysis-A Pilot Cross-Over Equivalence Trial.

The 2015 Update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Guideline for Hemodialysis Adequacy increased the contribution of residual kidney function in calculating standard Kt/Vurea (stdKt/Vurea). However, no study has assessed the effect of prescribing twice weekly hemodialysis according to this guideline on patients' quality of life or uremic solute levels. Twenty six hemodialysis patients with average residual urea clearance (Kru) 4.7±1.8 ml/min and hemodialysis vintage of 12±15 months (range two months to 4.9 years) underwent a cross-over trial comparing four weeks of twice weekly hemodialysis and four weeks of thrice weekly hemodialysis. Twice weekly hemodialysis was prescribed to achieve stdKt/Vurea 2.2 incorporating Kru using the 2015 KDOQI Guideline. Thrice weekly hemodialysis was prescribed to achieve spKt/Vurea 1.3 regardless of Kru. Quality of life and plasma levels of secreted uremic solutes and β2 microglobulin (β2m) were assessed at the end of each period. Equivalence testing between twice and thrice weekly hemodialysis based on the Kidney Disease Quality of Life instrument (primary analysis) was inconclusive. Symptoms as assessed by the secondary outcomes Dialysis Symptom Index and post-dialysis recovery time were not worse with twice weekly hemodialysis. StdKt/Vurea was adequate during twice weekly HD (2.7±0.5), and ultrafiltration rate and plasma potassium were controlled with minimally longer treatment times (twice weekly: 195±20 vs. thrice weekly: 191±17 minutes). Plasma levels of the secreted solutes and β2m were not higher with twice weekly than thrice weekly hemodialysis. Twice weekly hemodialysis can be prescribed using the higher contribution assigned to Kru by the 2015 KDOQI Guideline. With twice weekly hemodialysis, quality of life was unchanged, and the continuous function of the residual kidneys controlled fluid gain and plasma levels of potassium and uremic solutes without substantially longer treatment times.

SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study

ObjectivesTo evaluate the comparative effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors in preventing hyperkalemia in people with type 2 diabetes in...

Effect of Different Level of Potassium and Sulfur Fertilizers on Growth and Yield of Onion (Allium cepa L.)

Effect of Different Level of Potassium and Sulfur Fertilizers on Growth and Yield of Onion (Allium cepa L.)

The value of midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test in the diagnosis of primary aldosteronism subtypes

Objective: To explore the value of the midnight 1 mg dexamethasone suppression test combined with adrenocorticotropic hormone (ACTH) stimulation test in the diagnosis of primary aldosteronism (PA) subtypes. Methods: A cross-sectional study. Clinical data of patients diagnosed with PA at the First Medical Center of Chinese PLA General Hospital from January 2020 to September 2022, who completed the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test, were analysed retrospectively. The clinical characteristics and trial results of patients with aldosterone-producing adenoma (APA) and idiopathic hyper aldosteronism (IHA)were compared. The efficacy of the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test in distinguishing APA and IHA was evaluated by drawing receiver operating characteristic (ROC) curves, and the cut-off value of the diagnostic indicator was determined with the maximum Youden index. Results: A total of 82 patients with PA were included, including 43 males and 39 females, aged (50.8±11.4) years old. They were divided into APA group (n=49) and IHA group (n=33) based on PA subtype. There was no statistically significant difference in body mass index, systolic and diastolic blood pressure between the two groups (all P>0.05). The blood potassium and orthostatic renin levels in the APA group were lower than those in the IHA group, and the differences were statistically significant (all P<0.001). The orthostatic plasma aldosterone concentration (PAC), orthostatic aldosterone to renin ratio (ARR), PAC before and after captopril challenge test(CCT), ARR after CCT, PAC before and after saline infusion test (SIT), and the proportion of unilateral lesions in the APA group were all higher than those in the IHA group, and the differences were statistically significant (all P<0.001). After the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test (30, 60, 90, 120 min), the PAC and PAC/cortisol levels in the APA group were significantly higher than those in the IHA group (all P<0.05). The PAC at 90 min showed the highest diagnostic capability according to the area under the ROC(AUC) (0.930,95%CI:0.874-0.986), and the Youden index was the highest at a PAC cut-off value of 39.05 ng/dl(0.766). The sensitivity and specificity for distinguishing APA from IHA were 91.8% and 84.8%, respectively. Conclusions: The midnight 1 mg dexamethasone suppression test with ACTH stimulation test could be useful for differentiating the subtypes of PA. Among them, the PAC and PAC/cortisol at 90 min showed best diagnostic efficacy.

