PPI usage was associated with adverse kidney outcomes; however, these findings were based on observational studies and low-quality evidence. Additional rigorous studies are needed for further clarification.

A tool to predict peritonitis-associated treatment failure among peritoneal dialysis (PD) patients has not yet been established. We conducted a multicentre, retrospective cohort study among 1,025 PD patients between 2006 and 2016 in Thailand to develop and internally validate such a tool. Treatment failure was defined as either a requirement for catheter removal, a switch to haemodialysis, or peritonitis-associated mortality. Prediction model performances were analysed using discrimination (C-statistics) and calibration (Hosmer-Lemeshow test) tests. Predictors were weighted to calculate a risk score. In total, 435 patients with 855 episodes of peritonitis were identified; 215 (25.2%) episodes resulted in treatment failure. A total risk score of 11.5 was developed including, diabetes, systolic blood pressure <90 mmHg, and dialysate leukocyte count >1,000/mm3 and >100/mm3 on days 3–4 and day 5, respectively. The discrimination (C-statistic = 0.92; 95%CI, 0.89–0.94) and calibration (P > 0.05) indicated an excellent performance. No significant difference was observed in the internal validation cohort. The rate of treatment failure in the different groups was 3.0% (low-risk, <1.5 points), 54.4% (moderate-risk, 1.5–9 points), and 89.5% (high-risk, >9 points). A simplified risk-scoring scheme to predict treatment failure may be useful for clinical decision making regarding PD patients with peritonitis. External validation studies are needed.

The estimated UP-Dial severity band can facilitate the interpretation of UP in practice-based research settings and can be used to support treatment decisions.

Objective: To evaluate the prevalence of depression and the association between depression and health-related quality of life among hemodialysis (HD) and peritoneal dialysis (PD) patients.Materials and Methods: This analytical cross-sectional study was conducted using the Beck Depression Inventory Thai version (BDI-II) and the Kidney Disease Quality of Life Short Form Thai version (KDQOL-SF) during July 1st-November 19th 2015. Linear regression was used to analyze an association between depression and quality of life. Meanwhile, logistic regression was performed to determine association between dialysis modality and depression level categorized into two groups; depression (BDI-II≥14), and no depression (BDI-II<14).Results: Of 81 dialysis patients; 60.5% was male, mean±standard deviation age was 57.9±13.6 years old. Forty and 41 patients underwent HD and PD, respectively. Overall, dialysis patients had the prevalence of depression of 35.8% (95% confidence interval (95% CI)=25.4-47.2), 37.5% (95% CI=22.7-54.2) and 34.1% (95% CI=20.1-50.6), respectively. There was no association between dialysis modality and depression score. The results revealed the reverse of association between depression score and the KDQOL-SF score. The beta coefficient (β) were -1.08 (95% CI -1.34 to -0.82; p-value<0.001) in overall patients, -0.96 [95% CI -1.30 to -0.63; p-value<0.001] in HD patients, and -1.28 [95% CI -1.73 to -0.82; p-value<0.001] in PD patients.Conclusion: Depression is commonly revealed in dialysis patients and significantly associated with their quality of life. Healthcare providers need to pay attention to depression not merely emphasizing in physical treatments.

Background. Cissus quadrangularis Linn. (CQ) is a medicinal plant with good evidence for the treatment of hemorrhoids, listed in the Thai National List of Herbal Products in the oral dosage form. Acmella paniculata (Wall ex. DC.) R. K. Jansen. (AP) is a medicinal plant with a local anesthetic effect. Objective. To investigate the potential of rectal suppositories containing CQ and AP extracts to alleviate symptoms of hemorrhoids compared with the commercialized rectal suppository containing hydrocortisone and cinchocaine. Materials and Methods. Hemorrhoid outpatients (n = 105) with different severity grades (I, II, or III) from eight hospitals in northern Thailand were included in this study. Hemorrhoid severity was graded by proctoscopy associated with either anal pain or bleeding related to hemorrhoids or both. The patients were randomly allocated to two groups: CQ-AP group (n = 52) or the commercialized rectal suppository group (n = 53). One suppository was rectally administered twice daily in the morning and at bedtime for seven days. Evaluations were performed by physicians on days 1, 4, and 8 of the study. The primary endpoints were bleeding and prolapse size, while the secondary endpoint was anal pain. Results. Baseline demographics, lifestyle, constipation, number of prolapses, grade of hemorrhoid severity, and duration of experiencing hemorrhoids were comparable in both groups of patients. The effects of CQ-AP and the commercialized rectal suppository on bleeding, prolapse size, and anal pain were comparable. The patients in both groups were satisfied with both products at comparable levels and stated a preference for further use in the case of hemorrhoids recurrence. In terms of safety, the patients in the commercialized rectal suppository group experienced a higher incidence of adverse events, including anal pain and bleeding. Conclusion. Rectal suppositories containing a combined extract of CQ and AP show potential in alleviating hemorrhoidal symptoms with a good safety profile.