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1. Is Loss of Residual Renal Function Related to Longitudinal Uric Acid and CRP Levels in Peritoneal Dialysis Patients?

Author

Aygül ÇELTİK, Zalal ALATAŞ, Mümtaz YILMAZ, Meltem SEZİŞ DEMİRCİ, Gülay AŞÇI, Hüseyin TÖZ, and Mehmet ÖZKAHYA

Subjects
c-reactive protein, peritoneal dialysis, residual renal functions, sodium, uric acid, Medicine
Abstract

Aim:Residual renal functions have positive effects on morbidity and mortality among patients undergoing peritoneal dialysis. Our aim is to investigate the effects of baseline laboratory data and longitudinal uric acid and C-reactive protein (CRP) levels on loss of residual renal functions within the first three years of peritoneal dialysis.Materials and Methods:This is a retrospective cohort study. Thirty-four patients who started peritoneal dialysis due to end-stage renal disease were included. The primary endpoint was loss of residual renal function and was defined as residual urine volume of less than 200 mL/24 hours. Patients were followed for three years after the onset of peritoneal dialysis or until loss of residual renal functions. Demographic and clinical data were recorded retrospectively.Results:The follow-up period was 32.7 (12.9-36) months. Ten patients lost residual renal function 22.1±9.8 months after the initiation of peritoneal dialysis. Longitudinal uric acid level was 6.1±1.2 mg/dL and longitudinal CRP level was 0.5 (0.3-0.7) mg/dL. In patients with residual renal function loss, baseline sodium and triglyceride were lower, while parathormone were higher. There was no difference between the groups in terms of longitudinal uric acid and CRP levels. Baseline parathyroid hormone [hazard ratio (HR), 1,003; 95% confidence interval (CI) 1,001-1,006; p=0.013], body mass index (HR 0.817; 95% CI 0.684-0.975; p=0.025), and baseline sodium level (HR 0.801; 95% CI; 0.665- 0.965; p=0.019) were risk factors for residual renal function loss.Conclusion:In peritoneal dialysis patients, residual renal function loss were associated with baseline sodium, triglyceride, and body mass index. There was no correlation between residual renal function loss and longitudinal CRP and uric acid levels. Prospective studies are needed to determine the optimal uric acid and CRP levels.

Published
2022
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2. Lactic Acidosis Secondary to Metformin in a Patient Presenting with Acute Renal Failure due to Diarrhea: Case Report

Author

Mehmet Ozkahya, Mehmet Nuri Turan, Erhan Tatar, Mustafa Yaprak, Meltem Sezis Demirci, Aygul Celtik, Hüsnü Pullukçu, and Arzu Nazli Zeka

Subjects
Nephrology, medicine.medical_specialty, Biguanide, medicine.drug_class, business.industry, Urology, medicine.medical_treatment, Hasta, medicine.disease, High anion gap metabolic acidosis, Gastroenterology, Metformin, Transplantation, Endocrinology, Lactic acidosis, Internal medicine, medicine, Surgery, Hemodialysis, business, medicine.drug
Abstract

Metformin is a biguanide used in the treatment of type 2 diabetic patients with normal renal function. Lactic acidosis is the most serious side effect of metformin. Renal failure is the most common cause of reduced lactate excretion. It is aimed to present a case of metformin-induced lactic acidosis exacerbated by acute renal failure. A 68-year-old female patient used metformin was admitted to the infectious disease department due to diarrhea, nausea and vomiting. Type B lactic acidosis due to metformin was diagnosed after the detection of high anion gap metabolic acidosis and high lactate level on blood gas analysis. Hemodialysis was performed because of acute renal failure. The patient was discharged on the 11th day of the hospitalization with normal serum parameters. Metformin may cause lactic acidosis among patients with acute renal failure; early hemodialysis provides rapid clinical improvement. KEy woRDS: Acute renal failure, Hemodialysis, Lactic asidosis, Metformin doi: 10.5262/tndt.2013.1001.24 Yazisma Adresi: Mustafa YAPRAK Ege Universitesi Tip Fakultesi, Ic Hastaliklari Anabilim Dali, Nefroloji Bilim Dali, Izmir, Turkiye Gsm : 0 505 572 56 67 E-posta : mustafayaprakdr@yahoo.com Gelis Tarihi : 20.05.2012 Kabul Tarihi : 11.06.2012 duyarliligini artirir. Ayrica glikozun gastrointestinal sistemden absorbsiyonunu azaltir (4). Metforminin en sik yan etkisi diyare, bulanti ve kusma semptomlarini iceren gastrointestinal sistem yan etkileridir (5). Laktik asidoz, metformin kullaniminin seyrek gorulen ama ciddi bir yan etkisidir. Karaciger ve bobrek fonksiyon bozuklugu gibi komorbid durumlarin varliginda daha sik gorulmektedir (6). Insidansi her 100.000 hasta yilinda 9’dur (7). Laktat, hepatik glukoneogenez icin bir substrat oldugundan, metGIRIS Metformin biguanid sinifindan oral antidiyabetik bir ilactir. Tip 2 diyabetes mellitusta (DM), bobrek fonksiyonlari normal olanlarda ilk basamak ilac secenegidir (1). Metformin primer olarak hepatik glikoz uretimini baskilayarak hiperglisemiyi iyilestirir (2). Tip 2 DM’li kisiler normale gore 3 kat fazla glukoneogenez oranina sahiptir; metformin tedavisi bunu ucte bir oranina kadar azaltir (3). Buna ek olarak metformin periferik glikoz alimini artirarak insulin Yaprak M ve ark : Akut Bobrek Yetmezliginde Metformine Bagli Laktik Asidoz Turk Neph Dial Transpl 2013; 22 (1): 133-135 134 Turk Nefroloji Diyaliz ve Transplantasyon Dergisi Turkish Nephrology, Dialysis and Transplantation Journal Δ bikarbonata orani 1,42 saptandi. Bakilan laktat duzeyi 9,88 mmol/L saptanmasi uzerine metformin kullanimina bagli Tip B laktik asidoz olarak degerlendirildi. Metformin ve laktat klirensini saglamak ve metabolik asidozu duzeltmek amaciyla hasta bikarbonatli hemodiyalize (HD) alindi. Takibinde hastanin idrar cikisi basladi. Ikinci gun asidozu devam eden hasta tekrar HD’ye alindi. Ucuncu gun kan gazinda asidozu duzelen, laktati normale gelen hasta bikarbonat duzeyi dusuk oldugu icin tekrar HD’ye alindi. Kan gazi takipleri ve diyaliz tedavisi Tablo I’de verildi. Dorduncu gun kan gazi normal sinirlarda saptandi. Daha sonraki gunlerde HD ihtiyaci olmadi. Hastaya sonrasinda metformin kullanmamasi, DM tedavisi icin insulin kullanmasi onerildi. Yatisinin 11. gununde tum kan parametreleri duzelmis olarak sifa ile taburcu edildi.

Published
2013

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