ISSN 2518-0381 Volume 2 Number 1 November 2017 The ... · The uhers Vol2, No1, November 2017 Cambodian Journal of Nephrology 1 The Cambodian Journal of Nephrology CONTENTS Welcome

The Cambodian Journal of Nephrology

Volume 2 Number 1 November 2017

Meeting IssueThe Second Annual Meeting of Cambodian Association of Nephrology 2017Lim Vadhana, Congress President

CA

MBO

DIAN ASSOCIATION OF NEPHROLO

GY

ស គ ត ក

ISSN 2518-0381

©2017 The AuthersCambodian Journal of Nephrology Vol.2, No.1, November 2017 1


CONTENTS

Welcome LetterWelcome Message to Attendees of “The second annual conference of Cambodian Association of Nephrology 2017”Lim Vadhana

The second annual conference of Cambodian Association of Nephrology “All about CKD and AKI” 2017 Preliminary Program

AbstractsStandard procedure for arteriovenous fistula, superficialization and percutaneous transluminal angioplasty.Toshihide NaganumaCalcium Management in CKD patientsLIM SochunCalcium Channel Blockers and the Cardio-renal SystemPham Van BuiContrast Induced Nephropathy(CIN), how to minimize the risk?NIV Rathvirak“Kidney transplantation; Principles and Methods” AND “Passenger Lymphocyte Syndrome in the ABO-Incompatible Kidney Transplant Recipient Receiving Rituximab.”Shunji NishideThe management of acute hyponatremia in adultHY Chanseila

Dialysis columnBasic Carbohydrate Counting for Glycemic Control in Diabetic Hemodialysis Patients.Toru Hyodo

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Where a manuscript is posted in the Journal in multiple languages and where there is any discrepancy between the versions in different languages, the Eng-lish language version will prevail over the others.

សារណាដែលបានចះផសាយកនងទសសនាវែតរបសយយើងខញតវបានបកដតបជាភាសាយផសងៗ។

កនងករណើមានការតសពចតសពលយៅយលើពាកយឬភាសាណាមយយនាះយយើងខញសមផល

អភាពយៅែលអនយតបយោគដែលបានសរយសរជាភាសាអងយគលេស។

CA

MBO

DIAN ASSOCIATION OF NEPHROLO

GY

ស គ ត ក

©2017 The AuthersCambodian Journal of Nephrology Vol.2, No.1, November 2017


The second annual conference ofCambodian Association of Nephrology

“All about CKD and AKI”2017 Preliminary Program

8:00 Arrival of National and International participants and speakers(Register)8:30-8:35 National Anthem8:35-8:45 Welcoming and Opening Speech by Prof.Lim Vadhana, director of CAN

Session 1 Chairman:Prof.LIM Vadhana, Prof.Toru Hyodo8:45-9:05 Standardprocedureforarteriovenousfistula,superficialization and percutaneous transluminal angioplasty Presented by : Dr.Toshihide Naganuma, Osaka, Japan 9:05-9:25 Calcium Management in CKD patients Presented by : Dr. LIM Sochun, general secretary of CAN, Calmette Hospital, Cambodia9:25-9:45 Calcium Channel Blockers and the Cardio-renal System Presented by : Prof. Pham Van Bui, Vietnam9:45-9:55 Roche presentation9:55-10:10 Question & Answer10:10-10:30 Coffee Break

Session 2 Chairman:Dr.LIM Sochun, Prof.Pham Van Bui, Vietnam10:30-10:50 ContrastInducedNephropathy(CIN),howtominimizetherisk? Presented by : Dr. NIV Rathvirak, executive member of CAN, Calmette Hospital, Cambodia10:50-11:10 “Kidney transplantation; Principles and Methods” AND “Passenger Lymphocyte Syndrome in the ABO-Incompatible Kidney Transplant Recipient Receiving Rituximab.” Presented by : Dr. Shunji Nishide, Osaka, Japan11:10-11:30 The management of acute hyponatremia in adult Presented by : Prof. HY Chanseil, executive member of CAN, Calmette Hospital, Cambodiaseil, executive member of CAN, Calmette Hospital, Cambodia11:30-11:40 Roche presentation11:40-11:50 La Renon presentation11:50-12:10 Question & Answer12:10 Closing Ceremony, photo and lunch

Date : November 18, 2017　Venu : IHotel Cambodiana

Welcome Letter

Remark by Prof. Lim Vadhana

President of the Cambodian Association of Nephrology,At the 2nd Annual Conference of the Cambodian Association of Nephrology

18 November 2017, Phnom Penh, Cambodia

Dear Excellencies, distinguished guests, dear colleagues, friends, ladies and gentlemen. On behalf of the Cambodian Association of Nephrology, it is my great pleasure to host this event and welcome you to the annual conference of nephrology. I am very grateful to you for taking time off from your busy schedule to attend this important conference. I’d like to begin by giving a brief introduction to CAN and describe what it is that we do here. Cambodian Association of Nephrology, being legally permitted by Ministry of Interior of Cambodia in April 2016, is created by our Cambodian nephrologists with a strong support of Professor TORO HYODO. The main task of our association is to promote health and welfare of our people in any condition. As you can see the number of cases of kidney diseases is increasing non-stop worldwide as well as in Cambodia, they become a burden to the family and the society. In order to solve this problem, our members of CAN are trying very hard to publicize to our people about the prevention and treatment of kidney diseases. CAN also trains doctors and medical officers to be able to understand and treat kidney diseases efficiently. Today, with the participation of our national and international guests from Vietnam and Japan, we are very delighted to welcome you to the second annual conference of nephrology of Cambodia. I am very honored to announce that the conference starts now. Last, I would like to wish you a very successful conference and a wonderful day. Thank you. LIM VADHANA

សមគោរពឯកឧតតមគោកជទាវសាសសាត ចារយគវជជបណឌតបងបអននឌងកមយៗដែលបានចលរមកនងកមវធែវគសសវសាលនវថងៃគនះ។

ខញបាទគវជជបណឌត លម វឌឍនា មានកឌតតឌយសជនសមខគោយសមាគមសគគពទយតសមងគនាមកមពជាទាងមលសមដលែងអណរគណយា ងគសជៀលគសរៅបផត

ចគោះវតតមានែថលែថលែ របសគញៀវកតតឌយសទាងអសកនងឱកាសគនះ។ ខញបាទសមគលែៀតឱកាសគពលគនះ ជរាប សតសៗអពជវសបវតតឌរបសសមាគមគយងខញ។

សមាគមសគគពទយតសមងគនាមកមពនជាសតវបានបគងកតគ�ងនឌងទទលសាគា លជាផលែអវការគោយសកសងមហាថផទៃថនសពះរាជាណាចសកកមពនជាគៅដខគមសា

ឆ ២០១៦។ សមឌទឌផលគនះបានផតមចគផតមគ�ងគសកាមការខឌតខសបងដសបងយា ងសសសាកសសសារបសសកមសគគពទយតសមងគនាមកមពនជាសបមាណជាជាង១០នាក

គោយមានការជយគសជាមដសជងយា ងសកមពសាសសតចារយTOROHYODOដែលជាសបធានកឌតតឌយសរបសសមាគមបចនបបន។សមាគមគយងខញ

ប គងកតគ�ងកន ង គោ លបនងគធវយា ងណាជយគលកកពសែលសខមាលភាពរបសសបជាជនគោយមឌនគឌតពសបាកកថររផលចគនញអវទាងអស។

ែចគយងទាងអសោបានសជាបថសពវថងៃគនះចននអកជងតសមងគនាមគៅកនងពឌ ពគោកកែចជាកនងសបគទសកមពនជាកពងដតមានការគកនគ�ងខពសគរ

គោយសពយបារមភដែលគនះបានកាលែ យជាបនទៃនកែធងៃនធងៃររបសសកមសគសារកែចជារោឋា ឌបាលសបគទសនមយ ។ៗគែមបចលរមចដនកសសមាលបនទៃនកែធងៃនធងៃរ

គនះគយងទាងអសោជាសមាជកថនសមាគមសគគពទយតសមងគនាមកមពនជាមានភារកឌចែថលែថលែ កនងការផសពវផសាយែលសារធារណជនទគៅគោយមានការ

យលែងអព វធបងក រ នឌងដទាសខភាពគោយគចៀសផតពបញហា ែោសកកគនះ។ សមាគមគយងខញកមានភារកឌចកនងការជយបណតន ះបណាត លែលសគគពទយ

កែចជាមននតសខាឌបាលគោយមានការយលែងនឌងសមតថភាពកនងការពយាបាលជងតសមងគនាមសបកបគោយភាពសតមសតវនឌងគណភាពខពស។

ថងៃគនះសមាគមសគគពទយតសមងគនាមកមពនជាមានកឌតតឌយសបានសបារពនវសនឌបាតសបចាឆគលកទ២ គោយមានការចលរមយា ងគសចនកះករព

សណាកគញៀវជាតឌកែចជាគញៀវអនតរជាតឌជាបងបអនដែលបានអគញមកពសបគទសគវៀតណាមនឌងសបគទសជបាន។

ខញបាទសមសបកាសគបកសនឌបាតសបចាឆគលកទ២របសសមាគមសគគពទយតសមងគនាមកមពនជាពគពលគនះតគៅ។ជាទបប ខញបាទសមគោរពជន

ពរែលគញៀវកឌតតឌយសទាងអសដែលមានវតតមានគៅទគនះគោយទទលបាននវសខភាពល មានជយជនះរាលកឌចការ ឈះឧបសគគាទាងអសគបបឃលែ ងឃលែ ត

គ�យ៕

សាសសាត ចារយលមវឌឍនា



Standardprocedureforarteriovenousfistula,superficializationand percutaneous transluminal angioplasty.

Toshihide Naganuma1,2), Ayumi Takizawa2,3), Haruki Wakai2), Toru Hyodo2)

1) The Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan2) NGO Ubiquitous Blood Purification International, Yokohama, Japan3) Japanese Society for Technology of Blood purification, Tokyo, Japan

Arteriovenousfistula1) Today I will show you a video of the typical arteriovenous fistula (AVF) creation procedure we perform in the distal forearm at our hospital.2) First of all, after applying a tourniquet, we visually examine whether there is a suitable vein in the forearm and whether this vein continues to the elbow. Continuity of the vein can be confirmed by placing your right index finger on the cubital vein and feeling the pulsation of the peripheral blood vessels with your left index finger. If pulsation cannot be felt, the vein may be too thin or blocked in mid-forearm, upon which AVF creation is attempted somewhere else.3) Next, we remove the tourniquet and confirm whether there is enough pulsation in the artery by palpation. 4) A line is marked on both the artery and the vein, between which the incision will be made.5) After sterilizing the site, a local anesthetic of 1% Xylocaine is injected. A 30 G needle is used at our hospital to minimize pain. The tissue is plumped up to prevent cutting the blood vessels underneath by mistake when making the incision.6) We then make the incision. The scalpel is inserted at a shallow angle to avoid damaging the blood vessels, but the incision needs to be made into the dermis.7) The incision is opened using a retractor, but if there is a thick layer of tissue left on the blood vessels, it is isolated using mosquito forceps and cauterized using bipolar cautery, which is then incised with Metzenbaum scissors. Bleeding is stopped using bipolar cautery.

