scispace - formally typeset
Search or ask a question
Author

Prasert Thanakitcharu

Bio: Prasert Thanakitcharu is an academic researcher from Rangsit University. The author has contributed to research in topics: End stage renal disease & Renal function. The author has an hindex of 4, co-authored 6 publications receiving 65 citations.

Papers
More filters
Journal Article
TL;DR: The authors conclude that the inferior vena cava diameter and collapsibility index (IVC-CI) can provide a useful guide for noninvasive intravascular volume status assessment of critically-ill patients.
Abstract: Background: Assessment of intravascular volume status is an essential parameter for the diagnosis and management of critically-ill patients. Generally, central venous pressure (CVP), which is an invasive measure, has been recommended for this purpose. Since CVP has been associated with many complications, inferior vena cava diameter and collapsibility index (IVC-CI) were used in the present study to evaluate the intravascular volume status of critically-ill patients at Rajavithi Hospital. Objective: To conduct a prospective, cross-sectional study to evaluate the IVC diameter as a guidance for estimating the volume status in critically-ill patients by bedside ultrasonography, focusing on correlations between CVP and IVC-CI and IVC diameter. Material and Method: Critically-ill patients who had been placed with a functioning central venous catheter were prospectively enrolled. Evaluation of intravascular volume status was performed by bedside ultrasonography to measure the IVC diameters (IVCD), both end-inspiratory (iIVCD) and end-expiratory (eIVCD). The IVC collapsibility indices (IVC-CI) were calculated by an equation and then were compared with the CVP values. Results: Of the 70 enrolled patients, with a mean age of 63.8 + 1.9 years, 64.3% were intubated. The most common indication of ICU admission was sepsis with hemodynamic instability (80.0%). The volume status of patients was stratified by their CVP levels as hypovolemic 15.7%, euvolemic 32.9% and hypervolemic 51.4% which correspond with the IVC-CI of 45.69 + 16.16%, 31.23 + 16.77%, and 17.82 + 12.36% respectively (p < 0.001). The highest significant correlation was found between the CVP and IVC-CI (r = -0.612, p < 0.001). In addition, there was a significant correlation between CVP and iIVCD (r = 0.535, p < 0.001); and between the CVP and mean IVCD (r = 0.397, p = 0.001). Conclusion: The present study supported the correlation between CVP and IVC-CI. The authors conclude that the IVC-CI can provide a useful guide for noninvasive intravascular volume status assessment of critically-ill patients. Keywords: Central venous pressure, Inferior vena cava diameter, Collapsibility index, Intravascular fluid volume, Ultrasonography

42 citations

Journal Article
TL;DR: Assessment of body fluid distribution and edematous states in CKD patients measured by MF-BIA was a reliable measure and demonstrated that subclinical edema actually occurred in early stages of CKD before detection of overt edema by physical examination.
Abstract: Background: Abnormalities in body water distribution are common in chronic kidney disease (CKD) patients. Volume expansion, even in the absence of overt edema, contributes to high blood pressure, and progressive volume expansion eventually leads to clinical edema and fluid overload. Total body water (TBW) can be accurately estimated by multifrequency bioelectrical impedance analysis (MF-BIA) which has been proposed for earlier detection of subclinical edema in CKD patients. Objective: To study body fluid distribution and edematous states in CKD patients measured by MF-BIA, compared with clinical edema assessed by physical examination. In addition, to evaluate the correlation of MF-BIA estimated TBW and anthropometry-derived TBW calculated by Watson formula. Material and Method: CKD patients at Rajavithi Hospital together with healthy adults were prospectively enrolled during a 12-month period. The body fluid compositions assessed by bioelectrical impedance analyzer (InBody® S20, Republic of Korea) were taken immediately after physical examination for edema detection. The patients were categorized into stages 1 to 5 according to CKD staging in the NKF-K/DOQI guidelines, and reclassified into 3 groups of stages1-2, stages 3-4, and stage 5. Results: Sixty-nine CKD patients were compared with 48 healthy volunteers. The estimated glomerular filtration rate (GFR) in CKD patients and normal controls were 53.5+41.1 and 113.9+0.8 ml/min/1.73 m2 respectively. The extracellular water (ECW) to TBW ratio, which represents edematous state if higher than 0.4, was significantly higher in patients with CKD stages 3-4 (0.400+0.008) and stage 5 (0.404+0.011), than in those in CKD stages 1-2 (0.393+0.009) and controls (0.385+0.007) (p<0.001). The prevalence of edematous state detected by BIA (edema-BIA) in CKD patients was significantly greater than in normal controls (78.3% vs. 25.0%, p<0.001). The number of CKD patients with edema-BIA was also significantly higher than the number of patients with clinical edema (36.2%), which represented a significant proportion of patients (42.1%) with subclinical edema. The sensitivity and specificity of edema detected by physical examination in all CKD patients compared to the assessment by MF-BIA were 44.4% and 93.3% respectively. There was a significant correlation between the TBW calculated by the Watson formula and TBW estimated by MF-BIA (r2 = 0.848, p<0.001). Conclusion: The present study demonstrated that assessment of body fluid distribution by MF-BIA was a reliable measure. Subclinical edema actually occurred in early stages of CKD before detection of overt edema by physical examination. TBW calculated by Watson formula can alternatively be used for evaluation of hydration status and can assist physicians in prescribing appropriate management for CKD patients. Keywords: Body fluid distribution, Subclinical edema, Chronic kidney disease, Multifrequency bioimpedance analysis

