Journal of the Nephrology Society of Thailand

2024 Annual Report of the Thailand Renal Replacement Therapy (TRT) Registry – Executive Summary

Bancha Satirapoj — 2026-05-31

The 2024 Thailand Renal Replacement Therapy (TRT) Registry Annual Report examines national trends in incidence, prevalence, practice patterns, and outcomes to inform health policy and system planning. In 2024, the incidence of renal replacement therapy (RRT) reached a historic high of 515 per million population (33,976 new cases), largely reflecting the expansion of hemodialysis (HD) following the implementation of the 2022 “free-choice” dialysis policy. Peritoneal dialysis (PD) initiation declined markedly, while kidney transplantation remained limited. RRT prevalence more than doubled from 2016 to 2024, exceeding 2,600 per million population, with HD accounting for most of the increase. Diabetes (32.7%) and hypertension (32.2%) were the leading causes of end-stage kidney disease. The dialysis population was predominantly older (mean age 62.6 years) and had relatively low educational attainment. Important care gaps were identified, including high catheter use at HD initiation, frequent twice-weekly dialysis, suboptimal anemia control, prevalent mineral and bone disorders, and insufficient preventive care. Between 2017 and 2024, cumulative mortality reached 39.2% (9.5 deaths per 100 patient-years), with higher mortality in PD than HD patients. Cardiovascular disease and infections were the leading causes of death. One-year survival was 95.4%, declining to 61.9% over five years. Despite expanded RRT access under universal coverage, improving long-term outcomes and system sustainability will require strengthened chronic kidney disease prevention, optimized dialysis quality, equitable financing, expanded transplantation, and continued investment in high-quality registry data.

Advances in Urinary Sediment Analysis

Win Kulvichit — 2026-05-31

Urine sediment examination is a fundamental diagnostic tool that provides immediate and clinically relevant information about underlying kidney disease. Microscopic analysis of urine sediment by trained specialists helps differentiate among various renal conditions, particularly distinguishing prerenal acute kidney injury from acute tubular necrosis. It also plays a key role in evaluating glomerular syndromes and crystalline nephropathy. By assessing cellular morphology and identifying casts and crystals, urine sediment analysis offers critical insights into the nature of renal injury and disease pathogenesis. Recent advances in automated urine analysis, including digital microscopy and flow cytometry, have enhanced efficiency and accuracy. These technologies enable rapid quantification of urinary elements, reduce interobserver variability, and integrate seamlessly with laboratory information systems to improve workflow. Despite these innovations, physician-performed urine sediment examination remains an indispensable tool in nephrology. Its contribution to improving diagnostic accuracy in acute kidney injury highlights the importance of maintaining proficiency in this technique among clinicians managing kidney disease.

Kidney Xenotransplantation

Kornrawee Sawasdichai — 2026-05-31

Kidney transplantation is the best treatment for patients with end-stage kidney disease. However, there are still many patients today who have not received a kidney transplant and are still on the waiting lists. The gap between the demand for kidney transplants and the limited availability of human organs has led to prolonged waiting times, higher mortality rates, and a significant burden on healthcare systems worldwide. Kidney xenotransplantation, the transplantation of kidneys from non-human species, most commonly pigs, into humans, has emerged as a potential solution to the global shortage of donor organs for patients with end-stage kidney disease. Despite promising advances in genetic engineering, immunosuppressive therapies, and xenotransplantation protocols, the clinical application of kidney xenotransplants remains challenging. These include immune rejection, potential zoonotic infections, and long-term organ viability. This review explores the current state of kidney xenotransplantation, focusing on recent breakthroughs in gene editing technologies such as CRISPR-Cas9, which enable the creation of genetically modified pigs with organs more compatible with human recipients. We also discuss the immunological hurdles and strategies to modulate the human immune response. We also explore the efforts to eliminate the transmission of porcine viruses.

Diagnostic Performance of Breast Arterial Calcification for Detecting Coronary Artery Calcification in Women with Chronic Kidney Disease

Pattranid Mueangpaisarn — 2026-05-31

Background: Arterial calcification is common in patients with chronic kidney disease (CKD) and contributes substantially to cardiovascular morbidity and mortality. Breast arterial calcification (BAC), which occurs exclusively in arterial media, may serve as a surrogate marker of coronary artery calcification (CAC) in CKD.
Methods: This cross-sectional study included 103 women aged >40 years who underwent digital mammography, lateral lumbar spine x-ray for abdominal aortic calcification (AAC), and non-contrast CT for coronary artery calcification (CAC). The BAC score was calculated based on the number of calcified breast arteries, the maximum length of calcification, and calcification density.
Results: BAC severity increases with advancing CKD stage. In multivariable analysis, adjusting for traditional cardiovascular risk factors, BAC was independently associated with reduced kidney function and older age. In patients with advanced CKD, BAC demonstrated high sensitivity (85.7%) and moderate accuracy (67.6%) for detecting CAC. Both BAC and AAC scores were significantly associated with CAC, with area under the curve (AUC) values of 0.67 and 0.84, respectively. The combined BAC and AAC model showed improved predictive performance for CAC (AUC 0.88).
Conclusions: Combined BAC and AAC provide good predictive performance for CAC, supporting the potential role of BAC as a noninvasive surrogate marker of vascular calcification burden in female patients with CKD.

