Browsing by Author "Chagriya Kitiyakara"

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    Abdominal aorta and pelvic artery calcifications on plain radiographs may predict mortality in chronic kidney disease, hemodialysis and renal transplantation
    (2018-02-01) Sinee Disthabanchong; Kotcharat Vipattawat; Bunyong Phakdeekitcharoen; Chagriya Kitiyakara; Vasant Sumethkul; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2017, Springer Science+Business Media B.V., part of Springer Nature. Purpose: Vascular calcification is common in chronic kidney disease (CKD) and predicts poor patient outcomes. While computed tomography is the gold standard for evaluation of vascular calcification, plain radiograph offers a simpler and less costly alternative. The calcification of abdominal aorta, iliac and femoral arteries has been evaluated by plain radiograph, but the data on their outcome predictabilities are still limited. The present study investigated the role of abdominal aortic calcification (AAC) and pelvic arterial calcification (PAC) in predicting overall morality in non-dialysis CKD stages 2–5 (CKD 2–5), maintenance hemodialysis (HD) and long-term kidney transplant (KT) patients. Methods: Four hundred and nineteen patients were included. Lateral abdominal and pelvic radiographs were obtained. The degree of AAC and PAC was evaluated according to the methods described previously by Kaupplia et al. and Adragao et al. Patients were followed prospectively for 5 years. Results: AAC and PAC scores correlated well with the correlation coefficients of 0.442 for CKD 2–5, 0.438 for HD and 0.586 for KT (p < 0.001). Patients with AAC score > 6 or PAC score > 1 were older, showed higher prevalence of DM and had higher serum phosphate and PTH but lower serum albumin and eGFR. A more severe degree of AAC was associated with an increase in KT duration, whereas a more severe degree of PAC was associated with worsening kidney function and prolonged dialysis vintage. Kaplan–Meier survival curves revealed AAC score > 6 as a significant predictor of all-cause mortality in CKD 2–5 but not in HD or KT, whereas PAC score > 1 was a significant predictor of all-cause mortality in all three populations. After adjusting for age, the predictability of AAC was lost, whereas PAC remained an independent predictor of mortality in all three populations. Adjustments for cardiovascular and CKD risk factors including age, gender, BMI, DM, serum albumin, calcium and phosphate attenuated the predictability of PAC in HD but not in CKD 2–5 or KT patients. Conclusion: PAC was better than AAC in predicting mortality in CKD, HD and KT patients.
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    Acute deterioration of renal function induced by star fruit ingestion in a patient with chronic kidney disease
    (2006-09-01) Kannika Niticharoenpong; Panas Chalermsanyakorn; Ravat Panvichian; Chagriya Kitiyakara; Mahidol University
    Star fruit (Averrhoa carambola) is a popular tropical fruit, usually consumed as fresh fruit or as fruit juice. In patients on dialysis, consumption of star fruits can lead to alterations of consciousness. In this case report, we describe a patient with underlying chronic kidney disease, who developed a rapid increase in serum creatinine and oxalate nephropathy after chronic ingestion of star fruit juice without overt neurotoxicity. The decline in renal function was not fully reversible after stoppage. This case demonstrates that star fruit consumption should be considered as a cause of rapid deterioration in renal function in patients with underlying chronic kidney disease that may result in permanent renal injury. © Società Italiana di Nefrologia.
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    Analysis of Foxp3, CD25, and CD127 expressed on regulatory T cells in Thai subjects
    (2009-06-01) Masatha Thongpan; Chagriya Kitiyakara; Yada Louischaroen; Prasit Keesukphan; Sansanee C. Chaiyaroj; Mahidol University
    Foxp3+ natural regulatory T cells (nTreg) play a distinct role in maintaining self tolerance at the periphery. CD25hi and CD127 lo were proposed for the identification and purification of nTreg but they have not been confirmed in non-Caucasian populations. This study examined the sensitivity and purity of Foxp3 nTreg identified by CD25 and CD127 in the peripheral blood of Thai subjects (13 males, 15 females with age range of 20-42 years old). The proportions of nTreg/CD4+ as identified by the different markers were as follows: Foxp3+, 18.3 ± 6.4%; CD25hi, 6.4 ± 3.2%; and CD127lo, 54.3 ± 14.2%. Sensitivity tests showed the following results: CD25hi, 23.1%; CD127lo, 40.6%; CD25hiCD127lo, 7.4%. Purity tests concluded as follows: CD25hi, 63.6%; CD25int, 24.9%; CD25lo, 8.7%, CD127lo, 26.5%; CD127hi, 14.9%, and CD25hiCD127lo, 52.0%. In conclusion, the proportions of nTreg in Thai subjects are similar to Caucasian populations. CD25 hi is superior to CD127lo for separating Foxp3+ nTreg. Combining CD25hi and CD127lo does not improve the nTreg purity. Abbreviations: CD25hi, CD25 highly expressed cells; CD25int, CD25 intermediately expressed cells; CD25lo, CD25 low expressed cells; CD127hi, CD127 high expressed cells; CD127 lo, CD127 low expressed cells.