8) Next, the vein is isolated using mosquito forceps and secured with surgical tape. In this image, the upper left is the peripheral side and the lower right is the central side.9) The vein branches are ligated using 3-0 silk suture threads.10) The sheath around the vein is detached in the running direction of the vein, so that the vein is sufficiently visible.11) Next, the artery is isolated after confirming pulsation.12) The artery is isolated using mosquito forceps and secured with surgical tape, and the artery branches are ligated after cauterization using bipolar cautery.13) We then line up the isolated vein and artery and measure the distance between them to form a mental image of anastomosis.14) Next the vein are dissected.15) Holding a tweezer with narrow tips and using the outer tube of an 18 G butterfly needle, we dilate the vein with saline solution. If the pressure is high or the vein is thin, a 3Fr Fogarty catheter is used. 16) The site of anastomosis is dilated with saline solution.17) Bulldog clamps are placed on the artery.18) We then confirm the anastomosis site of the vein and artery.19) The lateral aspect of the vein is incised using a scalpel, and the incision is opened with ophthalmic scissors to approximately 7 mm.20) Next the artery is dissected.21) We use one 7-0 Prolene for anastomosis.

Instead of using two strands of thread to tie the two ends, with this method, the ends are clearly visible and anastomosis is close to a loop and smooth, but you will need some practice. The person on the right is the surgeon and the person on the left is the assistant.22) The suture is threaded from the peripheral side, and anastomosis is performed by continuous suture from the back. Please look at the video. There is about a 1 mm gap between suture points. After the back is sutured from the peripheral side to the central side, the front is sutured from the peripheral side to the central side. 23) At this time, you must be careful not to suture the back. When we reach the end, we make a knot by tying at least 5 times.24) We next remove the bulldog clamp on the vein, the one on the peripheral artery and the one in the center and confirm if there is good thrill and no leaks.25) The image has been flipped over. Because venous outflow occlusion can cause bleeding from the anastomosis site, we check the outflow, and if there is connective tissue around the blood vessels, it is isolated using mosquito forceps.26) The incision is closed by mattress suture using 4-0 nylon thread, and 3 stitches are usually enough for this site. Lastly, we affix the dressing tape.

Superficialization1) First, the skin incision must be designed to allow for the puncture site to be adequately made. There are several designs for this incision, but we make a crestal incision.2) Dissection should be done quite boldly, and the subcutaneous tissue is incised to reach the fascia using scissors or an electric scalpel.3) If there is any bleeding, it is stopped using bipolar cautery.4) Mosquito forceps are applied on the stumps of the incised fascia.5) After the fascia is incised to some extent, the

brachial artery is palpated using fingers, and dissection is made.6) The median nerve may be present nearby, and additional anesthesia may be required, if there is more pain. 7) The artery is encircled with vascular tape.8) The artery branches are ligated with silk suture, and the artery is exposed.9) The artery is further exposed by removing the veins and median nerve alongside it. 10) Here we are checking the fascia.11) The fascia is placed so the artery is on top of the fascia.12) An incision is being made between the adipose tissue and fascia.13) The fascia is being placed.14) The skin flap is being placed, and blood flow is being simulated.15) A cut is made using scissors into the fatty tissue where the blood vessel is to travel.16) The blood vessel is encased with fat and attached to the skin flap.17) Confirm if the superficialized artery can be palpated. If the fat on the flap is too thin, the skin can cause necrosis due to circulation disorder and if it is too thick, it will be difficult to puncture18) Lastly, the surgical wound is closed.

Percutaneous Transluminal Angioplasty1) In Japan the shunt is rarely surgically created after stenosis or obstruction, and PTA is usually performed, elevating the patency rate of vascular access.2) A sheath is inserted into the vein and a PTA balloon is inserted expanding the stenosis. There are balloons that can increase the pressure to up to 30 ATM.3) In this case, X-ray examination using contrast medium is performed, but ultrasound is also used. 4) The procedure is simple but the device can be expensive at about 300 dollars.

Abstracts



នតវធសដងដារសមរាបអនវតតន Arteriovenous Fistula, Superficialization នងPercutaneous Transluminal Angioplasty.

តសហដ ណាហកា នមា (Toshihide Naganuma)1,2), អាយម តាគហសា វា (Ayumi Takizawa)2,3), ហរគ វា កៃ (Haruki Wakai)2),

ថរ ហយដ (Toru Hyodo)2)

1) The Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan2) NGO Ubiquitous Blood Purification International, Yokohama, Japan3) Japanese Society for Technology of Blood purification, Tokyo, Japan

Arteriovenous Fistula

1) នៅៃនងកថងៃននះ ខញសមបងហា ញអៃទាងអសគនវវនដអទាៃទងនង

Arteriovenous Fistula (AVF) ដដលពៃនយងបានអនវតតនាឯមនរ

នពទរបសនយងខញ ។

2) ជាបឋម នយងនបបាស Tourniquet នដើមពនតនមលថានតមន

សរកសឈាមដវាននៅៃនងៃភនកដ ឬអត ។ នហយសរកសឈាមននាះ

បនតនៅដលដៃងកដដដរឬនទ ។ នយងអាចដងបានតាមរយៈការដាៃ មម

កដសនសសនសដា របសនយងនៅពនលសរកសឈាម (Cubital Vein)

ននាះ នហយនបមមកដសនសសនខាងនវេងរបសនយង ន ត តអារមមណ

នៅនលរញរនចញពសរកសឈាមខាងៗ(Peripheral Blood Vessels)។

នបសនជានយងមនអាចដងអពរនោចបានននាះមននយថាសរកសឈាម

ដវានអាចនសតងនពៃ ឬ តវបានរាងសះពពាៃៃណាត លៃភនកដមៃ ។

ដនចះ នយងតវអនវតត AVF នៅទតាងនសងវញ ។

3) បនាបមៃ នយងដៃ Tourniquet នចញ នហយសងកាតពនតនម

លថានតមនការរនោចគបគននៅៃនងសរកសឈាមអារដទដដរឬ

នទ។

4) នយងគសដសបនាតនដើមចណាសរកសឈាមអារដទ នង ដវាន

នដើមងយសលៃនងការវះកាត ។

5) នកាយពនវេការសមលា បនមនរាគរច នយងនវេការចាៃថាសៃ Xy-

locaine 1% ។ មនល 30 កាម តវបាននបបាសនៅៃនងមនរ

នពទរបសនយងនដើមកាតបនថយការឈចាប។

ជាលកាតវបានបនបាា ងន�ងនដើមទបសកា តការកាតចសរកសឈាមខា

ងនកាមនដាយអនចតនាៃ�នងនពលវះកាត ។

6) បនាបមៃនយងនវេការវះកាត ។ Scalpel តវបានោត

បញយលរាៃៗ នដើមនចៀសវងៃនអាយសរកសឈាមរងការចខាត ។

ដតការវះកាតតវបានបពតតន�ងនៅខាងៃនង Dermis ។

7) នយងនបបាស Retractor ៃនងការវះកាតនបៃ ។

បាដនត នបសនជាមនសទាបជាលកាកាស នៅនសះសលខាងៃនងសរកស

ឈាមននាះ នយងនវេការដញៃវនចញនដាយនបបាសៃកតនត Mos-

quito Forceps នង Cauterized នដាយនប Bipolar Cautery

។ បនាបមៃ វះកាតនដាយនបៃកតនត Metzenbaum ។ ការហរ

ឈាមតវបានបញឈបនដាយការនបបាស Bipolar Cautery ។

8) បនាបមៃ នយងយៃសរកសឈាមនចញនដាយនបបាសៃកតនត

Mosquito Forceps នងការពារវនដាយសកានតវះកាត (Surgical

កាតសរកសឈាម ។ ជនសឱការនបដសអនបាះ 2 ចងចងទាងសងខាង

វ ននះជយនអាយនយងអាចនមលន�ញដៃខាងចងបានចបាស នង

Anastomosis មនរាងមលនងរនោង ៃបាដនតវ ននះតមវនអាយនយង

នវេការហវេៃហតជានចនដងជាមនសន ។ អៃដដលនៅខាងសត គជាគ

នពទវះកាត នហយអៃនៅខាងនវេងគជាជនយការ។

22) នថរអនបាះតវបាននដរបនតពដៃចនហៀងមៃ (Peripheral Side)

ចដណៃឯ Anastomosis តវបានអនវតតពដៃខាងនកាយមៃ ។

សមអនញញទសសនាវនដអ ។ ននះគជាគោតបមណ 1មម

រវងនថរនមយៗ ។ នកាយពនវេការនដរពចនហៀងដៃខាងនកាយ

(Peripheral Side) មៃដលចណចៃណាត ល នលៃននះនយងនវេការនដរ

ពចនហៀងដៃខាងម នៅចណចៃណាត ល (Central Side) វញមតង ។

23) មៃដលចណចននះ នយងតវនវេការបងបយតៃនអាយនដរចដៃ

ខាងនកាយ ។ នៅនពលនយងនដរដលដៃខាងចងនហយននាះ នយង

តវរចងវយា ងនហយណាសនអាយបាន 5 ដង ។

24) បនាបមៃ នយងដៃដនងកាៀប Bulldog Clamps

នចញពនលសរកសឈាមដវាន ។ ដៃដនងកាៀបដដលនៅដៃខាងនកាយ

(Peripheral Artery) មន នហយដៃដនងកាៀបដដលនៅដៃៃណាត ល

តាមនកាយ ។ នយងតវពនតនមលថាវមន Good Thrill នង

គម នឈាមហរនចញមៃ ។

25) នយងបដងវេរនអៃងបចសចះនកាម ។ នពាះនបសនលហរកនសរ

កសឈាមមនភាពរាងសះ វអាចនងនវេនអាយឈាមហរនចញមៃតាម

នថរ ។ នហតដនចះ នយងតវនវេការពនតលហរកនឈាម ។ នបសន

ជាមនជាលការជវញសរកសឈាមននាះ នយងនវេការដញៃវនចញនដាយ

នបៃកតនត Mosquito Forceps ។

26) នយងនវេការនដរតវញនដាយនប បាសដសអនបាះន�នង 4-0 នហយ

បដហលជា 3នថរគ គប គនសមបការនដរតននះ ។ ច ងនកាយ

នយងយៃ Dressing Tape មៃបតពនលជាការនសច ។

ការវះកាតសរសសឈាមដ�ើមស� Superficialization

1) ជាបឋម នយងនវេការវះកាតដសៃនដាយរចនាវនអាយមនចននាលា ះ

គប គនងយសលៃនងការអនវតត Puncture site ។

វមននចនរនបៀបៃនងការរចនា នដើមការវះកាតននះ បាដនតនយងអនវតត

តាមដបប Crestal Incision ។

2) នយងគរនវេការវះនអាយបានបនតច ចដណៃជាលកានកាមដសៃ

នយងនប បាសៃកតនតឬ Scalpel អគសន នដើមនវេការវះនអាយដល

Fascia ។

3) នបសនជាមនឈាមហរនចញមៃននាះ នយងនប បាស Bipolar

Cautery នដើមឃាតឈាម ។

4) នយងនបបាស Mosquito Forceps នដើមគបចង Fascia

ដដលបានកាតរច ។

5) បនាបពនយងនវេការវះ Fascia បានទហសមសបននាះ នយងយៃ

មមកដមៃសងកាត សរកសឈាមនដើមកដ នហយនវេការវះកាត ។

6) ចនកាល អាចមនសរកសបសទៃណាត ល (Median Nerve)

