Publications by authors named "Noppawit Aiumtrakul"

5 Publications

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Cardio-ankle vascular index with renal progression and mortality in high atherosclerosis risk: a prospective cohort study in CORE-Thailand.

Clin Exp Nephrol 2021 Oct 13. Epub 2021 Oct 13.

Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.

Background: Increased arterial stiffness is linked to markers of endothelial dysfunction and vasculopathy such as albuminuria, vascular calcification, left ventricular hypertrophy and cardiovascular (CV) diseases. Studies of arterial stiffness on renal progression are limited.

Objective: The study aimed to evaluate the association between high cardio-ankle vascular index (CAVI) and renal endpoint and all-cause mortality in a Thai population with high atherosclerosis risk.

Methods: A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. Subjects were divided into 3 groups with mean CAVI < 8, 8-8.9, and ≥ 9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15 mL/min/1.73 m, doubling of serum creatinine, initiation of dialysis and death related to renal causes. The secondary outcomes were all-cause mortality, CV mortality and eGFR decline.

Results: A total of 4898 subjects (2743 men and 2155 women) were enrolled. Cox proportional hazards model showed a significant relationship of high CAVI (CAVI ≥ 9) and primary composite outcome. Subjects with high CAVI at baseline had a 1.45-fold (95% CI 1.13-1.84) significant risk for the primary composite outcome and 1.72-fold (95% CI 1.12-2.63) risk for all-cause mortality, compared with normal CAVI (CAVI < 8). After stepwise multivariate analysis, the high CAVI group was only positively associated with primary composite outcome. Kaplan-Meier curve of the primary composite outcome and all-cause mortality demonstrated the worst survival in the high CAVI group (log-rank test with P < 0.05).

Conclusion: In a Thai cohort with high atherosclerosis risk, increased arterial stiffness was a risk factor for worsening renal function, including end-stage renal disease and initiation of dialysis.
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http://dx.doi.org/10.1007/s10157-021-02149-xDOI Listing
October 2021

Association of body mass index with kidney function and mortality in high cardiovascular risk population: A nationwide prospective cohort study.

Nephrology (Carlton) 2021 Aug 31. Epub 2021 Aug 31.

Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.

Background: There is increasing awareness of the impact of obesity and underweight on cardiovascular (CV) disease, chronic kidney disease (CKD) and mortality. Abnormal body mass index (BMI) might be associated with worse clinical outcomes, including CKD progression, but limited evidence exists among Asian patients with high CV risk.

Objective: To investigate the association of BMI with progressive loss of kidney function and all-cause mortality in Thai patients with high CV risk.

Methods: In a national cohort of 5887 high CV risk subjects, we assessed the association of high BMI with the composite renal outcome (estimated glomerular filtration rate [eGFR] decline over 40%, eGFR less than 15 mL/min/1.73 m , doubling of serum creatinine, initiation of dialysis and death related to renal causes) and with all-cause mortality in Cox proportional hazards models.

Results: A total of 5887 participants (3217 male and 2670 female) with high CV risk were enrolled. Participants were classified into five groups by their baseline BMI; <20 kg/m (n = 482), 20-24.9 kg/m (n = 2437), 25-29.9 kg/m (n = 2140), 30-34.9 kg/m (n = 665) and 35 kg/m (n = 163), respectively. On multivariate analysis of Cox proportional hazards models, adjusted for other covariates, baseline BMI ≥35 kg/m was an independent predictor of loss of kidney function (HR 1.60, 95% CI 1.04-2.40) and all-cause mortality (HR 2.68, 95% CI 1.50-4.80). Baseline BMI <20 kg/m was an independent predictor of all-cause mortality as well (adjusted HR 2.26, 95% CI 1.50-3.42).

Conclusion: In the high CV risk Thai population, a BMI of 35 kg/m or more is associated with loss of kidney function and mortality. On the other hand, a BMI less than 20 kg/m is also associated with all-cause mortality.
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http://dx.doi.org/10.1111/nep.13970DOI Listing
August 2021

Hyperuricemia and Impaired Renal Function: A Prospective Cohort Study.

Kidney Dis (Basel) 2021 May 6;7(3):210-218. Epub 2020 Nov 6.

Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.

Background: Related studies have demonstrated a relationship of elevated serum uric levels with a decline in kidney function. However, limited evidence exists in a Southeast Asian community-based population.

Objective: The study aimed to examine the relationship between serum uric acid levels and impaired renal function.

Methods: A prospective cohort study was conducted in the Thai army health checkup population between July 1, 2006 and December 31, 2012. Inclusion criteria included age older than 20 years and baseline estimated glomerular filtration rate (eGFR) over 60 mL/min/1.73 m. Cox regression analysis was used to evaluate the association between incidence of impaired renal function and baseline serum uric acid quartiles. Impaired renal function was defined as eGFR <60 mL/min/1.73 m over 3 months.

