Journal of the Nephrology Society of Thailand

Chronic Active Antibody-Mediated Rejection and Kidney Allograft Survival: A 14-Year Single-Center Retrospective Analysis

Piyavadee Homkrailas — 2024-08-26

Background: Chronic active antibody-mediated rejection (ABMR) is a significant cause of graft loss in kidney transplants. The current treatment strategies have not been very effective. The present study examined kidney allograft survival after diagnosis and treatment of chronic active ABMR and explored factors associated with allograft survival.
Methods: 144 kidney transplants were identified from 2007 to 2021. Thirty patients had ABMR, and 15 cases in 12 patients were classified as having chronic active ABMR according to the 2017 Banff classification.
Results: The average time from transplantation to the diagnosis of chronic active ABMR was six years. The median graft survival after the diagnosis was 2.6 years. Fifty-eight percent of the patients lost their grafts. The average serum creatinine and urine protein/creatinine ratio at the time of diagnosis of chronic active ABMR were 2.6 mg/dL and 1.5 g/g, respectively. Higher serum creatinine was the only factor significantly associated with graft failure. The association between heavier proteinuria and graft loss was also noted, but the difference did not reach statistical significance.
Conclusion: Chronic active ABMR was associated with poor graft survival. Decreased allograft function at diagnosis was significantly associated with graft failure.

Comparison of Amino Acid Loss Between Constant Amino Acid Plus Dextrose Infusion and Sequential Dextrose Followed by Amino Acid Infusion During Hemodialysis: A Randomized Crossover Trial

Sarinpa Uparimat — 2024-08-26

Background: Increasing amino acid loss has been observed in patients receiving intradialytic parenteral nutrition (IDPN). There are two standard protocols for lipid-free formula-IDPN infusion: constant amino acid plus dextrose infusion and sequential dextrose followed by amino acid infusion. However, the difference in amino acid loss between the two infusion protocols has never been explored.
Methods: The present study is a randomized crossover trial performed on ten malnourished chronic hemodialysis patients. They were randomized to receive a constant or sequential infusion protocol. The crossover was performed one week later. Plasma and dialysate amino acid concentrations were determined before and after the hemodialysis session. The changes in blood pressure and capillary glucose concentrations during hemodialysis were also recorded.
Results: The average declines in plasma essential, non-essential, and total amino acid concentrations were comparable between the two infusion protocols. Substantially higher non-essential and total amino acid concentrations were observed in the dialysate from the constant infusion group. In the sequential infusion group, the average capillary glucose level was higher at the 2nd hour and lower at the 4th hour of hemodialysis, and two patients had hypotension.
Conclusion: Constant infusion of amino acid plus dextrose solution during hemodialysis resulted in a more significant loss of amino acids into dialysate than the sequential infusion of dextrose followed by amino acids.

Artificial Intelligence in Nephrology: Advancements, Opportunities, and Concerns in Hemodialysis

Nataphut Boonvisuth — 2024-08-26

Artificial Intelligence (AI) is a rapidly evolving field that is making inroads into various industries, including medicine. The advancements in AI technology have demonstrated their potential to improve diagnostic accuracy, treatment outcomes, and overall patient well-being, making it a valuable tool for healthcare professionals and institutes. This article provides an overview of the history and terminology of AI, including machine learning and deep learning. It also examines the benefits and limitations of AI in medicine, with a specific focus on its application in the field of nephrology. In this area, AI has demonstrated its potential to enhance patient care via clinical decision support systems, particularly in hemodialysis. The article highlights how AI is being used in various aspects of hemodialysis, including anemia management, dialysis adequacy and service planning, arteriovenous access assessment, dry weight prediction, intradialytic adverse event detection, mineral and bone disorder management, mortality and cardiovascular disease prediction, and cognitive function assessment. The goal is to provide readers with a preliminary understanding of AI and its potential to transform the practice of nephrology in the future.

Chinese Herbal Medicine Induced Nephrotoxicity

Nattawadee Mokkongphai — 2024-08-26

For centuries, Chinese herbal medicine has been used for various purposes, including treating several diseases, aiding in weight reduction, and as food ingredients. The enduring belief is that natural products are safer than modern drugs containing synthetic chemicals. Alternative medicine remains widespread in Thailand today. However, herbs containing compounds like aristolochic acid, other plant alkaloids, and additives from manufacturing processes can cause renal failure. Due to the underreporting of adverse effects, Chinese herbal medicine is often used without caution and with little awareness of potential risks. Renal failure from these herbs can result from mechanisms such as Smad signaling, p53-mediated signaling, and the action of organic anion transporters, leading to apoptosis, fibrosis, and tubular atrophy in the kidneys. Several studies have found that using steroids to treat patients with renal failure caused by Chinese herbal medicines can help slow the progression of kidney failure and reduce the need for renal replacement therapy.

Preemptive Kidney Transplantation

Thitiyaporn Boonrubjirarojana — 2024-08-26

Currently, kidney transplantation (KT) is considered the best mode of renal replacement therapy (RRT) because it offers a better quality of life and overall survival compared to other options. Clinical practice guidelines typically recommend preemptive KT before the patient starts dialysis due to its superior clinical outcomes. These outcomes include better graft and patient survival, a lower acute rejection rate, and cost-effectiveness compared to KT after dialysis. However, several barriers hinder the widespread adoption of preemptive KT, such as limited donor availability, the readiness of recipients, and reimbursement issues. Given the increasing number of patients with end-stage kidney disease requiring RRT globally, including in Thailand, preemptive KT should be considered the first and preferred choice of RRT for these patients. This review focuses on the advantages and barriers of preemptive KT, the appropriate time to begin the preparation process, and potential solutions to increase the number of preemptive KTs in Thailand.

Renovascular Hypertension

Panhathai Kasempim — 2024-08-26

Currently, the evaluation of treatment for hypertension due to abnormal renal artery conditions involves a multidisciplinary medical team, including nephrologists, cardiologists, radiologists, and vascular surgeons. This is because patients with hypertension caused by abnormal renal arteries often exhibit a variety of symptoms, which can lead to cardiovascular complications, resulting in increased morbidity and potentially higher mortality rates. From the past to the present, there have been randomized controlled trials comparing the treatment of hypertension due to abnormal renal arteries using medication versus angioplasty with stent placement. The results of these studies remain inconclusive due to significant limitations in each study. This review aims to compile information on the pathology, clinical symptoms, diagnostic criteria, and current treatment guidelines to provide physicians and researchers with a comprehensive understanding, enabling them to further study the topic or apply this knowledge in patient care.