សថតនៅៃដនលាងននាះ ដនចះនបសនជាអៃជមងៃមនការឈចាប នយងនប

បាស ថាសៃ ។

Tape) ។ នៅៃនងរបភាពននះ ដៃខាងនលដបាៃខាងនវេងគជា

Perip h eral Side ចដណៃឯដៃខាងនកាមកនដបាៃខាងនវេងគជា

ចណចៃណាត ល (Central side)។

9) ដមៃធាងកនសរកសឈាមដវានតវបានតភាបនដាយនបដស 3 - 0

(Silk Suture Threads) ។

10) សទាបទនាបជវញសរកសដវានតវបាននគដញៃនចញនៅតាមទស

នៅកនសរកសឈាមដនចះនយងអាចនមលន�ញសរកសឈាមបានគប

គន ។

11) បនាបមៃនទៀត នយងនវេការដញៃសរកសឈាមអាដទរនចញនកាយ

ពនតថាវមនរនោច ។

12) នយងនវេការដញៃសរកសឈាមអាដទរនចញនដាយនបបាសៃកតនត

Mosquito Forceps នងការពារវនដាយសកានតវះកាត (Surgical

Tape)។ ចដណៃដមៃធាងកនសរកសឈាមអាដទរតវបានតភាបនដាយ

នប បាស Bipolar Cautery បនាបពនវេ Cauterization រច ។

13) បនាបមៃ នយងតនមៀបសរកសឈាមដវាន នង អាដទរ

ដដលតវបានដញៃនចញពគននាះ នហយនវេការវសដបដវងវនដើម

បនងកាើតនៅជារបភាព Anastomosis ។

14) បនាបមៃ សរកសឈាមតវបាននគវះកាត ។

15) កានចនាសមយ ជាមយនង Narrow Tips នងនប បាសមនល

នមអនៅ 18កាមដដលភាបមៃជាមយនងបពង Outer Tube ។

នយងនវេការពងងើៃសរកសឈាមនដាយនប បាស Saline Solution ។

នបសនជាសមស ឬ សរកសដវានតចនពៃ នយងនប បាសកាតទរ

3 Fr Fogarty Catheter ។

16) នយងអាចន�ញរបភាព Anastomosis កានដតនដាយសរ

Saline Solution ។

17) យៃដនងកាៀប Bulldog Clamps នគៀបពនលសរកសឈាមអាដទរ។

18) បនាបមៃ នយងនវេការពនតដៃខាង Anastomosis

កនសរកសឈាមដវាន នង អាដទរ ។

19) នយងនបបាស Scalpel នដើមនវេការវះកាតដៃខាងនកាយកន

សរកសឈាមដវាន ។ នហយនយងនវេការវះនដាយនបៃកតនត Ophthal-

mic Scissors បមណ 7មម ។

20) បនាបមៃសរកសឈាមអាដទរតវបាននគវះកាត។

21) នយងនប បដ�ន (Prolene) 7-0 មយសមបការវះ

7) នយងនប បាស Vascular Tape នដើមរជវញសរកសឈាម ។

8) នយងចងសរកសឈាមជាមយនងសរកសស ត

នហយនវេការកាតវបនញញមៃខាងនរៅ ។

9) នយងកាតសរកសដដលនៅអមជាមយនងសរកសឈាម

ពមទាងសរកសបសទៃណាត ល នដើមបនញញសរកសមៃខាងនរៅបដនថម

នទៀត ។

10) នពលននះ នយងៃពងនវេការពនត Fascia ។

11) នយងនវេការតមម Fascia នដើមនអាយសរកសឈាមនៅពនល

Fascia វញ ។

12) ការវះកាត តវបាននវេន�ងនៅចននាលា ះ ជាលកា Adipose នង

Fascia ។

13) នយងនវេការសនរេ Fascia ។

14) នយងគប Skin Flap នហយសៃលង Simulated លហរឈាម

។

15) នយងនប បាសៃកតនតនដើមកាតនៅៃនងជាលកាខាលា ញ ដដលសថតនៅ

ចៃណាត លលាយវដដលសរកសឈាមតវលាងកាត ។

16) នយងរសរកសឈាមជាមយនងខាលា ញនហយភាបវនៅនង Skin Flap។

17) នបសនជាខាលា ញនៅនល Flap នសតងនពៃននាះ វអាចបណាត លនអាយ

មនភាពចបៃចបលកនចរនតឈាមនៅៃនងដសៃ (Necrosis)

នហយនបសនជាវកាសនពៃននាះ គពបាៃៃនងការចាៃមនល ។

18) បទម របសរច ការវះកាត តវបានបញប ។

PTA

1) នាឯបនទសជបាន ការវះកាត Shunt មតងនទៀត គៃមមនណាស

ៃនងៃរណដដលមន Stenosis ឬការសះននាះ ។ ជាបឋម នគអនវតត

PTA នដើមបនងកាើនអតាភាពអត មត (Patency rate) កនដនណរ

ការរបសសរកសឈាម។

2) នយងនវេការសៃបញយលសទាបការពារ (Sheath)

ចលនៅៃនងសរកសឈាម បនាបមៃសៃបញយលនបាងនបាា ងសមប

PTA នៅៃនងននាះនដើមពងងើៃដៃដដលសះ ។

មននបាងនបាា ងដដលអាចបនងកាើនសមដល 30 ATM ងដដរ ។

3) ៃនងៃរណននះ ការពនត X-ray នដាយនប Contrast Me-

dium តវបានអនវតត ៃបាដនតនយងៃនវេការពនតតាមនអៃ ងដដរ។

4) វ ននះគសមញញ បាដនតឧបៃរណននះអាចមនតកលកថលា បដហល

300 ដោលា រឯនណាះ ៕

AbstractsAbstracts



Calcium Management in CKD patients

LIM Sochun, MD

General secretary of Cambodian Association of Nephrologyinternist and nephrologist at Calmette hospital and University of Health and Sciences

Chronic renal failure (CKD) can give several complications through following their stages. One of them is phosphorus and calcium disorder. Aging is associated with decreases in bone quality and in glomerular filtration. Consequently, renal osteodystrophy and CKD are common comorbid conditions in the elderly. Biochemical abnormalities in the homeostasis of calcium and phosphorus begin early in CKD, leading to an increase in fracture risk and cardiovascular complications since early stages of the disease.

The management of the disease is also controversial: calcium and vitamin D, although recommended, must be prescribed with caution, considering vascular calcification risk and the development of adynamic bone disease.

ការពយាបាលវបតតផសវរ នង កាលសយមដៅដលអនកជមងដសោយតមមងដោម

លមសជន

យវជជបណឯកយទសតមងយនាមបយតមើការយៅមនទៃើរយពទយកាលដមា ដផកជមងៃទយៅកនងមជឍមណលោងឈាមជាសើម

AbstractsAbstracts

បញហា យខសាយតមងយនាមរាថរេោចបណាល　 យោយមាននវផលវបាកជា

យតចើនយៅតាមណាកកាលថនករ ធងៃនធងៃររបសជងយនះ។

កនងចយណាមយនាះ វ បកាលសយអមន ង ផសវរកជាផលវបាកមយកនង

ចយណាមយនាះដែរ។

ភាពរងមារបស ងយចះយៅតាមោយ ែចោដែរ ភាពរងមារបស

ងកោចយចះយៅតាមភាពយខសាយថនតមងយនាម។

យហយនះយហើយយទើបបញហា ថនការយចះភាពរងមារបស ងដងដជបញក

ោបយៅយលើអកជងយខសាយតមងយនាមរាថរេដែលមានវយចាស។ វប

កាលសយអមនងផសវរោចយកើ មានយ�ើងតាងដពើ ណាកកាលែបងថនការ

យខសាយតមងយនាមដែលោចបណាលយោយអកជងជបនងបញហា បាក ង

របញហា សថសឈាមជាយែតម។

ការពយាបាលវបកាលសយអម នង ផសវរយោយថកាលសយអម នង

វតាមើនយែតវដយធវើយ�ើងយោយតបងតបយ ពើយតពាះការពយាបាលយោយ

ថទាងយនាះោចយធវើយោយមានបញហា ងនង បញហា សថសឈាមកានដ

ធងៃនធងៃរ៕



Calcium Channel Blockers and the Cardio-renal System

Prof. Pham Van Bui, Viet Nam

The most important property of Calcium Channel Blockers (CCBs) is to selectively inhibit the entrance of calcium ions into the cell when the calcium channel becomes permeable. There are at least two types of calcium channel, the L and the T/N. The movement of calcium ions through L channel, which is blocked by CCBs and increased in activity by catecholamines, would result in vascular constriction whereas the T/N channels are found predominantly in nerve endings, which secrete norepinephrine once stimulated and resulting in increase in heart rate and vaso-constriction. All old CCB generations (1st, 2nd, 3rd

generations) only block L channel but have no effect on T type. Consequently, they cause vasodilation and lowering blood pressure with the risk of increase in heart rate due to calcium ions keeping entering T/N channels. In renal glomeruli, L channels locate predominantly in the afferent arterioles whereas T/N channels are in both afferent and efferent arterioles. Therefore, the 1st, 2nd, 3rd generation CCBs, by only acting on L channels, can cause untraglomerular hypertension in the conditions such as uncontrolled arterial hypertension, hyperglycemia, albuminuria/proteinuria…, and injure glomeruli in the long run.Recently, Cilnidipine, considered as the 4th generation CCB, acts on both L and T/N channels. Therefore, in the cardiovascular system, Cilnidipine helps to low blood pressure without

tachycardia reflex secondary to norepinephrine released from nerve endings and lowering blood pressure. Also, in the kidney, there is no risk of intraglomerular hypertension as both afferent and efferent are dilated due to both L and T/N channels are blocked by Cilnidipine. As such, Cilnidipine distinguishes from other L channel CCBs with additional T/N-type of CCB property. Its cardioprotective, renoprotective and neuroprotective action can provide additional benefit regarding reduced morbidity in the management of hypertension by sympathetic overactivity, and intraglomerular pressure control