Evaluation of Serum Electrolyte Abnormalities and Kidney Function to Assess Risk of Kidney Disease in Hypertensive Patients at Kenyatta National Hospital

HTN is a known leading cause of kidney disease with over 20% of the population aged 20 years or older with HTN developing CKD. Complications from HTN and kidney disease contribute significantly to global mortality. In Kenya, data from WHO shows that about 4 million individuals suffer from CKD, with many progressing to kidney failure. The aim was to assess serum electrolyte abnormalities and kidney function among hypertensive patients at KNH. The study utilized cross-sectional retrospective data from KNH patient records. The CKD-EPI equation was used to calculate eGFR. Fisher et al.’s equation determined sample size. Data were stratified by variables such as DBP, age, sex, SBP, proteinuria, serum creatinine, urea levels, serum electrolytes, and eGFR. Data collection involved 189 patients: 82 males (43.4%) and 107 females (56.6%), with a median age of 54.00 years. 93 patients (49.20%) were &lt;54 years and 96 (50.80%) were ≥54 years. 78.84% of HTN patients had abnormal serum creatinine levels, and 54.5% had abnormal serum urea levels. 58.7% showed proteinuria. Elevated sodium levels (&gt;145 mmol/l) affected 39.68% of patients, while reduced potassium levels (&lt;3.5 mmol/l) were found in 15.34%. 41.27% had elevated chloride levels above 106 mmol/l. CKD stages varied: 3.2% had G1, 17.5% had G2, 14.8% had G3a, 29.1% had G3b, 16.4% had G4, and 19.0% had G5. Reduced renal function, estimated using GFR, was prevalent among hypertensive patients (79.4%) (95% CI:72.9-82.9), notably those ≥54 years. In conclusion, the risk of progressive kidney disease was high amongst hypertensive patients and this was evident from the proportion of patients who have abnormal kidney function including proteinuria. Early screening and implementation of therapeutic strategies can improve patient’s quality of life.

Evaluation of Myostatin and Some Biochemical Variables in Both Type 2 Diabetic and Diabetic Nephropathy Patients

Background: The kidneys are essential organs that keep blood pH stable and eliminate excess water, salts, and aid in the body's waste removal. Aim of the study: The study aims to investigate the importance of myostatin in the development of diabetic nephropathy patients. In addition, the level of urea, creatinine, sodium, potassium, and phosphorus. Materials and methods: A Case-Control study lasted from- November 2023 to January 2024, at Al-Amal Kidney Dialysis Center and Azadi Teaching Hospital in Kirkuk Governorate. The 135 blood samples, their ages (25-70), were divided into three groups. The first group G1 (n:50) patients with T2DM. The second group G2 (n:55) with diabetic nephropathy. The third group G3 for control. Serum samples were utilized to measure MSTN by ELISA, blood urea, serum creatinine, S.PO4, S. Na+, S. K+, and S. Ca++ by spectrophotometer. Results: Significant variations (P&lt;0.05) in MSTN were seen between study groups (8.43±4.69, 10.99±7.05, 5.63±3.38) ng/ml. Additionally, significant differences exist between (G1 vs G2), (G1 vs G3), and (G2 vs G3) with p-value &lt;0.05 Diabetic nephropathy G2 had the highest mean urea and creatinine levels (136.69±38.21, 5.99±1.87), followed by G1 (34.92±9.06, 0.89±0.26) and control group G3 (31.00±4.72), with significant differences (p ≤ 0.001) among three groups. Additionally, G1 with G2, G2 with G3, and G1 with G3 had significant differences (p-value&gt;0.01). Conclusion: This study found higher myostatin, urea, and creatinine in diabetic nephropathy and diabetic patients. The data also showed hyponatremia, hypocalcemia, hyperkalemia, and hyperphosphatemia in diabetic nephropathy and diabetic patients.