9 citations

Journal Article
TL;DR: UNGAL level may be a useful marker for predicting AKI in adult patients undergoing open cardiac surgery and also to determine the risk factors for AKI development.
Abstract: Background: Acute kidney injury (AKI) is a common complication in patients undergoing open cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin (UNGAL) is an early marker of AKI, however, its predictive value in adult patients undergoing open cardiac surgery has never been investigated in Thailand. Objective: The present study aimed to determine the cut-off level of UNGAL for predicting AKI in adult patients undergoing open cardiac surgery and also to determine the risk factors for AKI development. Material and Method: In all, 130 patients at Rajavithi Hospital were prospectively enrolled during a six-month period. UNGAL was obtained at baseline before surgery, and at 0, 3, and 6 hours after surgery and assessed by ARCHITECT NGAL assay. Serum creatinine levels were measured at baseline before surgery simultaneously for the collection of UNGAL and then daily after surgery. AKI was defined as an increment in serum creatinine of >0.3 mg/dl within 48 hours according to the Acute Kidney Injury network (AKIN) criteria. Results: Forty-six patients (35.4%) developed AKI, and 80.4% of these patients had the onset of AKI within the first 6 hours after surgery. In this group, UNGAL increased significantly at 0, 3, and 6 hours after surgery compared with patients without AKI. UNGAL at 3 hours after surgery was the best time-point for predicting AKI. The cut-off value was >11.3 ng/ml with the sensitivity and specificity of 72% and 60%, respectively. By univariate analysis, older age, lower ejection fraction, impaired baseline renal function and longer cardiopulmonary bypass (CPB) time were clinical factors associated with AKI. However, by multivariate analysis, only lower ejection fraction and longer CPB time were associated with AKI. Conclusion: UNGAL level may be a useful marker for predicting AKI in Thai adult patients undergoing open cardiac surgery. Lower ejection fraction and longer CPB time were two major risk factors for AKI development. Keywords: Neutrophil gelatinase-associated lipocalin (NGAL), Cardiac surgery, Acute Kidney injury

8 citations

Journal Article
TL;DR: Hemoglobin cycling was commonly found in Thai ESRD patients treated with hemodialysis and ESA and the influence of hemoglobin cycling on mortality and hospitalization rates could not be significantly demonstrated in the present study.
Abstract: Background: Erythropoiesis-stimulating agent (ESA) treatment is the optimal therapy for anemia in end-stage renal disease (ESRD) patients receiving hemodialysis. During treatment with ESA, the level of hemoglobin usually fluctuates widely; this phenomenon is known as “hemoglobin cycling” and may be associated with higher rates of mortality. Objective: To estimate the prevalence of hemoglobin cycling in Thai ESRD patients treated with chronic maintenance hemodialysis and ESA, to assess its clinical impact on patient outcomes, and to identify the associated risk factors for hemoglobin cycling occurrence. Material and Method: An analytic retrospective study was conducted of 150 patients on chronic hemodialysis who were treated with ESA at Rajavithi Hospital and the Kidney Foundation of Thailand at Priest’s Hospital between January 2008 and December 2010. Hemoglobin cycling was defined as hemoglobin variability over a period of at least 8 weeks and amplitude of more than 1.5 g/dl. Results: Hemoglobin cycling was experienced by 90.7% of patients. The mean amplitude was 2.4+0.7 g/dl and mean duration of hemoglobin cycling was 8.5+5.0 weeks. Most patients (34.7%) experienced two episodes. The mean level of hemoglobin in patients with hemoglobin cycling (gr. I) and those without it (gr. II) were 10.1+0.9 g/dl and 10.2+0.7 g/dl respectively (p = 0.60). The mortality and hospitalization rates in gr. I and II were not significantly different (OR = 2.52; 95% CI: 0.31-20.27, p = 0.70 and OR = 1.65; 95% CI: 0.43-6.18, p = 0.56 respectively), and the numbers of ESA dose adjustments in gr. I and gr. II were also not significantly different (7.2+2.4 vs. 8.2+1.7 dose change/patient/year, p = 0.14). The serum levels of blood urea nitrogen, creatinine, intact parathyroid hormone, ferritin, % transferrin saturation, weekly Kt/Vurea and co-morbidity (diabetes mellitus, congestive heart failure, cerebrovascular disease and hypertension) were not significantly different in the two groups of patients. Conclusion: Hemoglobin cycling was commonly found in Thai ESRD patients treated with hemodialysis and ESA. The influence of hemoglobin cycling on mortality and hospitalization rates could not be significantly demonstrated in the present study; however, both mortality and hospitalization rates showed an upward trend in patients with hemoglobin cycling. Keywords: Anemia, Erythropoiesis-stimulating agent, Hemoglobin cycling, Hemodialysis