Calcium Channel Blockers នង The Cardio-Renal System

សាតសាចារយមវា នបាយ,តបយទសយវៀណាម

លកខណៈពយសសសខានបផ ថន Calcium Channel Blockers

(CCBs) គ យែតមបើទបសាក ការយតចៀចលថនកាលសយអម (Ca2+)

ចលយៅ កនងយកាសកាយៅយពលដែល Calcium Channel

មានសមថភាពតជាប។CalciumChannelោា ងយហាចណាសមាន

២តបយទគ Channel Lនង T/N។ចលនារបសកាលសយអម

(Ca2+)តាមរយៈChannelLតវបានរារាងយោយCCBsនង

បយងកតនសកមភាពយោយ Catecholamines ោចបណាលយៅជា

VascularConstriction។T/NChannelsដែលមានវមានោា

ងយតចើនយលើសលបយៅកនងខាងចងថនសរថសតបសាទតាមរយៈNorepi-

nephrine ដែលបណាលយោយចងវ កយបះែងយកើនយ�ើង នង

បណាលយោយមាន Vaso-Constriction ។ CCB

ជនានចាសទាងអស (ជនានទើ 1 ទើ 2 នងទើ 3) ទបសាក ដ

Channel L បាដនដាមនមានឥទពលយលើតបយទ T យនាះយទ ។

ជាលទផល វបណាលយោយមាន Vasodilation នងបនថយសមាព ធ

ឈាមជាមយនងហាន យថនការយកើនយ�ើងថនអតតាចងវ កយបះែង

យោយសារដការយតចៀចលថនកាលសយអម (Ca2+) យៅកនង Chan-

nelsT/N។

យៅកនង Glomeruli ថនតមងយនាម, Channels L

មានវមានោា ងយតចើនយលើសលបយៅកនង Afferent Arterioles

ចដណកឯChannelsT/NមានវមានទាងយៅកនងAfferent

នងEfferentArterioles។យហែយចះយហើយCCBsជនានទើ

1ទើ2នងទើ3យធវើសកមភាពដយលើChannelsLបាយណាណ ះ

ដែលោចបណាលយោយមាន Untraglomerular Hypertension

ែចជាHypertension,Hyperglycemia,Albuminuria/Pro-

teinuria...នងរបសGlomeruliរយៈយពលយរ។

តៗ យនះ Cilnidipine តវបានយគចាទកជា CCB ជនានទើ 4

យែតរយលើ Channels L នង T / N ។ ែយចះយហើយ

យៅកនងតបពនសរថសឈាមយបះែង (Cardiovascular System),

Cilnidipine បានជយបនថយសមាព ធឈាមយោយោន Tachycardia

ReflexSecondaryយៅកានNorepinephrineដែលបយញយចញ

ពើចងថនសរថសតបសាទនងបនថយសមាព ធឈាមយនាះយ�ើយ។

ែចោយនះផងដែរយៅកនងតមងយនាមមនមានហាន យថនជងIntra-

glomerularHypertensionយនាះយទយតពាះAfferentនងEf-

ferent តវបានពងងតកយោយសារដChannel Lនង T /N

តវបានរារាងយោយ Cilnidipine ។ ែចយនះ Cilnidipine

គតវបានដបងដចកោចពើChannelLរបសCCBsយោយសារដ

វមានចណចពយសសោចរារាងChannelT/Nបាន។

សកមភាពថនCardioprotective,RenoprotectiveនងNeuro-

protectiveោចផលនវអថតបយោជនបដនថមែចជា ជយសតមលែល

ការតគបតគងការយ�ើងខពសថនសមាព ធឈាមHypertensionយោយការ

ការពារសរថសឈាមយបះែងការពារតមងយនាមនងការពារតបពន

សរថសតបសាទផងដែរ៕

AbstractsAbstracts



Contrast Induced Nephropathy(CIN), how to minimize the risk?

NIV Rathvirak, M.D

Nephrologist, Department of general medicine A4 and hemodialysis CHEA SIM, CALMETTE hospital.

Contrast induced nephropathy (CIN) defined as a rise in serum creatinine of >0.5 mg/dl (>44 mmol/l) or a 25% increase from baseline value, assessed at 48 hours after a radiological procedure. Because of the increased use of contrast media (for diagnosis or therapeutic purpose) and the increased of the prevalence of diabetic and cardiovascular patients, the potential risk of CIN has also been increased. In US, it represents the 3rd cause of hospital acquired AKI with the incidence about 2% in patients without risk factors, and up to 9% in patients with risk factors. CIN is a phenomenon that has been studied throughout the years. Many studies show the

benefits of using I.V isotonic sodium chloride or/and N-Acetylcysteine (NAC) to reduce the incident of CIN. But there are others strategies that can also minimize the risk. The aim of this presentation is to find out the suitable CIN’s prevention for Cambodian patient.

បញហា តមមងដោមដមកាយការចាកសារធាត Contrastៈ វធការពារ

នើវរ វរៈ

យវជជបណឯកយទសតមងយនាមបយតមើការយៅមនទៃើរយពទយកាលដមា ដផកជមងៃទយៅក4នងមជឍមណលោងឈាមជាសើម

AbstractsAbstracts



AbstractsAbstracts

“ដោលការណនងវធសាមសតកននងការវះកាតបតយរតមមងដោម” នង “ដោគសញញា សន Passenger Lymphocyte Syndrome ដៅកននងអនកជមងផលា សបតយរតមមងដោមដ�លរានមបដេទឈាម ABO មនសមមសបសមរាបការបតយរសរោងគ”

សយាងយនើសើែ(ShunjiNishide),សើហើែណាហាក នមាា (ToshihideNaganuma),ហើសាអសើមាា ោ(HisaoShimada),ោគើហើរេខសគ(AkihiroKosoku),ខាសសាោា ខាយបយ(KazuyaKabei),មាោគអើវា យ(TomoakiIwai),ណបាយគ�វា បារាា(NobuyukiKuwabara),ណរហើក�មាា ោ(NorihikoKumada),យងយអាជតោ(JunjiUchida),យាសើោគថយកមា (YoshiakiTakemoto),ថសសាោា ណាកាតាន(TatsuyaNakatani)

មនទៃើរយពទយសាកលវទយាលយយវជជសាតសអសាកាដផកតមងយនាម (The Department of Urology, Osaka City University Graduate School of Medicine)

ចយពាះអកជមងៃដែលមានជមងៃ តមងយនាមែណាកកាលចងយតកាយការបអរតមង

យនាមដែលទទលបានយជាគជយ

ោចយធវើយោយពកយគមានភាពតបយសើរយ�ើងនវគណភាពថនជតវ នងបនថយហានា

យែលោយជតវ យបើយតបៀបយធៀបយៅនងការពយាបាលយោយការោងឈាមរ

យៈយពលយរ។ ែយចះ វបងហា ញោា ងចបាសថ ការបអរតមងយនាមគ

តបយសើរជាងការោងឈាមកនងរយៈយពលដវង។កបាដនកនងអ�នងយពល3ដខ

ែបងថនយតកាយពើការបអរសររាងគា អតតាហាន យដែលបណាលយោយសាលេ បកនង

ចយនាមអកជមងៃ លេ សបអរតមងយនាមមានការយកើនយ�ើង។យនាះគយោយសារដ

ហាន យដែលបណាលមកពើការវះកា ទៃ លផងរមផសជាមយនងការយតបើតបាស

ថរារាងតបពនភាពសាា កតម ខពសបដនថមយទៀ។

យៅកនងការយធវើបទបងហា ញយនះយយើងនងយធវើការពភាកសាអពើនើ វធើកនងវះកាបអរ

តមងយនាម នង ការពយាបាលយោយការយតបើថបនថយតបពនភាពសា។

យហើយយយើងនងបដនថមរបាយការណ1ករណើដែលមានភាពពបាកកនងការតគប

តគងយតកាយការវះកាយៅតងចណចបនភាពសាា យនះ

តពមទាងយធវើយរាគវនចយយៅយលើ យរាគសញញ ថន Passenger Lymphocyte

Syndrome(PLS)។

តសើវយ64ឆដែលមានជមងៃយខសាយតមងយនាមរាា ថរេយោយសារដជមងៃទកយនាម

ដផមបានយៅមនទៃើរយពទយរបសយយើងយែតមបើទទលការបអរតមងយនាមយោយោមា

នតបយទឈាមABOមនសមតសបសតមាបការបអរសររាងគា(បអរពើតបយទA

យៅB)ពើបើដែលមានោយ59ឆ។អកជមងៃបានចាបយផតមយធវើការពយាបាល

យោយការោងឈាមយៅដខម នាឆ 2014។មានភាពមនសើោចនន

4 យៅកនងតបយទ HLA-A, HLA-B នង HLA-DR របសពកយគទាងពើរ ។

យហើយលទផលថនការយធវើយស (Flow Cytometry Lymphocyte

CrossmatchTest)តាមរយៈយអកទទលបានលទផលអវជជមាន។មនមាន

អងគាបែតបាណជាកោករបសអកបរចាគ(NopreformedDonor-Spe-

cific Antibodies) តវបានយគរកយ�ើញតាមរយៈការយធវើយសយោយយតបើការ

យធវើយសយោយដផកយលើAntigenដមយយ�ើយ។យយើងយតបើវធើCoombs

សតមាបតបយទអងគាបែតបាណAnti-A-TypeImmunoglobulinG1:16

នងយតបើបយចកយទសSalineAgglutinationTechniqueសតមាបAn-

ti-ImmunoglobulinMAntibodyTiter1:16។

អកជមងៃបានទទលនវការពយាបាលតាមដបប Desensitization Protocol

យោយោនការវះកា គមានតមដថ Rituximab (150mg/m2)