An investigation of association between human milk mineral patterns and infant growth.

Human milk is widely acknowledged as the optimal food for infant aged 0 ~ 6 months. While there has been extensive documentation on the mineral and trace element composition of human milk, results on the relationship between mineral content and infant growth remain mixed. This cross-sectional study aims to explore human milk mineral patterns and to investigate associations between human milk mineral patterns, human milk metabolomic profile and infant growth. A total of 200 breast milk samples from seven cities in China was included. Human milk mineral and trace elements was detected by inductively coupled plasma mass spectrometer (ICP-MS). K-means cluster analysis was utilized to derived human milk mineral patterns. Untargeted human milk metabolomic profiles was determined using high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Differences of infant growth rate and metabolomic profiles were then compared across patterns identified. Three human milk mineral patterns were identified. Cluster I was characterized as the highest levels of potassium, magnesium and calcium, while the lowest levels of copper, zinc, manganese and selenium. Cluster II showed the most abundant sodium, iron, zinc, manganese and selenium. Cluster III had the lowest levels of sodium, potassium, magnesium, iron and calcium. Infants of cluster I showed significantly higher length-for-age z score (0.60 ± 2.03, p = 0.03). Compared with other clusters, samples of cluster I showed lower expression of metabolites of arachidonic acid (ARA) and nicotinate and nicotinamide metabolism pathway. A human milk mineral pattern was identified which is related to increased infant growth rate and altered metabolic signature. Future work is needed to understand these human milk patterns in terms of biologic mechanisms and generalization to other populations.

Estimated Effect of Restarting Renin-Angiotensin System Inhibitors after Discontinuation on Kidney Outcomes and Mortality.

While renin-angiotensin system inhibitors (RASi) have been the mainstream treatment for patients with CKD, they are often discontinued due to adverse effects such as hyperkalemia and acute kidney injury. It is unknown whether restarting RASi after discontinuation improves clinical outcomes. Using the OCKR (Osaka Consortium for Kidney disease Research) database, we performed a target trial emulation study including 6,065 patients with an eGFR of 10-60 mL/min/1.73m2 who were followed up by nephrologists and discontinued RASi between 2005 and 2021. With a clone-censor-weight approach, we compared a treatment strategy for restarting RASi within a year after discontinuation with that for not restarting RASi. Patients were followed up for five years at maximum after RASi discontinuation. The primary outcome was a composite kidney outcome (initiation of kidney replacement therapy, a ≥50% decline in eGFR, or kidney failure [eGFR <5 mL/min/1.73m2]). Secondary outcomes were all-cause death and incidence of hyperkalemia (serum potassium levels ≥5.5 mEq/L). Among those who discontinued RASi (mean [standard deviation (SD)] age 66 [15] years, 62% male, mean [SD] eGFR 40 [26] ml/min/1.73m2), 2,262 (37%) restarted RASi within a year. Restarting RASi was associated with a lower hazard of the composite kidney outcome (hazard ratio 0.85 [95% confidence intervals (CIs) 0.78 to 0.93]) and all-cause death (hazard ratio 0.70 [95% CI 0.61 to 0.80]) compared with not restarting RASi. The incidence of hyperkalemia did not differ significantly between the two strategies (hazard ratio 1.11 [95% CI 0.96 to 1.27]). Restarting RASi after discontinuation was associated with a lower risk of kidney outcomes and mortality but not related to the incidence of hyperkalemia.

