Journal of the Nephrology Society of Thailand

Home Hemodialysis

Thanawan Wuthapanich — 2026-02-27

Home hemodialysis (HHD) is a patient-centered alternative to in-center hemodialysis for individuals with end-stage kidney disease (ESKD). This literature review examines the evidence and practical steps for implementing HHD. Research suggests that HHD may offer advantages over traditional in-center hemodialysis, including improved clinical outcomes, such as better blood pressure control and enhanced quality of life. The successful implementation of HHD requires careful patient selection, thorough training, and a suitable home setup. Technological advancements have increased HHD accessibility, enabling patients to manage their treatment better. However, wider adoption faces barriers, including high costs and training needs. This review highlights the potential of HHD to improve care for patients with kidney failure and discusses its role as a valuable treatment option within a comprehensive approach to ESKD management.

Sodium-Glucose Cotransporter-2 Inhibitors in Critically Ill Patients and Acute Kidney Injury: Clinical Considerations

Narongrit Siriwattanasit — 2026-02-27

Acute kidney injury (AKI) is a severe complication, affecting up to 50% of critically ill patients. The advent of sodium-glucose cotransporter-2 (SGLT2) inhibitors has challenged traditional paradigms of renoprotection. Their mechanisms include restoration of tubuloglomerular feedback, metabolic reprogramming toward ketone utilization, anti-inflammatory actions, and modulation of the sympathetic nervous system. Emerging evidence suggests a complex risk–benefit profile for SGLT2 inhibitors in critical illness. Observational studies consistently show associations with reduced ICU admissions, lower infection rates, and improved survival. However, interventional studies indicate nuanced effects, including potential increases in vasopressor requirements in septic patients. The ongoing PREVENTS-AKI trial, specifically designed for ICU patients, will provide definitive evidence to guide clinical practice. The use of SGLT2 inhibitors in this vulnerable population requires careful consideration of unique safety concerns, including euglycemic diabetic ketoacidosis, increased vasopressor requirements, electrolyte disturbances, volume depletion, and genitourinary infections. Implementation should follow structured protocols with a thorough baseline assessment, daily monitoring, and clear discontinuation criteria. Until more robust evidence emerges, SGLT2 inhibitors represent a promising but cautiously applied option for AKI prevention in selected critically ill patients.

Fluid Assessment by Venous Excess Ultrasound

Thanphisit Trakarnvanich — 2026-02-27

Critically ill patients often experience fluid overload, which is associated with an increased risk of complications and mortality. One key pathophysiological aspect of fluid overload is fluid accumulation in the venous system and/or impaired cardiac function, affecting both systolic and diastolic phases (systolic and diastolic dysfunction). This results in reduced perfusion to vital organs, making the rapid and timely diagnosis and treatment of fluid overload crucial for\ minimizing complications and reducing patient mortality. Traditional physical examination methods may be prone to errors. Currently, a panel of ultrasound techniques known as ‘Point of Care Ultrasound’ (POCUS) refers to the use of ultrasound for specific purposes to guide treatment decisions. POCUS can be performed on multiple organs, a practice referred to as multi-organ POCUS, which includes the assessment of the heart, lungs, and veins. Venous Excess Ultrasound (VExUS), a component of POCUS, is a novel Doppler technique used to assess fluid overload in the venous system. However, VExUS should not be used to predict responsiveness to fluid management. This examination primarily focuses on the inferior vena cava, followed by the hepatic, portal, and renal veins.

Prevalence of Chronic Kidney Disease in Lafia, North Central Nigeria

Aminat Suleman-Alabi — 2026-02-27

Background: Chronic kidney disease (CKD) is a growing global public health problem associated with increased morbidity, mortality, and health-care costs. The burden of CKD is disproportionately higher in low- and middleincome countries, where access to early detection and renal care is often limited. In Nigeria, population-based data on CKD prevalence remain scarce, particularly in North Central regions such as Lafia. This study aimed to determine the prevalence of CKD and describe selected demographic and health-care access characteristics among adults in Lafia, Nigeria.
Methods: This cross-sectional study enrolled 190 participants aged 18 years and above. Serum creatinine was measured using Jaffe’s method, and estimated glomerular filtration rate (eGFR) was calculated using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as an eGFR <60 mL/min/1.73 m².
Results: The overall prevalence of CKD in the study population was 13.7%. Participants with CKD had a mean age of 39.4+3.1 years. The prevalence of CKD was higher in females compared with males. Only 61.6% of participants reported having access to a health-care facility.
Conclusions: This study demonstrates a relatively high prevalence of CKD (13.7%) among adults in Lafia, North Central Nigeria, with a notable burden observed in younger individuals. Limited access to health-care services may further exacerbate underdiagnosis and late presentation. These findings highlight the urgent need for community-based screening programs and improved access to healthcare services.