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    Assessing clinical evidence of drug interactions between citrus juices and cyclosporine
    (2013-08-01) Pakawadee Sermsappasuk; Nathorn Chaiyakunapruk; Manupat Lohitnavy; Chagriya Kitiyakara; Naresuan University; University of Queensland; University of Wisconsin Madison; Mahidol University
    Background: Previous studies have demonstrated that grapefruit juice increased the bioavailability of cyclosporine;however, the results from the literature are inconsistent. Other citrus fruits such as pomelo or orange juice had variable effects on the bioavailability of cyclosporine.Objective: To assess the effect of grapefruit juice and other types of citrus juice on oral bioavailability of cyclosporine in humans using meta-Analysis.Methods: We conducted a meta-Analysis of placebo-controlled studies evaluating the effects of citrus juices on bioavailability of cyclosporine. The studies were identified in PubMed, Cochrane CENTRAL, CINAHL, ISI Web of Knowledge, Psych Info International, Pharmaceutical Abstract (IPA), and reference lists of relevant papers. The weighted-mean difference (WMD) was calculated for net changes in the area under the curve (AUC) of cyclosporine. All studies conducted as placebo-controlled crossover studies in humans to compare the effect of citrus juices and control (drinking water) on AUC of cyclosporine and/or Cmin,ss were reviewed. All studies included were evaluated and extracted independently, and discrepancies were resolved through discussion.Results: Eighteen studies were identified. A subgroup analysis suggested that grapefruit juice significantly increased AUC of cyclosporine (WMD = 1762.5 ng·h/ml, 95%CI = 1178.9-2346.0 ng·h/ml, p > 0.001). While a meta-Analysis of all other types of citrus juices (tangerine juice, Seville orange juice, sweet orange juice, and citrus soda) except pomelo juice revealed no effect on the AUC of cyclosporine (WMD = -181.0 ng·h/ml,95%CI = -582.8-220.9 ng·h/ml, p > 0.5), a study of pomelo juice indicated a significant increase in the AUC of cyclosporine.Conclusions: Grapefruit juice intake increases oral bioavailability of cyclosporine in both healthy volunteers and renal transplant patients, whereas all other types of citrus juices may not have an influence on the oral bioavailability of cyclosporine. Current evidence suggests that pomelo juice may be able to increase cyclosporine oral bioavailability.
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    The association between trough blood concentration and systemic exposure of tacrolimus: Comparison between once-daily (Advagraf®) and twice-daily (Prograf®) formulation in de novo kidney transplant recipients
    (2019-01-01) Sayamon Sukkha; Busba Chindavijak; Wichit Nosoongnoen; Bunyong Phakdeekitchareon; Chagriya Kitiyakara; Vasant Sumethkul; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University
    © 2019 The Japanese Society for the Study of Xenobiotics Available data of early conversion from twice-daily tacrolimus (TAC-BID) to once-daily tacrolimus (TAC-OD) in de novo kidney transplant (KT) recipients are limited. We conducted a prospective study of early conversion to TAC-OD in de novo KT recipients. Eligible patients were enrolled to receive TAC-BID (Prograf®) and then converted to TAC-OD (Advagraf®) by 1:1 ratio, approximately 14 days after KT (range 9–22). Blood samples were investigated for pharmacokinetic parameters before and 7–14 days after the conversion. Fifteen patients were included and provided AUC0-24 of 202.9 ± 44.4 ng h/mL for TAC-BID (pre-conversion) and 193.0 ± 63.4 ng h/mL for TAC-OD (post-conversion) (p = 0.41). Mean trough blood concentration (Cmin) of TAC-BID and TAC-OD was 6.4 ± 1.4 ng/mL and 4.9 ± 1.6 ng/mL (p = 0.01). Correlation coefficient (r) between Cmin and AUC0-24 of TAC-BID and TAC-OD were 0.620 and 0.875. Additional analysis found that patients with a drop of Cmin > 30% had a significant lower AUC0-24 after conversion. Renal function remains stable. We conclude that early conversion to TAC-OD is safe and well tolerated with an indifferent systemic exposure. However, patients with a drop of Cmin > 30% after conversion to TAC-OD will require additional dose adjustment.
