Papers by Anutra Chittinandana
Nephrology, Sep 20, 2020
Background: Elevated plasma levels of fibroblast growth factor 23 (FGF23) have emerged as a predi... more Background: Elevated plasma levels of fibroblast growth factor 23 (FGF23) have emerged as a predictor for the development of acute kidney injury (AKI) in patients undergoing cardiac surgery and those with critical illnesses. However, accurate data in cases involving acute decompensated heart failure (ADHF) remains limited. Methods: Single centre cohort study was performed in patients admitted for ADHF. Plasma c-terminal FGF23 (c-FGF23) was measured at baseline and 24 hours after being diagnosed with ADHF. AKI was defined by KDIGO 2012 criteria. Results: The study enrolled 62 patients diagnosed with ADHF. The incidence of AKI was 45% and significantly increased the risk of death. Patients developing AKI had significantly higher levels of plasma c-FGF23 at baseline in comparison with those not developing AKI [median value 1258.5 (57.2, 15 850) vs 230.2 (68.515 850) RU/mL, P = .005]. During the first 24 hours, plasma c-FGF23 levels decreased in both groups, and the levels of c-FGF23 at 24 hours were consistent with the baseline [861.8 (75.7, 15 850) vs 226.3 (56, 5450.8) RU/mL, P = .006]. Receiver operating characteristic analysis of both first time and second time for plasma c-FGF23 collection yielded an area under curve of 0.71 for the prediction of AKI incidence. With the cutoff point at 450 RU/mL, the sensitivity and specificity of plasma c-FGF23 at the baseline for predicting AKI were 71.4% and 61.8% respectively. Conclusion: Plasma c-FGF23 may serve as a novel biomarker for development of AKI in patients with ADHF. These results should be revalidated in larger-scale, cohort studies. K E Y W O R D S acute decompensated heart failure, acute kidney injury, biomarker, fibroblast growth factor 23 Patients with acute decompensated heart failure (ADHF) have a high incidence of acute kidney injury (AKI) of 29% to 63%. 1,2 AKI is an important risk factor for prolonged hospitalization, 3 poor long-term quality of life 3 and mortality. 1-3 Therefore, AKI must be diagnosed, treated or prevented quickly and appropriately. Many urinary biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), 4-6 kidney injury molecule-1(KIM-1) 4,5 and interleukin 18 (IL-18) 4 have been studied in order to predict the occurrences of AKI in these
PubMed, Aug 1, 2006
Objective: Chronic kidney disease (CKD) is a major public health problem worldwide. Until now, no... more Objective: Chronic kidney disease (CKD) is a major public health problem worldwide. Until now, no large-scale data about the prevalence of pre-dialysis CKD has been reported in Thailand. Material and method: The clinical and laboratory data from the ground air force personnel who were routinely checked up during 2002-2003 were collected and descriptively analyzed. The pilots and air crews were excluded. All personnel were working in Bangkok. Results: 15,612 RTAF personnel completed the annual check up. Eighty-two percent were male. The average age was 45.7 +/- 8 (19-65) years. According to the classification of stages of CKD by Kidney Disease Outcome Quality Initiative (K/DOQI), the prevalence of CKD is 9.1% by Cockcroft Gault formula and 4.6% by Modification of Diet in Renal Disease. Patients with diabetes mellitus, hypertension, hypercholesterolemia and proteinuria were found in 8.2%, 45.8 %, 28.2 % and 1.8% respectively. CKD patients were older had higher body weight, Body Mass Index (BMI), blood pressure and blood sugar than non CKD personnel. Conclusion: CKD were not uncommon among RTAF personnel. The Cockcroft-Gault and MDRD equations were different in detecting CKD in the present study. The appropriate equation to determine GFR in Thai population should be evaluated. Low sensitivity of dipstick proteinuria may cause the low prevalence of stage 1 and 2 CKD.
