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Wathanavasin W, Phannajit J, Poosoonthornsri M, Lewsuwan S, Tanateerapong P, Chongthanakorn K, Takkavatakarn K, Katavetin P, Tiranathanagul K, Eiam-Ong S, Susantitaphong P. A Randomized Controlled Trial of Comparative Efficacy between Sodium Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous Catheters Among Patients Requiring Maintenance Hemodialysis. Can J Kidney Health Dis 2021; 8:20543581211046077. [PMID: 34616559 PMCID: PMC8488503 DOI: 10.1177/20543581211046077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports. Objective: To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients. Design: A multicenter, randomized, open-label study Setting: In a developing country, Thailand Patients: Chronic HD patients with tunneled central venous catheter Measurements: Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infection Methods: The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI). Results: The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA). Limitations: Short follow-up period. Conclusions: In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis. Trial registration: The study was registered with the Thai Clinical Trials Registry TCTR 20200610003
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Affiliation(s)
- Wannasit Wathanavasin
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Chulalongkorn University, Bangkok, Thailand.,Division of Clinical Epidemiology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Patchara Tanateerapong
- Nephrology unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | | | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Chulalongkorn University, Bangkok, Thailand
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Takkavatakarn K, Aniwan S, Kamjohnjiraphunt N, Towannang P, Maeboonruen N, Saejew T, Pavatung P, Boonyakrai C, Chongthanakorn K, Prueksapanich P, Eiam-Ong S, Rerknimitr R, Kanjanabuch T. Whether Antibiotic Prophylaxis Is Necessary in Peritoneal Dialysis Patients Undergoing Elective Colonoscopy With Postprocedural Peritoneal Lavage. Kidney Int Rep 2020; 5:1783-1787. [PMID: 33102972 PMCID: PMC7569702 DOI: 10.1016/j.ekir.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Satimai Aniwan
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | - Piyaporn Towannang
- Peritoneal Dialysis Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nopparat Maeboonruen
- Peritoneal Dialysis Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thunvarat Saejew
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Preeyarat Pavatung
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanchana Boonyakrai
- Division of Nephrology, Department of Medicine, Taksin Hospital, Bangkok, Thailand
| | - Kamonrat Chongthanakorn
- Division of Nephrology, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Piyapan Prueksapanich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Susantitaphong P, Siribumrungwong M, Takkavatakarn K, Chongthanakorn K, Lieusuwan S, Katavetin P, Tiranathanagul K, Lekhyananda S, Tungsanga K, Vanichakarn S, Eiam-Ong S, Praditpornsilpa K. Effect of Maintenance Intravenous Iron Treatment on Erythropoietin Dose in Chronic Hemodialysis Patients: A Multicenter Randomized Controlled Trial. Can J Kidney Health Dis 2020; 7:2054358120933397. [PMID: 32612843 PMCID: PMC7307402 DOI: 10.1177/2054358120933397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background: There is no consensus on intravenous (IV) iron supplement dose, schedule, and
serum ferritin target in functional iron deficiency anemia to maintain
optimum target levels of iron stores by several guidelines. Objective: To examine the effect of IV iron supplementation to different targets of
serum ferritin on erythropoietin dose and inflammatory markers in chronic
hemodialysis (HD) patients with functional iron deficiency anemia. Design: A multicenter, randomized, open-label study. Setting: In a developing country, Thailand. Patients: Chronic HD patients with functional iron deficiency anemia. Measurements: Erythropoietin resistance index, high-sensitivity C-reactive protein, and
fibroblast growth factor 23. Methods: Two hundred adult chronic HD patients with transferrin saturation less than
30% and serum ferritin of 200 to 400 ng/mL were randomized 1:1 to maintain
serum ferritin 200 to 400 ng/mL (low-serum ferritin group, N = 100) or 600
to 700 ng/mL (high-serum ferritin group, N = 100). During a 6-week titration
period, participants randomized to the high-serum ferritin group initially
received 600 mg IV iron (100 mg every week), while the participants in the
low-serum ferritin group did not receive IV iron. During the 6-month
follow-up period, the dose of IV iron was adjusted by protocol. Results: The mean dose of IV iron was 108.3 ± 28.2 mg/month in the low-serum ferritin
group and 192.3 ± 36.2 mg/month in the high-serum ferritin group. The mean
serum ferritin was 367.0 ± 224.9 ng/mL in the low ferritin group and 619.6 ±
265.2 ng/mL in the high ferritin group. The erythropoietin resistance index
was significantly decreased in the high-serum ferritin group compared to the
low-serum ferritin group after receiving IV iron in the 6-week titration
period (mean difference: −113.43 ± 189.14 vs 41.08 ± 207.38 unit/week/g/dL;
P < .001) and 3-month follow-up period (mean
differences: −88.88 ± 234.43 vs −10.48 ± 217.75 unit/week/g/dL;
P = .02). Limitations: Short follow-up period. Conclusion: Maintaining a serum ferritin level of 600 to 700 ng/mL by IV iron
administration of approximately 200 mg per month as a maintenance protocol
can decrease erythropoietin dose requirements in chronic HD patients with
functional iron deficiency anemia. Trials registration: The study was registered with the Thai Clinical Trials Registry
TCTR20180903003.