ដមយបាយណាណ ះយៅ2សបាហមនការបអរសររាងគា។

Pre-transplant Immunosuppression រមបអលជាមយនងការ Sup-

pressionB-lymphocyteអសរយៈយពល4សបាហថនសារធាMy-

cophenolate Mofetil (MMF) កនងបរមាណ 0,5 តកាម / ថងៃ

យែតមបើយចៀសវងOverimmunosuppression។យែតមបើែកអងគាបែតបាណ

(Anti-A Antibodies) អកជមងៃបានលេងកាការែកយកអងគាបែតបាណជា

សងោរ(StandardAntibodyRemoval)ដែលមាន1ែណាកកាលថន

Double-Filtration Plasmapheresis នងការ លេ សបអរបាលេ សា (Plasma

Exchange)1ែង។

យតកាយយពលវះកាថBasiliximab(20មើលើតកាម)តវបានយគផលយោយ

អកជមងៃយៅថងៃទើ 0 នងថងៃទើ 4 ជាមយនងថ Cyclosporine

កនងយោលបណងរកសាករ កកឈាមពើ250យៅ300ng/mLកនងក�នង

យពលមយដខែបងយតកាយការវះកា។កតមយតបើតបាសMMFយតកាយការ

បអរសររាងគាតវបានដរកសាយៅកតម យសើនងមនយពលវះកា។

ែយណើរការថនការបអរតមងយនាមតវបានអនវយោយមានការខវះខា ។

យតកាយការវះកាយៅថងៃទើ18កតម យអមាកលេអបតនយចះហសពើការសាន10,4

យៅ8,5g/dL។ការតសាវតជាវបដនថមរមមានLactateDehydroge-

nase425U/L,Bilirubinសរប6mg/dLនងHaptoglobin

<5mg/dL។មនមានសនតាងថនការហរឈាម។យទាះបើជាយយើង

យ�ើញថោមានភាពយសលេកសាង (Hemolytic Anemia) កយោយ

កបាដនយយើងរកមនយ�ើញ Schizocytes តាមរយៈ Peripheral Smear

យនាះយទ ។ ការយធវើយកាសលយវចយតាមរយៈការតចបសាចបានបងហា ញថ

ោនការករយកើ ថនកណកឈាមយនាះយទ ទាង Antibody-Mediated ឬក

CellularRejection។យៅកនងPeripheralBloodអងទើគរAnti-

B-TypeImmunoglobulinGតវបានយគរកយ�ើញយហើយតាមការយធវើយរា

គវនចយបានបញជ កយោយយ�ើញថមានPLS។អ�នងយពលយនះយកាសកា

PeripheralBloodCD19នងយកាសកាCD20កនងខលេមនអកជមងៃមានចជាង

5%។

ការពយាបាលរបសោទទលបានការយជាគជយយោយការពយាបាលយោយការសើ

យសរេអើែ (Steroid Pulse Therapy) ។ MMF យកើនយ�ើងពើែល

2តកាមកនងមយថងៃនងបដមលេងពើcyclosporineយៅជាtacrolimus។

ោបានចាកបអលយកាសកាឈាមតកហមចនន8យ លេ កយែតមបើរកសាកតម យអមា

កលេអបតន។Anti-BAntibodyបានបាពើកនងឈាមPeripheralBlood

របសោ យហើយជមងៃយសលេកសាលេ ងរបសោកបានតបយសើរយ�ើងវញយៅថងៃយតកាយ

ការវះកា ថងៃទើ 60។មខងរតមងយនាមរបសោកយៅដែយណើរការ

លែដែល។

សរបយសចកើមក យយើងោចតបឈមនងសាថ នភាពលបាកជាពយសសយៅកនងរយៈ

យពល perioperative ថនការបអរតមងយនាម។ យទាះជាោា ងណាកយោយ

យយើងនងោចទទលបាននវលទផលលតាមរយៈការពយាបាលដែលសមតសប៕

“Kidney transplantation; Principles and Methods” AND “Passenger Lymphocyte Syndrome in the ABO-Incompatible Kidney Transplant Recipient Receiving Rituximab.”

Shunji Nishide, Toshihide Naganuma, Hisao Shimada, Akihiro Kosoku, Kazuya Kabei, Tomoaki Iwai, Nobuyuki Kuwabara, Norihiko Kumada, Junji Uchida, Yoshiaki Takemoto, Tatsuya Nakatani

The Department of Urology, Osaka City University Graduate School of Medicine

In patients with end-stage renal disease, successful renal transplantation improves the quality of life and increases survival, as compared with long-term dialysis treatment. So, it is clear that kidney transplantation is superior to dialysis over the long term. But, during the first 3 months after transplantation, the risk of death among the transplant recipients is increased. This is related to risks associated with the surgery itself and to the use of high-dose immunosuppressive therapy. In this presentation, surgical procedure of kidney transplantation and immunosuppressive therapy will be discussed. And add a case report that had been difficult to manage postoperatively in the immune area; diagnosed with Passenger Lymphocyte Syndrome (PLS). A 64-year-old woman with end-stage chronic renal failure due to diabetes nephropathy visited our hospital to receive ABO-incompatible (type A to B) unrelated living-donor kidney transplant from her 59-year-old husband. The patient began hemodialysis in June 2014. There were 4 mismatches in their HLA-A, HLA-B, and HLA-DR types, and the results of the flow cytometry lymphocyte crossmatch test were negative. No preformed donor-specific antibodies were detected by single antigen-based assay. The anti-A-type immunoglobulin G antibody titer was 1:16 using the Coombs method, and the anti-immunoglobulin M antibody titer was 1:16 using the saline agglutination technique. The recipient received a desensitization protocol without splenectomy consisting of only a single

dose of rituximab (150 mg/m2) at 2 weeks before transplant. Pretransplant immunosuppression included B-lymphocyte suppression for 4 weeks of mycophenolate mofetil (MMF) at 0.5 g/day to avoid overimmunosuppression. To remove the anti-A antibodies, the patient underwent standard antibody removal consisting of 1 session of double-filtration plasmapheresis and 1 session of plasma exchange. Postoperative immunosuppression with basiliximab (20 mg) was given at day 0 and at day 4 with cyclosporine, which was given to maintain a blood trough level of 250 to 300 ng/mL during the first month after the transplant procedure. The MMF dose after transplant was maintained at the pretransplant dose level



The management of acute hyponatremia in adult

Dr. HY Chanseila, nephrologist, college of CHEA Sim hemodialysis center and department of general medicine A, Calmette hospital.

Sodium is an electrolyte, and it helps regulate the amount of water that’s in and around the cells. Hyponatremia is an important and common electrolyte abnormality that can be seen in clinical practice at the hospital. Many medical illnesses, such as congestive heart failure, liver failure, renal failure, or pneumonia, may be associated with hyponatremia. The severity of neurologic symptoms correlates well with the rate and degree of the drop in serum sodium. A gradual drop in serum sodium, even to very low levels, may be tolerated well if it occurs over several days or weeks, because of neuronal adaptation. On the contrary in acute hyponatremia, symptoms range from mild anorexia, headache, and muscle cramps, to significant alteration in mental status including confusion, coma, or seizure. This neurologic symptom complex can lead to tentorial herniation with subsequent brain stem compression and respiratory arrest, resulting in death in the most severe cases.The treatment is quite complex and depending on the cause of hyponatremia (sodium lost or sodium diluted). The information on the drugs the patient has been using is important because many medications may precipitate hyponatremia (for example: diuretics). The goal of treatment acute hyponatremia is to return the sodium levels to normal to prevent cerebral edema and brain death. The recommendations for treatment of acute hyponatremia rely on the current understanding of the central nervous system

(CNS) adaptation to an alteration in serum osmolality. Therefore, correction of hyponatremia should take into account the limited capacity of this adaptation mechanism to respond to acute alteration in the serum tonicity, because the degree of brain edema and consequent neurologic symptoms depend as much on the rate and duration of hypotonicity as they do on its magnitude. Keys words: acute hyponatremia, neurological symptom, goal of treatment.

ការពយាបាលវបតតនៃការថយចះសរចសរាវនៃរារជាតដយមកនងឈាម

ហ ចនទសលា

វេជជបណត ឯកវេស តមរង វោរ បវមរការវៅរនទរវេេយ កាលមរែត មនែកជរងេវៅក នង រជឍរណលលាងឈារ ជា សរ

សដយយរជាសារជាតមដលជយវវវោយបរមាណេកវៅកនែនងខលនរនសសមាន

លនងរវេៀងេកវៅវមរៅវកាសកានងេកវៅកនែនងវកាសកា។

កងវវះជាតសដយយរជាបញហា មដលជបញកញាបវៅកនែនងរនទរវេេយមដលបញហា

វនវះោចបណតា លរកេរលវហតវមចនយែ ងដចជាការវខសោយតរងវោរ

វខសោយវបវះដង រ រលាកសតជាវដើរ។

ជាេវៅកងវវះជាតសដយយរវៅកនែនងឈារោចបណតា លវោយអនែកជង

វហរខរ កបាល នង បងករជាវោគសញញា ជាវមចនដចជា៖ ឈងកបាល

ឈងសាចដ កលតចវរ េវងវងសាមា រត រ មបកាចជាវដើរ មដលោច

វវវោយអនែកជងមានវមរវះថនែ កដលជើេតកនែនងករណនរ។

កាេយាបាលកងវវះ　 ជាតសដយយររនមរនេងមកវៅវលមតការមែរជាត

សដយយរវោវះវេ បមនតា មគវេេយមតេមតរករលវហតចបាសលាសថវតកងវវះ

ជាតសដយយរបណតា លរកេការបាតបងជាតសដយយរេកនែនងខលន រ វោយសារ

បរមាណេកកនែនងសសសឈារវមចនវលសចណវះមជល។

មានមតការមសវងយលេរលវហតចបាសលាសសនការចវះជាតសដយយរវេ

មដលោចវោយវយងវវការេយាបាលវោយមតរមតេ នង ជយអនែកជង

វោយតេវមរវះថនែ កបានេតមបាកដ ៕

AbstractsAbstracts



Basic Carbohydrate Counting for Glycemic Control in Diabetic Hemodialysis Patients.

