This national survey of barriers to and constraints of acute peritoneal dialysis (aPD) in acute kidney injury (AKI) was performed by distributing an online questionnaire to all medical directors of public dialysis units registered with the Nephrology Society of Thailand during September–November 2019. One hundred and thirteen adult facilities responded to the survey covering 75 from 76 provinces (99%) of Thailand. aPD was performed in 66 centres (58%). In facilities where aPD practice was available, the utilization rate was relatively low (<10 cases/year) and limited to specific conditions, including HIV seropositive patients, previous receiving dialysis education and plan and difficult vascular access creation. Only 9% of facilities performed aPD routinely, but interestingly all such units permitted bedside catheter insertion by the nephrologists or internists. The major constraints placed on aPD practice were PD catheter insertion competency, timely catheter insertion support and the medical supporting team’s knowledge/competency deficits. aPD for AKI is underutilized in Thailand and limited by the inability to undertake timely PD catheter insertion and knowledge and competency deficits.

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<b><i>Introduction:</i></b> The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). <b><i>Methods:</i></b> A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. <b><i>Results:</i></b> The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (−353 vs. 175 mL per day, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.

setting where a proportion of neonates do not receive TH, we conducted this study with the following objectives a) to compare the incidence and severity of AKI in neonates with perinatal asphyxia who receive therapeutic hypothermia (TH+) to those who don't receive it (TH-) b) compare the levels of urinary biomarkers in those with AKI to those without AKI. Methods: A prospective observational study was conducted in the neonatal intensive care of a tertiary referral hospital from March 2018 to November 2019. Neonates (inborn and outborn) >35 completed weeks gestational age with perinatal asphyxia and moderate to severe hypoxic ischemic encephalopathy using the Sarnat and Sarnat classification were included. TH using whole body cooling was administered in all babies who were admitted within 6 hours of life for 72 hours with 18 hours of re-warming. The incidence and severity of AKI was compared between TH+ and TH-. Urinary biomarkers like neutrophil gelatinase associated lipocalin (NGAL), cystatin C (ucysC) and beta 2 microglobulin (B2m) were tested on day 1 of life using a Luminex based assay and were compared between those who had and did not have AKI.Results: Among 39 neonates, 29 (74%) received therapeutic hypothermia. Thirty (76%) were males and 25 (64%) were inborn babies, 10 (25%) were preterm. The median birth weight was 2.3 (2.1, 2.7) kg. The incidence of AKI was 5/10 (50%) in TH-group when compared to 5/29 (18%) in TH+ group (p=0.04). In the TH+ group, 80% had stage 1 AKI, 20% had stage 2 AKI when compared to 20% stage 1, 60% stage 2 AKI and 20% stage 3 in TH-group (p=0.15). None of neonates required dialysis. After adjusting for other risk factors for AKI like shock, ventilation and sepsis, TH+ was associated with a significantly lower incidence of AKI (p=0.03). The urinary levels of NGAL were higher in neonates with AKI (210 (66, 473) ng/ml) when compared to those without AKI (140 (42, 556) ng/ml) (p=0.65) while levels were comparable for B2m (p=0.11) and ucysC (p=0.45) . Conclusions: Therapeutic hypothermia is associated with a significantly lower incidence of AKI in neonates with perinatal asphyxia. Urinary NGAL is a useful biomarker for the diagnosis of AKI in neonates with perinatal asphyxia.

Background Metformin-associated lactic acidosis (MALA) is a rare event but underrecognition may lead to unfavorable outcomes in type 2 diabetes patients. While many risk factors of MALA have been identified, how to reduce mortality from MALA is a matter of debate. This study aimed to explore the factors associated with 30-day mortality amongst MALA patients. Methods An observational study enrolled patients diagnosed with MALA between January 2014 and December 2017. MALA was defined by a history of metformin administration, metabolic acidosis (arterial blood gas pH <7.35 or HCO3 <15 mmol/L), and elevated plasma lactate level (>5 mmol/L). We examined risk factors including age, sex, underlying diseases, current medications, blood tests, disease severity, and dialysis data. Mortality status was identified from medical records or report on telephone. Results We included 105 MALA patients. Most patients (95.2%) were diagnosed acute kidney injury stage 3 according to KDIGO 2012 definition. The 30-day mortality rate was 36.2% and dialysis rate was 85.7%. The survivors had higher proportions of underlying chronic kidney disease, presence of metabolic acidosis, receiving renal replacement therapy within 6 hours, and haemodialysis, whereas the non-survivors had higher percentage of hypertension and disease severity. Lower APACHE II score (HR = 0.95; 95%CI, 0.91–0.99; p = 0.038), time to dialysis < 6 hours (0.31; 0.14–0.69; 0.004), and haemodialysis (0.20;0.06–0.67; 0.010) were associated with lower 30-day mortality, using multivariate Cox-regression analysis. Conclusions Mortality rate amongst patients with MALA was high. Early dialysis treatment within 6 hours after admission and haemodialysis were independently associated with lower 30-day mortality. The large scale, well-designed studies need to confirm these encouraging results.

Purpose Un-decision for start peritoneal dialysis (PD) was a challenging problem with conventional video counseling in CKD stage 5. This study aims to evaluate customized (for local context) versus conventional video counseling for PD decision-making in CKD stage 5 under PD first policy. Methods In 120 CKD stage 5 in tertiary-care hospital, Thailand who indicated initiate PD between May 2016 to January 2017 were enrolled in a randomized, open-label, controlled study. Patients were randomized to customized and conventional video counseling. The primary outcome was the acceptance rate along with PD catheter insertion on schedule. The secondary outcomes included changing the patient’s knowledge and confidence in PD and unplanned start PD rate. Results 120 patients were analyzed (customized n=60; conventional n=60). The two groups were similar for age (55.7±12.3 vs. 56.2±13.4 years), BUN (89.8±30.8 vs. 86.8±29.5 mg/dL), Cr (10.37±5.39 vs. 11.29+4.90 mg/dl) and eGFR (4.78+2.79 vs. 5.62+2.82 mL/min/1.73m2). Acceptance rate along with PD catheter insertion on the schedule in customized video counselling group was not significant difference with conventional video counselling group (66.6% vs. 63.3%, relative risk 0.97, 95% confidence interval 0.73 to 1.29, p = 0.86). Patient’s knowledge and confidence in PD were increasing but not significant difference between both groups. Conclusions Among CKD stage 5 in PD first policy, customized counseling was not a significant difference in rate of accept for start PD along with PD catheter insertion on schedule with conventional video counseling. Other counseling method to improve the accept rate for start PD need to further investigation.