Background: Finerenone is associated with a lower, yet clinically relevant, risk of hyperkalemia compared with steroidal mineralocorticoid receptor antagonists in diabetic kidney disease (DKD) trials. However, real-world data on hyperkalemia and its associated factors are lacking. Methodology: FINE-TURK is a national, observational cohort of DKD patients who were initiated on finerenone. Eligible adults were included; demographic, clinical, and laboratory data were evaluated. The primary outcome (PO) was hyperkalemia risk signal (potassium ≥ 5.0 mEq/L), and the secondary outcome (SO) was clinically meaningful hyperkalemia (potassium ≥ 5.5 mEq/L). Multivariate logistic regression (LR) was used to define features associated with both PO and SO. LR, random forest (RF), gradient boosting, and CatBoost classifiers were used to define important features associated with the PO. Results: 699 patients were included. 259 (37.1%) reached the PO, and 51 (7.3%) reached the SO. Baseline potassium and estimated glomerular filtration rate (eGFR) were the most important variables associated with both outcomes and were consistently identified as the top features across all models. Thiazide use, presence of diabetic retinopathy, and diabetes duration were also associated with the PO. LR demonstrated the highest recall; random forest achieved the highest precision in performance. Discussion: Real-world data suggest that the risk of clinically meaningful hyperkalemia is similar to that in the clinical trials. In parallel with the safety analysis of clinical trials, baseline potassium and eGFR were consistently the most important factors associated with hyperkalemia risk.

Background/Objectives: Finerenone improves cardiovascular and renal outcomes in diabetic kidney disease (DKD), but hyperkalemia remains a key safety concern. Patients with elevated baseline potassium levels (≥4.9 mEq/L) are largely excluded from clinical trials, and real-world data in this population are scarce. Methods: In this retrospective multicenter cohort study derived from the FINE-TURK cohort, adults with DKD who initiated finerenone with baseline potassium ≥ 4.9 mEq/L were included. The primary outcome was clinically significant hyperkalemia (K ≥ 5.5 mEq/L) within three months. Multivariable logistic regression analyses were used to identify associated factors, with multiple sensitivity analyses performed. Results: A total of 166 patients were included, of whom 47 (28.3%) had baseline potassium levels between 5.1 and 5.5 mEq/L. Of the 166 patients, 35 (21.1%) reached the primary outcome, and 10 (6%) patients had follow-up potassium ≥ 6.0 mEq/L. 126 (76.8%) patients required no intervention, 24 (14.6%) were initiated on potassium binders, and finerenone was discontinued in only 12 (7.3%) patients. Lower baseline estimated glomerular filtration rate, baseline urinary albumin, loop diuretic use and 20 mg finerenone dose were associated with the primary outcome. In contrast, baseline potassium was not associated with the primary outcome. Conclusions: In patients with DKD and elevated baseline potassium levels, finerenone initiation was associated with manageable rates of hyperkalemia. Our findings support the cautious use of finerenone in selected patients under close monitoring, as well as highlight the need for a multidimensional approach to hyperkalemia risk assessment.

Background/Objectives: Finerenone improves cardiovascular and renal outcomes in diabetic kidney disease (DKD), but hyperkalemia remains a key safety concern. Patients with elevated baseline potassium levels (≥ 4.9 mEq/L) are largely excluded from clinical trials, and real-world data in this population are scarce. Methods: In this retrospective multicenter cohort study derived from the FINE-TURK cohort, adults with DKD who initiated finerenone with baseline serum potassium ≥ 4.9 mEq/L were included. The primary outcome was clinically significant hyperkalemia (CSH) (≥ 5.5 mEq/L) within three months. Multivariable logistic regression analyses were used to identify associated factors, with multiple sensitivity analyses performed. Results: 166 patients were included, of whom 47 (28.3%) had baseline potassium levels between 5.1 to 5.5 mEq/L. Of the 166 patients, 35 (21.1%) developed CSH, and 10 (6%) patients had follow-up potassium ≥ 6.0 mEq/L. 126 (76.8%) patients required no intervention, 24 (14.6%) were initiated on potassium binders, and finerenone was discontinued only in 12 (7.3%) patients. Baseline eGFR, baseline urinary albumin, loop diuretic use and 20mg finerenone dose were associated with CSH. In contrast, baseline serum potassium was not associated with CSH. Conclusions: In patients with DKD and elevated baseline potassium levels, finerenone initiation was associated with manageable rates of hyperkalemia. Our findings support the cautious use of finerenone in selected patients under close monitoring, as well as highlight the need for a multidimensional approach to hyperkalemia risk assessment.

Objectives: Chronic Autoimmune Thyroiditis (AIT) is a prevalent etiology of hypothyroidism and is postulated to affect ovarian reserve (OR). Ovarian reserve in patients with hypothyroidism secondary to total thyroidectomy has not yet been specifically investigated. Anti-Mullerian hormone (AMH) is a verified and well-known biomarker reflecting OR. We aimed to investigate AMH levels in patients with hypothyroidism resulting from AIT or total thyroidectomy, and to assess the impact of both hypothyroidism and thyroid autoimmunity on ovarian reserve. Methods: A cross-sectional study conducted at Bakırköy Dr. Sadi Konuk Education and Research Hospital in Istanbul, Turkey, between June 2022-June 2024. The study cohort comprised 56 euthyroid women with established hypothyroidism (30 cases with AIT and 26 post-total thyroidectomy) and 30 age- and BMI-matched healthy women. Parameters measured included AMH, FSH,LH, estradiol, fT3, fT4, TSH, TPOAbs, and TgAbs. Results: No statistically significant difference was detected in AMH levels when comparing hypothyroid patients (irrespective of etiology) and healthy controls. Furthermore, no correlation was observed between AMH levels and TSH and/or thyroid autoantibodies. Conclusions: Regardless of the underlying etiology, women with hypothyroidism demonstrate comparable AMH concentrations of healthy women. Furthermore, thyroid autoimmunity itself does not appear to exert an additional detrimental effect on AMH.

Aims: The aim of this study is to evaluate the role of De Ritis ratio in predicting intra-hospital mortality in patients treated in intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). The De Ritis ratio is calculated using the formula: aspartate aminotransferase (AST)/alanine aminotransferase (ALT).Methods: Data from 414 patients admitted to the ICU with a diagnosis of COVID-19 at a single-center between March 2020 and March 2022 were retrospectively analyzed. Patients were divided into two groups: survivors and deceased patients. Demographic, clinical, and laboratory data of the patients were compared. Between-group comparisons were performed using the Mann-Whitney U test for continuous variables and Chi-square or Fisher’s exact tests for categorical variables, as appropriate. The performance of the De Ritis ratio in predicting mortality was evaluated using ROC curves, the Youden Index and APACHE-inclusive sensitivity model. Model discrimination was assessed using AUC with bootstrap 95% confidence intervals, calibration using the Brier score and Hosmer-Lemeshow test, multicollinearity using variance inflation factors, and internal validation using bootstrap optimism correction.Results: Of the 414 patients, 211 (51.0%) died. The De Ritis ratio was higher among non-survivors than survivors [median 1.61 (IQR 1.14-2.28) vs 1.17 (IQR 0.86-1.61), p