5 citations

Journal Article
TL;DR: The efficacy of anemia treatment and safety of the biosimilar epoetin-alfa was demonstrated in hemodialysis patients and significant regression of LVVI and some reduction in LVMI were shown in this 24-week prospective trial.
Abstract: Background: Anemia is common in end-stage renal disease (ESRD) patients and an important determinant for left ventricular hypertrophy (LVH) in dialysis patients. There are increasing numbers of biosimilar epoetinalfa entering Thailand. Objective: To conduct a prospective trial to evaluate the efficacy and safety of a biosimilar epoetin-alfa (epoetin) (EspogenTM) in ESRD patients receiving chronic hemodialysis complicated by anemia and to address its impact on the left ventricular mass index (LVMI) and volume index (LVVI) in these patients. Material and Method: Twenty-two hemodialysis (HD) subjects were recruited from Rajavithi and Huachiew Hospitals. Inclusion criteria were chronic HD, hemoglobin (Hb) < 10 g/dL without preceding treatment (epoetin or transfusion) for 1 month. Echocardiographic baselines were obtained. Epoetin-alfa was initially given 4,000 IU subcutaneously twice a week and titrated biweekly to keep the Hb range of 11 to 12 g/dL (titration period 12 weeks). Treatment continued until the end of 24 weeks. Records were made for conventional blood tests, blood pressure, amount of drugs needed to control blood pressure, and adverse events. Echocardiogram was repeated (on observer blinding) at the completion of the present study. Results: After 24-week of epoetin therapy, the predialysis Hb level increased significantly from 8.0 + 1.3 g/dL to 11.0 + 1.1 g/dL (p < 0.001). The mean dose of epoetin at the present study entry was 143.6 + 87.8 IU/kg/week. At the present study entry, LVH was present in 86.4% of the patients. At the completion of the present study, a decrease in LVMI was observed in 50% of the patients; however, the mean LVMI change was not significantly different. Notably, there were minimal but significant changes in LVEDD (52.8 + 7.0 vs. 50.1 + 6.9 mm, p < 0.05), LVVI (86.2 + 25.2 vs. 75.5 + 19.5 mL/m2, p < 0.05) and when subjects were partitioned into tertiles of baseline LVMI, the LVVI change was confined to the highest tertile (103.7 + 25.2 vs. 79.6 + 21.9 mL/m2, p < 0.05). The aortic root diameter also significantly decreased despite some increase in blood pressures but without significant change in number of antihypertensive agents. No serious adverse event was observed during the present study period. Conclusion: The efficacy of anemia treatment and safety of the biosimilar epoetin-alfa was demonstrated in hemodialysis patients. Significant regression of LVVI and some reduction in LVMI were shown in this 24-week prospective trial. Keywords: Erythropoietin, Epoetin, Anemia, Hemodialysis, End-stage renal disease, Left ventricular mass index, Left ventricular volume index