Mangosteen-Derived Mangostin as a Topical Prophylaxis Against Catheter-Related Infections: A Multicenter, Double-Blind Randomized Placebo-Controlled Trial

Sutthikarn Ruammek — 2026-05-31

Background: Non-tunneled hemodialysis (HD) catheters (NTHCs) are associated with high rates of systemic and localized infections. Mangostin, a xanthone derived from mangosteen, exhibits antimicrobial and anti-inflammatory properties; however, its clinical efficacy in preventing exit site infection (ESI) and catheter-related bloodstream infection (CRBSI) has not been established. The present study evaluated the efficacy of topical mangostin ointment in preventing systemic and local infection.
Methods: This multicenter, double-blind, randomized, placebo-controlled trial enrolled 66 acute and chronic HD patients from 3 hospitals. Participants were randomized to receive topical mangosteen-derived mangostin ointment (mangostin group) or a placebo, applied at the catheter exit site immediately following insertion, and were monitored until catheter removal.
Results: The composite incidence of ESI and CRBSI was significantly lower in the mangostin group than in the placebo group (P=0.025), corresponding to a 78% risk reduction. Furthermore, a higher proportion of patients in the mangostin group had mild inflammation (exit-site inflammation score ≤2) (p=0.008).
Conclusion: Topical mangostin significantly reduces the combined incidence of local and systemic infection and inflammation in patients with NTHC. Further studies are needed to explore its efficacy in patients with a tunneled HD catheter or a peritoneal dialysis catheter.

Effect of High‑Dose Oral Vitamin C on 24‑Hour Urinary Oxalate Excretion: A Systematic Review and Meta‑analysis of Intervention Trials

Nutthavuth Arjinpathana — 2026-05-31

Background: High-dose oral vitamin C (≥ 1,000 mg/day) is widely consumed, yet its impact on 24-hour urinary oxalate—a primary driver of calcium oxalate supersaturation—remains a critical clinical concern, particularly for patients with nephrolithiasis. This study evaluated the effect of high-dose vitamin C on changes in 24-hour urinary oxalate concentration, with specific subgroup analyses comparing stone formers (SF) to non-stone formers (NSF).
Methods: We conducted a systematic review and random-effects meta-analysis of human intervention trials published between January 2000 and December 2025. Eligible studies included adults receiving oral vitamin C (≥1,000 mg/day) for >2 days, with documented 24-hour urinary oxalate measurements.
Results: Three short-term trials (n=141$; SF=59, NSF=82) were included. In the primary analysis (r=0.50), high-dose vitamin C significantly increased 24-hour urinary oxalate concentration by a pooled mean difference (MD) of 9.57 mg/day (95% CI: 0.56 to 18.57; I2=96.4 %). Subgroup analysis revealed a significantly larger increase in SF (MD 15.86 mg/day; 95% CI: 5.01 to 26.70) compared to NSF (MD 6.76 mg/day; 95% CI: 0.28 to 13.24; p < 0.001). While the magnitude of statistical significance for the overall and NSF effects was sensitive to the correlation coefficient, the direction of the effect remained consistently positive.
Conclusion: High-dose oral vitamin C is associated with increased 24-hour urinary oxalate excretion, with a more pronounced effect observed in the SF group. Given the high heterogeneity and the sensitivity of the results, supplementation in high-risk individuals should be managed with caution.

Kidney Health for All: Caring for People, Protecting the Planet

Raymond Vanholder — 2026-05-31

The current kidney care model - focused on late-stage disease and in-center hemodialysis - is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet”, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, the environment, and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders: educating and engaging the public, policymakers, and health professionals to raise awareness of the threat of kidney disease, and an urgent move toward patient-centered care.

Clinical Outcomes of Methanol Intoxication Outbreak Managed with Hemodialysis at Nopparat Rajathanee Hospital: Case Series and Literature Review

Yatip Mukdaloy — 2026-05-31

Following a mass methanol poisoning outbreak from illicit liquor in Bangkok in August 2024, hemodialysis became the primary life-saving treatment due to the unavailability of fomepizole in Thailand. This case series describes the baseline characteristics, biochemical parameters, treatment modalities, and clinical outcomes of patients with methanol poisoning treated with hemodialysis at a quaternary care hospital under the Ministry of Public Health in Bangkok, Thailand. Between August 22 and September 3, 2024, a total of 17 confirmed cases of methanol intoxication were identified. Most patients (94.1%) were male. The most common presenting symptoms were dyspnea (94.1%) and blurred vision (70.6%). Laboratory findings demonstrated severe metabolic acidosis, with a median pH of 7.08, serum bicarbonate of 4.0 mEq/L, and an anion gap of 35.0 mEq/L. All patients (100%) underwent intermittent hemodialysis, while 35.3% required additional continuous renal replacement therapy. The median door-to-dialysis time was 6 hours. The survival rate was 76.5% (13 cases), and the mortality rate was 23.5% (4 cases). Permanent disability occurred in 29.4% (5 cases), including permanent visual impairment (17.6%) and neurological deficits (11.7%). Early initiation of hemodialysis, combined with effective resource management during a mass casualty event, was a critical factor in achieving clinical outcomes comparable to international benchmarks
despite limited access to antidotes.