Background: The aim of this study was to investigate the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on the glomerulus through the evaluation of podocyturia in patients with diabetic kidney disease (DKD).Methods: The study population was composed of 40 male patients with type 2 diabetes mellitus; 22 of them received SGLT2i (SGLT2i group), and the others who did not were the control. The DKD‐related parameters of patients were monitored before SGLT2i initiation, and then in the third and sixth month of the follow‐up period. Patients' demographic, clinical, laboratory, and follow‐up data were obtained from medical charts. Microalbuminuria was measured in 24‐h urine. The number of podocytes in the urine was determined by immunocytochemical staining of two different markers, namely podocalyxin (podx) and synaptopodin (synpo). Concentrations of urine stromal cell‐derived factor 1a and vascular endothelial growth factor cytokines were quantified with an enzyme‐linked immunosorbent assay kit.Results: At the end of the follow‐up period, decreases in glycosylated hemoglobin, glucose, systolic and diastolic blood pressure, uric acid level, and microalbuminuria, and improvement in body mass index level and weight loss were significant for the SGLT2i group. On the other hand, there was no significant difference in terms of these parameters in the control group. The excretion of synaptopodin‐positive (synpo⁺) and podocalyxin‐positive (podx⁺) cells was significantly reduced at the end of the follow‐up period for the SGLT2i group, while there was no significant change for the control.Conclusions: At the end of the follow‐up period, male patients receiving SGLT2i had better DKD‐related parameters and podocyturia levels compared to baseline and the control group. Our data support the notion that SGLT2i might have structural benefits for glomerular health.

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Background and Objectives: Bone and mineral disease (BMD) is a prevalent complication of advanced chronic kidney disease (CKD). The risk of fractures can be assessed via dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). This study aims to evaluate the effectiveness of two imaging modalities in identifying bone mineral status in individuals with pre-dialysis chronic renal disease and to assess their correlation with bone turnover markers. Materials and Methods: This controlled cross-sectional study, conducted at a single center from 2019 to 2022, assessed two groups of individuals aged 18 to 50. The patient cohort consisted of individuals with stage 4–5 chronic kidney disease, whereas the control cohort consisted of healthy participants. The participants’ bone and mineral status was evaluated using both QCT and DXA methods. Diagnostic measurements of the lumbar spine and femoral neck, obtained using DXA and QCT, were compared. Z-scores were utilized to evaluate low bone mineral density, with low Z-scores identified in either lumbar spine or femoral neck measures being seen as indicative of low bone mineral density. Results: Data from 38 participants (patient group: 18; control group: 20) who underwent QCT and/or DXA were evaluated. Thirty-three subjects were assessed using both QCT and DXA (patient group: 14; control group: 19). The median age of the patient cohort was 44 (range: 22–50), whereas the median age of the control cohort was 42 (range: 27–48) (p = 0.72). Women constituted 33% of the patient cohort and 50% of the control cohort (p = 0.23). In the patient cohort, low bone mineral density was detected in four individuals (28%) through QCT, and in just two patients (14%) through DXA. Compared to DXA, QCT identified a higher number of cases of low bone mineral density in the CKD cohort; however, no statistically significant difference was observed (p = 0.06). In addition, our study found that TRACP5b had a strong negative correlation with the DXA L1–L4 Z-score. Conclusions: This study revealed that QCT may be more sensitive than DXA for detecting low bone density in pre-dialysis CKD patients. Additionally, DXA may overestimate lumbar spine BMD in this population, and the strong negative correlation between TRACP5b levels and the DXA L1–L4 Z-score highlights the potential role of biochemical markers in assessing bone status in CKD