Risk Factors and Outcome of Decreased Bone Mineral Density in Chronic Kidney Disease Stages 5-5D Patients

Kritsada Adunyatam — 2026-02-27

Background: Mineral and bone disorders in chronic kidney disease (CKD) involve disturbances in mineral metabolism and hormonal regulation that lead to bone loss, fractures, and increased mortality. While bone mineral density (BMD) testing does not directly assess bone turnover, the 2017 KDIGO guidelines recommend BMD testing in CKD stages G3a–G5D for those at risk of osteoporosis, given the growing evidence linking low BMD to adverse outcomes. However, data in advanced CKD remains limited.
Methods: This retrospective study evaluated BMD in 189 patients with CKD stages 5-5D who underwent total hip, femoral neck, or lumbar spine BMD testing between 2011 and 2022, with an average follow-up of 51.2 months.
Results: Multivariate analyses revealed that the presence of a lower T-score or osteoporosis at any skeletal site, as well as at each site separately, was associated with traditional risk factors, including older age, lower body mass index, and female sex. Biochemical markers, such as reduced serum calcium, elevated alkaline phosphatase, decreased total lymphocyte and platelet counts, as well as elevated mean corpuscular volume, were associated with reduced BMD. Patients with CKD stage 5D experienced greater BMD decline than those in stage 5. Osteoporosis at all skeletal sites predicted all-cause mortality.
Conclusion: Reduced BMD and osteoporosis in advanced CKD were linked to traditional risk factors, disordered mineral metabolism, systemic inflammation, and nutritional deficiencies, and were predictors of mortality.

Clinical Application of Bioelectrical Impedance Analysis for Fluid Assessment in Hemodialysis Patients

Nichanone Kanjanasuphak — 2026-02-27

Background: Fluid overload is common in maintenance hemodialysis (MHD) patients and is associated with adverse cardiovascular events and mortality. Conventional clinical methods for fluid assessment have limited accuracy. This study evaluated the effectiveness of bioelectrical impedance analysis (BIA) for the fluid evaluation in MHD patients.
Methods: A prospective interventional study was conducted in 34 clinically stable MHD patients at Ranong Hospital from June to August 2025. Fluid status was assessed monthly using BIA, combined with standard of care, and dry body weight was adjusted accordingly. The outcomes were the change in fluid status, expressed as target average fluid overload (TAFO), dialysis-related complications, and blood pressure control before and after BIA-guided management.
Results: At baseline, 67.6% of patients were fluid overloaded, 20.6% were normovolemic, and 11.8% were dehydrated. In the overloaded group, mean TAFO significantly decreased from 3.4 ± 2.8 L to 2.1 ± 2.8 L at 3 months (p = 0.001). Dehydrated patients shifted toward normovolemia, while normovolemic patients remained stable. Dialysis-related complications, including intradialytic hypotension and hypertension, symptoms of cramps and fatigue, improved significantly in the overload group. The mean number of antihypertensive drug classes was also substantially reduced.
Conclusions: BIA-guided fluid management improved fluid control in MHD patients, resulting in reduced dialysis-related complications and fewer anti-hypertensive drug classes. These findings support integrating BIA into standard clinical practice for individualized volume management, particularly in patients with fluid overload.

Effect of Preoperative Calcitriol Administration on Postoperative Hypocalcemia in Dialysis Patients Undergoing Parathyroidectomy: A Randomized Controlled Trial

Teerapon Muangpaisan — 2026-02-27

Background: Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease receiving dialysis, and parathyroidectomy is often required when medical treatment fails. Postoperative hypocalcemia is a frequent and serious complication that contributes to morbidity and prolonged hospitalization. This study aimed to determine whether preoperative administration of calcitriol reduces the severity of postoperative hypocalcemia and the need for parenteral calcium supplementation in dialysis patients undergoing parathyroidectomy.
Method: A single-center, open-label randomized controlled trial was conducted in 26 dialysis patients with severe secondary hyperparathyroidism. Participants were randomly assigned in a 1:1 ratio to receive either calcitriol 2 micrograms per day combined with calcium carbonate 3.6 grams per day for three days before surgery (intervention group, n=13) or calcium carbonate alone (control group, n=13). All patients were followed with serial calcium measurements for at least 72 hours after surgery. The primary outcome was the nadir serum calcium level within 24 hours postoperatively.
Result: Baseline characteristics were similar between groups. The intervention group showed significantly higher nadir serum calcium within 24 hours (8.15±0.57 vs. 7.59±0.56 mg/dL; p=0.020). The intervention group also required a lower total dose of intravenous calcium infusion (1,232.8±883.0 vs. 2,845.5±2,253.2 mg; p=0.024) and a shorter duration (3.6±1.9 vs. 5.6±2.6 days; p=0.036).
Conclusions: Short-term preoperative administration of calcitriol reduced the severity of postoperative hypocalcemia and decreased the requirement for intravenous calcium infusion in dialysis patients undergoing parathyroidectomy. These findings support the role of calcitriol as an effective perioperative strategy, although larger studies are needed to confirm long-term outcomes.