Toru Hyodo, M.D., Ph.D1), 2), Yukie Kitajima, R.D., Ph.D1), 2), 3)

1) NGO Ubiquitous Blood Purification International, Yokohama, Japan 2) Cambodia-Japan Friendship Blood Purification Center, Sen Sok International University Hospital, Phnom Penh, Cambodia

3) Tokyo Healthcare University, Tokyo, Japan

Key words : Basic carbohydrate counting, Diabetic dialysis patients, glycemic control

[History of carbohydrate counting and the effect for diabetic dialysis patients] Carbohydrate counting used in dietary therapy for diabetes, is based on the concept that the postprandial rise in blood glucose levels is primarily affected by ingested carbohydrates [1-4]. This method has been widely accepted and used since 1993, when its usefulness was demonstrated in the United States, owing to the advantage of ease of understanding by patients [5]. Life with Diabetes, a guidance book for patients that was published by American Diabetes Association in the United States in 2004, states that the dietary carbohydrate level, not fat or protein levels, is the determinant of postprandial blood glucose levels (Table 1) [6]. In terms of renal failure, the US National Kidney Foundation provides information about carbohydrate counting on their website under the title of “Carbohydrate counting with chronic kidney disease” and recommends it as a common dietary therapy for patients with chronic diabetic nephropathy and end-stage renal failure [7]. However, there is a common misunderstanding that energy intake determines postprandial blood glucose levels in Japan [8]. It seems to lead to the increase of dialysis patients due to diabetic nephropathy. This situation seems to be same in Cambodia. We examined the effectiveness of use of the basic carbohydrate counting in Japanese diabetic dialysis patients. In the basic carbohydrate counting method, compared with pre-instruction values, pre-dialysis blood glucose and HbA1c levels were significantly decreased at term of follow-up (Fig. 1, 2). There were no significant changes in other parameters (Fig. 3). The carbohydrate counting could be applied independently of, but concurrently with, the control of potassium and phosphorus intake, which is the basis of dietary therapy for dialysis patients [9].

[Basic Carbohydrate Counting Procedure]The basic carbohydrate counting (BCC), targets all diabetic patients, places emphasis on learning to understand the amount of carbohydrates in food items, and encourages them to eat a consistent amount of carbohydrates at each meal to minimize fluctuations in blood glucose levels (Fig. 4).

1) Determining of energy requirementsTotal daily energy requirements were determined in accordance with physical activity levels, using the following formula developed by the Japan Diabetes Society [10]

Required energy intake = ideal body weight (IBW) × physical activity levelIBW (kg) = height (m) × height (m) × 22

Dialysis Column

[Figure 1, 2, and 3] The changes of pre-dialysis blood glucose, HbA1c, Hb, Alb, potassium, and phosphorous by the basic carbohydrate counting (BCC). All of the blood glucose and HbA1c values were significantly decreased when they were compared with the value just before the basic carbohydrate counting (BCC) was introduced. On the other hand, Hb, Alb, potassium, and phosphorous did not show any significant changes. 0: just before BCC ***: P<0.005

[Table 1] Nutrients in Food Groups by American Diabetes Association in 2004. The dietary carbohydrate level, not fat or protein levels, is the determinant of postprandial blood glucose levels.

[Fig. 4]The image of blood glucose changes after breakfast, lunch, and dinner by the basic carbohydrate counting induction. If for example, the amount of carbohydrates per a day is that of 6 pieces of rice balls, it is possible to minimize fluctuations in blood glucose levels by eating a consistent amount of rice balls at each meal.



[Reference]1) Nuttall, FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P: Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 1984; 7: 465-470.

2) By JMM, Amelsvoort V, Stratum P Van, Kraal JH, Lussenburg RN, Houtsmuller UMT: Effects of varying the carbohydrate: fat ratio in a hot lunch on postprandial variables in male volunteers. Br J Nutr 1989; 61: 267-283.

3) Christopher Zipp, Jessica Terrone Roehr, Lucia Beck Weiss, Frank Filipetto: Impact of intensive nutritional education with carbohydrate counting on diabetes control in type 2 diabetic patients. Patient Prefer Adherence 2010;30:7-12.

4) Richard M. Bergenstal, Mary Johnson, Margaret A. Powers, Alan Wynne, Aleksandra Vlajnic, Priscilla Hollander, Marc Rendell: Adjust to Target in Type 2 Diabetes. Diabetes Care 2008;31:1305-10.

5) The DCCT Research Group. Nutrition interventions for intensive therapy in the Diabetes Control and Complications Trial. J Am Diet Assoc 1993; 93: 768-72.

6) #19 Carbohydrate Counting: LIFE with DIABETES / Martha M. Funnell. — 4th ed., American Diabetes Association, Virginia, USA, 2004, pp399-424.

7) Carbohydrate counting eith chronic kidney disease. National Kidney Foundation. http://www.kidney.org/atoz/content/carbcount.cfm

8) Hyodo T, Kitajima Y, Mikami N, Wakai H, Nakajima F, et al. The Lack of the Knowledge about the Postprandial Blood Glucose by the Education using the Single Absolute Tool for the Diabetic Dietary Therapy in Japan. Arch Renal Dis Manag 2015; 1: 001-002.

9) Yukie Kitajima, Toru Hyodo, Noriko Mikami, Miho Hida, Junko Kawakami. Carbohydrate counting: a simple method of dietary management for glycemic control in Japanese diabetic hemodialysis patients. Contr to Nephrol, 2017; 189: pp262 – 269.

10) The Japan Diabetes Society (ed): The Guidance for Diabetes Therapy, 2016-2017., The Japan Diabetes Society, Bunkodo Co., Ltd., Tokyo, Japan, 2016, pp41-42 (in Japanese).

Energy requirements (kcal/kg; IBW) depend on physical activity levels, and the reference values are set as follows: low (such as individuals mainly engaged in desk work and housewives): 20-30 kcal/kg; medium (such as those mostly working while standing): 30-35 kcal/kg; and high (such as those mainly engaged in heavy work): 35 kcal/kg or higher.Basically, carbohydrates, proteins, and lipids should account for 60, 20, and 20%, respectively, of the total energy intake. As it is particularly important to consider the nutritional balance, the target proportion of carbohydrates was set at 50-60%. Furthermore, as it examined patients undergoing maintenance dialysis, the protein/energy ratio was appropriately managed by monitoring the serum phosphorus level. When the energy intake was insufficient, patients were advised to complement it with lipids, mainly unsaturated and medium chain fatty acids.

2) BCC instructions To facilitate patients’ understanding, we focused on providing practical and clear information about which foods would affect blood glucose levels. At the first instruction session in BCC, we took time to explain about foods that raise (and do not affect) postprandial blood glucose levels using a handout containing a list and illustrations of these foods, as well as about the carbohydrate content of vegetable side dishes (Fig. 5). Carbohydrates and sugars in staple grain foods (such as rice, udon and soba noodles, bread, and pasta), cakes, and sweets are the primary dietary source of blood glucose, and proteins from meat and fish or fats and lipids have minimal effects on postprandial blood glucose levels. Therefore, at first, patients were simply instructed to eat a consistent amount of staple grain foods at each meal. Taking the advanced age of most patients into account, we kept the instructions as simple as possible.

Dialysis ColumnDialysis Column

[Fig.5] The carbohydrates and non-carbohydrate food items



[របភាព 1, 2, នង 3]បដតមបតមលថនជាសករយៅកនងឈាមមនយពលោងឈាម(pre-dialysis)HbA1c,Hb,Alb,បាតាសយអមនងផសវរយោយការគណនាកាបអើតោមលោឋា ន(BCC)។ជាសករកនងឈាមនងថមលេHbA1c តវបានយចះគរឱយកសមាគា ល យបើយតបៀបយៅនងថមលេមនយពលអនវBCC។មយាា ងវញយទៀHb,Alb,បាតាសយអមនងផសវរមនបានបងហា ញពើការ លេ សបអរណាមយគរយោយកសមាគា លយ�ើយ។

0:justbeforeBCC ***:P<0.005

[តាោងទ 1]សារធាចមយៅកនងតកមោហារយោយសមាគមនជងទកយនាមដផមោយមរកឆ 2004។ កតមកាបអើតោយៅកនងរបបោហារគជាកតាកណថនកតមជាសករយៅកនងឈាមយតកាយទទលទានោហារ។មនដមនកតមជាខាលេ ញឬកតមតបយអើនយ�ើយ

[របភាព 4]របភាពថនបដតមបតមលជាសករកនងឈាមបនាទៃ បពើទទលទានោហារយពលតពកោហារថងៃតងនងោហារយពលោងៃ ចយតកាយការដណនាអពើការរាបចននកាបអើតោជាមលោឋា ន។ ឧទាហរណៈ បរមាណថនកាបអើតោកនងមយថងៃយសើរែបាយព6ែ។បនថយោការៈដតបតបលថនករជាសករកនងឈាមយោយការោា តោបតសវអងករកនងោហារនើមយៗ។ែយចះយយើងោចកាបនថយបដតមបតមលកតមជាសករយៅកនងឈាមកនងកតមអបបបរមាបានយោយយធវើការទទលទានបរមាណែបាយពយសើៗោយរៀងរាលយពលបាយ។

ការោបចនរនកាបអមដាតមលដាឋា ន (BCC) សមរាបការមគបមគងគលាដសរម (Glycemic) ចដពាះអនកជងលាងឈាមដ�លរានជមងទកដោមដផអែម

រហយអែ(ToruHyodo),M.D.,Ph.D1),2),យគអ�ើតាយើមាា (YukieKitajima),R.D.,Ph.D1),2),3)

1)NGOUbiquitousBloodPurificationInternational,Yokohama,Japan2)Cambodia-JapanFriendshipBloodPurificationCenter,SenSokInternationalUniversityHospital,PhnomPenh,Cambodia3)TokyoHealthcareUniversity,Tokyo,Japan

ពាកគនលាះ : ការោបចនរនកាបអមដាតមលដាឋា ន(BCC), អនកជងលាងឈាមដ�លរានជមងទកដោមដផអែម, ការមគបមគងគលាដសរម(Glycemic)

[ មបវតតសន មលដាឋា នសនការោបចនរនកាបអមដាត នង មបសទធភាពសមរាបអនកជងលាងឈាមដ�លរានជមងទកដោមដផអែម ។ ]

ការរាបចននកាបអើតោ តវបានយតបើតបាសកនងការពយាបាលយោយរបបោហារសតមាបជងទកយនាមដផម យោយដផកយៅយលើផ គន ថ

ការយកើនយ�ើងថនកតមជាសករយៅកនងឈាមយតកាយទទលទានគបណាលមកពើការបរយភាគោហារដែលមានសារធាកាបអើតោ[1-4]។វធើ

សាតសយនះតវបានយគទទលសាគា លនងអនវោា ងទលទោយចាបតាងពើឆ 1994 យៅយពលដែលសហរែឋាោយមរកបានយធវើការបងហា ញពើអថតបយោជន

នងភាពងយតសលកនងការយលែងយោយអកជង [5]។LifewithDiabetesគជាយសៀវយៅដណនាសតមាបអកជមងៃមយដែលតវបានយបាះ

ពមភយៅកនងឆ2004យោយសមាគមនជងទកយនាមដផមថនតបយទសោយមរក(AmericanDiabetesAssociation)។កនងយនាះបានសរយសរថ

កតម កាបអើតោយៅកនងរបបោហារ គជាកតាកណថនកតម ជាសករយៅកនងឈាមយតកាយទទលទានោហារ ។ មនដមនកតម ជាខាលេ ញ

ឬកតម តបយអើនយ�ើយ(តារាងទើ1)[6]។USNationalKidneyFoundationបានផលព មានអពើការរាបចននកាបអើតោយៅយលើ

