Aim: To determine the prognostic risk factors of patients with hepatitis B virus related acute‐on‐chronic liver failure (HBV‐ACLF) treated with plasma exchange (PE)‐based artificial liver support system (ALSS), and create a prognostic predictive model.Methods: A total of 304 HBV‐ACLF patients who received PE‐based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.Results: According to 28‐day survival, a total of 207 patients who survived and 97 non‐survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alpha‐fetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short‐term prognosis. We built a model named ALSS‐prognosis model (APM) to predict the 28‐day survival of HBV‐ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD‐Na, and CLIF‐C ACLF score.Conclusions: Low AFP was found to be an independent risk factor for high mortality in HBV‐ACLF patients treated with PE‐based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD‐Na, and CLIF‐C ACLF score for short‐term outcomes, and could aid physicians in making optimal therapeutic decisions.

The purpose of this review is to outline the currently available circulating biomarkers to predict diabetic retinopathy (DR) in patients with diabetic kidney disease (DKD). Studies have extensively reported the association between DR and DKD, suggesting the presence of common pathways of microangiopathy. The presence of other ocular complications including diabetic cataracts may hinder the detection of retinopathy, which may affect the visual outcome after surgery. Unlike DKD screening, the detection of DR requires complex, costly machines and trained technicians. Recognizing potential biological markers related to glycation and oxidative stress, inflammation and endothelial dysfunction, basement membrane thickening, angiogenesis, and thrombosis as well as novel molecular markers involved in the microangiopathy process may be useful as predictors of retinopathy and identify those at risk of DR progression, especially in cases where retinal visualization becomes a clinical challenge. Further investigations could assist in deciding which biomarkers possess the highest predictive power to predict retinopathy in clinical settings.

Despite an increase in incident peritoneal dialysis (PD) use of 20% per year, the overall PD prevalence in Indonesia is only 1–2%, with the goal of 30% yet to be reached by 2019. In the absence of contraindications, increasing continuous ambulatory PD (CAPD) use may be an attractive option for Indonesia to reduce the high costs of end-stage kidney disease (ESKD) treatment. The implementation of CAPD in Indonesia faces several challenges, including the cost of PD, the unique archipelagic geography, limited facilities and trained medical personnel in rural areas, inadequate reimbursement rates and incentive fees, high rates of PD discontinuation, as well as insufficient knowledge regarding CAPD by the general public and health professionals. Changes in the policy of medical service incentive fees and improvements in the national health insurance system regulation over CAPD may improve the utilization of PD for ESKD patients in Indonesia. Nationwide promotional and preventive efforts on chronic kidney disease, dialysis modality education and establishment of PD training programs for medical professionals are necessary.

Patients with chronic kidney disease (CKD), including dialysis and transplant patients, are at greater risk of contracting SARS-CoV-2 due to kidney dysfunction and preexisting comorbidities. To date, a specific guideline on managing these high-risk patients infected with COVID-19 has not been established. As the current management of COVID-19 comprises mainly experimental drugs, the authors aim to provide information on dosing adjustments at different stages of kidney dysfunction and notable renal side effects. We performed a nonsystematical review of currently available COVID-19 drugs exploring several different clinical trial databases and search browsers. Several antivirals and monoclonal antibodies used in COVID-19 treatment require dosage adjustments in kidney dysfunction. In a global pandemic setting, nephrologists need to consider the appropriate dosage according to the renal function and closely monitor the side effects of different drug combinations to obtain the optimum therapeutic effect while avoiding further renal damage. Further studies are required to determine the safety and efficacy of these drugs in renal patients.

Patients chronically infected with hepatitis B virus (HBV) may travel to areas with high endemicity of malaria. The overlap between malaria and HBV infection can be clinically severe and present a diagnostic challenge as both diseases manifest similar symptoms. This case describes a fatal case of a 43-year-old man with chronic HBV infected with Plasmodium falciparum malaria that presents as acute kidney injury (AKI) and jaundice following a trip to malaria-endemic region. Despite administering antimalarial and 6 courses of renal replacement therapy, the patient’s clinical condition did not improve, leading to septic shock, multi-organ dysfunction, and eventually, death. AKI and jaundice are commonly seen in severe P. falciparum malaria, as well as acute exacerbation of chronic HBV. This case emphasizes the importance to consider malarial screening when evaluating sick returning travelers, even in those with underlying chronic HBV. Given the severity of coinfection, prompt identification of this overlap can avert the rapid deterioration of severe malaria by early administration of intravenous artesunate and renal replacement therapy.