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    Author Correction: Women and other risk factors for chronic kidney disease of unknown etiology in Thailand: National Health Examination V Survey (Scientific Reports, (2021), 11, 1, (21366), 10.1038/s41598-021-00694-9)
    (2021-12-01) Wichai Aekplakorn; Suwat Chariyalertsak; Pattapong Kessomboon; Sawitri Assanangkornchai; Surasak Taneepanichskul; Nareemarn Neelapaichit; Anchalee Chittamma; Chagriya Kitiyakara; Ramathibodi Hospital; Chulalongkorn University; Faculty of Medicine, Khon Kaen University; Faculty of Medicine, Prince of Songkia University; Chiang Mai University
    The original version of this Article contained an error in Affiliation 6, which was incorrectly given as ‘Faculty of Medicine, Ramathibodi School of Nursing, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand’. The correct affiliation is listed below: Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand The original Article has been corrected.
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    Bioimpedance Analysis–Guided Volume Expansion for the Prevention of Contrast-Induced Acute Kidney Injury (the BELIEVE Pilot Randomized Controlled Trial)
    (2020-01-01) Sarassawan Kananuraks; Montira Assanatham; Sarinya Boongird; Chagriya Kitiyakara; Kanin Thammavaranucupt; Thosaphol Limpijarnkij; Daruneewan Warodomwichit; Andrew Davenport; Arkom Nongnuch; University College London; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2020 International Society of Nephrology Introduction: Peri-procedural i.v. fluid administration is important for the prevention of contrast-induced acute kidney injury (CI-AKI). However, standardized fluid management protocols may not be suitable for all patients. We therefore wished to determine whether an individualized fluid administration protocol guided by measuring extracellular water (ECW) using bioimpedance analysis (BIA) would be safe and would reduce the incidence CI-AKI compared to a standardized fluid administration prescription. Methods: In this pilot, randomized, parallel-group, single-blind, controlled trial, we compared the effect of BIA-guided isotonic bicarbonate administration according to the ratio of ECW to total body water (ECW/TBW) to our standard isotonic bicarbonate protocol in regard to the safety and efficacy of preventing CI-AKI in chronic kidney disease patients undergoing elective cardiac angiography. Our primary outcome was the incidence of CI-AKI, which was defined as a ≥0.3 mg/dl or 150% increase in serum creatinine concentration within 48 to 72 hours after cardiac angiography. Results: We studied 61 patients, 30 in the bioimpedance group and 31 in the control group. Age was similar (72.5 ± 7 vs. 71.4 ± 7.9 years), as were body mass index (25.5 vs. 25.8 kg/m2) and baseline serum creatinine (1.3 ± 0.3 vs. 1.4 ± 0.4 mg/dl). The peri-procedural fluid volume administered was significantly greater in the BIA-guided hydration group (899.0 ± 252.7 ml vs. 594.4 ± 125.9 ml, P <.01). The incidence of CI-AKI was 3.3% in BIA-guided hydration group and 6.5% in the control group (relative risk = 0.52, 95% confidence interval = 0.05−5.40, P = 1.00). Adverse events reported were comparable between groups (6.7% vs. 6.5%, P = 1.00). Conclusions: The overall incidence of CI-AKI after cardiac angiography in our patients with mild-to-moderate renal insufficiency was lower than anticipated. Isotonic bicarbonate administration guided by bioimpedance measurements was safe, and probably led to a lower incidence of CI-AKI, although this not reach statistical significance.
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    Chryseobacterium meningosepticum Infection and Cardiac Tamponade in a Long-Term Hemodialysis Patient
    (2006-10-01) Thitima Lothuvachai; Khanchit Likittanasombat; Samaniya Milindankura; Amporn Sakulsaengprapha; Chagriya Kitiyakara; Mahidol University
    Chryseobacterium meningosepticum is a lactose-nonfermenting gram-negative bacilli ubiquitously found in the natural and hospital environment. Clinical infection caused by C meningosepticum is very rare among healthy adults. We present the case of a patient with end-stage renal disease who developed purulent pericarditis with C meningosepticum infection, which rapidly evolved into cardiac tamponade and death. To our knowledge, this is the first case in which C meningosepticum caused fatal purulent pericarditis in a hemodialysis patient. © 2006 National Kidney Foundation, Inc.
