Journal of the Nephrology Society of Thailand

The Effect of GLP-1 Receptor Agonist as Add-on Therapy to SGLT-2 Inhibitor on Albuminuria in Type 2 Diabetes with Chronic Kidney Disease

Pollawut Jamfa, Atthapol Vanadaj — Sun, 01 Dec 2024 00:00:00 +0700

Background: The effectiveness GLP-1 receptor agonist as an add-on therapy to SGLT-2 inhibitor in reducing albuminuria in diabetic kidney disease remains largely underexplored. This trial aims to evaluate the impact of this dual therapy compared to SGLT-2 inhibitor alone on albuminuria reduction over 6 months in patients with type 2 diabetes and chronic kidney disease
Methods: This retrospective cohort study included patients with type 2 diabetes and albuminuria between January 2018 and December 2023. A total of 122 patients who received either SGLT-2 inhibitors alone or in combination with GLP-1 receptor agonists were included. The primary outcome was the difference in the mean percent change in the urine albumin-to-creatinine ratio (UACR) at 6 months. Secondary outcomes included changes in HbA1c, blood pressure, body weight, serum creatinine, estimated glomerular filtration rate (eGFR), and adverse events.
Results: The mean percent change in UACR from baseline was 7.26% (-21.84, 36.36) in the SGLT-2 inhibitor group and -5.43% (-28.1, 17.25) in the combination therapy group. The between-group difference was -12.7% (-48.8, 23.4) (P=0.491). While the combination group showed a trend toward HbA1c and blood pressure reductions, these differences did not reach statistical significance. Neither group had significant changes in body weight, serum creatinine, or eGFR. Adverse events were similar between the two groups.
Conclusion: Adding GLP-1 receptor agonist to SGLT-2 inhibitor did not significantly reduce albuminuria, blood pressure, or HbA1C after 6 months of follow-up in patients with diabetic kidney disease.

Factors Associated with Non-Recovery of Renal Function in Patients with Septic Acute Kidney Injury

Pongpon Suttiruk, Anan Chuasuwan — Sun, 01 Dec 2024 00:00:00 +0700

Background: Acute kidney injury (AKI) is a common complication in patients with infection and septicemia, contributing to increased mortality and longer hospital stays. However, factors predicting renal recovery in patients with septic AKI remain unclear. This study investigated biochemical factors associated with renal recovery in septic AKI patients.
Methods: This was a retrospective, single-center study of patients admitted with infection-associated AKI between January 1st, 2015, and December 31st, 2020. Patients were categorized into full recovery and non-recovery groups, and factors associated with non-recovery of renal function within 90 days were analyzed.
Results: A total of 4,431 patients with septic AKI were included in the final analysis. Of these, 2,429 patients (54.82%) were in the full recovery group, and 2,002 patients (45.18%) were in the non-recovery group. Independent predictors of non-recovery included older age, male gender, AKI severity, the need for dialysis and assisted ventilation, thrombocytopenia, elevated serum phosphorus and magnesium levels, and lower serum albumin. There was no association between underlying conditions or the degree of chronic kidney disease and renal outcomes.
Conclusions: Older age, male gender, infection and AKI severity, the need for dialysis, thrombocytopenia, and lower serum albumin were associated with non-recovery of renal function in patients with septic AKI.

The Professor Emeritus Sa-nga Nilvarangkun, MD, Endowed Lectureship: National Policy & Sustainability on Thailand Dialysis Program

Thanom Supaporn — Sun, 01 Dec 2024 00:00:00 +0700

Short Biography
Current Selected Positions:
Senior Consultant in Nephrology and Internal Medicine, PhraMongkutklao Hospital.
Senior Consultant in Nephrology and Internal Medicine, Office of Medical Services of The Permanent Secretary, Ministry of Defence Bangkok Thailand
Advisor: Executive Committee of the Thai Society of Transplantation
Past Selected Careers:
Member of the Executive Committee of the Nephrology Society of Thailand (2001-2008)
Chair: Thailand Renal Replacement Therapy subcommittee of the Nephrology Society of Thailand (2003-2008)
Member of the National Health Security Office working committee to develop national renal replacement therapy policy recommendation in 2007
President of the Thai Transplantation Society (2017-2019)

The Professor Emeritus Visith Sitprija, MD, Ph.D. Endowed Lectureship: From Cloning to Clinic

Chairat Shayakul — Sun, 01 Dec 2024 00:00:00 +0700

Short Biography
Current Selected Positions:
Staff, Renal Unit, Department of Medicine, Faculty of Medicine Siriraj Hospital
Vice Secretary, Consortium of Thai Medical Schools (COTMES)
Chairman, Central Research Ethics Committee (Medicine Panel)
Committee member, Working Committee of Prince Mahidol Award Youth Program
Committee member, National Subcommittee on Rational Drug Use
Committee member, Patient, Personnel and People Safety National Steering Committee
Consultant, Mahidol scholarship program, Mahidol University
Thailand Quality Award (TQA) Assessor
Awards:
Best Internship Award, Bhumibol Adulyadej Hospital (1985)
Outstanding Siriraj Alumni Award for Working alumni with success in every field (2021)
Suankularb Wittayalai Distinguished Alumni Award (OSK 96 - 2023)
Selected Publications:
https://shorturl.at/2qpk5

