Effect of Sulodexide on Urinary Biomarkers of Kidney Injury in Normoalbuminuric Type 2 Diabetes: A Randomized Controlled Trial

Glycosaminoglycans or sulodexide has shown benefits in early experimental diabetic nephropathy (DN) models, but its efficacy in patients with early stage of DN is unknown. Methods. Twenty patients were randomly assigned to the placebo group and another 20 patients were randomly assigned to receive sulodexide 100 mg/day for 14 weeks. Primary outcome was a change of urinary TGF-beta1, albuminuria, and glomerular filtration rate (GFR). All patients had stable metabolic profiles for at least 90 days before randomization. Results. Urinary TGF-beta1 increased significantly in the placebo group but did not change significantly in the sulodexide group. Additionally, the mean change of urine TGF-beta1 in the placebo group was significantly higher than that in the sulodexide group (8.44±9.21 versus 2.17±6.96 pg/mg Cr, P=0.02). Mean changes of urinary albumin were 15.05±30.09 μg/mg Cr (P=0.038) in the placebo group and 13.89±32.25 μg/mg Cr (P=0.069) in the sulodexide group. No consistent patterns of side effects were observed. Conclusion. In this 14-week trial, benefits of sulodexide in preventing the increase of urinary TGF-beta1 were observed in patients with normoalbuminuric type 2 diabetes. The study suggests that sulodexide treatment may provide additional renoprotection in early stage DN. This trial is registered with TCTR20140806001

Clinical Study Effect of Sulodexide on Urinary Biomarkers of Kidney Injury in Normoalbuminuric Type 2 Diabetes: A Randomized Controlled Trial

Glycosaminoglycans or sulodexide has shown benefits in early experimental diabetic nephropathy (DN) models, but its efficacy in patients with early stage of DN is unknown. Methods. Twenty patients were randomly assigned to the placebo group and another 20 patients were randomly assigned to receive sulodexide 100 mg/day for 14 weeks. Primary outcome was a change of urinary TGF-beta1, albuminuria, and glomerular filtration rate (GFR). All patients had stable metabolic profiles for at least 90 days before randomization. Results. Urinary TGF-beta1 increased significantly in the placebo group but did not change significantly in the sulodexide group. Additionally, the mean change of urine TGF-beta1 in the placebo group was significantly higher than that in the sulodexide group (8.44 ± 9.21 versus 2.17 ± 6.96 pg/mg Cr, = 0.02). Mean changes of urinary albumin were 15.05 ± 30.09 g/mg Cr ( = 0.038) in the placebo group and 13.89 ± 32.25 g/mg Cr ( = 0.069) in the sulodexide group. No consistent patterns of side effects were observed. Conclusion. In this 14-week trial, benefits of sulodexide in preventing the increase of urinary TGF-beta1 were observed in patients with normoalbuminuric type 2 diabetes. The study suggests that sulodexide treatment may provide additional renoprotection in early stage DN. This trial is registered with TCTR20140806001

Obesity and Its Relation to Chronic Kidney Disease: A Population-Based, Cross-Sectional Study of a Thai Population

Obesity represents a significant problem in patients with cardiovascular disease and chronic kidney disease (CKD). We investigated the association between body mass index (BMI) and CKD in Thai individuals. Participants underwent general health screening. Overweight, weight at risk, obese I and obese II were defined as having a BMI ≥23 kg/m2, 23-24.9 kg/m2, 25-29.9 kg/m2 and ≥30 kg/m2, respectively. CKD was defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m2. An estimate of the GFR was obtained by the four-variable Modification of Diet in Renal Disease (MDRD) equation. The study population had 12,348 males and 3,009 females. The survey population had a 14.5% prevalence of CKD. There was also a significant graded relationship between the degrees of overweight with the prevalence of CKD. Mean BMI were 25.06±3.29 kg/m2 for CKD subjects and 23.98±3.11 kg/m2 for non CKD subjects (P<0.001). Prevalence of overweight and abdominal obesity in the participants with CKD were found to be higher than in those without CKD (overweight, 74.6% vs. 61.3%, P<0.001; abdominal obesity, 28.3% vs. 25.7%, P=0.009). In a multivariate logistic regression analysis; weight at risk (adjusted odds ratio 1.19; 95% CI 1.04-1.37), obese I (adjusted odds ratio 1.44; 95% CI 1.26-1.64), and obese II (adjusted odds ratio 1.99; 95% CI 1.59-2.48) were associated with CKD. In conclusion, our data supported that overweight and obesity were associated with increased risk for CKD in Thai individuals undergoing a general health screening, independently of age, gender, blood pressure, serum lipid, uric acid, and glucose levels

Clinical factors for severity of Plasmodium falciparum malaria in hospitalized adults in Thailand.

Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of >38.5°C, (4) white blood cell counts >10×10(9)/µL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05). Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1) ethnicity of Thai [odds ratio (OR) = 3.601, 95% confidence interval (CI) = 1.011-12.822] or Myanmar [OR = 3.610, 95% CI = 1.138-11.445]; (2) referrals [OR = 3.571, 95% CI = 1.306-9.762]; (3) no prior history of malaria [OR = 5.887, 95% CI = 1.354-25.594]; and (4) albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802-28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could develop severe malaria and require ICU admission. Early identification and the timely initiation of appropriate treatments may well improve the outcomes and reduce the mortality of these patients

Patient recruitment flow chart.

<p>Patient recruitment flow chart.</p

Univariate and multivariate logistic regression analysis of baseline characteristic, as well as clinical and laboratory parameters for requirement of ICU in hospitalized patients with severe falciparum malaria.

<p><b>Note:</b> ICU = intensive care unit; OR = odds ratio; CI = confidence interval.</p

Baseline characteristics, clinical and laboratory parameters, management and outcomes of hospitalized patients with severe falciparum malaria (ICU or without ICU admission).

<p><b>Note:</b> ICU = intensive care unit; IQR = interquartile range; WBC = white blood cell counts; FCT = fever clearance time; PCT = parasite clearance time.</p

Baseline characteristics, clinical parameters, management and outcomes of patients with severe falciparum malaria requiring ICU (with shock or without shock).

<p><b>Note:</b> ICU = intensive care unit; IQR = interquartile range; WBC = white blood cell counts; FCT = fever clearance time; PCT = parasite clearance time.</p