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    Connective tissue growth factor gene expression and decline in renal function in lupus nephritis
    (2012-04-01) Chiraporn Tachaudomdach; Surasak Kantachuvesiri; Siribha Changsirikulchai; Surangkana Wimolluck; Koset Pinpradap; Chagriya Kitiyakara; Mahidol University; Faculty of Medicine, Srinakharinwirot University
    In lupus nephritis (LN), kidney inflammation may be followed by fibrosis and progressive decline in function. Transforming growth factor (TGF)-β is a notable mediator of fibrosis, but it has other beneficial roles, thus indicating a need for alternate therapeutic targets for inhibition of fibrosis. Connective tissue growth factor (CTGF) acts as a downstream mediator of TGF-β in promoting fibrosis, without mediating the immunosuppressive effects of TGF-β. Animal studies show that CTGF may have important roles in renal fibrosis, but data are limited in human subjects. The present study tested the hypothesis that renal CTGF mRNA expression is related to TGF-β1 and collagen I expression and is predictive of renal function deterioration in patients with LN (n=39). Gene expression was measured using multiplex real-time quantitative RT0-PCR and renal function was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) glomerular filtration rate (GFR) equation. Decline in GFR was assessed by regression of GFR at biopsy to 1 year following biopsy. CTGF mRNA expression was significantly correlated with TGF-β1 and collagen I. GFR at biopsy was 89.2±39.2 ml/min. Renal CTGF mRNA expression correlated inversely with baseline GFR. Renal CTGF mRNA was significantly higher in patients with moderate to severe CKD compared to those in the milder CKD group (low GFR 4.92±4.34 vs. high GFR 1.52±1.94, p < 0.005). CTGF mRNA was also higher in patients with subsequent decline in GFR [GFR decline (5.19±4.46) vs. no GFR decline (1.79±1.97); P < 0.01]. In conclusion, renal expression of CTGF was positively related to TGF-β1 and collagen I in patients with LN. Furthermore, high CTGF mRNA expression was associated with poor GFR at baseline and subsequent deterioration of kidney function. CTGF expression in the kidney may serve as an early marker for renal disease progression and could be evaluated as a target for therapeutic intervention to prevent renal failure in LN.
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    Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease
    (2019-10-01) Natalia Alencar de Pinho; Adeera Levin; Masafumi Fukagawa; Wendy E. Hoy; Roberto Pecoits-Filho; Helmut Reichel; Bruce Robinson; Chagriya Kitiyakara; Jinwei Wang; Kai Uwe Eckardt; Vivekanand Jha; Kook Hwan Oh; Laura Sola; Susanne Eder; Martin de Borst; Maarten Taal; Harold I. Feldman; Bénédicte Stengel; Ognjenka Djurdjev; Mila Tang; Naohiki Fujii; Shoichi Maruyama; Takahiro Imaizumi; Jianzhen Zhang; Zaimin Wang; Helen G. Healy; Ziad A. Massy; Christian Combe; Maurice Laville; Roberto Pecoits Filho; Antonio Lopes; Ronald Pisoni; Brian Bieber; Charlotte Tu; Pornpen Sangthawan; Warangkana Pichaiwong; Pinkaew Klyprayong; Paula Orlandi; Raymond Townsend; Alan Go; Luxia Zhang; Vivek Kumar; Ashok Kumar Yadav; Seema Baid-Agrawal; Curie Ahn; Dong Wan Chae; Seung Hyeok Han; Pablo G. Rios; Liliana Gadola; Veronica Lamadrid; Johannes Leierer; Julia Kerschbaum; Martin H. de Borst; Frans J. Van Ittersum; Jan A. Van den Brand; Maarten A. De Jong; Maarten W. Taal; Adam Shardlow; University of Queensland; Tokai University School of Medicine; University of New South Wales (UNSW) Australia; Charité – Universitätsmedizin Berlin; Université Paris-Sud; Pontificia Universidade Catolica do Parana; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; University of Nottingham; Peking University; The University of British Columbia; Medizinische Universitat Innsbruck; University of Groningen, University Medical Center Groningen; University of Pennsylvania Perelman School of Medicine; Friedrich-Alexander-Universität Erlangen-Nürnberg; Seoul National University College of Medicine; Centro de Diálisis Peritoneal; Arbor Research Collaborative for Health; Nephrological Center
    © 2019 International Society of Nephrology Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
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    Contribution of Four Polymorphisms in Renin-Angiotensin-Aldosterone-Related Genes to Hypertension in a Thai Population
    (2019-01-01) Pimphen Charoen; Jakris Eu-Ahsunthornwattana; Nisakron Thongmung; Pedro A. Jose; Piyamitr Sritara; Prin Vathesatogkit; Chagriya Kitiyakara; Maha Abdalla; School of Medicine and Health Sciences; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University
    © 2019 Pimphen Charoen et al. Introduction. The roles of genes in the renin-angiotensin-aldosterone system (RAAS) in hypertension, including angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II receptor type 1 (AGTR1), and aldosterone synthase (CYP11B2), have been widely studied across different ethnicities, but there has been no such investigation in Thai population. Materials and Methods. Using 4,150 Thais recorded in the Electricity Generating Authority of Thailand (EGAT) study, we examined the association of rs1799752, rs699, rs5186, and rs1799998 located in or near ACE, AGT, AGTR1, and CYP11B2 genes in hypertension. We investigated their roles in hypertension using multivariate logistic regression and further examined their roles in blood pressure (BP) using quantile regression. Sex, age, and BMI were adjusted as potential confounders. Results. We did not observe associations between hypertension and rs1799752 (P=0.422), rs699 (P=0.36), rs5186 (P=0.49), and rs1799998 (P=0.71). No evidence of association between these SNPs and BP was found across an entire distribution. A nonlinear relationship between age and BP was observed. Conclusion. In Thai population, our study showed no evidence of association between RAAS-related genes and hypertension. While our study is the first and largest study to investigate the role of RAAS-related genes in hypertension in Thai population, restricted statistical power due to limited sample size is a limitation.
