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Background To evaluate the effectiveness of a Shared Decision-Making (SDM) program in reducing unplanned dialysis among patients with advanced chronic kidney disease (CKD) and to identify factors predictive of unplanned dialysis. Methods This retrospective cohort study was conducted at Phanatnikhom Hospital in Chonburi, Thailand, from October 2021 to September 2023. Patients aged 18 years and older with CKD stages 4 and 5 who were receiving renal replacement therapy (RRT) were included. Starting in October 2022, the Shared Decision-Making (SDM) program was implemented as the standard of care. Baseline demographic data, dialysis modalities, and the incidence of unplanned dialysis were collected. Unplanned dialysis was defined as dialysis initiated through a temporary catheter or within a short time frame after the initial dialysis decision. Results Among 111 patients, 66 received SDM, and 45 received usual care. The incidence of unplanned dialysis was significantly lower in the SDM group compared to the usual care group (33.3% vs. 66.7%, p  < 0.001). Multivariate analysis indicated that participation in the SDM program (OR = 0.19, p  = 0.001), peritoneal dialysis (OR = 0.26, p  = 0.032), and higher serum albumin at the initiation of dialysis (OR = 0.33, p  = 0.014) were protective factors against unplanned dialysis. Conclusions The SDM program effectively reduces unplanned dialysis in patients with advanced CKD by aligning medical decisions with patient preferences and priorities. Peritoneal dialysis and higher serum albumin levels at dialysis initiation are also associated with lower rates of unplanned dialysis.

Accurately distinguishing hypovolemic hyponatremia from the syndrome of inappropriate antidiuresis (SIAD) remains challenging due to limitations in traditional pre-saline infusion urine sodium measurements. This prospective cohort study at two Thai medical centers evaluated whether post-saline infusion urine sodium improves diagnostic accuracy. We enrolled 113 hospitalized adults with non-edematous hypotonic hyponatremia (serum sodium < 130 mmol/L). Asymptomatic patients received 500 mL of 0.9% saline, while symptomatic patients received 150 mL of 3% saline. Urine sodium was measured before and after infusion (Time 1). Diagnostic performance was assessed using AUC curves, with Youden’s J statistic determining optimal cutoffs. Post-infusion urine sodium at Time 1 demonstrated superior accuracy compared to pre-infusion measurements (AUC 0.75 vs. 0.61, P  = 0.01). A cutoff of 24.5 mmol/L at Time 1 achieved 75.2% accuracy (95% CI: 66.2–82.9), 62.5% sensitivity (95% CI: 45.8–77.3), and 82.2% specificity (95% CI: 71.5–90.2). These findings highlight the clinical utility of post-saline urine sodium. In conclusion, measuring urine sodium after saline infusion significantly improves differentiation between hypovolemic hyponatremia and SIAD compared to pre-infusion testing. The 24.5 mmol/L cutoff at Time 1 offers a practical, evidence-based threshold for clinicians, reducing misdiagnosis risks and guiding appropriate fluid management in hyponatremic patients.

Background/Objectives: Despite the widespread recognition of preprocedural anxiety in awake invasive procedures, there is a paucity of data examining its prevalence and clinical impact in patients undergoing percutaneous kidney biopsy. This study aimed to determine the prevalence of preprocedural anxiety, assess its association with peri-procedural hemodynamic parameters, and identify factors associated with elevated anxiety. Methods: In this prospective observational study, 151 adults scheduled for percutaneous kidney biopsy between June 2023 and January 2025 were enrolled. Anxiety was assessed 24 h before the procedure using the Thai State–Trait Anxiety Inventory Y1 (STAI-Y1). Blood pressure and pulse rate were measured at baseline and 30 min before biopsy. Mixed-effects models evaluated associations between anxiety and hemodynamic changes, and logistic regression identified predictors of anxiety. Results: Clinically significant anxiety (STAI-Y1 ≥ 40) was present in 55% of patients, with 43.4% reporting very high anxiety. Anxiety status was not independently associated with changes in systolic or diastolic blood pressure or pulse rate. However, diastolic blood pressure increased significantly from baseline to preprocedural across all patients (mean increase 5.45 mmHg; p = 0.008), irrespective of anxiety. Higher serum creatinine (OR 1.29; p = 0.012) and a history of previous kidney biopsy (OR 4.28; p = 0.004) were independently associated with anxiety. Conclusions: Preprocedural anxiety is highly prevalent among patients undergoing kidney biopsy but does not independently influence peri-procedural hemodynamic parameters. Targeted screening and supportive interventions may benefit patients at increased risk of anxiety.

Introduction BK polyomavirus (BKPyV)‐associated nephropathy (BKPyVAN) can cause a significant risk of allograft impairment after kidney transplantation (KT). Intact BKPyV‐specific immunity is associated with viral containment. This study investigated BKPyV‐specific immunological factors among KT recipients. Methods This prospective study in a single transplant center from January 2019 to August 2019 assessed associations between clinical and immunological characteristics, with a focus on BKPyV‐cell‐specific immunity and BKPyVAN, among KT recipients aged ≥15 years. The numbers of interferon‐gamma (IFN‐γ)‐producing CD4+ T, CD8+ T, natural killer (NK), and natural killer T (NKT) cells were measured after stimulation with large T antigen and viral capsid protein 1 (VP1). Results In total, 100 KT recipients were included (mean age ± SD, 42 ± 11 years); 35% of the recipients were female patients, and 70% had received induction immunosuppressive therapy. The 1‐year cumulative incidence of high‐level BKPyV DNAuria (possible BKPyVAN) and (presumptive BKPyVAN) was 18%. Among 40 patients with immunological factor data, pre‐KT %NK cells (hazard ratio [HR], 1.258; 95% confidence interval [CI], 1.077–1.469; p = .004) and %VP1‐specific NK cells (HR, 1.209; 95% CI, 1.055–1.386; p = .006) were factors independently associated with possible and presumptive BKPyVAN. KT recipients with possible and presumptive BKPyVAN were more likely to exhibit significant mean coefficients of %NK, %VP1‐specific NK, and %NKT cells at 1 month after KT than before KT (all p < .05). Conclusion Individuals with nonspecific and VP1‐specific NK cells before KT and increasing numbers of these cells after KT may be at risk for high‐level BKPyV DNAuria and presumptive BKPyVAN. Further studies are needed to determine the utility of BKPyV‐specific innate immune surveillance in predicting the occurrence of BKPyVAN. Initial levels and post‐KT increases in NK, NKT, and VP1‐specific NK cells were greater in KT recipients who exhibited BKPyV DNAuria within 1 year after KT. BKPyV‐specific NK‐ and NKT‐cell immune surveillance could be used to identify patients at risk for post‐transplant viral reactivation.