Nihon Toseki Igakkai Zasshi, 1999
Journal of Hypertension, Jun 1, 2011
(ALD) were tested and diastolic blood pressure (DBP) responses were monitored. Genetic equilibriu... more (ALD) were tested and diastolic blood pressure (DBP) responses were monitored. Genetic equilibrium test was performed by Hardy-Weinberg equilibrium method. Results: Neither the basic line nor reduction of blood pressure exhibited significant difference between ACEI and CCB groups. In ACEI group, with particular AGT A-6G genotypes or CYP11B2 T-344C genotypes, AGT GG genotype showed higher levels of AngII and ALD than AGT AG and AA genotypes(P = 0.046, P = 0.037, respectively), while CYP11B2 TT higher than CYP11B2 CC and CT (P = 0.042, P = 0.047, respectively). AGT GG genotype and CYP11B2 TT genotype were more likely to show a trend for decreasing DBP response than AGT AG and AA genotypes, and CYP11B2 CC and CT genotypes, respectively (76.3
Vascular Health and Risk Management, Mar 1, 2010
To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensive patient... more To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensive patients in Thailand. Patients and methods: A cross-sectional study was performed during January to December 2007 at outpatients departments of Bhumibol Adulyadej hospital. Nondiabetic hypertensive patients without a history of pre-existing kidney diseases participated in this study. A questionnaire was used for collecting information on demographics, lifestyle, and family history of cardiovascular and kidney disease. Spot morning urine samples were collected for albuminuria estimation. Albuminuria thresholds were evaluated and defined using albumin-creatinine ratio (ACR). Results: A total of 559 hypertensive patients (283 males, 276 females), aged 58.0 ± 11.6 years were enrolled in this study. Microalbuminuria (ACR 17 to 299 mg/g in males and 25 to 299 mg/g in females) was found in 93 cases (16.6%) [15.0%-18.2%]. The independent determinants of elevated urinary albumin excretion in a multiple logistic regression model were; body mass index 30 (odds ratio (OR) = 2.24, 95% confidence intervals (CI): 1.33-3.76) and dihydropyridine calcium channel blockers (DCCB) use (OR = 1.92, 95% CI: 1.22-3.02). Conclusion: In Thai nondiabetic hypertensive patients, microalbuminuria was not uncommon. Obesity and use of dihydropyridine calcium channel blocker were found to be the important predictors. Prognostic value of the occurrence of microalbuminuria in this population remains to be determined in prospective cohort studies.
International Journal of Nephrology and Renovascular Disease, Feb 1, 2017
Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients wit... more Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (HPT). This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT. Materials and methods: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group). Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH) levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested. Results: A total of 30 patients (16 low doses and 14 controls) took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413). The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0). Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957). There was no difference in the adverse events between both groups. Conclusion: Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials.
Purpose: To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensiv... more Purpose: To assess the prevalence and risk factors of microalbuminuria in nondiabetic hypertensive patients in Thailand. Patients and methods: A cross-sectional study was performed during January to December 2007 at outpatients departments of Bhumibol Adulyadej hospital. Nondiabetic hypertensive patients without a history of pre-existing kidney diseases participated in this study. A questionnaire was used for collecting information on demographics, lifestyle, and family history of cardiovascular and kidney disease. Spot morning urine samples were collected for albuminuria estimation. Albuminuria thresholds were evaluated and defined using albumin-creatinine ratio (ACR). Results: A total of 559 hypertensive patients (283 males, 276 females), aged 58.0 ± 11.6 years were enrolled in this study. Microalbuminuria (ACR 17 to 299 mg/g in males and 25 to 299 mg/g in females) was found in 93 cases (16.6%) [15.0%‑18.2%]. The independent determinants of elevated urinary albumin excretion in a ...
Nephrology, 2020
BackgroundElevated plasma levels of fibroblast growth factor 23 (FGF23) have emerged as a predict... more BackgroundElevated plasma levels of fibroblast growth factor 23 (FGF23) have emerged as a predictor for the development of acute kidney injury (AKI) in patients undergoing cardiac surgery and those with critical illnesses. However, accurate data in cases involving acute decompensated heart failure (ADHF) remains limited.MethodsSingle centre cohort study was performed in patients admitted for ADHF. Plasma c‐terminal FGF23 (c‐FGF23) was measured at baseline and 24 hours after being diagnosed with ADHF. AKI was defined by KDIGO 2012 criteria.ResultsThe study enrolled 62 patients diagnosed with ADHF. The incidence of AKI was 45% and significantly increased the risk of death. Patients developing AKI had significantly higher levels of plasma c‐FGF23 at baseline in comparison with those not developing AKI [median value 1258.5 (57.2, 15 850) vs 230.2 (68.515 850) RU/mL, P = .005]. During the first 24 hours, plasma c‐FGF23 levels decreased in both groups, and the levels of c‐FGF23 at 24 hour...
American Journal of Physiology-Renal Physiology, 1994
In the isolated perfused rat kidney, endothelin (ET) added to the perfusate at concentrations ran... more In the isolated perfused rat kidney, endothelin (ET) added to the perfusate at concentrations ranging from 50 to 500 pmol/l resulted in a dose-dependent reduction in renal perfusate flow (RPF) and inulin clearance (CIn). The decrease in RPF (17 +/- 3 vs. 34 +/- 3 ml.min-1 x g-1; P < 0.01 compared with control) and CIn (89 +/- 13 vs. 317 +/- 19 microliters.min-1 x g-1; P < 0.01 compared with control) by ET (500 pmol/l) was prevented by the ET antagonist BQ-123 (10 microM), with full recovery of RPF [36 +/- 2 vs. 34 +/- 3 ml.min-1 x g-1; not significant (NS) compared with control] and CIn (299 +/- 51 vs. 317 +/- 19 microliters.min-1 x g-1; NS compared with control). In the absence of ET, perfusion of the kidney with a similar concentration of BQ-123 (10 microM) did not induce any changes in RPF (36 +/- 5 vs. 34 +/- 3 ml.min-1 x g-1; NS compared with control) or CIn (320 +/- 14 vs. 317 +/- 19 microliters.min-1 x g-1; NS compared with control). After 60 min of arterial clamping, B...