យគហទពររបសពកយគយតកាមចណងយជតងថ“Carbohydratecountingwithchronickidneydisease”យហើយដណនាវសតមាបអកជមងៃទកយនា

មដផមរាា ថរេនងជងយខសាយតមងយនាមែណាកកាលចងយតកាយថយនះគជាវធើទយៅកនងការពយាបាលយោយរបបោហារផងដែរ[7]។កបាដនយៅឯតប

យទសជបានមានការយលតច�ជាទយៅថ ការបរយភាគកា�អរោចបណាលយោយកតម ជាសករយៅកនងឈាមមានការយកើនយ�ើងយតកាយការទទលទាន [8]។

វទនងជាកតាមយដែលនាយោយមានការយកើនយ�ើងថនអកជមងៃោងឈាមយោយសារជងទកយនាមដផម ។ សាថ នភាពយនះហាកែចជាតសយែៀងោយៅកនង

តបយទសកមពនជាដែរ។

យយើងបានយធវើការពន យយៅយលើតបសទភាពថនការយតបើតបាសវធើសាតសរាបចននកាបអើតោដបបមលោឋា នយនះសតមាបអកជមងៃោងឈាមជន

ជាជបានដែលមានជមងៃទកយនាមដផម។កនងវធើរាបចននកាបអើតោដបបមលោឋា នយនះយបើយយើងយធវើការយតបៀបយធៀបវយៅនងវធើសាតសពើមនយ�ើញថ

កតម ជាសកយៅកនងឈាមនងកតម HbA1cមានការយចះគរយោយកសមាគា ល(របភាពទើ1,2)។មនមានការ លេ សបអរអវើគរយោយក

សមាគា លយលើបាា រាាដមាតយផសងយ�ើយ(របភាពទើ3)។វធើសាតសរាបចននកាបអើតោយនះគរដអនវោចយោយដ�កកបាដនបចនបបនយយើងយធវើការ

តគបតគងវរមោជាមយនងបាតាសយអមនងផសវរដែលមានយៅកនងរបងោហាររបសអកជមងៃោងឈាមផងដែរ[9]។

[�ដណរការកននងការោបចនរនកាបអមដាតមលដាឋា ន]

ការរាបចននកាបអើតោមលោឋា ន(BCC)តវបានអនវសតមាបអកជមងៃទកយនាមដផមទាងអសយហើយសងក ធងៃនយៅយលើការសកសាយែតមបើ

យលែងអពើបរមាណកាបអើតោយៅកនងោហារ នង ជរញយោយពកយគទទលទានោហារដែលមានបរមាណកាបអើតោយរ យែតមបើកាបនថយការ

ដតបតបលថនកតម ជាសករយៅកនងឈាម(របភាព4)។

Dialysis Column



[ឯកសារដោង]1) Nuttall, FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P: Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 1984; 7: 465-470.

2) By JMM, Amelsvoort V, Stratum P Van, Kraal JH, Lussenburg RN, Houtsmuller UMT: Effects of varying the carbohydrate: fat ratio in a hot lunch on postprandial variables in male volunteers. Br J Nutr 1989; 61: 267-283.

3) Christopher Zipp, Jessica Terrone Roehr, Lucia Beck Weiss, Frank Filipetto: Impact of intensive nutritional education with carbohydrate counting on diabetes control in type 2 diabetic patients. Patient Prefer Adherence 2010;30:7-12.

4) Richard M. Bergenstal, Mary Johnson, Margaret A. Powers, Alan Wynne, Aleksandra Vlajnic, Priscilla Hollander, Marc Rendell: Adjust to Target in Type 2 Diabetes. Diabetes Care 2008;31:1305-10.

5) The DCCT Research Group. Nutrition interventions for intensive therapy in the Diabetes Control and Complications Trial. J Am Diet Assoc 1993; 93: 768-72.

6) #19 Carbohydrate Counting: LIFE with DIABETES / Martha M. Funnell. — 4th ed., American Diabetes Association, Virginia, USA, 2004, pp399-424.

7) Carbohydrate counting eith chronic kidney disease. National Kidney Foundation. http://www.kidney.org/atoz/content/carbcount.cfm

8) Hyodo T, Kitajima Y, Mikami N, Wakai H, Nakajima F, et al. The Lack of the Knowledge about the Postprandial Blood Glucose by the Education using the Single Absolute Tool for the Diabetic Dietary Therapy in Japan. Arch Renal Dis Manag 2015; 1: 001-002.

9) Yukie Kitajima, Toru Hyodo, Noriko Mikami, Miho Hida, Junko Kawakami. Carbohydrate counting: a simple method of dietary management for glycemic control in Japanese diabetic hemodialysis patients. Contr to Nephrol, 2017; 189: pp262 – 269.

10) The Japan Diabetes Society (ed): The Guidance for Diabetes Therapy, 2016-2017., The Japan Diabetes Society, Bunkodo Co., Ltd., Tokyo, Japan, 2016, pp41-42 (in Japanese).

Dialysis ColumnDialysis Column

[របភាព 5] ោហារដែលមានសារធាកាបអើតោនងោហារដែលោនសារធាកាបអើតោ។

1)ការកណបរមាណថមពល(កា�អរ)ដែលចាបាច

តមវការថមពលតបចាថងៃសរបតវបានកណតាមកតម ថនការយធវើលហាតបាណយោយយតបើរបមនែចខាងយតកាម ដែលបយងកត យ�ើងយោយសមាគម

ជងទកយនាមដផមជបាន[10]

Requiredenergyintake=Idealbodyweight(IBW)×Physicalactivitylevel

IBW(kg)=Height(m)×Height(m)×22

ថមពលចាបាច(Kcal/kg;IBW)ោតសយយលើកតម សកមភាពថនរាងកាយយហើយថមលេជាមធយមតវបានកណែចខាងយតកាម:

ទាប (កនងករណើអកជមងៃជាអកយធវើការយៅកនងការោលយឬយមផទៃះ):20-30kcal/kg

មធយម (កនងករណើអកជមងៃជាអកយធវើការឈរយតចើន):30-35kcal/kgនង

ខពស (កនងករណើអកជមងៃជាអកយធវើការងរធងៃនៗ ):35kcal/kgឬខពសជាងយនះ។

ជាទយៅ កាបអើតោ តបយអើន នងជាខាលេ ញគរដមានចនន 60, 20 នង 20% ថន ថមពលសរបដែលបានទទលទាន ។

យោយសារវមានសារៈសខានជាពយសសសតមាបការគ ពើ លយភាពថនោហារបថមភយោលយៅថនកាបអើតោតវបានយគកណពើ50-60%។

យលើសពើយនះយោងយៅតាមការពន យយៅយលើអកជងដែលកពងពយាបាលយោយការោងឈាមអតតាតបយអើន/ថមពលតវបានតគបតគងោា ង

តមតវយោយការត ពន យកតម ផសវរយសរេម(SerumPhosphorus)។យៅយពលដែលទទលទានថមពលមនបានតគបតោនអកជងតវបាន

យគដណនាឱយបយពញបដនថមជាមយនងជាខាលេ ញដែលភាគយតចើនជាោសើ UnsaturatedនងMediumchainfattyacids។

2)ការដណនាអពើBCC

យែតមបើជយសតមលែលអកជមងៃយោយងយតសលយលយយើងយសខានយៅយលើការអនវជាកដសងនងផលព មានចបាសោសអពើោហារណា

ដែលបាះពាលែលករ ជាសករយៅកនងឈាម ។ យៅវគគាដណនាែបងអពើ BCC យយើងបានចណាយយពលយែតមបើពនយលពើោហារដែលបយងកតន

(នងមនបាះពាល) ែលកតម ជាសករកនងឈាមយតកាយការទទលទាន យោយយតបើតបាសកនយសៀវយៅ ដែលមានបជើនងរបភាពថនោហារទាងយនះ

កែចជាការពពណនាអពើមហាអបោហារដែលបយងកតនកតម ជាសករយៅកនងឈាម(របភាពទើ5)។

កាបអើតោនងសករមានយៅកនងោហារដែលយតបើតបាសតោបធញជា(ែចជាអងករមើUdonឬមើសបា(Soba)នបងនងបាា សា)។រឯ

ន Cakes នងបដងមគជាតបពសខានថនជាសករកនងឈាម ។ យហើយតបយអើនពើសាច នងតើ ឬខាលេ ញ នងជាខាលេ ញ

មានផលបាះពាល ចចយៅយលើកតម ជាសករយៅកនងឈាមយតកាយយពលទទលទានោហារ។ យហែយចះែបងអកជងតវបានយគដណនាយោយោា

ចណើោហារតោបធញជាតសបតាមោហារនើមយៗ ។ យយើងយធវើការដណនាយោយសាមញបផ តាមដែលោចយធវើយៅបាន យែតមបើយោយអកជមងៃចាស

ជរាកោចអនវយោយខលេមនឯងបាន។



Author Guidelines

1. The Cambodian Journal of Nephrology (hereinafter referred to as “Journal”) is an English/Cambodian/Japanese language journal published by Reiseikai Media (Cambodia) Co., Ltd (“Company”). The purpose of the Journal is to widely introduce medical achievements in the fields of basic and clinical medicine on nephrology and thereby to contribute to the develop-ment of medicine and human beings.

2. Authors are requested to understand and accept to the content of this author guideline (here-inafter referred to as “Guideline”) before submitting manuscripts to the Journal. The Guide-line may be revised from time to time at the sole discretion of the Company.

3. Copyrights of the submitted manuscripts will, in principle, remain with the authors, provided, however, that during the effective period of copyrights and throughout the world, the Compa-ny has the non-exclusive right to reproduce, distribute and transmit to the public, all or part of the copies of the manuscripts, as well as the non-exclusive right to translate, proofread or adapt them to the extent necessary to post in the Journal. Where the copyright of the submit-ted manuscript belongs to someone other than the person who has submitted to the Journal, the person who has submitted shall obtain a prior approval from the copyright owner for sub-mitting the manuscript to the Journal according to the Guideline.

4. Copyrights in any work of translation, proofreading or any other adaptation conducted by the Company on the submitted manuscripts will belong to the Company. The authors may not, without a prior written consent of the Company, use such works in any medium other than the Journal, notwithstanding section 28 of the Japanese Copyrights Act and its counterpart provi-sion of a law of the relevant countries.

5. Authors must not make any objection to the translation, proofreading or any other adaptation conducted by the Company to the submitted manuscripts.

