Associations of left ventricular systolic dysfunction with the factors among Thai patients on peritoneal dialysis: a cross-sectional study.

BACKGROUND: Factors associated with left ventricular systolic dysfunction (LVSD) of peritoneal dialysis (PD) patients are limited. We aim to explore and quantify the associated factors of LVSD among PD patients. METHODS: Participants from a PD clinic treated between 2012 and 2014 at the HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand were recruited and divided into 2 groups according to their left ventricular ejection fraction (LVEF) (< 50% vs. ≥ 50%) with LVEF < 50% considered as LVSD. Correlations among the clinical, laboratory and echocardiographic variables were analyzed. The factors associated with LVSD were explored with univariate and multivariate logistic regression analyses. Beta coefficient along with odds ratio and 95% confidence interval (CI) were calculated and the P value < 0.05 was considered significant. RESULTS: Among 103 subjects stratified as LVSD (n = 18, 17.5%). The mean (SD) age was 59.3 (12.7) years, and nearly halves were males. Preexisting CAD, diabetes (DM) and current smoking were 20 (19.4%), 63 (61.2%) and 23 (22.3%) patients, respectively. The median time of dialysis vintage was 12 (3, 24) months. Factors associated with LVSD and corresponding ORs with 95% CI by multivariate analysis were prior coronary artery disease (CAD) [5.08 (1.16, 22.19)], DM [6.36 (1.29, 31.49)], smoking [10.62 (2.17, 51.99)], neutrophil to lymphocyte ratio (NLR) > 3.6 [6.77 (1.41, 32.52)], and high serum phosphate [9.39 (2.16, 40.92)] were significantly associated with LVSD. CONCLUSIONS: Prior history of CAD, DM, smoking, high NLR and serum phosphate levels were found to be associated with LVSD for our PD patients. The evidence from prospective study is needed to confirm the predictive value of these variables.

National survey: Evaluation of cardiovascular risk factors in Thai patients with type 2 diabetes and chronic kidney disease after the development of cardiovascular disease.

AIM: The aim of the present study was to evaluate the achievement in controlling the risk factors of cardiovascular diseases (CVD) in Thai patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). METHODS: The DMHT dataset from 2011 to 2012, which was the cross-sectional study of the national survey in Thai patients with T2DM was analyzed. RESULTS: There were 1254 of 15 149 diabetic patients with estimated glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 that had developed CVD for more than 12 months. The prevalence of CVD was 8.3%. The mean age in years was 68.2 with a standard deviation (SD) of 8.7. Males and females were 38.7 and 61.3%, respectively. The mean duration of diabetes was 8.5 (SD 0.2) years. The mean body mass index was 25.5 (SD 4.4) kg/m2 . The percentage of patients with the target level of blood pressure control at ≤130/80 mm Hg was 47.1%. The percentage of patients who received angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) was 58.9%. The percentage of patients with the target level of LDL control at <70 mg/dL was 17.2%. The percentage of patients with the target level of HbA1C at 7% was 39.2%. There were 63 (5.0%) patients having recurrent CVD. CONCLUSIONS: Most Thai patients with T2DM and CKD with eGFR < 60 mL/min per 1.73 m2 could not achieve the therapeutic goals after the development of CVD. The national health policy should be planned to improve the quality of care to increase the number of patients who achieve the recommended goals.

Factors Related to Erythropoietin Hyporesponsiveness in Peritoneal Dialysis Patients with Anemia.

Background: Anemia in peritoneal dialysis (PD) patients can be improved after treatment with erythropoietin (EPO). However, several factors previously reported can cause EPO hyporesponsiveness including nutritional deficiency, infection or inflammation, secondary hyperparathyroidism with bone marrow fibrosis, angiotensin converting enzyme inhibitor (ACEI) administration, and dialysis inadequacy. Correction of these factors may lower doses and costs of EPO for these patients. Objective: To calculate the prevalence of EPO hyporesponsiveness and the associated factors in PD patients with anemia. Material and Method: We reviewed medical records of 195 PD patients who received EPO treatment during January 2000 to June 2013.The doses of EPO were titrated maximally to 8,000 U/week to maintain a target Hematocrit (Hct) level between 33% and 36%. PD patients Hct less than 30% before and after EPO administration for 3 months were included in this study. There were 44 patients who were recruited by the criteria. They had no history of bleeding or red cell transfusions within 2 months. The EPO resistance index (ERI) was calculated as weekly EPO doses per Hct levels per kilograms body weight (kg). The EPO hyporesponsiveness was defined as the weekly EPO doses was >150 U/kg. The relationship between the ERI and continuous parameters was calculated by the student's t-test. Chi-square and Fisher's exact correlation were performed to analyze the relationship between ERI and categorical variables. The p-value <0.05 was considered statistically difference. Results: There were 13 (6.7%) patients having Hct less than 33% after the administration EPO >150 U/kg/week for 3 months. The statistically significant relationship between ERI and gender was detected. Female had higher rate of having EPO hyporesponsiveness (p = 0.02). Conclusion: The prevalence of EPO hyporesponsiveness was 6.7%. Female gender was a factor related to EPO hyporesponsiveness in our study.