Objective predictors for delirium tremens based on physiological and metabolic parameters

BACKGROUND: The search for markers and predictors of complicated forms of alcoholism, which include alcoholic delirium and acute psychotic reactions with hallucinatory and delusional phenomena, is one of the actual problems of modern addiction medicine. AIM: Clinical validation of a model for early detection of patients at high risk of developing complicated alcohol withdrawal syndrome (AWS) based on laboratory diagnostics. SUBJECTS AND METHODS: A prospective, cohort, observational study was performed. The study included 200 patients; 9 were excluded. The included patients were distributed as follows: uncomplicated AWS, 98 patients (51.3%); alcohol delirium, 67 patients (35.1%); and alcohol-induced psychotic disorder, 26 patients (13.6%). Potassium, sodium, calcium, and platelet count were compared between the groups, and the relationships between sex, age, and potassium levels in patients with alcohol delirium were studied. RESULTS: Potassium, sodium, and platelet count were significantly different in patients with alcohol delirium and in those with uncomplicated AWS and alcohol-induced psychotic disorder. Blood calcium levels were significantly different between patients with alcohol delirium and uncomplicated AWS. Women were found to be less sensitive to metabolic disorders that developed as a result of alcohol consumption, as evidenced by lower incidence of delirium. The high prevalence of alcohol delirium among older patients is a consequence of decompensation of metabolic regulation mechanisms. CONCLUSIONS: Predictive model of alcohol delirium, based on the results of blood potassium level study, proved effectiveness in clinical application.

Effects of NF-κB Inhibitor on Sepsis Depend on the Severity and Phase of the Animal Sepsis Model.

Hyperinflammation occurs in sepsis, especially in the early phase, and it could have both positive and negative effects on sepsis. Previously, we showed that a new concept of NF-κB inhibitor, exosome-based super-repressor IκBα (Exo-srIκB) delivery, has a beneficial effect on sepsis. Here, we further investigate the therapeutic effects of Exo-srIκB at different severities and phases of sepsis using an animal polymicrobial intra-abdominal infection model. We used a rat model of fecal slurry polymicrobial sepsis. First, we determined the survival effects of Exo-srIκB on sepsis according to the severity. We used two different severities of the animal sepsis model. The severe model had a mortality rate of over 50%. The mild/moderate model had a less than 30% mortality rate. Second, we administered the Exo-srIκB at various time points (1 h, 6 h, and 24 h after fecal slurry administration) to determine the therapeutic effect of Exo-srIκB at different phases of sepsis. Lastly, we determined the effects of the Exo-srIκB on cytokine production, arterial blood gas, electrolyte, and lactate. The survival gain was statistically significant in the severe sepsis model when Exo-srIκB was administered 6 h after sepsis. Interleukin 6 and interleukin-10 were significantly decreased in the kidney when administered with Exo-srIκB. The laboratory data showed that lactate, glucose, and potassium levels were significantly lowered in the NF-κB inhibitor group. In conclusion, Exo-srIκB exhibited a beneficial therapeutic effect when administered 6 h post fecal slurry administration in a severe sepsis model.

Zircon U-Pb Dating, Geochemistry, Lu-Hf Isotope Characteristics, and Geological Significance of Volcanic Rocks in Zhenghe Fozi Mountain National Geopark, Fujian, China

Fozi Mountain National Geopark is located in Zhenghe County in the northern region of Fujian Province, where the volcanic rocks of the Zhaixia Formation of the Shimaoshan Group are exposed. Zircon U-Pb dating and geochemical analysis were carried out to constrain its age and tectonic environment. The results show that three zircon U-Pb dating samples have attained ages of 99.2 ± 1.0 Ma, 99.6 ± 0.8 Ma, and 99.7 ± 2.0 Ma. Volcanic rocks in the core scenic area of Fozi Mountain were formed during the Late Cretaceous period. Elemental analysis showed that these volcanic rocks were dominated by the shoshonite series. They include gray dacite porphyry, grayish-white breccia tuff, volcanic agglomerate, and gray tuffaceous sandstone. These rocks were characterized by high silicon, high alkali content, and rich potassium levels. Lu-Hf isotope analysis of zircons revealed that their εHf(t) values varied from −8.7 to −6.8. The corresponding TDM2 values were primarily distributed in the range of 1.71 Ga to 1.59 Ga. These findings indicated that the magma primarily originated from the partial melting of the Mesoproterozoic crystalline basement, accompanied by a small number of mantle-derived materials. Tectonic environment analysis indicated that these rocks were formed in the post-orogenic intraplate extensional environment, which was associated with the back-arc extension or lithospheric thinning caused by the subduction of the paleo-Pacific plate beneath the Eurasian plate. The formation of these volcanic rocks was attributed to post-orogenic magmatism.