Tumor-induced Osteomalacia with Proximal Tubulopathy: A Case Report

Chamanant Satjanon, Rungthiwa Kitpermkiat — Sun, 01 Dec 2024 00:00:00 +0700

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome that poses diagnostic challenges. Most patients present with symptoms such as bone pain, fractures, or muscle weakness, which are caused by the tumor’s production of fibroblast growth factor-23 (FGF-23). This phosphaturic hormone decreases the expression of type 2 sodium-phosphate cotransporters (NaPi-2a and NaPi-2c) in the kidney’s proximal tubule, leading to hypophosphatemia due to increased phosphate excretion. Additionally, FGF-23 inhibits the enzyme 1α-hydroxylase (CYP27B1), which converts 25(OH)D to the active form of vitamin D, 1,25(OH)2D, while stimulating the enzyme 24-hydroxylase (CYP24A1), which increases the breakdown of 1,25(OH)2D. This reduction in active vitamin D contributes to the development of osteomalacia. Diagnosing TIO is often delayed due to the small size of the tumor, which is difficult to locate, and the non-specific symptoms. This article reports the case of a 58-year-old man who experienced bilateral thigh pain for three years. Initially diagnosed with osteoporosis, he was treated with pain medication, anti-resorptive therapy, and physical therapy. However, eight months before admission, his thigh pain worsened, and he had difficulty walking. Laboratory tests revealed renal phosphate wasting, hypophosphatemia, and elevated levels of intact FGF-23. Additionally, proteinuria, glucosuria, and elevated urine beta-2 microglobulin indicated proximal tubulopathy. A 99mTc-Hynic-TOC scan with SPECT/CT revealed increased uptake in the right medial thigh. He was diagnosed with TIO and Fanconi syndrome.

From the Editor

Sinee Disthabanchong — Sun, 01 Dec 2024 00:00:00 +0700

Time flies—it has already been two years since I took the role of editor-in-chief of JNST. Over this period, the journal has been very well received, with a rapid increase in views and downloads. We have maintained a rigorous double-blind peer review process for all submitted articles. I am also pleased to share that Q1-ranked journals have cited at least two articles published in JNST in 2023.
In terms of efforts to support the inclusion of JNST in international databases, the editorial team has submitted various documents for quality evaluation by the Thailand Citation Index, with results expected by January 2025. Additionally, the editorial team has planned to request Digital Object Identifier (DOI) numbers for all articles published in the journal from 2025 onward, aiming to enhance article accessibility.
In this final issue of 2024, we have included a section on the Endowed Lectureships that were presented throughout the year. The Professor Emeritus Sa-nga Nilvarangkun, MD, Endowed Lectureship was delivered by Professor Thanom Supaporn, who spoke on the topic “National Policy & Sustainability of the Thailand Dialysis Program.” The Professor Emeritus Visith Sitprija, MD, Ph.D., Endowed Lectureship was presented by Professor Chairat Shayakul, who discussed “From Cloning to Clinic.” Short biographies of both distinguished lecturers and summaries of their presentations can be found in the Endowed Lectureship section of the journal.
Finally, I hope that JNST remains a sustainable resource for academic articles on kidney diseases. It serves as an excellent platform for both local and international researchers to submit their work, facilitating the dissemination of new knowledge that can be recognized and accessed globally. As we welcome the New Year of 2025, I wish everyone dedicated to the care of kidney disease patients much happiness and prosperity.

Air Pollution-Related Kidney Disease in Urban Medicine

Supawiwatch Rodjanasingha, Solos Jaturapisanukul — Sun, 01 Dec 2024 00:00:00 +0700

Air pollution, particularly particulate matter (PM), is a significant environmental issue that affects various bodily systems and is linked to an increased incidence of illness. It leads to more hospitalizations, reduced quality of life, and higher mortality rates, especially in urban areas where people are continuously exposed to PM from transportation and industrial activities. Studies now suggest that long-term exposure to toxic PM particles can accumulate in the body, affecting kidney function and contributing to the development of chronic kidney disease (CKD). The underlying pathology involves several mechanisms. PM triggers inflammatory responses, damages the lining of blood vessels, and causes arterial constriction. These effects, combined with proteinuria, progressively impair kidney function, eventually leading to CKD. This knowledge can be used to develop preventive measures and treatment strategies for patients at risk of CKD due to air pollution exposure in the future.

Proteinuria in Kidney Transplant Recipients

Chanyanuch Rakpithayanon, Natavudh Townamchai — Sun, 01 Dec 2024 00:00:00 +0700

Proteinuria is a common complication following kidney transplantation and is a strong predictor of transplant rejection, allograft loss, and mortality. It can arise from several causes, including immune rejection of the transplanted kidney, underlying glomerular diseases, or tubular damage caused by immunosuppressive medications. The key to managing proteinuria in transplant recipients is identifying and directly addressing the underlying cause. Additionally, lifestyle modifications—such as quitting smoking and reducing salt and protein intake—are recommended. Blocking the renin-angiotensin system shows promise in reducing proteinuria, although its long-term effects on graft and patient survival remain uncertain. Research into new therapies for post-transplant proteinuria continues, with drugs like sodium-glucose cotransporter 2 inhibitors showing promising results in reducing proteinuria and slowing the decline in allograft function. However, more studies are needed to confirm their efficacy and safety in kidney transplant recipients.