Laparoscopic Retrograde Peritoneal Dialysis Catheter Insertion: Technique and Outcomes.

Objective: The study aimed to present technique and outcomes of laparoscopic retrograde peritoneal dialysis catheter insertion in chronic kidney disease (CKD) patients. Material and Method: We retrospectively reviewed 11 complicated CKD patients, who underwent both laparoscopic and laparoscopic retrograde peritoneal dialysis catheter (lap PD, r-lap PD) insertion at HRH Princess Maha Chakri Sirindhorn Medical Center during April 2013 to March, 2016. Technique, outcomes and complications were presented. Results: After a follow-up period of 14 months in patients who underwent lap PD insertion, there was no infection, bleeding complication, or hernia presented. Dialysate leakage after immediate dialysis was found in one r-lap PD insertion patient but healed spontaneously. No catheter removal or revision was observed. Conclusion: The described r-lap PD catheter insertion technique was straightforward, effective and reproducible. Though the sample size was limited, the procedure can used as an alternate in complicated CKD patients.

A Report of Peritonitis from Aeromonas sobria in a Peritoneal Dialysis (PD) Patient with Necrotizing Fasciitis.

A 70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD)for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.

Echocardiographic and Clinical Characteristics Cross-Sectional Study in Association with Thai Peritoneal Dialysis Patients: Data from a Single Center Study.

BACKGROUND: The dialysis patients have a lot of changes in cardiac structure and function detected by echocardiography and they have been recognized as key outcome predictors. However, the available data regarding echocardiographic alterations in Thai Continuous Ambulatory Peritoneal Dialysis (CAPD) patients is limited. This study aimed to determine the correlation between baseline clinical and echocardiographic characteristics of Thai CAPD patients. MATERIAL AND METHOD: This study was a single center and cross-sectional observational study, which enrolled all CAPD outpatients (104 patients), treated at Srinakharinwirot Medical University between 1 September 2012 and 31 June, 2014. Their demographic and echocardiographic data were collected one time and the latest laboratory data to the patient's echocardiographic study date were analyzed. RESULTS: One hundred and four patients (50 men and 54 women) whose mean age was 59.4 ± 12.7 years and median duration of CAPD was 12 months were recruited. An extremely high prevalence of elevated left ventricular mass index (LVMI), 82.7% was found which mean LVMI was higher in male than female (166.2 ± 55.6 vs. 131 ± 47.6 g/m2). All patients had diastolic dysfunction and most ofthem had diastolic dysfunction grade I. The studyfactors of male gender, history of hypertension, high serum phosphate, low hemoglobin level, corrected QT interval, and duration of CAPD longer than 24 months can predict the variation of LVMI. Interestingly, the study found that a duration of CAPD of longer than 42 months might reduce right ventricular systolic pressure. CONCLUSION: This study revealed a higher prevalence of left ventricular hypertrophy (LVH) in Thai CAPD patients when compared with previous studies and anemia still be an important independentfactor for developing LVH. Longer period of CAPD may regress LVH and lower RVSP that should be proven by longer well-designed prospective studies.

Time-dependent incidence rates and risk factors for transferring to hemodialysis in patients on peritoneal dialysis under the Thai PD-First Policy.

BACKGROUND: Haemodialysis (HD) transfer (HDT) is the major challenge of peritoneal dialysis (PD). This study aimed to analyse the time-dependent incidence rates and risk factors for permanent HDT in patients under Thailand's PD First policy. METHODS: The records of 20,545 patients from January 2008 to June 2018 were studied. The time on therapy (TOT) was divided into 0-3, 3-12, 12-24, 24-36, 36-48 and more than 48 months. The time-dependent incidence rates and causes of PD dropout were investigated. The risk factors for HDT were analysed by multivariable Poisson regression model and presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: The main cause of PD dropout was death (45.7%) with 17.4% of the patients transferred to HD. The median (25th to 75th interquartile range) dialysis vintage was 1.4 (0.5-2.7) years. The incidence rates of HDT increased with TOT. Patients with universal coverage were transferred to HD less frequently than those with other health schemes. Patients who were illiterate or only had primary school education had a higher risk of being transferred to HD after 48 months of TOT (IRR 1.41 (95% CI 1.07-1.89)). Peritonitis within the first year of PD was the risk for HDT during 13-48 months of PD. The reasons for HDT changed with TOT. Mechanical complications followed by peritonitis were the main causes of HDT during the first 3 months, and after that peritonitis was the main reason. CONCLUSIONS: The incidence of HDT increased with TOT. The risks for HDT changed over time on PD.

COVID-19 incidence and outcomes among patients with kidney replacement therapy.