The Effect of Intradialytic Aerobic Exercise on Dialysis Parameters and Fatigue in Hemodialysis Patients: A Non-randomized Interventional Study.

Introduction Hemodialysis is the standard treatment for end-stage renal disease. However, patients receiving hemodialysis can become less active as a result of treatment, resulting in the accumulation of waste products. Intradialytic exercise improves the clearance of urea and creatinine by opening up vascular beds. Materials and methods We conducted a non-randomized interventional study to evaluate the effect of intradialytic aerobic exercise on dialysis parameters and fatigue among 295 hemodialysis patients selected through consecutive sampling (control group, n=147; experimental group, n=148) from two tertiary care centers. Baseline data on background variables and pre-test dialysis parameters (e.g., blood urea, creatinine, potassium, and hemoglobin levels) were assessed in both groups. Following connection to the hemodialysis machine, participants in the experimental group engaged in 15 minutes of intradialytic aerobic exercise per two hours of dialysis for a total of eight weeks, besides receiving routine care, compared to those in the control group. Post-test dialysis parameters were assessed for both groups at the end of the eighth week. The collected data were analyzed and tabulated using SPSS (IRB Inc., Armonk, New York). Results Intradialytic exercise led to significant improvements in post-test blood urea, creatinine, and fatigue in the experimental group (p<0.001). However, post-test serum potassium and hemoglobin levels remained relatively unchanged. Conclusion This study demonstrates the benefits of intra-dialytic aerobic exercise as a safe complementary therapy for a large population of dialysis patients, leading to better patient outcomes.

Study on comparison of electrolytes in hospitalized patients of critical care medicine by automated biochemistry analyzer and arterial blood gas analyzer

Critical care medicine department has to assess electrolytes accurately and quickly to initiate the treatment. Blood samples are analyzed in a matter of seconds by arterial blood gas analyzers (ABG), albeit their accuracy is still up for debate. The current study objectives were to estimate and compare the levels of electrolytes (sodium, potassium, and chloride) in hospitalized critical care patients as determined by automated biochemistry analysis and blood gas analyzer and to assess the degree of agreement between the two instruments and obtain information on whether these values can be interchanged. A prospective hospital based observational study was undertaken after obtaining institutional ethical committee clearance. The study included a total of 195 paired venous and arterial samples from the patients admitted to Critical Care Medicine Unit of NIMS Hospital, Jaipur, India in whom electrolytes were analysed on Arterial Blood Gas (ABG) analyzer and Automated Biochemistry Analyzer (ABA). Analysis was done on ABL555 blood gas analyzer located in the critical care medicine unit and vitros 5600, located in Clinical Biochemistry. Statistical analysis was done using Student’s t test and Pearson’s correlation coefficient test.A total of 195 samples were analyzed. The mean levels of sodium, potassium and chloride were 136.64 ± 5.44 mmol/L, 3.87 ± 0.523 mmol/L and 100.79 ± 6.65 mmol/L respectively analyzed by ABG analyzer. The mean levels of sodium, potassium and chloride were 136.65 ± 5.81mmol/L, 88 ± 0.543 mmol/L and 100.47 ± 6.41 mmol/L respectively analyzed by ABA. Student’s t test comparison p values for sodium, potassium and chloride were 0.458 (Not Significant), 0.1867 (Not Significant) and 0.0438 (Significant) between the two instruments. The strength of agreement between the two instruments for sodium, potassium and chloride were analyzed using pearsons correlation coefficient. There was strong agreement for all the three parameters between the two instruments and the p value was 0.00001 (highly significant) for all the three parameters.The results of this investigation showed no discernible differences between the automated biochemistry analyzer and arterial blood gas analyzer measurements of sodium, potassium, and chloride. Clinicians can make critically important decisions by relying on the results of arterial blood gas analysis.

Relationship between Baseline Serum Potassium and 1-Year Readmission in Pediatric Patients with Heart Failure: A Retrospective Cohort Study.

