Influence of Type 2 Diabetes on Serum Electrolytes and Renal Function Indices in Patients
Journal Title: Journal of Clinical and Diagnostic Research - Year 2018, Vol 12, Issue 6
Abstract
ABSTRACT Introduction: Type 2 diabetes, a disease condition characterised by hyperglycaemia can damage the kidney, an organ which regulates water and electrolytes. Also, high blood sugar can increase plasma osmolarity thereby, drifting water movement from the intracellular to the extracellular spaces and alter the distribution of electrolytes in the body. However, little is known on the relationship between serum electrolytes, renal function and Type 2 Diabetes (T2D). Aim: This study was aimed to assess the serum electrolyte level of diabetic patients in order to evaluate the relationship of these electrolytes with renal dysfunction indices as well as other diabetes risk factors in T2D patients. Materials and Methods: A case-control study involving 72 T2D and 75 Non-Diabetic (ND) outpatients was conducted at Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. The patients’ demographic and anthropometric data was obtained and the serum electrolytes; potassium (K+), sodium (Na+) and chloride (Cl-) ions along with creatinine and urea as renal function indices were measured. Results: Serum K+ was significantly higher (p = 0.002) in T2D patients while Na+, Cl-, creatinine and urea were insignificantly higher in T2D patients compared to the ND patients. Serum K+ disorder were significantly greater (p<0.05) in T2D patients as 8.8% of T2D patients were hyperkalaemic compared to ND patients (2.7%). Creatinine level positively correlated with K+ (p = 0.004) while age, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) correlated with serum electrolytes. Conclusion: T2D was found to promote electrolyte imbalance particularly potassium ion derangement and may affect renal function. Risk factors of T2D such as old age and high blood pressure may also promote electrolyte disorders. INTRODUCTION Electrolytes in the body including sodium (Na+), calcium (Ca2+), potassium (K+), chlorine (Cl-) and magnesium (Mg2+) play important physiological roles in the body such as enhancing enzyme activities, creating electrical gradients, promoting several metabolic and cellular activities, and ensuring normal homeostasis [1]. However, distortion or imbalance of the normal electrolyte level may lead to clinical abnormalities or disorders which are frequently associated with increased morbidity and mortality [2]. Electrolyte imbalance is frequently observed in clinical subjects and usually caused by several factors including gastrointestinal absorption capacity, nutritional deficiencies, acid-base abnormalities, pharmacological agents, renal disease, acute illness or diseases which can act alone or in combination [3-5]. Diabetes is one of the diseases which frequently lead to electrolyte distortion [4,6]. In a diabetic condition, high blood glucose increases plasma osmolarity which in turn creates an osmotic driving force that drifts water movement from the intracellular spaces to the extracellular spaces [7]. This osmotic drift and water movement has two major effects on electrolyte concentration in the body. It could lead to a dilutional effect lowering electrolyte concentration if they are extracellular, or increase the extracellular concentration if the water movement carries along intracellular electrolytes to the extracellular space especially in a state of insulin deficiency [8]. This osmotic drift leads to a condition termed as electrolyte disorder or imbalance. Both hyper- and hypo-electrolyte levels are observed in diabetes. Certain studies have shown hyperkalaemia, hypernatraemia, and hypermagnesaemia etc., to occur in diabetic patients as well as hypokalaemia and hyponatraemia are also possible due to osmotic diuresis, antidiabetic agents or exogenous insulin administration [9-12]. The derangement of chloride in diabetes remains unclear as very few studies have evaluated the extent of chlorine alteration among various populations [13]. Moreover, diabetic nephropathy, which is one of the complications of diabetes characterised by impaired renal function or failure can lead to electrolyte imbalance as elevated blood sugar damages the nephron, thereby altering electrolyte absorption and reabsorption [9]. Diabetes is a multifactorial disease which is associated with sex, age, blood pressure etc., [14]. Recently, the increasing prevalence of this disease is drifting from the high-income countries to middle and low-income countries, especially Nigeria which presents the greatest disease burden in Africa affecting over 1.2 million people [15]. However, scanty data is available on the electrolyte profile of diabetic patients in Nigeria especially in relation to the prevailing risk factors including renal dysfunction indices. Hence, this study was aimed to assess the serum electrolyte level of diabetic patients in order to evaluate the relationship of these electrolytes with renal dysfunction indices along other diabetes risk factors. MATERIALS AND METHODS Study Population and Design: This was a continuation of an ongoing case–control study which recruited T2D patients and patients without diabetes (ND) of Nigerian ethnicity at Enugu State University Teaching Hospital (ESUTH) in Enugu Nigeria. The sample size (n) was calculated according to Charan and Biswas using the formula: n= = 74.19. Where; SD = standard deviation, Za/2 = Zscore for type 1 error of 5%, ZB = Zscore at 95% power and d = Effect size from previous study [16,17]. Thus, approximately 74 participants were recruited for each arm (case and control). E thics Approval and Consent to Participate: The study design was reviewed and approved by the Ethical Committee of ESUTH Enugu, Keywords: Hyperglycaemia, Osmotic drift, Renal dysfunct
Authors and Affiliations
Godwill Azeh Engwa, Friday Nweke Nwalo, Thom-Justus Chidera Attattama, Micheal Chinweuba Abonyi, Emmanuela N. Akaniro-Ejim, Marian N. Unachukwu
Keywords
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