BACKGROUND: Type 2 diabetes mellitus (T2DM) is a global pandemic and its prevalence is rapidly increasing in developing countries, including Thailand. The most common comorbidity of T2DM is hypertension. T2DM with a hypertension comorbidity is likely to exacerbate the development of, or more severe microvascular complications. This study aims to determine the association between the hypertension comorbidity and microvascular complication among T2DM patients in Thailand. METHODS: The present study is a nationwide, multicenter, cross-sectional survey of T2DM outpatients across Thailand. Binary logistic mixed effect regression was used to investigate the effect of hypertension and other risk factors on the presence of microvascular complications. Imputation was used to investigate potential bias introduced by missing values. RESULTS: Of the 55,797 T2DM patients included in our sample, 55.35% were hypertensive. Prevalence of microvascular complication diagnosis in the last 12 months was higher in T2DM patients with hypertension than those without hypertension (12.12% vs. 9.80%, respectively). Patient with a hypertension comorbidity had 1.32 time the odds of developing microvascular complication (adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.20 to 1.46; P<0.001). Older age, longer diabetes duration had 1.07 and 1.21 times the odds of developing microvascular complication, per 10 years (age) and 5 years (duration), respectively (OR(age), 1.07; 95% CI, 1.03 to 1.12; P<0.001; and OR(duration), 1.12; 95% CI, 1.07 to 1.16; P<0.001; respectively). Minimal bias was introduced by missing values, and did not influence to the magnitude of effect of hypertension on the presence microvascular complication. CONCLUSION: Hypertension comorbidity is highly associated with microvascular complication among T2DM patients. Patients with T2DM and physicians should pay attention to blood pressure control.
Bias (Epidemiology) ; Blood Pressure ; Comorbidity* ; Cross-Sectional Studies* ; Developing Countries ; Diabetes Mellitus, Type 2 ; Diagnosis ; Humans ; Hypertension* ; Odds Ratio ; Outpatients ; Pandemics ; Prevalence ; Risk Factors ; Thailand*

Purpose: Renal scintigraphy (RS) with either technetium-99 m diethylene-triamine-pentaacetate (Tc-99 m DTPA) or technetium-99 m mercaptoacetyltriglycine (Tc-99 m MAG3) has both been used to evaluate early allograft function after kidney transplantation (KT). This study was done to compare the predictive performance of RS using these two radiopharmaceuticals for prediction of outcomes during first 3 months of KT. Methods: This retrospective study included patients who received KT then underwent both Tc-99 m DTPA and Tc-99 m MAG3 RS, successively. Receiver operating characteristic (ROC) curve analysis was used to determine the predictiveness of RS parameters on early clinical adverse outcomes of either (1) graft-related death, (2) need for graft resection, (3) delayed graft function requiring temporary dialysis, or (4) a serum creatinine level of ≥ 2.0 mg/dL at three months post-KT, as well as to predict biopsy-confirmed acute tubular necrosis and acute rejection. Results: Of 187 patients included, 77 (41.2%) had at least one early adverse clinical outcome. Tc-99 m MAG3 RS was more predictive than Tc-99 m DTPA RS, in terms of AUCROC, in three parameters including time to peak (0.754 vs. 0.516, p-value 0.0001), 20-min to peak ratio (0.762 vs. 0.651, p-value 0.006), and 20-min to 3-min ratio (0.823 vs. 0.699, p-value 0.0005). Acute tubular necrosis was better predicted by Tc-99 m MAG3 RS while both were at best only modest in predicting acute rejection. Conclusion Three parameters which, when obtained from Tc-99 m MAG3 RS, had superior predictiveness compared with Tc-99 m DTPA RS, including time to peak, 20-min to peak ratio, and 20-min to 3-min ratio.

Introduction: Patients with peritoneal dialysis (PD) who develop volume overload (VO) have high risks of dropout from death or advancement to hemodialysis. We aimed to determine the mortality rates, associated factors, and patient survival rates of PD patients who had history of admission from VO. Methods: We reviewed data of PD patients who were registered in the Database of Peritoneal dialysis in EXcel (DPEX) from January 2008 to December 2018. They were followed until death or the end of June 2020. Patients with at least 18 years of age and history of admission from VO were classified into two groups. Group A had a history of VO after starting PD. Group B had a history of VO before and after starting PD. The mortality rates were calculated. Patient survival and associated factors were evaluated by Kaplan-Meier and multiple cox regression, respectively. Results: 1,882 patients had history of admission from VO. The overall mortality rate was 28.9 per 100 person-years. The mortality rates in group A and group B were 25.4 and 41.7 per 100 person-years, respectively. Patients in group A had lower age, fewer comorbidities, longer dialysis vintage, and better patient survival than those in group B. Factors related to worsening patient survival were increased age, diabetes, and comorbidities. Conclusion: Patients with history of admission from VO before and after the start of PD had higher mortality rates than those with history of admission from VO after PD. Increased age, diabetes, and comorbidities were the associated factors of patient survival.