The Role of Erythropoietin Levels in Predicting Long-Term Outcomes following Severe Acute Kidney Injury.

INTRODUCTION: Acute kidney injury (AKI) survivors are at an increased risk of chronic kidney disease, end-stage kidney disease, and mortality. Little is known about the effect of erythropoietin (EPO), a kidney-producing hormone, in post-AKI setting. We aimed to investigate the role of EPO as a predictor of long-term outcomes in post-severe AKI survivors. METHODS: We performed a retrospective analysis of post-AKI cohort conducted between August 2018 and December 2021. Adults who survived severe AKI stages 2-3 were enrolled. Serum EPO was obtained at 1 month after hospital discharge. We explored whether EPO level could predict long-term kidney outcomes at 12 months including mortality, kidney replacement therapy, doubling serum creatinine, and major adverse kidney events at 365 days. RESULTS: One hundred and twelve patients were enrolled. Median EPO level was significantly higher in non-survivors than survivors (28.9 [interquartile range: 16.2-50.7] versus 11.6 mU/mL [7.5-22.3], p = 0.003). The best EPO level cut-off was 16.2 mU/mL (sensitivity 77.8%, specificity 62.1%). Serum EPO predicted 12-month mortality with an area under the curve (AUC) of 0.69. Combining clinical model using age, baseline, and discharge kidney function with serum EPO improved prediction with AUC of 0.74. Multivariable analysis demonstrated that high-level of EPO group had significantly higher mortality compared with low-level EPO group (15.2% vs. 3.0%, p = 0.020). Hematocrit was significantly lower in high-level EPO group compared with low-level EPO group at 12 months (33.4 ± 1.1% vs. 36.0 ± 0.9%, p = 0.038). CONCLUSIONS: Plasma EPO appears to be a useful marker for predicting long-term outcome in post-severe AKI survivors.

From the "PD First" policy to the innovation in PD care.

OBJECTIVE: Due to the rapid growth of peritoneal dialysis (PD) program under the "PD First" policy of Thailand, it is necessary to have many voluntary well-training PD staffs and a good education program for PD nurses to serve an excellent PD outcome. In the present study novel devices, which could be practically used in PD patients, were developed by the creative PD trainee idea of to facilitate PD self-care and decrease work load of PD staffs. MATERIAL AND METHOD: Young PD nurses in the 3rd generation of PD trainee program from King Chulalongkorn Memorial Hospital were assigned to develop novel tools in order to assisting patient care in real practice. The efficacy of these inventions and patient satisfaction were assessed by comparing with the standard method. RESULTS: The authors presented two interesting innovations in the present study. The first one, "Troubleshooting Wheel", contained six common complaints and the advice for correcting each problem in the platform of rotating wheel. Participants could solve problems more rapidly than using the standard handbook for PD (p < 0.01) and also found the correct responses more frequently than the handbook (p < 0.01). The second one, "Exit Site Abacus", the sliding platform with automatic calculation of the sum of exit site score, was the easier method in evaluating the exit site infection than the conventional exit site scoring using the Prowant's table or their own memory. CONCLUSION: Reinforcement of the development of PD nursing program not only increases the number of PD staffs but also contributes to the innovations for improving quality of PD care by the young new staffs.