Journal of the Nephrology Society of Thailand

Educational Levels and 6-Month Peritonitis Risk in Peritoneal Dialysis Patients Along the Thai-Cambodian Border

2026-08-30T23:14:42+07:00

Background: Peritonitis is a common complication of peritoneal dialysis (PD). This study explored whether educational levels among patients and caregivers in rural areas of the Thai-Cambodian border influence the risk of early peritonitis in incident PD patients.
Methods: This 10-year retrospective cohort study evaluated patients with end-stage kidney disease (ESKD) undergoing PD at a clinic in Sa Kaeo Province, Thailand, along the Thai-Cambodian Border, between January 2016 and January 2026.
Results: Among 81 participants (mean age: 55.9 ± 10.9 years), diabetic kidney disease was the leading cause of ESKD (66.7%). Patients and their caregivers received education and training on PD from a multidisciplinary team before being permitted to begin PD at home. Caregivers assisted with PD for 45.7% of patients. Regarding educational attainment, 42.0% of patients and 35.5% of caregivers completed grades 1–4, while 21.0% of patients and 4% of caregivers had no formal education. There were 10 peritonitis events and 3 deaths. Univariable and multivariable analyses revealed no significant association between patient or caregiver educational levels and the incidence of PD-associated peritonitis in the first 6 months.
Conclusion: Within this rural border network, the education levels of patients and caregivers showed no correlation with the risk of peritonitis during the first 6 months after initiating PD.

Malnutrition-Inflammation Score and Mortality Risk in Peritoneal Dialysis Patients

2026-08-30T23:14:35+07:00

Background: Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is linked to increased morbidity and mortality. This study evaluated the association between the malnutrition-inflammation score (MIS) and mortality in PD patients.
Methods: This single-center, retrospective cohort study included 269 PD patients between January 2010 and December 2022. Patients were categorized by MIS levels: mild (Group A), moderate (Group B), and severe (Group C). Groups B and C received targeted nutritional interventions as part of routine care. Patients were followed until death, therapy transition, transplantation, or February 2025.
Results: Group B demonstrated the lowest mortality rate (17.8 per 100 person-years) and a significant survival advantage in Kaplan-Meier survival estimates and multivariable Cox regression after adjustment for confounders. Following interventions, 64% of Group B showed improvement in the MIS category, whereas 65% of Group C remained unchanged. Conversely, 60% of Group A (which received no intervention) experienced a worsening of the MIS category. Older age and diabetes were independent predictors of higher mortality.
Conclusion: Patients with moderate MIS achieved better survival than those with mild or severe MIS, likely driven by targeted interventions. The dynamic shifts across MIS categories underscore the critical need for regular, routine nutritional and inflammatory assessments followed by appropriate interventions.

Ketamine-Induced Uropathy: A Case Report and Literature Review

2026-08-30T23:14:33+07:00

Ketamine-induced uropathy caused by long-term use of ketamine leads to lower urinary tract symptoms, hydronephrosis, and recurrent urinary tract infection. The principles of treatment involve cessation of ketamine abuse, symptomatic treatments including pain control, and surgical intervention in severe cases. We report the case of a 42-year-old previously healthy male who presented with altered consciousness for 2 hours. He had frequently abused ketamine for recreational purposes over a period of two years. His laboratory results revealed acute kidney injury, uremia, metabolic acidosis, and hyperkalemia. Computed tomography revealed bilateral moderate hydronephrosis and hydroureter without any identifiable cause of obstruction, along with diffused bladder wall thickening and reduced bladder capacity, findings compatible with ketamine-induced uropathy. Continuous kidney replacement therapy was performed until his serum creatinine and electrolyte levels were normalized. He was strongly advised to discontinue ketamine use. In addition, symptomatic treatment, mainly pain controllers, was provided.

Hyponatremia Due to Cerebral Salt Wasting in Central Nervous System Disorders

2026-08-30T23:14:44+07:00

Hyponatremia is a common electrolyte imbalance observed in patients with central nervous system disorders. The majority of cases result from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW). Distinguishing between CSW and SIADH is crucial due to their distinct treatment strategies. CSW is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine due to brain injury, which leads to the release of brain natriuretic peptide along with decreased sympathetic nervous system activity. This results in hypovolemia, which in turn stimulates ADH. Clinical and laboratory findings indicating dehydration, such as hypotension, decreased skin turgor, and hemoconcentration, help differentiate CSW from SIADH, where extracellular fluid volume is slightly increased or normal. The treatment of CSW involves administering adequate fluids and sodium to restore normal intravascular volume, along with fludrocortisone to prevent further fluid loss. Appropriate and effective management of CSW is essential for restoring fluid and electrolyte balance and reducing the risk of complications. This article reviews the current mechanisms, diagnosis, and treatment of CSW.

Donor-Derived Infection in Kidney Transplant Recipients

2026-08-30T23:14:32+07:00

Donor-derived infections in kidney transplant recipients are a rare complication following kidney transplantation. However, when it occurs, it can slow down recovery, increase the duration of treatment, raise medical costs, decrease the patient’s quality of life, and may even be severe enough to lead to death. Diagnosing infections in donor kidney transplant recipients requires cooperation among multiple agencies, including the agency that treated the donor before death, the organ transplant center, and the receiving transplant unit. The diagnosis involves taking a medical history, conducting physical exams, and performing laboratory tests to detect transmissible infections post-transplant, such as human immunodeficiency virus, Hepatitis B virus, and Hepatitis C virus. This ensures that the donated organs will cause the least harm to the transplant recipient and contribute to better post-transplant outcomes.

Intradialytic Parenteral Nutrition

2026-08-30T23:14:53+07:00

Patients with end-stage kidney disease undergoing hemodialysis are at an increased risk of morbidity and mortality, which is closely associated with altered nutritional status and the development of protein-energy wasting. Although nutritional counseling and oral nutritional supplements are primary interventions, they may not always be sufficient to improve nutritional status. As a result, intradialytic parenteral nutrition (IDPN) has emerged as a promising alternative to support nutritional needs. Although studies indicate that IDPN can improve nutritional parameters—such as serum protein levels, body weight, and overall quality of life—robust evidence on clinical outcomes, such as hospitalization or mortality, remains limited. This article aims to review the literature on IDPN, including indications for use, outcomes, IDPN composition, and assessment of clinical response, to enhance utilization and develop effective clinical recommendations to optimize nutritional support for hemodialysis patients.

Obesity and the Kidneys: From Molecular Mechanisms to Modern Treatments

2026-08-30T23:14:51+07:00

The rising global prevalence of obesity poses a significant public health challenge, strongly linked to cardiovascular disease, kidney disease, and diabetes, collectively termed Cardiovascular-Kidney-Metabolic Syndrome (CKM). Obesity contributes to progressive kidney damage, potentially leading to end-stage kidney disease, through mechanisms such as obesity-related glomerulopathy, altered renal hemodynamics, adipokine dysregulation, lipotoxicity, and chronic inflammation. Bariatric surgery, while highly effective for weight reduction and renoprotection, involves substantial risks due to its invasive nature. This has spurred the development of anti-obesity medications and novel drugs targeting glucagon-like peptide-1 receptors, offering safer, more effective options. Despite limited guidelines and data on the renal benefits of these therapies for patients with chronic kidney disease, further research is crucial.