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    Distribution pattern of mesangial C4d deposits as predictor of kidney failure in IgA nephropathy
    (2021-06-01) Suchin Worawichawong; Sirithep Plumworasawat; Wisit Liwlompaisan; Vasant Sumethkul; Bunyong Phakdeekitcharoen; Umaporn Udomsubpayakul; Panus Chalermsanyakorn; Chagriya Kitiyakara; Faculty of Medicine Ramathibodi Hospital, Mahidol University
    Mesangial C4d deposits have been associated with worse outcomes in Western patients with IgA nephropathy (IgAN), but there is limited data in Asians. Previously, a high proportion of stained glomeruli was often required for the classification of C4d positive (C4d+ve). Positive staining in lower proportion of staining would be classified as C4d-ve. This retrospective study evaluated the prognostic value of C4d+ve using a less stringent definition (one C4d+ve glomerulus) in Thai patients with IgAN (n = 120). Baseline findings and outcomes were compared between those with more extensive C4d staining patterns and those with more restricted staining. Clinico-pathologic parameters and risk for kidney outcomes (kidney failure or decline GFR50%) were compared between C4d+ve versus C4d-ve, and between different patterns: Focal (< 50%) versus Diffuse (≥ 50% of glomeruli); or Global (≥ 50) versus Segmental (< 50% of mesangial area). The hazard ratios were estimated using Cox proportional hazard models for Model 1 (Oxford score+ C4d) and Model 2 (Model 1+ clinical factors). C4d+ve (n = 81) had lower eGFR, more global sclerosis, and interstitial fibrosis than C4d-ve at baseline. The 5-year kidney survival for C4d+ve was lower (53.7%) than C4d-ve (89.7%); P = 0.0255. By univariate analysis, T1, T2, C4d+ve, eGFR<60, proteinuria were predictors of kidney outcome. By multivariate analysis, proteinuria, T1, T2 and C4d+ve were independent predictors (Model 2 HR (95% CI) C4d+ve: 3.24 (1.09–9.58), p = 0.034). Segmental had lower eGFR, higher tubulointerstitial fibrosis, and segmental sclerosis compared to Global pattern. Clinicopathological parameters were not different between Focal and Diffuse patterns. Outcomes were similar between staining patterns. In conclusion, C4d staining may be a valuable marker of poor prognosis in Asian patients with IgAN. Less stringent criteria for C4d+ve should be considered as no differences in outcomes were observed between more extensive staining with less extensive patterns. More studies are needed to identify the optimum criteria for C4d+ve.
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    Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody
    (2020-01-01) Surasak Kantachuvesiri; Atiporn Ingsathit; Duangtawan Thammanichanond; Kunvadee Choochaeam; Supasil Sra-ium; Chagriya Kitiyakara; Arkom Nongnuch; Bundit Sakulchairungrueng; Suchin Worawichawong; Faculty of Medicine, Ramathibodi Hospital, Mahidol University
    © 2020 Elsevier Inc. Background: Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT). Methods: A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted. The novel protocol consisted of 3 to 5 sessions of pretransplant double-filtration plasmapheresis (DFPP) with or without low-dose intravenous immunoglobulin together with low-dose anti-thymocyte globulin (ATG) induction (1-1.5 mg/kg/d for 3-4 days) and low-dose tacrolimus (Tac) (trough level 5-10 ng/mL), mycophenolate, and prednisolone. Results: The study included 17 patients. The lymphocyte crossmatch via complement-dependent cytotoxicity was negative in 12 patients and positive for B cell immunoglobulin M in 5 patients. The novel desensitization protocol resulted in a decrease of at least 50% of DSA mean fluorescence intensity from baseline (from 4320 ± 549 before DFPP to 1601 ± 350 before transplantation, P <.005) and successful kidney transplantation with good allograft function in all cases. Early DSA rebound was observed in 3 patients after transplantation, and kidney biopsy revealed subclinical antibody-mediated rejection in 1 patient and diffuse C4d staining without cell infiltration in 2 patients. There were good long-term outcomes in patient and graft survival (100% and 94.1%, respectively). Only 1 allograft loss occurred because of nonadherence. The majority of patients have stable allograft function with serum creatinine less than 1.5 mg/dL. However, infections, including CMV and other organisms, were commonly observed. Conclusions: Desensitization protocol with DFPP, low-dose ATG, and Tac provides excellent outcomes in living donor kidney transplantation in highly sensitized Asian populations.