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Affiliation(s)
- Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Research Unit for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Monchai Siribumrungwong
- Nephrology Unit, Department of Medicine, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Pisut Katavetin
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Kitrungphaiboon T, Puapatanakul P, Chuengsaman P, Tiskajornsiri K, Halue G, Siribamrungwong M, Matayart S, Chongthanakorn K, Poonvivatchaikarn U, Boonyakrai C, Somboonsilp W, Katavetin P, Praditpornsilpa K, Eiam-Ong S, Johnson DW, Kanjanabuch T. Intraperitoneal Cefepime Monotherapy Versus Combination Therapy of Cefazolin Plus Ceftazidime for Empirical Treatment of CAPD-Associated Peritonitis: A Multicenter, Open-Label, Noninferiority, Randomized, Controlled Trial. Am J Kidney Dis 2019; 74:601-609. [PMID: 31331757 DOI: 10.1053/j.ajkd.2019.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/05/2019] [Indexed: 01/22/2023]
Abstract
RATIONALE & OBJECTIVE Compared to combination therapy, intraperitoneal (IP) cefepime monotherapy for continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis may provide potential benefits in lowering staff burden, shortening time-consuming antibiotic preparation, and reducing bag contamination risk. This study sought to evaluate whether cefepime monotherapy is noninferior to combination regimens. STUDY DESIGN Multicenter, open-label, noninferiority, randomized, controlled trial. SETTING & PARTICIPANTS Adult incident peritoneal dialysis (PD) patients with CAPD-associated peritonitis in 8 PD centers in Thailand. INTERVENTIONS Random assignment to either IP monotherapy of cefepime, 1g/d, or IP combination of cefazolin and ceftazidime, 1g/d, both given as continuous dosing. OUTCOMES Primary end point: resolution of peritonitis at day 10 (primary treatment response). SECONDARY OUTCOMES initial response (day 5), complete cure (relapse/recurrence-free response 28 days after treatment completion), relapsing/recurrent peritonitis, and death from any cause. Noninferiority would be confirmed for the primary outcome if the lower margin of the 1-sided 95% CI was not less than-10% for difference in the primary response rate. A 2-sided 90% CI was used to demonstrate the upper or lower border of the 1-sided 95% CI. RESULTS There were 144 eligible patients with CAPD-associated peritonitis, of whom 70 and 74 patients were in the monotherapy and combination-therapy groups, respectively. Baseline demographic and clinical characteristics were not different between the groups. The primary response was 82.6% in the monotherapy group and 81.1% in the combination-therapy group (treatment difference, 1.5%; 90% CI, -9.1% to 12.1%; P=0.04). There was no significant difference in the monotherapy group compared with the combination-therapy group in terms of initial response rate (65.7% vs 60.8%; treatment difference, 4.9%; 95% CI, -10.8% to 20.6%; P=0.5) and complete cure rate (80.0% vs 80.6%; treatment difference, -0.6%; 95% CI, -13.9% to 12.8%; P=0.7). Relapsing and recurrent peritonitis occurred in 4.6% and 4.6% of the monotherapy group and 4.2% and 5.6% of the combination-therapy group (P=0.9and P=0.8, respectively). There was nominally higher all-cause mortality in the monotherapy group (7.1% vs 2.7%; treatment difference, 4.4%; 95% CI, -2.6% to 11.5%), but this difference was not statistically significant (P = 0.2). LIMITATION Not double blind. CONCLUSIONS IP cefepime monotherapy was noninferior to conventional combination therapy for resolution of CAPD-associated peritonitis at day 10 and may be a reasonable alternative first-line treatment. FUNDING This study is supported by The Kidney Foundation of Thailand (R5879), Thailand; Rachadaphiseksompotch Fund (RA56/006) and Rachadaphicseksompotch Endorsement Fund (CU-GRS_61_06_30_01), Chulalongkorn University, Thailand; National Research Council of Thailand (156/2560), Thailand; and Thailand Research Foundation (IRG5780017), Thailand. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT02872038.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Chanchana Boonyakrai
- Division of Nephrology, Department of Internal Medicine, Taksin Hospital, Bangkok Metropolitan Administration, Bangkok
| | | | - Pisut Katavetin
- King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | | | - Somchai Eiam-Ong
- King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Talerngsak Kanjanabuch
- King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Kidney Metabolic Disorders, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; CAPD Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Chongthanakorn K, Tiranathanagul K, Susantitaphong P, Praditpornsilpa K, Eiam-Ong S. Effective Determination of Dry Weight by Intradialytic Bioimpedance Analysis in Hemodialysis. Blood Purif 2009; 27:235-41. [DOI: 10.1159/000199428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 11/19/2008] [Indexed: 11/19/2022]
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