Pediatric heart failure (HF) is associated with high readmission rates, but the optimal serum potassium range for this population remains unclear. In this single-center retrospective cohort study, 180 pediatric patients hospitalized for HF between January 2016 and January 2022 were stratified into low-potassium (<3.7 mmol/L), middle-potassium (3.7-4.7 mmol/L), and high-potassium (≥4.7 mmol/L) groups based on the distribution of potassium levels in the study population. The primary outcome was readmission for HF within 1 year of discharge. Cox regression and restricted cubic spline models were used to assess the association between potassium levels and 1-year HF readmission rates. Notably, 38.9% of patients underwent 1 or more 1-year readmissions for HF within 1 year. The high-potassium group had a significantly higher readmission frequency than the middle-potassium group. In multivariate Cox regression models, potassium levels of ≥4.7 mmol/L were independently associated with increased 1-year readmission risk. A J-shaped relationship was observed between baseline potassium levels and 1-year readmission risk, with the lowest risk at 4.1 mmol/L. In pediatric patients with HF, a serum potassium level ≥ 4.7 mmol/L was independently associated with increased 1-year readmission risk. Maintaining potassium levels within a narrow range may improve outcomes in this population.

The Importance of the FUT2 rs602662 Polymorphism in the Risk of Cardiovascular Complications in Patients after Kidney Transplantation.

The FUT2 gene encodes an enzyme called α-1,2-fucosyltransferase, which is involved in the formation of blood group antigens AB0(H) and is also involved in the processes of vitamin B12 absorption and its transport between cells. FUT2 gene polymorphisms are associated with vitamin B12 levels in the body. Vitamin B12 deficiency associated with hyperhomocysteinemia is a major risk factor for cardiovascular diseases (CVDs), which are one of the main causes of death in patients after kidney transplantation. The aim of our study was to determine the impact of the rs602662 (G>A) polymorphism of the FUT2 gene on the functionality of transplanted kidneys and the risk of CVD in patients after kidney transplantation. The study included 402 patients treated with immunosuppression (183 patients taking cyclosporine (CsA) and 219 patients taking tacrolimus (TAC)). The analysis of the FUT2 rs602662 (G>A) polymorphism was performed using real-time PCR. Patients with CsA were more likely to be underweight (1.64% vs. 0.91%) and obese (27.87% vs. 15.98%), while those taking TAC were more likely to be of normal weight (39.27%) or overweight (43.84%). No statistically significant differences were observed comparing the mean blood pressure, both systolic and diastolic. The renal profile showed a higher median urea nitrogen concentration in patients with CsA (26.45 mg/dL (20.60-35.40) vs. 22.95 mg/dL (17.60-33.30), p = 0.004). The observed frequency of rs602662 alleles of the FUT2 gene was similar in the analyzed groups. The A allele was present in 43.7% of patients with CsA and 41.1% of those taking TAC (OR = 0.898; 95% CI: 0.678-1.189; p = 0.453). In the group with CsA, the GG genotype was present in 32.2% of patients, the GA in 48.1% and the AA in 19.7%. A similar distribution was obtained in the TAC group: GG-33.8%, GA-50.2%, and AA-16.0%. An association of genotypes containing the G allele with a higher incidence of hypertension was observed. The G allele was present in 65% of people with hypertension and in 56% of patients with normal blood pressure (p = 0.036). Moreover, the evaluation of the renal parameters showed no effect of the FUT2 polymorphism on the risk of organ rejection because the levels of creatinine, eGFR, potassium, and urea nitrogen were prognostic of successful transplantation. Our results suggest that the rs6022662 FUT2 polymorphism may influence the risk of cardiovascular diseases.

The Stress Index as a Predictor of Mortality in Patients with Isolated Moderate to Severe Traumatic Brain Injury.