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    Effect of bioelectrical impedance analysis-guided dry weight adjustment, in comparison to standard clinical-guided, on the sleep quality of chronic haemodialysis patients (BEDTIME study): A randomised controlled trial
    (2019-09-02) Sethanant Sethakarun; Sutachard Bijaphala; Chagriya Kitiyakara; Sarinya Boongird; Pariya Phanachet; Sirimon Reutrakul; Kwanchai Pirojsakul; Arkom Nongnuch; University of Illinois at Chicago; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Vichaiyut Hospital
    © 2019 The Author(s). Background: Sleep disturbance is common among chronic haemodialysis patients, which leads to poor quality of life, in addition to increased instances of morbidity and mortality. Hypervolemia has been linked to sleep problems observed in chronic haemodialysis patients, which suggests that optimising one's fluid status could improve the sleep quality of this patient group. In our study, we subjectively examined and objectively measured sleep parameters, using actigraphy recordings, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and Epworth Sleepiness Scale (ESS), in order to compare bioelectrical impedance analysis (BIA)-guided and standard clinical-guided dry weight adjustment. Methods: We randomly selected 19 chronic haemodialysis patients with subclinical hypervolemia, defined as a clinically euvolemic status, despite the ratio of extracellular water to total body water being more than 0.4 in BIA. Furthermore, these patients, who were poor sleepers (PSQI > 5), were assigned to either a BIA-guided dry weight group (BIA group) or a standard clinical-guided one (clinical group). The primary outcome was changes in sleep actigraphy parameters between the groups at 1, 3, and 6 months. Changes observed in the PSQI and ESS score between the two groups over the same period of time were the secondary endpoints. Results: The mean age of the participants was 63.53 ± 11.12 years, and 42% of them were male. All sleep parameters measured by means of actigraphy were not significantly different between the two groups. Interestingly, at 3 and 6 months, the subjective sleep quality significantly improved in the BIA group, as reflected by a greater decline in the PSQI score, in comparison with the clinical group (3 months: mean difference - 1.82 [- 3.13 to - 0.51], P = 0.006; 6 months: mean difference - 3.16 [- 4.49 to - 1.83], P < 0.001). However, sleepiness assessed by the ESS was not significantly different between the groups throughout the study. Conclusions: Optimisation of the fluid status by employing BIA did not improves sleep actigraphy parameter, however, it significantly ameliorates the subjective sleep quality of chronic haemodialysis patients. This observation should be further explored in larger samples and longer clinical trials. Trial registration: This trial was registered at ClinicalTrials.gov (NCT02825589) on July 7, 2016.
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    Effects of glomerular filtration rate estimating equations derived from different reference methods on staging and long term mortality risks of chronic kidney disease in a Southeast Asian cohort
    (2016-08-01) Sukit Yamwong; Chagriya Kitiyakara; Prin Vathesatogkit; Krittika Saranburut; Anchalee Chittamma; Sayan Cheepudomwit; Somlak Vanavanan; Tawatchai Akrawichien; Piyamitr Sritara; Mahidol University; Electricity Generating Authority of Thailand
    © 2015 Asian Pacific Society of Nephrology Aim: There are limited data on the risks of chronic kidney disease (CKD) in Southeast Asian populations. Several GFR estimating equations have been developed in diverse Asian populations, but they produce markedly discrepant results. We investigated the impact of Asian equations on the mortality risk of CKD in a Thai cohort during long term follow-up, and explored the differences between equations grouped according to the reference GFR methods used to develop them. Methods: Employees of the Electricity Generating Authority of Thailand (n = 3430) were enrolled in a health survey and followed up for 22 years. The risks for all-cause mortality for each GFR stage classified by CKD-EPI or different Asian equations were assessed by using Cox proportional hazard models. Results: Equations derived from DTPA clearance (Chinese MDRD, Thai GFR, Singapore CKD-EPI) produced higher GFR, whereas equations from inulin clearance (Japanese CKD-EPI, Taiwan MDRD or Taiwan CKD-EPI) produced lower GFR compared to CKD-EPI. (Average ΔGFR: inulin, –14.9 vs. DTPA +5.80 mL/min per 1.73 m2, P < 0.001). CKD prevalence varied widely (0.7 to 24 %) with inulin-based equations being higher than DTPA-based. GFR stage concordance was over 80% for equations using similar reference method compared to less than 40% between inulin and DTPA-based equations. Low GFR (<45) was an independent mortality risk factor when DTPA-based equations were used, but not when inulin-based equations were used. Conclusion: Chronic kidney disease prevalence and prognosis in Thais varied widely depending on the equation used. Differences in the reference GFR methods could be an important cause for the discrepancies between Asian equations.