Intradialytic nutritional support influences nutritional status, muscle strength, and related clinical outcomes in patients undergoing hemodialysis (HD). This study aims to compare the effects of intradialytic nutrition on patient outcomes, malnutrition and sarcopenia risks, and handgrip strength (HGS) in HD patients. A cross-sectional study was conducted involving 129 HD patients (62 receiving intradialytic nutritional support and 67 not) from two HD centers located in the same geographic region. Nutritional status was assessed using the MNA-SF, while physical performance was evaluated with SARC-F and HGS. Biochemical markers, including serum albumin, phosphorus, potassium, and hemoglobin (Hb) levels, were measured. The group receiving intradialytic nutritional support had significantly higher serum albumin (4.0 [3.7–4.2] g/dL vs. 3.5 [3.2–3.7] g/dL; p < 0.001, respectively) and potassium levels (5.6 [5.1–6.2] mmol/L vs. 5.0 [4.7–5.4] mmol/L; p < 0.001, respectively) compared to the group not receiving support. Phosphorus levels were similar between the two groups (4.8 [3.8–6.1] mg/dL vs. 5.3 [4.5–5.2] mg/dL; p = 0.059, respectively). The nutritional support group had lower Hb levels (10.9 ± 1.7 g/dL vs. 11.8 ± 2.0 g/dL; p = 0.008, respectively) and required higher doses of erythropoiesis-stimulating agents (32.0 [24.0–48.0] IU/month×103 vs. 24.0 [18.0–33.0] IU/month×103; p = 0.046, respectively). No significant differences were observed between the groups for MNA-SF and SARC-F scores (13.0 [12.0–14.0] vs. 14.0 [12.0–14.0]; p = 0.608, 5.0 [3.0–7.0] vs. 4.0 [2.0–6.0]; p = 0.053, respectively). The number of patients below the HGS cut-off (27/16 kg) was significantly lower in the nutritional support group (25 [40.3%] vs. 40 [59.7%]; p = 0.028, respectively), and the difference between groups was more pronounced in male patients in terms of median handgrip strength values. The nutritional support group had a higher rate of receiving social financial assistance (45 [72.6%] vs. 37 [55.2%]; p = 0.041) and a higher weekly protein intake. Intradialytic nutritional support was associated with higher serum albumin levels and handgrip strength, with the latter being more prominent among male patients. However, potassium levels were found to be higher in the nutritional support group, which may present a clinical concern and warrants further monitoring. No significant differences were observed in malnutrition or sarcopenia risk. These findings highlight the potential benefits and limitations of intradialytic nutritional interventions and provide a basis for future prospective studies. Not applicable.

Background: Fabry disease (FD) is a rare metabolic disorder, in which a lifelong enzyme replacement therapy (ERT) constitutes the cornerstone of disease-specific therapy. In this study, we examined the effects of the COVID-19 pandemic and lockdown measures on the management of FD patients. Methods: We collected data in three main domains; mood status, adherence to ERT, and COVID-19 infection. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate the mood statuses of FD patients and the Morisky Medication Adherence Scale (MMAS) and the Medication Adherence Report Scale (MARS) to assess patients’ adherence to non-disease specific therapy. We also examined a control group to compare the mood status data. Results: A total of 67 FD patients (males: 47.8%, mean age: 37.0 years) were recruited to the study, of which 58 were receiving ERT. Both the HADS depression and anxiety scores were higher in the control group compared to FD patients. During the first wave of the pandemic, 25 patients reported to have missed an infusion for a mean of 2.3 ± 1.7 doses and half of the patients had adopted a home-based infusion treatment regimen. COVID-19 infection developed in 25 patients, of which one died. The majority of our patients (71.6%) have had at least one shot of the vaccine. Conclusion: We found that FD patients were more resilient to the negative psychological effects of lockdown. Traumatic growth may be an important factor in explaining this finding. Government-supported home therapy programs might be beneficial for FD patients to increase the therapy adherence.

Background: Recent data have reinforced the concept of a reciprocal relationship between COVID-19 and kidney function. However, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. Methods: We recruited 336 adult consecutive patients (male 57.1%, mean age 55.0±15.9) that were hospitalized with the diagnosis of COVID-19 in the tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. Results: Baseline eGFR was under 60 mL/min/1.73m ² in 61 patients (18.2%). Acute kidney injury occurred in 29.1% of the patients. In-hospital mortality was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p:0.005, odds ratio:0.974, CI:0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m ² . Conclusions: On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19; We recommend to determine eGFR in all patients on admission and use it as an additional tool for risk stratification. Close follow-up should be warranted in patients with reduced eGFR.