Integrated assessment of Hepatic, Renal, and Vitamin D status in Iraqi patients with Diabetic foot ulcer

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes mellitus, and DFUs linked to significant morbidity and impaired wound healing. In addition to infection and inflammation, changes in liver and renal function and vitamin D levels could play a role in disease progression and clinical outcome. The purpose of this study was to conduct a comprehensive evaluation of hepatic function, renal function and vitamin D levels among diabetic foot ulcer patients. Materials and Methods: A case–control study was performed using patients with DFUs and apparently healthy controls. Venous blood samples were taken for biochemical analysis. Biochemical liver function tests such as alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total protein and serum albumin were performed. The renal function was measured by serum urea, serum creatinine and estimated glomerular filtration rate (eGFR). The serum calcium and 25-hydroxyvitamin D concentrations were also measured. Biochemical parameters were compared among groups by statistical analyses, and statistical significance was considered as P < 0.05. Results: Diabetic foot ulcer patients showed significant differences in some of the liver and kidney markers when compared to healthy control patients. Serum urea and creatinine concentrations were significantly elevated while serum albumin, total protein, calcium and vitamin D were significantly decreased. In the patient group, the liver enzymes ALT, AST and ALP had significant changes. In addition, lower eGFR levels were noted in the patients, suggesting that the kidneys were not functioning well. These results indicate that there are biochemical abnormalities in multiple systems in people with DFUs. Conclusion: There is a significant disturbance in hepatic and renal functions along with low vitamin D levels, which are associated with diabetic foot ulcers. Routine biochemical evaluation can help identify and detect systemic complications early on and assist in the better management of DFU patients.