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    Extracellular Matrix and Collagen Index in Lupus Nephritis
    (2009) Pleumjit Tankee; Suwikran Wongpraphairot; Panas Chalermsanyakorn; Koset Pinpradap; Nippa Srinak; Porntip Chatchaipun; Sasivimol Rattanasiri; Surasak Kantachuvesiri; Vasant Sumethkul; Chagriya Kitiyakara; ปลื้มจิตร ตันกี่; สุวิกรานต์ วงศ์ประไพโรจน์; พนัส เฉลิมแสนยากร; โกเศศ ปิ่นประดับ; นิพย์ภา ศรีนาค; พรทิพย์ ฉัตรชัยพันธ์; ศศิวิมล รัตนสิริ; สุรศักดิ์ กันตชูเวสศิริ; วสันต์ สุมธกุล; ชาครีย์ กิติยากร; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Department of Medicine; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Department of Pathology; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Section for Clinical Epidemiology and Biostatistics
    Background: Interstitial fibrosis is associated with poor long term outcome in many kidney diseases. We investigated the predictive value of extracellular matrix quantification on long term outcome in patient with lupus nephritis. Methods: A cohort of 43 patients with lupus nephritis (LN) was followed from the time of biopsy. Kidney biopsy specimens were stained with picro-sirius red. The magnitude of fibrotic tissue was calculated by computerized image analysis. Each biopsy tissue was evaluated for different parameters: collagenous matrix index (CMI), fibrillary collagen index (FCI), activity index and chronicity index. Result: At baseline, median serum creatinine(Cr) was 0.8 mg/dl and mean eGFR was 90.3 ± 37.6 ml/min/ 1.73 m2. Median follow up was 56.4 (range 1.2 - 13.2) months. Thirty-three patients achieved remission (22 complete remission, 11 partial remission), 20 patients had decreased 25%eGFR, 6 patients had renal failure (dialysis, eGFR<15 or Cr >5) and 9 patients died. At the time of biopsy, the activity index correlated with Cr, eGFR and proteinuria. Chronicity index correlated with Cr and eGFR. CMI correlated with Cr and tended to correlate with eGFR. Low CMI predicted good long term renal outcome as assessed by 25% decreased eGFR, renal failure and death. Low activity index was associated with earlier remission. The activity index, chronicity index and FCI predicted of long term renal outcome. Summary: A computerized system for extracellular matrix quantification of LN predicts long term renal outcome. Future studies are necessary to determine benefit.
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    Glomerular albumin filtration through podocyte cell body in puromycin aminonucleoside nephrotic rat
    (2008-06-01) Akihiro Tojo; Maristela Lika Onozato; Chagriya Kitiyakara; Satoshi Kinugasa; Satoru Fukuda; Toshio Sakai; Toshiro Fujita; University of Tokyo; Georgetown University; Mahidol University; Sakai Electron Microscope Application Laboratory
    It is an a priori concept that protein molecules including albumin are filtrated through the slit membrane between the foot processes of podocytes. However, foot processes are effaced and the number of slit membranes is reduced in nephrotic syndrome, suggesting another pathway of albumin filtration through the foot process cell body. Thus, we investigated the pathway of gold-and fluorescein isothiocyanate (FITC)-labeled albumin filtration in the puromycin aminonucleoside (PAN) model of nephrotic syndrome in the rat. PAN rats at day 7 with established nephrotic proteinuria were injected with 8-nm gold-labeled albumin and FITC-labeled albumin through the jugular vein followed by kidney fixation at 10 or 30 min. Goldlabeled albumin was accumulated in the paramesangial area and in the endosomes of glomerular endothelial cells of both control and PAN rats by electron microscopy. On the other hand, FITC-labeled albumin was detected between foot processes in the control but more in the podocyte cell body in the PAN rat. In conclusion, albumin will be filtrated through the decreased numbers of slit diaphragms; however, albumin can be also taken up in the podocyte, the mesangium, and the glomerular endothelium, suggesting that there might be other routes of glomerular albumin clearance in nephrotic syndrome. © 2008 The Japanese Society for Clinical Molecular Morphology.
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    Herbal or traditional medicine consumption in a Thai worker population: Pattern of use and therapeutic control in chronic diseases
    (2019-09-18) Napatt Kanjanahattakij; Pakakrong Kwankhao; Prin Vathesatogkit; Nisakron Thongmung; Yingampa Gleebbua; Piyamitr Sritara; Chagriya Kitiyakara; Electricity Generating Authority of Thailand; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Chao Phya Abhaibhubejhr Hospital; Einstein Medical Center
    © 2019 The Author(s). Background: Herbal and traditional medicines (HTM) are widely used in Asian countries. Specific data on prevalent of HTM usage and association with chronic diseases in the Thai population is currently lacking. We examined the prevalence and factors associated with HTM use in a Thai worker population. In addition, we explored the relationship between HTM use and therapeutic control of cardiovascular risk factors and documented the most common types of HTM used in various chronic diseases. Methods: Employees of EGAT (The Electric Generating Authority of Thailand) who had participated in a health examination were studied. Each participant documented their HTM consumption and self-reported chronic diseases in a questionnaire. Clinical disease and therapeutic control were also defined by concomitant laboratory tests. Results: Of a total of 6592 subjects, 32.6% were HTM-users. Age < 50 years, female gender, self-reported history of diabetes, liver disease, cancer, dyslipidemia, and alcohol use were independently associated with HTM use. HTM consumption increased in proportion to the numbers of self-reported chronic diseases. There were no differences in the therapeutic control of cardiovascular risk factors between HTM users and non-users. Liver and kidney function were not different. The most commonly used HTM was turmeric. Conclusions: HTM consumption is common in community-based Thai subjects, with higher use among those with chronic diseases. Although there were no differences in control of cardiovascular risk factors between HTM users and non-users, many of the commonly used herbs have relevant biological activities for chronic disease prevention or treatment.
