CKD prevalence in the Thai population is much higher than previously known and published. Early stages of CKD seem to be as common as later stages. However, albuminuria measurement was not confirmed and adjusting for persistent positive rates resulted in the prevalence of 14.4%. Furthermore, the awareness of CKD was quite low in the Thai population.

Fructose is a commonly used sweetener associated with diets that increase the prevalence of metabolic syndrome. Thiazide diuretics are frequently used in these patients for treatment of hypertension, but they also exacerbate metabolic syndrome. Rats on high-fructose diets that are given thiazides exhibit potassium depletion and hyperuricemia. Potassium supplementation improves their insulin resistance and hypertension, whereas allopurinol reduces serum levels of uric acid and ameliorates hypertension, hypertriglyceridemia, hyperglycemia, and insulin resistance. Both potassium supplementation and treatment with allopurinol also increase urinary nitric oxide excretion. We suggest that potassium depletion and hyperuricemia in rats exacerbates endothelial dysfunction and lowers the bioavailability of nitric oxide, which blocks insulin activity and causes insulin resistance during thiazide usage. Addition of potassium supplements and allopurinol with thiazides might be helpful in the management of metabolic syndrome. The metabolic syndrome (MS) is a constellation of risk factors for cardiovascular disease and type 2 diabetes and consists of abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high BP, insulin resistance, and hyperglycemia. 1,2 Endothelial dysfunction and hyperuricemia also are closely associated with MS. 3,4 Hydrochlorothiazide (HCTZ) is beneficial in patients with hypertension because it reduces morbidity and mortality, especially the frequency of stroke and congestive heart failure. 5,6 As a result, thiazides are recommended as the first-line therapy for hypertension. 6 However, many patients with hypertension have MS. In turn, HCTZ usage, although critical in the management of hypertension, can have several adverse effects, such as electrolyte disorders (hypokalemia, hyponatremia, and hypomagnesemia), hyperuricemia, hyperlipidemia, and impairment of glucose metabolism in addition to volume depletion. 7-10 These adverse effects result in the development or exacerbation of MS. Although low-dosage thiazides have led to a reduction of these adverse effects, they increase the incidence of new onset of diabetes 9 and can be associated with hypokalemia, hyperuricemia, and hyperlipidemia. 11 Understanding the precise mechanisms by which HCTZ exacerbates MS is important. Some evidence suggests that thiazide-induced hypokalemia may mediate insulin resistance. 12,13 In addition, experimental hyperuricemia can cause endothelial dysfunction, 3,14 hypertension, 15 and hyperinsulinemia. 3,16 Furthermore, we recently reported that hyperuricemia causes the development of MS, and allopurinol, which lowers uric acid levels, improves these features of MS in fructose (F)-fed rats. 3 We therefore hypothesized that hy-

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.

No abstract

Objective To determine the clinical outcome of left ventricular hypertrophy (LVH) (left ventricular wall diastole thickness ≥ 1.2 cm) detected by echocardiography in non-diabetic, continuous ambulatory peritoneal dialysis (CAPD) patients without dilated cardiomyopathy. Design A prospective, descriptive study was conducted between 1 July 1995 and 31 January 1998. Patients were followed up for 24 months. Setting Peritoneal dialysis unit in a medical school hospital. Patients and Methods Baseline and yearly echocardiograms were carried out on 66 patients receiving CAPD. Cardiac death was assessed. LVH was correlated with outcome. Results Of 66 nondiabetic CAPD patients without dilated cardiomyopathy, 20 had a normal echocardiogram (LV wall thickness < 1.2 cm), 21 had mild hypertrophy, and 25 severe hypertrophy (LV wall thickness > 1.4 cm in diastole). In the first two groups, 21% were admitted with congestive heart failure (CHF) after starting dialysis. The 1-year cumulative survival was 85% among those with mild hypertrophy and 91% in the normal group. In the group with severe hypertrophy, 57% were admitted at least once with CHF, and the 1-year cumulative survival was 56%. Eighty-two percent of those who died in the severe group, which accounted for the significantly worse survival ( p = 0.003), died from cardiac or cerebrovascular causes, compared with none of those with a normal echocardiogram. Conclusions Severe LVH was found in a third of our CAPD patients and was associated with a significantly high cardiovascular morbidity and mortality.