The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: a prospective multicentre study.

BACKGROUND: Etiologies for acute kidney injury (AKI) vary by geographic region and socioeconomic status. While considerable information is now available on AKI in the Americas, Europe and China, large comprehensive epidemiologic studies of AKI from Southeast Asia (SEA) are still lacking. The aim of this study was to investigate the rates and characteristics of AKI among intensive care unit (ICU) patients in Thailand. METHODS: We conducted the largest prospective observational study of AKI in SEA. The data were serially collected on the first 28 days of ICU admission by registration in electronic web-based format. AKI status was defined by full Kidney Disease: Improving Global Outcome criteria. We used AKI occurrence as the clinical outcome and explored the impact of modifiable and non-modifiable risk factors on the development and progression of AKI. RESULTS: We enrolled 5476 patients from 17 ICU centres across Thailand from February 2013 to July 2015. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 2471 of 4668 patients (52.9%). Overall, the maximum AKI stage was Stage 1 in 7.5%, Stage 2 in 16.5% and Stage 3 in 28.9%. In the multivariable adjusted model, we found that older age, female sex, admission to a regional hospital, medical ICU, high body mass index, primary diagnosis of cardiovascular-related disease and infectious disease, higher Acute Physiology and Chronic Health Evaluation II, non-renal Sequential Organ Failure Assessment scores, underlying anemia and use of vasopressors were all independent risk factors for AKI development. CONCLUSIONS: In Thai ICUs, AKI is very common. Identification of risk factors of AKI development will help in the development of a prognostic scoring model for this population and should help in decision making for timely intervention, ultimately leading to better clinical outcomes.

Dialysis dose and risk factors for death among ESRD patients treated with twice-weekly hemodialysis: a prospective cohort study.

BACKGROUND/AIMS: We aimed to define the dosing and risk factors for death in patients undergoing twice-weekly hemodialysis. METHODS: A prospective multi-center cohort study was conducted with one-year observation. Patients treated with twice- or thrice-weekly hemodialysis were identified. Death and first admission were the outcomes. spKt/V was a factor of interest. RESULTS: We enrolled 504 twice-weekly and 169 thrice-weekly hemodialysis patients. The mean weekly values of spKt/V in the two groups were 3.4 and 5.1. The one-year survival rate and times to hospitalization were similar in both groups. The hazard ratios for death in higher spKt/V quartile was not associated with lower mortality, p = 0.70. The four significant predictors for death were serum albumin, HR = 2.6, current smoking, HR = 19.3, age, HR = 1.1, and the Index of Coexistent Disease [ICED], HR = 1.9. CONCLUSION: The effect of spKt/V on short-term mortality was not obvious in twice-weekly dialysis patients. Attention should be paid to patients who smoke, have hypoalbuminemia, are elderly, or have a high ICED.

Early as compared to late initiation of twice-weekly hemodialysis and short-term survival among end-stage renal disease patients.

INTRODUCTION: The impact of timing of hemodialysis (HD) for end-stage renal disease (ESRD) patients treated with twice-weekly HD remains unclear. We aimed to determine the effects of late initiation of HD on short-term mortality and hospitalization. METHODS: A multicenter cohort study was conducted in 11 HD centers in Northeastern Thailand (HEmodialysis Network of the NorthEastern Thailand study group). We recruited adult ESRD patients who were treated with twice-weekly HD for more than 3 months and had data on eGFR at HD initiation. Clinical and laboratory values at the time of recruitment were recorded. Late and early (eGFR at start <5 and >5 ml/min/1.73 m2 ) initiations were defined. Outcomes were disease-related death (excluding any accidental deaths) and first hospitalization. Data analysis was performed by multivariable cox-regression analysis. FINDINGS: A total of 407 patients who had data on eGFR at HD initiation (303 in late group and 104 in early group) were included for analysis. There were 56.8% male with a mean age of 55 years. During the 15.1 months of follow-up, there were 27 (6.6%) disease-related deaths. The 1-year survival rate was similar among late and early initiation groups. The incidence density of first hospitalization in the late group was significantly lower than those in the early group (HR adjusted, 0.63; 95% CI, 0.40-0.99, p = 0.047). Among 303 patients who were in the late start group, patients with diabetes had a higher mortality rate (HR, 3.49; 95% CI, 1.40-8.70, p = 0.007) when compared to non-diabetic patients. DISCUSSION: Early initiation of HD at eGFR >5 ml/min/1.73 m2 had no short-term survival benefit compared to the late group in ESRD patients treated with twice-weekly HD for at least 3 months in a resource-limited setting. A survival benefit from an early start of HD was found among diabetic patients.

Survival and technical failure in a large cohort of Thai CAPD patients.

OBJECTIVE: To evaluate patient and technique survival, and to analyze factors influencing survival in a large Thai CAPD program. MATERIAL AND METHOD: A single center, retrospective, observational cohort study was carried out to examine the baseline factors affecting patient and technique survival. RESULTS: From January 1995 to December 2005, 322 incident CAPD patients were recruited for study. One hundred and thirteen patients (35.1%) died during the study period of 7,706 patient-months. Median patient survival time was 46.4 months. The major cause of death was related to infection. In multivariate analysis, only age at enrollment and baseline serum albumin were strong risk factors of death. Median technique survival was 41.2 months. The major cause of technique failure was peritoneal dialysis related infection. History of peritonitis, baseline serum albumin, and dialysis commencement in recent era were technique failure predictors. A neutral effect of self and caregiver performer was observed in the present study. CONCLUSION: Patient survival in the presented institute is similar to that reported in Western countries. Age and baseline serum albumin were the strongest predictors of death.

Risk factors of first peritonitis episode in Thai CAPD patients.

BACKGROUND: Peritonitis is a major complication of continuous ambulatory peritoneal dialysis (CAPD) patients. Information on the specific risk of peritonitis is important in reducing this common complication. MATERIAL AND METHOD: A single center retrospective cohort study was done to assess time to first peritonitis event and risk factors in Thai CAPD population. RESULTS: Between January 1995 and December 2005, 322 incident CAPD patients were recruited for the present study. During the study period of 4,281 patient-months, 198 episodes of first peritonitis were recorded. The median peritonitis-free time was 13.7 months. A Cox regression model showed that an increase in level of baseline albumin and hematocrit by 1 g/dL and 1% would decrease risk of peritonitis by 27% and 3%, respectively (hazard ratio (95%CI): 0.73 (0.59-0.91) and 0.97 (0.94-1.00)). A neutral effect of self and caregiver performer was observed in the present study. CONCLUSION: The present study confirmed the susceptibility of hypoalbuminemia and anemia to peritonitis. Awareness of particular risk groups should be achieved to prevent peritonitis.