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    High collagen I gene expression as an independent predictor of adverse renal outcomes in lupus nephritis patients with preserved renal function
    (2015-01-01) Chiraporn Tachaudomdach; Surasak Kantachuvesiri; Suwikran Wongpraphairot; Suchin Worawichawong; Pleumjit Tankee; Suda Riengrojpitak; Chagriya Kitiyakara; Mahidol University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University; Prince of Songkla University; Vachira Phuket Hospital
    Context. - The deposition of extracellular matrix is a major pathogenic mechanism leading to fibrosis and progressive decline in renal function in patients with lupus nephritis (LN). Currently, available clinicopathologic features cannot predict renal outcome consistently. Objective. - To test that the expression of renal fibrogenic genes correlates with renal fibrosis at the time of biopsy and is predictive of renal outcomes. Design. - Renal gene expression levels of transforming growth factor β-1 (TGFB1), and collagen I (COL1) were studied by real-time multiplex quantitative polymerase chain reaction in a prospective cohort of patients with LN (n = 39). Extracellular matrix index (ECMI) and collagen I/ III matrix index were measured from Picro-Sirius Red- stained slides under normal and polarized light, respectively. Results. - After follow-up (median, 43.9 months), renal failure (50% reduction in glomerular filtration rate [GFR] or dialysis) had developed in 13 subjects. The expression levels of renal fibrogenic genes were increased as compared to controls without LN. COL1 correlated with collagen I/III matrix index at baseline. Both high expression of TGFB1 or COL1 tended to predict renal failure by univariate analysis. By multivariate analysis, high ECMI and low GFR were predictive of renal failure. In patients with baseline GFR of 60 mL/min/1.73 m2or greater, high renal COL1 expression was an independent (hazard ratio = 4.4, P = .04) predictor of renal failure. Conclusions. - High renal COL1 expression is a strong predictor of adverse renal outcome in patients with LN and preserved baseline GFR. These findings support larger prospective studies to confirm the benefits of COL1 in identifying patients at high risk of progression to renal disease.
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    The impact of different GFR estimating equations on the prevalence of CKD and risk groups in a Southeast Asian cohort using the new KDIGO guidelines
    (2012) Chagriya Kitiyakara; Sukit Yamwong; Prin Vathesatogkit; Anchalee Chittamma; Sayan Cheepudomwit; Somlak Vanavanan; Bunlue Hengprasith; Piyamitr Sritara; Mahidol University. Faculty of Medicine Ramathibodi Hospital. Department of Medicine
    Background: Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group recommended that patients with CKD should be assigned to stages and composite relative risk groups according to GFR (G) and proteinuria (A) criteria. Asians have among the highest rates of ESRD in the world, but establishing the prevalence and prognosis CKD is a problem for Asian populations since there is no consensus on the best GFR estimating (eGFR) equation. We studied the effects of the choice of new Asian and Caucasian eGFR equations on CKD prevalence, stage distribution, and risk categorization using the new KDIGO classification. Methods: The prevalence of CKD and composite relative risk groups defined by eGFR from with Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI); standard (S) or Chinese(C) MDRD; Japanese CKD-EPI (J-EPI), Thai GFR (T-GFR) equations were compared in a Thai cohort (n = 5526) Results: There was a 7 fold difference in CKD3-5 prevalence between J-EPI and the other Asian eGFR formulae. CKD3-5 prevalence with S-MDRD and CKD-EPI were 2 - 3 folds higher than T-GFR or C-MDRD. The concordance with CKD-EPI to diagnose CKD3-5 was over 90% for T-GFR or C-MDRD, but they only assigned the same CKD stage in 50% of the time. The choice of equation also caused large variations in each composite risk groups especially those with mildly increased risks. Different equations can lead to a reversal of male: female ratios. The variability of different equations is most apparent in older subjects. Stage G3aA1 increased with age and accounted for a large proportion of the differences in CKD3-5 between CKD-EPI, S-MDRD and C-MDRD. Conclusions: CKD prevalence, sex ratios, and KDIGO composite risk groupings varied widely depending on the equation used. More studies are needed to define the best equation for Asian populations.