6. Authors must warrant that the submitted manuscripts would not infringe any third party’s copyrights, moral rights including rights in relation to privacy and defamation or any other rights. Clinical researches must have been performed according to the Declaration of Helsinki and ethical consideration must have been fully taken into. Experiments involving animals must have been conducted in the manner giving careful consideration to animal protection. Where the content of the submitted manuscripts involves interest of particular individuals or organizations/bodies, authors are requested to expressly write down such interest or possible conflict of interest in the text of the manuscripts.

7. Manuscripts acceptable to be submitted are not limited to those that are not yet submitted to or published in, the other journals or academic societies etc. If, however, authors intend to submit to the Journal, manuscripts that contain substantially the same part(s) of the content of those which are already submitted to or published in, other journals or academic societies etc., authors are requested to, including but not limited to, look up the author guidelines of the journals or members’ rules of the academic societies etc.; make inquiries to the journals or

academic societies etc. in advance where necessary; and obtain approvals for citation or repro-duction, so as to avoid any violation of ethics as researchers. Authors are requested to state citations (name of author, name of book, year of publication, page number etc.) in the text of the manuscripts where suitable.

8. The Journal does not prohibit authors from submitting the same manuscripts to other journals. However, the authors must understand and accept that under the authors guideline of other journals, submission to the Journal of a manuscript might cause prohibition of the same man-uscript from being submitted to other journals; and that in case where the authors are not al-lowed to submit a manuscript to other journals because the same manuscript has been submit-ted to the Journal, the Company will not owe any liability at all to the authors for posting the manuscript in the Journal.

9. Whether or not to post in the Journal the manuscripts submitted will be decided by the Editing Committee after the peer review by peers designated by the Editing Committee.

10. The manuscripts submitted to the Journal will not, in principle, be returned to the authors.

11. Proofreading by an author will be allowed only with the first proof, and the author must return the manuscript by the due date requested. The proofreading by an author will be allowed only as to corrections of omission of letters and typographers, and no additional writing to the manuscript in the proofreading is, in principle, permitted.

12. 1) Manuscripts to be submitted must be prepared using computer software. 2) Manuscripts must be in horizontal writing with appropriate spaces between the lines on

A4 size papers.

13. Neither the Company nor authors whose manuscripts have been posted in the Journal will not be paid for the publication of them.

14. Manuscripts must be submitted to the following:

Reiseikai Media (Cambodia) Co., Ltd.18/F Canadia Tower, No. 315, Ang Doung St,

Corner Monivong Blvd, Phnom Penh,Cambodia

E-mail: [email protected]



បទបបញញតតជាផល វការនៃការចះផសាយ

1. ទសសនាវែតTheCambodianJournalofNephrologyតវបានយបាះពមពផសាយជាភាសាដខរអងយគលេសនង

ជបានយោយតកមហាន Reiseikai Media (Cambodia) Co.,Ltd. កនងយោលបណងរមចដណកកនង

វសយយវជជសាតស កែចជាការអវឌឍធនធានមនសសតាមរយៈការដណនាពើមលោឋា នតគះថនជងតមងយនាមនង

សមទផលយវជជសាតសកនងវសយសខាបាលយោយបានទលទលោយផងដែរ។

2. អកនពនតវយលចបាសនងទទលសាគា លបទបបញថនការចះផសាយយនះ។សមចណាផងដែរថបទបបញយនះ

ោចនងតវបានយធវើវយសាធនកមតាមការសយរចចរបសយយើងខញ។

3. រាលសារណាទាងអសដែលបានចះផសាយជាមយយយើងខញតវបានរកសាសទយោយអកនពន។កបាដនតកមហាន

យយើងខញនងទទលបាននវសទយធវើការចមលេង ដចកចាយ យផញតរជាសាធារណៈ បកដតប នងដកសតមលយផសងៗ

បានទទាងពពយោក កនងក�នងយពលដែលបានតពមយតពៀងមយ។ យោងយៅតាមបទបញ កនងករណើដែល

អកនពនចងផលសទនពនយោយអកែថទតវមកសការអនញញ ពើតកមហានយយើងជាខញមនសន។

4. សារណាដែលតវបានបកដតប នង ដកសតមលយោយតកមហានយយើងខញនងតវបានរកសាសទតគបោា ងយោយ

តកមហានយយើងខញ។មាតតាទើ២៨សើពើចបាបរកសាសទរបសតបយទសជបាននងចបាបរកសាសទរបសតបយទសយផសងៗ

មនតវបានអនវយ�ើយ យបើសនជាោនការយលតពមពើតកមហានយយើងខញតាមរយៈោយលកខណអកសរជាមនយនាះ

យទ គមនអនញញ យោយ អកនពន យកសារណាដែលបានដកសតមលរចយៅតកមហានយយើងខញយកយៅយបាះពមព

យៅទសសនាវែតែថទយនាះយទ។

5. អកនពនមនោចជទាសយៅនងការបកដតបឬការដកសតមលថនសារណាដែលតកមហានយយើងបានយធវើយ�ើយ។

6. អកនពនតវធានាថសារណាដែលបានសរយសរមនសថយៅយតកាមការរកសារសទរបសអកែថទកែចជាបាះពាល

ែលកយស សទ ទៃ លខលេមន ឯកជនភាព នងសទយផសងយទៀរបសអកែថទយ�ើយ។ តកមអកតសាវតជាវដផក

យវជជសាតសតវដយធវើតាមយសចកើតបកាសរបសទើតកងHelsinkiនងពចារណាវជាជ ជតវៈតបកបយោយតកមសើលធម។

ការពយសាធនយៅយលើសវតវយធវើយ�ើងយៅកនងដបបបទមយដែលផលការយកចដាទកោកយៅយលើការការពារសវ។

កនងករណើអថបទដែលបានសរយសរមានជាបពាកពននងអថតបយោជនរបសបគគាលឬអងគាការឬតកមហានយនាះ

អកនពនតវសរយសរបញជ កអពើអថតបយោជនឬផលបាះពាលដែលោចយកើមានទាងយនាះយៅកនងអថបទដែល

បានសរយសរផងដែរ។

7. អកនពនោចយកសារណាដែលបានតបកាសរចនាឯសកាខ សោឬទសសនាវែតយផសងៗមកោកបាន។កបាដនកនង

ករណើចនចមយចននដែលបានសរយសរយៅកនងសារណាដែលបានោកជនមានអថនយែចោខាលេ ងយៅនងសារណា

ដែលបានយចញផសាយរចរាលយៅកនងទសសនាវែតែថទយនាះ អកនពន តវពនយយោយចបាសយោយ ទៃ លជាមយ

នងបទបញថនការចះផសាយកែចជាបទបញជ ថនការចលរមសកាខ សោ ឬតវយធវើការទនាកទនងជាមនយៅកាន

មាសយែតមថនសារណាកនងករណើចាបាចយែតមបើយធវើការសអនញញ សតមងអថបទ កនងយោលបណងយជៀសវងការ

រយោបពានយលើតកមសើលធមថនការតសាវតជាវ។ យលើសពើយនះ អកនពនតវសរយសរយោយបានចបាសពើតបព

ដែលបានែកតសងែចជាយឈាះយសៀវយៅយឈាះអកនពនថងៃយចញផសាយនងទពរជាយែតមផងដែរ។

8. ទសសនាវែតរបសយយើងខញមនយធវើការហាមតបាមអកនពនពើការយកសារណាយៅយចញផសាយយៅទសសនាវែតែថទ

យ�ើយ។កបាដនយយើងខញសមជតមាបផងដែរថសារណាដែលោកជនទសសនាវែតយយើងខញយហើយោចនងមនោច

ចះផសាយមងយទៀយៅតកមហានទសសនាវែតយនាះយទ។មយាា ងវញយទៀយយើងកសមបញជ កផងដែរថកនងករណើ

អកនពនយកសារណាមកោកជនយយើងខញ យធវើយោយសារណាែដែលយនាះមនោចយកយៅផសាយកនងទសសនាវែត

ែថទយយើងខញមនទទលខសតវយ�ើយ។

9. ការយតជតសយរើសសារណាយធវើយ�ើងយោយការវយថមលេពើគណៈកមាធការយរៀបចការយបាះពមពផសាយយោយមានការ

ពនយយ�ើងវញជាមន។

10. សារណាដែលបានោកជនយហើយមនោចែកវញបានយនាះយទ។

11. ការដកតមវរបសអកនពនោចយធវើយ�ើងបានដមងបាយណាណ ះតាមកាលបរយចទកណដែលបានយសើ។ អកនពន

ោចដកតមវបានកនងករណើបាពាកយឬខសអកាខ វរទបាយណាណ ះ។មនតវសរយសរបដនថមយនាះយទ។

12. 1)សារណាតវសរយសរយោយយតបើកពយអទរ។

2)តវយតបើខាA4បឈរនងមានគោសមតសប។

13. ទាងអកនពននងតកមហាននងមនតវបានបងតបាកសតមាបការយបាះពមភផសាយយៅកនងទសសនាវែតយនាះយទ។

14. សមយកសារណារបសអកមកោកជនតាមរយៈោសយោឋា នខាងយតកាម:

ReiseikaiMedia(Cambodia)Co.,Ltd.18/FCanadiaTower,No.315,AngDoungSt,

CornerMonivongBlvd,PhnomPenh,Cambodia

E-mail: [email protected]



Provisional Editors : Hideki Kawanishi Japan Kazunari Yoshida JapanAkihiro Yamashita Japan Toru Hyodo JapanNobuhisa Shibahara Japan Sovandy Chan CambodiaFumitaka Nakajima Japan Kenichi Kokubo JapanToshihide Naganuma Japan Tomotaka Naramura JapanSamnang Chin Cambodia


Intercultural “media” for all people concerned in healthcare and for all children

18/F Canadia Tower, No.315, Ang Doung St, Corner Monivong Blvd, Phnom Penh, Cambodiahttp://www.reiseikai-media.org/index-e.html

Publication of books and magazines

Planning, creation, and renewal of websites.

Translation services between Khmer, English, and Japanese languages.

Support in planning and organizing various academic meetings and training events.

Import, export and sale of healthcare items.

Publisher : The Cambodian Journal of Nephrology is published by Reiseikai Media (Cambodia) Co.,Ltd. <Representative director, CEO> Haruki Wakai <Office address> 18/F Canadia Tower, No.315, Ang Doung St, Corner Monivong Blvd, Phnom Penh, Cambodia <Tel> 023-962-486 (+855-23-962-486) <Fax> 023-962-310 (+855-23-962-310) <Email> [email protected] <Website> https://www.reiseikai-media.org/index-e.html https://www.reiseikai-media.org/cambodia/index-e.html ※All rights reserved.



Documents

ISSN 2518-0381 Volume 2 Number 1 November 2017 The ... · The uhers Vol2, No1, November 2017 Cambodian Journal of Nephrology 1 The Cambodian Journal of Nephrology CONTENTS Welcome