International Journal of Nephrology and Renovascular Disease, 2017
Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients wit... more Introduction: Cinacalcet is effective in reducing serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (HPT). This study focused on testing whether a prescription of low-dose cinacalcet on alternate days could be an option for treatment of secondary HPT. Materials and methods: A retrospective clinical study was conducted on chronic maintenance hemodialysis patients. Patients with secondary HPT who received cinacalcet at a starting dose of 25 mg on alternate days were reviewed (low-dose group). Patients who were being treated with a standard dose of cinacalcet in the same period of time were selected as the control group. The primary outcome was difference in the percentage of patients achieving >30% reduction of intact parathyroid hormone (iPTH) levels at 16 weeks. The changes of serum iPTH and other biochemical data were also tested. Results: A total of 30 patients (16 low doses and 14 controls) took part in the study. Baseline iPTH levels in the low-dose and control group were 1,065.9±477.7 and 1,214.1±497.6 pg/mL, respectively (p=0.413). The analysis showed that the percentage of patients who achieved the primary outcome showed little or no difference (33.3% in the low-dose group compared with 38.5% in the control group, p=1.0). Serum iPTH reduction during 16 weeks of study period in the low-dose and control group was 253.5±316.1 and 243.4±561.3 pg/mL, respectively (p=0.957). There was no difference in the adverse events between both groups. Conclusion: Among patients with secondary HPT, initial treatment with cinacalcet 25 mg on alternate days can decrease serum PTH levels. The role of low-dose cinacalcet in secondary HPT should be further determined in large-scale, randomized controlled trials.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2011
The percentage of utilizing peritoneal dialysis (PD) in Thailand was increased dramatically since... more The percentage of utilizing peritoneal dialysis (PD) in Thailand was increased dramatically since the implementation of PD-First policy in 2008. However, peritonitis remains a major obstacle to achieve success of this modality. The aim of the present study, was to assess the clinical characteristics of PD peritonitis in the PD-first policy era. The PD peritonitis patients in Bhumibol Adulyadej Hospital between October 2008 and December 2010 were reviewed. Microbiological diagnosis, treatment responses, technique, and patient survival were analyzed. Since October 2008, 93 peritoneal dialysis patients were followed-up in Bhumibol Adulyadej Hospital including 75 new cases. During the present study period of 1,560 patient-months, 51 episodes of peritonitis from 33 cases were recorded and analyzed. The mean age of the peritonitis patients was 57.9 +/- 16.1 years and 63.6% were females. The most common isolates were gram negative organisms (33.3%) followed by gram positive (17.6%) and fun...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
Continuous veno-venous hemofiltration (CVVH) is a mode of renal replacement therapy in critically... more Continuous veno-venous hemofiltration (CVVH) is a mode of renal replacement therapy in critically ill patients that has gained popularity all over the world. The authors reviewed one-year experience with CVVH in intensive care units (ICUs) of Bhumibol Adulyadej Hospital. The objectives of this study were to describe the characteristics of the patients and demonstrate the association between various factors and outcome. The medical records of 45 patients who underwent CVVH treatment were analyzed. All patients had been admitted into the ICUs of Bhumibol Adulyadej Hospital between 1 January 2005 and 31 December 2005. Average age of patients was 67.7 +/- 13.3 years (range from 27.0 years to 88.4 years). The male: female ratio was 1.4:1. Twenty-four patients were admitted to the medical ICU, 17 to the coronary care unit (CCU) and 4 to the surgical ICU. All of them needed mechanical ventilator support and 91.1% required vasopressor. Sixty percent of the patients had sepsis. Most of them ...
Nihon Toseki Igakkai Zasshi, 1999
Journal of Hypertension, 2011
(ALD) were tested and diastolic blood pressure (DBP) responses were monitored. Genetic equilibriu... more (ALD) were tested and diastolic blood pressure (DBP) responses were monitored. Genetic equilibrium test was performed by Hardy-Weinberg equilibrium method. Results: Neither the basic line nor reduction of blood pressure exhibited significant difference between ACEI and CCB groups. In ACEI group, with particular AGT A-6G genotypes or CYP11B2 T-344C genotypes, AGT GG genotype showed higher levels of AngII and ALD than AGT AG and AA genotypes(P = 0.046, P = 0.037, respectively), while CYP11B2 TT higher than CYP11B2 CC and CT (P = 0.042, P = 0.047, respectively). AGT GG genotype and CYP11B2 TT genotype were more likely to show a trend for decreasing DBP response than AGT AG and AA genotypes, and CYP11B2 CC and CT genotypes, respectively (76.3
Nephrology (Carlton, Vic.), 2011
Declaration of interests: All members of the Work Group were asked to submit a written record of ... more Declaration of interests: All members of the Work Group were asked to submit a written record of possible conflicts of interest related to the screening of chronic kidney disease. No other conflicts of interest were declared.
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Papers by Anutra Chittinandana