Journal of the Nephrology Society of Thailand

The Professor Emeritus Sa-nga Nilvarangkun, MD, Endowed Lectureship: Current Situation of Chronic Kidney Disease in Thailand.

Prasert Thanakitcharu — 2025-12-01

The alarming increase in the number of chronic kidney disease (CKD) patients in Thailand, particularly in the Northeast, is likely to lead to significant public health and future economic problems for both the patients and Thailand. This is due to the burden of high treatment costs, especially once patients require renal replacement therapy, either hemodialysis or peritoneal dialysis. Regarding the prevalence of chronic kidney disease of unknown etiology (CKDu) in Thailand, further research is still needed to confirm its exact causes, including the effects of various factors like heat stress, exposure to agricultural chemicals, and water source contamination. Awareness of the risk and presence of CKD among the Thai population remains low, resulting in most patients being diagnosed when they are already in an advanced stage of the disease. The Thai SEEK study found that only 1.9% of the population were aware that they had kidney disease. Therefore, early detection of CKD patients and appropriate treatment to slow down the deterioration of kidney function are crucial for those with CKD. Meanwhile, patients with end-stage renal disease should receive optimal treatment to minimize morbidity and mortality rates. It is expected that if the prevention and slowing of the progression of chronic kidney disease can
be effectively achieved, the prevalence of renal replacement therapy should gradually decrease in the future.

Professor Emeritus Visith Sitprija, MD, Ph.D. Endowed Lectureship: Kidney Diseases Across a Lifespan

Prapaipim Thirakhupt — 2025-12-01

Professor, Major General, Dr. Prapaipim Thirakhupt is a Senior Advisor in the Pediatric Nephrology Division at Phramongkutklao Hospital and Phramongkutklao College of Medicine. She earned her medical degree from Mahidol University, completed her pediatric residency training at Phramongkutklao Hospital, and pursued pediatric nephrology training at Children’s Hospital, Free University of Berlin, and the Pediatric Nephrology Department, Heidelberg University Hospital, Germany. She has over 30 years of experience in caring for children with kidney disease. She previously served as the Director of Academic Affairs at Phramongkutklao College of Medicine, Royal Thai Army; President of the Pediatric Nephrology Association of Thailand; and Council member of the Asian Pediatric Nephrology Association. Currently, she serves as a Council member of the Nephrology Society of Thailand, a Council member of the Royal College of Pediatricians of Thailand, and an Assessor for medical schools and pediatric nephrology training accreditation. Her professional interests include both pediatric nephrology and medical education.

Chimeric Antigen Receptor T-cells in Kidney Disease

Jirapath Tangkitchot — 2025-12-01

Chimeric antigen receptor (CAR) T-cells are T-lymphocytes genetically modified to recognize and kill specific antigens on cells, especially cancer cells. This emerging form of immunotherapy is gaining increasing significance in modern medicine. Initially developed to treat hematologic malignancies, CAR T-cell technology has evolved to target a broader range of cancers, including non-hematologic malignancies, as well as kidney-related diseases such as lupus nephritis, HIV-related kidney disease, and renal cell carcinoma. Research on CAR T-cell therapy for these conditions is growing, with more studies involving human subjects. However, as a relatively new therapeutic approach, most available data currently comes from case reports or series. Despite promising outcomes, CAR T-cell therapy can lead to severe complications, underscoring the need for large-scale studies and randomized controlled trials to establish sufficient evidence for its use in patient care.

Erythropoietin Hyporesponsiveness

Chalermchon Suttaluang — 2025-12-01

Erythropoietin hyporesponsiveness is a condition observed in patients with chronic kidney disease (CKD), who do not achieve target hemoglobin levels despite a significant increase in erythropoietin-stimulating agent doses or continue to require high doses to maintain the target. This condition is associated with an increased risk of CKD progression, end-stage renal disease, cardiovascular complications, and mortality. The causes of erythropoietin hyporesponsiveness include iron deficiency, infections/inflammation, hyperparathyroidism, blood loss, inadequate dialysis, and others. Treatment is tailored to the specific causes, including iron supplementation, management of mineral and bone disorders, treatment of infections or inflammation, and the use of hypoxia-inducible factor stabilizers. This article provides an overview of pathophysiology and appropriate treatment strategies to improve the quality of care for affected patients.