4 citations


Cited by
More filters
Journal ArticleDOI
01 Jan 2004-Drugs
TL;DR: An alarming increase in pure red cell aplasia in Thailand with follow-on epoetins manufactured in Asia indicates that stringent country-specific approval and pharmacovigilance protocols for ESAs manufactured in non-North American and non-EU European countries are urgently needed.
Abstract: Erythropoiesis-stimulating agents (ESAs) have become a hallmark of anaemia therapy in patients with chronic kidney disease (CKD). Although different ESAs are available for the treatment of renal anaemia, each nephrologist should select a single ESA for an individual patient. Epoetin alfa and epoetin beta have been used 1–3 times weekly but extended-interval dosing up to every 4 weeks is also effective in a substantial majority of CKD patients. However, the epoetin dose necessary to achieve or maintain target haemoglobin (Hb) levels increases substantially as the dosing interval increases. Subcutaneous administration of short-acting ESAs is more effective than the intravenous route of administration. Darbepoetin alfa and the continuous erythropoietin receptor activator (CERA) have been developed as a treatment for anaemia with extended administration intervals (every 2 weeks and every 4 weeks, respectively). Dose requirements for these long-acting ESAs are independent of the route of administration. Patents of short-acting ESAs have expired, which has opened the field for biosimilars. Epoetin biosimilars approved by the European Medicines Agency (EMA) or the US Food and Drug Administration (FDA) have been shown to have a comparable efficacy and safety profile to their originators. An alarming increase in pure red cell aplasia (PRCA) in Thailand with follow-on epoetins manufactured in Asia (but also those manufactured in Latin America) indicates that stringent country-specific approval and pharmacovigilance protocols for ESAs manufactured in non-North American and non-EU European countries are urgently needed. Two PRCA cases occurring with subcutaneous HX575 (one certain, one likely) indicate that chances of inducing a more immunogenic product are unpredictable, even with a biosimilar epoetin approved under the EMA biosimilar approval pathway. Phase III clinical trials with peginesatide, a pegylated synthetic peptide-based ESA without any homology to erythropoietin raised safety concerns in non-dialysis CKD patients but not in dialysis patients.

116 citations

Journal ArticleDOI
TL;DR: This article summarizes experiences with hematopoietic medicines, namely the epoetins (two biosimilars traded under five different brand names) and the filgrastims ( two biosimilar, six brand names).
Abstract: After the patents of biopharmaceuticals have expired, based on specific regulatory approval pathways copied products ("biosimilars" or "follow-on biologics") have been launched in the EU. This article summarizes experiences with hematopoietic medicines, namely the epoetins (two biosimilars traded under five different brand names) and the filgrastims (two biosimilars, six brand names). Physicians and pharmacists should be familiar with the legal and pharmacological specialities of biosimilars: The production process can differ from that of the original, clinical indications can be extrapolated, glycoproteins contain varying isoforms, the formulation may differ from the original, and biopharmaceuticals are potentially immunogenic. Only on proof of quality, efficacy and safety, biosimilars are a viable option because of their lower costs.

93 citations

Journal ArticleDOI
TL;DR: Urinary and plasma NGAL concentrations may identify patients at high risk for AKI in clinical research and practice and require prospective evaluation.

68 citations

Journal ArticleDOI
12 Feb 2017-Cureus
TL;DR: There is a positive relationship of CVP with minimum and maximum IVC diameters but an inverse relationship with the IVC collapsibility index.
Abstract: OBJECTIVE The objective of our study is to assess the correlation between inferior vena cava (IVC) diameters, central venous pressure (CVP) and the IVC collapsibility index for estimating the volume status in critically ill patients. METHODS This cross-sectional study used the convenient sampling of 100 adult medical intensive care unit (ICU) patients for a period of three months. Patients ≥ 18 years of age with an intrathoracic central venous catheter terminating in the distal superior vena cava connected to the transducer to produce a CVP waveform were included in the study. A Mindray diagnostic ultrasound system model Z6 ultrasound machine (Mindray, NJ, USA) was used for all examinations. An Ultrasonic Transducer model 3C5P (Mindray, NJ, USA) for IVC imaging was utilized. A paired sampled t-test was used to compute the p-values. RESULTS A total of 32/100 (32%) females and 68/100 (68%) males were included in the study with a mean age of 50.4 ± 19.3 years. The mean central venous pressure maintained was 10.38 ± 4.14 cmH2O with an inferior vena cava collapsibility index of 30.68 ± 10.93. There was a statistically significant relation among the mean CVP pressure, the IVC collapsibility index, the mean maximum and minimum IVC between groups as determined by one-way analysis of variance (ANOVA) (p < 0.001). There was a strong negative correlation between CVP and IVC collapsibility index (%), which was statistically significant (r = -0.827, n = 100, p < 0.0005). A strong positive correlation between CVP and maximum IVC diameter (r = 0.371, n = 100, p < 0.0005) and minimum IVC diameter (r = 0.572, n = 100, p < 0.0005) was found. CONCLUSION There is a positive relationship of CVP with minimum and maximum IVC diameters but an inverse relationship with the IVC collapsibility index.

52 citations

Journal ArticleDOI
TL;DR: This study represents a step forward in the area of intravascular volume estimation using IVC-CI, but the findings must be applied with caution owing to some methodologic limitations.
Abstract: BACKGROUNDIn search of a standardized noninvasive assessment of intravascular volume status, we prospectively compared the sonographic inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVPs). Our goals included the determination of CVP behavior across clinically relevant

50 citations