The Stress Index (SI), calculated as the ratio of blood glucose to serum potassium levels, is a promising prognostic marker in various acute care settings. This study aimed to evaluate the utility of the SI for predicting mortality in patients with isolated moderate-to-severe traumatic brain injury (TBI). This retrospective cohort study included adult trauma patients (aged ≥ 20 years) with isolated moderate to severe TBI (Abbreviated Injury Scale ≥ 3 for only head region) treated from 2009-2022. The SI was computed from the initial glucose and potassium levels upon arrival at the emergency department. Logistic regression models were used to assess the association between the SI and mortality after adjusting for relevant covariates. The most effective threshold value of the SI for predicting mortality was identified using receiver operating characteristic (ROC) analysis. Among the 4357 patients with isolated moderate and severe TBI, 463 (10.6%) died. Deceased patients had a significantly higher SI (61.7 vs. 44.1, p < 0.001). In multivariate analysis, higher SI independently predicted greater mortality risk (odds ratio (OR) 6.70, 95% confidence interval (CI) 1.66-26.99, p = 0.007). The optimal SI cutoff for predicting mortality was 48.50 (sensitivity 62.0%, specificity 71.4%, area under the curve 0.724). Patients with SI ≥ 48.5 had nearly two-fold higher adjusted mortality odds compared to those below the threshold (adjusted OR 1.94, 95% CI 1.51-2.50, p < 0.001). SI is a useful predictor of mortality in patients with isolated moderate-to-severe TBI. Incorporating SI with standard clinical assessments could enhance risk stratification and management approaches for this patient population.

Comparison of Blood Gas Analysis and Auto-Analyzer Results for Sodium and Potassium Levels in Elderly and Non-elderly Adult Emergency Department Patients.

Objectives This study aims to evaluate the concordance between blood gas and biochemical measurement methods for sodium and potassium levels in elderly and non-elderly patients within an emergency department (ED) setting. Methods A retrospective method comparison study was conducted at an ED from February 1, 2023, to March 1, 2023. The study included 414 patients, categorized into "elderly" (aged 65 and above; n = 138, 33.3%) and "non-elderly" (aged 18 to 64; n = 276, 66.7%) groups. Concordance was assessed using Bland-Altman, Passing-Bablok, and Lin's concordance correlation methods. Results In sodium measurements, the elderly group exhibited an average bias of -1.52 mEq/L (95% confidence interval [CI] -2.12 to -0.92), with lower and upper limits of agreement (LoA) at -8.46 and 5.42 mEq/L, respectively, indicating a broader variance than non-elderly patients, who showed an average bias of -0.82 mEq/L with limits of -4.97 to 3.32 mEq/L. For potassium, the elderly group's average bias was -0.46 mEq/L (95% CI -0.36 to -0.57), with limits of agreement from -1.68 to 0.75 mEq/L, compared to non-elderly patients with a bias of -0.29 mEq/L and limits of -0.71 to 0.13 mEq/L. Furthermore, concordance correlation coefficients revealed a reduced agreement in the elderly for both sodium (r ccc = 0.799) and potassium (r ccc = 0.529) compared to the non-elderly cohort (sodium r ccc = 0.821, potassium r ccc = 0.715). Conclusion The study identifies significant discrepancies in sodium and potassium levels between elderly and non-elderly patients, suggesting a need for diagnostic precision. It emphasizes the importance of customizing diagnostic approaches to better serve the elderly population in EDs.

Frequency of Hyponatremia &amp; Hypokalemia in Children under 5 Years with Acute Diarrhoea

Background: Acute diarrhea poses a significant health threat to children globally, often leading to severe morbidity and mortality, particularly in developing countries. Electrolyte imbalances, including hyponatremia and hypokalemia, are common complications associated with acute diarrhea, further exacerbating the risk of adverse outcomes. Objective: This study aimed to evaluate the frequency of sodium and potassium abnormalities, specifically hyponatremia and hypokalemia, in children presenting with acute diarrhea. Methodology: A prospective cohort study was conducted at the Pediatric department of a tertiary hospital from July 2022 to June 2023. A total of 130 pediatric patients aged up to 5 years, presenting with acute diarrhea, were included in the study. Clinical examinations were conducted, and demographic data, including age, gender, residence, and socioeconomic status, were recorded. Serum sodium and potassium levels were determined from venous blood samples, and hyponatremia and hypokalemia were defined as sodium levels &lt;130 mmol/l and potassium levels &lt;3.5 mmol/l, respectively. Statistical analysis was performed using SPSS 24.0. Results: The mean age of the patients was 2.38 years, with a disease duration of 3.54 days. Male patients accounted for 60% of the cohort, and urban residency was predominant (55%). Clinical symptoms included loose motion (100%), abdominal pain (70%), fever (35%), vomiting (31%), and lethargy (27%). Hyponatremia was observed in 30% of patients, while hypokalemia was present in 40% of cases. Conclusion: Sodium and potassium imbalances are prevalent among children with acute diarrhea, highlighting the need for vigilant monitoring and appropriate management strategies to prevent adverse outcomes. The high incidence of hyponatremia and hypokalemia underscores the importance of early recognition and intervention in pediatric patients presenting with acute diarrhea.