Efficacy of Magnesium Supplementation in the Prevention of Acute Kidney Injury

Supawiwatch Rodjanasingha — 2025-12-01

Acute kidney injury (AKI) is associated with high mortality and progression to chronic kidney disease, and increasing evidence indicates that hypomagnesemia may contribute to the risk of AKI while magnesium supplementation may provide nephroprotective effects. This review summarizes experimental and clinical data demonstrating that magnesium confers renal protection through multiple mechanisms, including improved renal blood flow, attenuation of oxidative stress and apoptosis, suppression of inflammation, and preservation of mitochondrial function. Clinical evidence suggests that magnesium supplementation reduces the incidence of AKI in patients undergoing cardiac surgery, contrast exposure, cisplatin or colistin therapy, and critically ill populations, and is also associated with lower mortality and decreased need for renal replacement therapy. Magnesium supplementation thus represents a safe, cost-effective, and promising strategy for preventing AKI, although large-scale randomized controlled trials are still warranted to confirm its long-term efficacy and safety.

Clinical Prediction Model for Hypokalemia in Hospitalized Patients with Acute Decompensated Heart Failure Treated with Intravenous Furosemide

Yutthana Rakphaka — 2025-12-01

Background: Hospitalized patients with acute heart failure often receive furosemide, which may lead to hypokalemia. Factors such as diuretic dose and concomitant use of multiple diuretics are associated with this risk. This study aimed to develop a clinical prediction model for hypokalemia to help prevent its occurrence and related complications.
Methods: This is a retrospective clinical study of hospitalized patients with acute decompensated heart failure (ADHF). Using multivariable logistic regression, we derived a prediction score by assigning weights to the predictor coefficients. The score was then internally validated to assess its reliability.
Results: Among 510 hospitalized patients with ADHF receiving furosemide, 143 (28%) developed hypokalemia. Furosemide doses >1.5 mg/kg/day were strongly associated with hypokalemia (adjusted OR 4.81, 95% CI 2.56–9.04, p <0.001). Five predictors were identified: baseline serum potassium <4 mmol/L, serum albumin >3.5 g/dL, low serum magnesium, furosemide dose >1.5 mg/kg, and no prior spironolactone use. Higher scores were associated with an increased risk of hypokalemia.
Conclusions: The clinical prediction model provides a practical tool for estimating the risk of hypokalemia. ADHF
patients identified as high risk may benefit from preventive strategies and closer monitoring of potassium levels.

Soluble Vascular Cell Adhesion Molecule as a Predictor of Arteriovenous Fistula Maturation: A Pilot Study

Pacharapon Sinchairojkul — 2025-12-01

Background: Predicting arteriovenous fistula (AVF) maturation in patients with end-stage kidney disease remains challenging. Soluble vascular cell adhesion molecule (sVCAM) is involved in vascular remodeling, but its predictive value is not well established. This study evaluated whether sVCAM levels can predict AVF maturation 8 weeks after creation.
Methods: In this prospective pilot diagnostic study, 19 patients undergoing AVF creation were enrolled. sVCAM levels were measured preoperatively and 4 weeks postoperatively. AVF maturation was assessed at 8 weeks using ultrasonographic criteria.
Results: Twelve patients (63%) achieved AVF maturation. Those with mature AVFs had significantly higher baseline sVCAM levels than those without maturation (1505.9±383.1 vs. 1029.9±378.3 ng/mL, p = 0.018). The percentage change in sVCAM levels also differed significantly between groups (mature: –6.6±35.8% vs. non-mature: +19.4±10.8%, p = 0.035). A baseline sVCAM threshold of ≥985.9 ng/mL yielded 100% sensitivity and 71.4% specificity for predicting AVF maturation (AUC = 0.845, 95% CI: 0.632–1.000). Combining sVCAM levels with clinical parameters, including age <73 years and BMI <30 kg/m², further improved predictive accuracy, achieving the highest AUC of 0.935 (95% CI: 0.804–1.000).
Conclusions: Preoperative sVCAM level is a promising biomarker for predicting successful AVF maturation. Incorporating clinical parameters alongside sVCAM further enhances predictive performance.