Results: A total of 9,534 participants (7,474 men and 2,060 women) were enrolled. Cox regression analysis revealed a significant association of serum uric acid level with impaired renal function in the whole population as the unadjusted hazard ratio (HR) (95% CI) of impaired renal function in second, third, and fourth quartiles were 2.1 (1.39, 3.17), 2.39 (1.6, 3.59), and 3.94 (2.71, 5.74), respectively, when compared with serum uric acid in the first quartile, respectively. After adjusting in 2 models, the HR still significantly persisted with similar magnitudes in all quartiles. Higher incidences of impaired renal function were observed among males than among females in all quartiles. Kaplan-Meier curve showed better renal survival rate in the lower quartile groups. Linear regression analysis showed that eGFR negatively correlated with serum uric acid ( = -0.213, < 0.001).

Conclusion: Our study suggests that an independent association exists of serum uric acid levels with the incidence of impaired renal function and renal progression in the Southeast Asian community-based population.
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http://dx.doi.org/10.1159/000511196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216020PMC
May 2021

Urine albumin dipstick independently predicts cardiovascular and renal outcomes among rural Thai population: a 14-year retrospective cohort study.

BMC Nephrol 2021 01 8;22(1):18. Epub 2021 Jan 8.

Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: Albuminuria is an established risk marker for both cardiovascular and renal outcomes. In this study, we expected to use portable and inexpensive test strips to detect urine albumin level for risk stratification in cardiovascular and renal outcomes among rural Thai community.

Objective: To evaluate the relationship between urine albumin dipstick and cardiovascular and renal complications in rural Thai population.

Methods: We conducted a retrospective study in 635 rural Thai adults who tested urine albuminuria by using commercial urine albumin dipstick and the Micral-albumin test II strips at baseline. The subjects were divided into normoalbuminuria (albumin < 20 mg/L), microalbuminuria (albumin 20-200 mg/L), or macroalbuminuria (Urine dipstick at least 1+ or albumin > 200 mg/L). We collected data on the incidences of primary composite outcomes including cardiovascular or renal morbidity and mortality. Incident density and cox regression were analyzed to evaluate the association between albuminuria status and primary composite outcome.

Results: During an average 14-year follow-up, 102 primary composite events occurred including 59 (13.1%), 32 (20.6%) and 11 (39.3%) among 452, 155, and 28 subjects with normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively. Incident densities of primary composite outcome were elevated continually according to the degree of albuminuria (9.36, 17.11 and 38.12 per 1000 person-years). Compared with the subjects without albuminuria, subjects with microalbuminuria and macroalbuminuria at baseline had higher risk for primary composite outcome in univariate model. After multivariate analysis was performed, the effect of macroalbuminuria was only persisted with 3.13-fold risk (adjusted HR 3.13; 95% CI 1.40-6.96, P= 0.005).

Conclusion: Albuminuria from semi-quantitative methods is an important factor predicting cardiovascular and renal risk among subjects in Thai rural population. Our findings support to also incorporating urine albumin dipstick into assessments of cardiovascular risk in the general population.
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http://dx.doi.org/10.1186/s12882-020-02215-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791992PMC
January 2021

Cardiovascular and Renal Outcomes in an Excellent Chronic Kidney Disease Clinic Compared with an Outpatient Clinic in a Primary Care Setting: A Retrospective Cohort Study.

Kidney Dis (Basel) 2019 Jun 3;5(3):144-152. Epub 2019 Jan 3.

Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. In standard care, the physician attempts to control all known risk factors, but treatment goals are achieved with difficulty. Assistance by a multidisciplinary care team may improve outcomes.

Objective: To compare the cardiovascular and renal endpoints between patients with CKD receiving care from excellent CKD and outpatient clinics.

Methods: A retrospective cohort study was conducted in a primary care setting in Thailand. Patients with CKD stages 3 and 4 in excellent CKD ( = 96) and outpatient clinics ( = 192) were matched in a 1: 2 ratio with the propensity score. We collected data from electronic medical records concerning the incidences of primary composite outcomes including rapid renal progression, end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and mortality. Multidisciplinary team care in the excellent CKD clinic consisted of physician, nurse, pharmacist, dietitian, physical therapist, and applied Thai traditional physician. The outpatient clinic consisted of physician care only.

Results: Subjects' mean age was 64.54 ± 10.96 years, and 52.1% were female. During an average 49.63 ± 8.36 months of follow-up, 74 events occurred including 35 (47.30%) patients who experienced renal events, 29 (39.19%) who experienced cardiovascular events, and 10 (13.51%) who experienced loss of life. The Kaplan-Meier curve indicated a higher percentage of subjects without primary composite outcomes in the excellent CKD clinic than those in the outpatient clinic (66.85%; 95% CI 0.48-0.80 vs. 44.71%; 95% CI 0.29-0.60; = 0.005). From multivariate analysis, the excellent CKD clinic group had a 64% lower risk for primary composite outcomes compared with those in the outpatient clinic (adjusted HR 0.36; 95% CI 0.18-0.74; = 0.005).

Conclusion: A multidisciplinary care system can reduce composition outcomes including cardiovascular and renal outcomes for the growing CKD population. The optimal outcomes arise from the medical personnel's teamwork, not from one physician alone.
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http://dx.doi.org/10.1159/000495464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587207PMC
June 2019
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