BACKGROUND: We aimed to investigate the incidence, fatality, and associated factors in patients with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT) hospitalized for coronavirus disease 2019 (COVID-19) infection and reimbursed from the National Health Security Office (NHSO). METHODS: The retrospective cohort analysis was conducted from an electronic-claimed database, and COVID-19 vaccination status was evaluated in patients with HD, PD, and KT from January 2020 to December 2021. There were 85,305 patients reimbursed for HD, PD, and KT by the NHSO. The rates of COVID-19 infection, COVID-19 vaccination, comorbidities, fatalities, and the cost of treatment were evaluated. RESULTS: COVID-19 infection was observed in 1,799 of 36,982 HD cases (4.9%), 1,531 of 45,453 PD cases (3.4%), and 95 of 2,870 KT cases (3.3%). Patients receiving COVID-19 vaccinations were most common in the KT group, followed by those with HD and PD (76.93% vs. 70.65% vs. 51.34%, respectively). KT patients had a lower fatality rate compared to those with PD and HD (8.42% vs. 18.41% vs. 21.40%, respectively). Advanced age, diabetes, cardiovascular diseases, and COVID-19 vaccination status were associated with fatality. The adjusted odds ratios of fatality after receiving one or two doses of vaccines were 0.7 (95% confidence interval [CI], 0.6-0.9) and 0.3 (95% CI, 0.2-0.4), respectively. The cost of treatment was highest in patients with HD, followed by PD and KT. CONCLUSION: The incidence of COVID-19 infection was higher in patients with HD than in those with PD or KT. COVID-19 vaccination following the national health policy should be encouraged for these patients to prevent fatality.

Survival Analysis and Associated Factors in Thai Patients on Peritoneal Dialysis Under the PD-First Policy.

BACKGROUND: The peritoneal dialysis First (PD-First) policy means that PD is the first modality of dialysis chosen for patients with end-stage renal disease (ESRD), as put forth by the Universal Health Coverage (UHC) scheme. It was initiated in Thailand in 2008. Our aim is to analyze patient survival, technique survival, and associated factors. METHODS: Data of PD patients from January 2008 to November 2016 were studied. We calculated patient and technique survival rates (censored for death and kidney transplantation). Factors associated with survival were analyzed by the Cox proportional hazard model. Patient and technique survival rates between 2008 - 2012 and 2013 - 2016 were compared. RESULTS: Our study included 11,477 patients. The mean (standard deviation [SD]) age at initiation of PD was 54.0 (14.4) years. The level of education in 85.2% of cases was illiterate or primary school. A total of 60.9% of patients developed ESRD secondary to diabetes. The 1- to 5-year patient survival rates were 82.6, 71.8, 64.0, 58.5, and 54.0%, respectively. The first-year technique survival rate was 94.8%. The patient and technique survival rates during 2013 - 2016 were better than those seen during 2008 - 2012. Factors associated with lower patient survival rates were: female gender, increased age at start of PD, coverage with civil servant medical benefit scheme, low educational levels, and a history of diabetes. CONCLUSION: Most patients had diabetes and low educational levels as seen in the outcomes in the previous literature. These factors impacted the survival of patients under the PD-First policy.

An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory failure.

BACKGROUND: Northern Thailand's biggest botulism outbreak to date occurred on 14 March 2006 and affected 209 people. Of these, 42 developed respiratory failure, and 25 of those who developed respiratory failure were referred to 9 high facility hospitals for treatment of severe respiratory failure and autonomic nervous system involvement. Among these patients, we aimed to assess the relationship between the rate of ventilator dependence and the occurrence of treatment by day 4 versus day 6 after exposure to bamboo shoots (the source of the botulism outbreak), as well as the relationship between ventilator dependence and negative inspiratory pressure. METHODS: We reviewed the circumstances and timing of symptoms following exposure. Mobile teams treated patients with botulinum antitoxin on day 4 or day 6 after exposure in Nan Hospital (Nan, Thailand). Eighteen patients (in 7 high facility hospitals) with severe respiratory failure received a low- and high-rate repetitive nerve stimulation test, and negative inspiratory pressure was measured. RESULTS: Within 1-65 h after exposure, 18 of the patients with severe respiratory failure had become ill. The typical clinical sequence was abdominal pain, nausea and/or vomiting, diarrhea, dysphagia and/or dysarthria, ptosis, diplopia, generalized weakness, urinary retention, and respiratory failure. Most patients exhibited fluctuating pulse and blood pressure. Repetitive nerve stimulation test showed no response in the most severe stage. In the moderately severe stage, there was a low-amplitude compound muscle action potential with a low-rate incremented/high-rate decremented response. In the early recovery phase, there was a low-amplitude compound muscle action potential with low- and high-rate incremented response. In the ventilator-weaning stage, there was a normal-amplitude compound muscle action potential. Negative inspiratory pressure variation among 14 patients undergoing weaning from mechanical ventilation was observed. Kaplan-Meier survival analysis identified a shorter period of ventilator dependency among patients receiving botulinum antitoxin on day 4 (P=.02). CONCLUSIONS: Patients receiving botulinum antitoxin on day 4 had decreased ventilator dependency. In addition, for patients with foodborne botulism, an effective referral system and team of specialists are needed.