On the Role of Mast Cells and Their Proteases in the Severe COVID-19

During the pandemic of the new coronavirus infection COVID-19 the question about the importance of mast cells and their proteases arose. The aim of this study is to determine the role of mast cells and their proteases chymase and tryptase in the pathogenesis of severe COVID-19. Materials and methods. The study included 55 patients: 29 male (52,7 %) and 26 female (47,3 %) aged 67 [62;71] years with severe COVID-19 and fatal outcome. An analysis of postmortem lung biopsies of patients with COVID-19 was carried out, determining the representation of mast cells, protease profile and degranulation activity. A correlation analysis was carried out between mast cell and clinical and laboratory parameters of patients. Results. Increased number of mast cells and their degranulation activity were found in patients with chronic heart failure, obesity, chronic kidney disease, coronary heart disease and acute cerebrovascular accident. Degranulation of tryptase-positive mast cells are depleted as the duration of the disease increases: the content of single tryptase-positive mast cells (%) negatively correlates with the duration of the disease and hospitalization (p = 0,015, r = -0,327 and p = 0,006, r = -0,368, respectively), the content of tryptase-positive mast cells fragments (%)correlates with the duration of hospitalization (p = 0,007, r = 0,357). Correlations were established between the levels of non-conjugated bilirubin and alanine aminotransferase with the content of single tryptase-positive mast cells (per mm2) (r = 0,340, p &lt; 0,05 and r = 0,307, p &lt; 0,05, respectively), as well as single degranulated tryptase-positive mast cells (per mm2) (r = 0,369, p &lt; 0,05 and r = 0,363, p &lt; 0,01, respectively), and the level of conjugated bilirubin with the content of single tryptase-positive mast cells (%) (r = 0,415, p &lt; 0,05). The blood calcium level correlates with the absolute total content of single tryptase-positive mast cells (p = 0,013, r = 0,457), as well as degranulated (p = 0,017, r = 0,441). A negative correlation was also found between potassium level and the relative content of single non-degranulated tryptase-positive mast cells (p = 0,014, r = -0,352). Correlations were found between the level of total bilirubin at the time of admission and over time with the content of single degranulated chymase-positive mast cells (per mm2) (p = 0,043, r = 0,277 and p = 0,027, r = 0,317, respectively). Urea level upon admission positively correlates with the absolute total content of single chymase-positive mast cells (p = 0,045, r = 0,277), as well as degranulated (p = 0,04, r = 0,283). The potassium level in the blood correlates with the total content of co-adjacent chymase-positive mast cells (p &lt; 0,05, r = 0,388), as well as content of co-adjacent degranulated chymase-positive mast cells (p &lt; 0,05, r = 0,388). Conclusion. Significant correlations were noted between mast cells parameters and duration of the disease and hospitalization, the presence of comorbidities, unconjugated and conjugated bilirubin, ALT, urea, total protein, sodium, potassium and calcium blood levels. An increase in the number of mast cells and their degranulation activity has been found in patients with comorbidities: chronic heart failure, obesity, chronic kidney disease, ischemic heart disease and previous stroke. The revealed depletion of degranulation processes of tryptase-positive mast cells as the duration of the disease increases indicates their role in lung damage. We noted participation of mast cells and their proteases chymase and tryptase in the development of liver and kidney damage in patients with COVID-19, which confirms their importance in the severe course of the disease and may be considered in the future for the development of pathogenetic therapy.