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Zhang S, Li H, Cai X, Zhao C, Cao J. The association between serum cystatin C and residual renal function in peritoneal dialysis patients. Ther Apher Dial 2022; 26:1241-1246. [PMID: 35253373 DOI: 10.1111/1744-9987.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suojian Zhang
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Haitao Li
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Xiaoqin Cai
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Caixia Zhao
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
| | - Juan Cao
- Department of Nephrology Taixing People's Hospital Taizhou Jiangsu China
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Hang C. Optimal indicator for changing the filter during the continuous renal replacement therapy in intensive care unit patients with acute kidney injury: A crossover randomized trial. World J Emerg Med 2022; 13:196-201. [DOI: 10.5847/wjem.j.1920-8642.2022.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/12/2022] [Indexed: 11/19/2022] Open
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Yang T, Sun S, Lin L, Han M, Liu Q, Zeng X, Zhao Y, Li Y, Su B, Huang S, Yang L. Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long-Term Chronic Dialysis and Death in Acute Kidney Injury Patients. Artif Organs 2017; 41:1127-1134. [PMID: 28544060 DOI: 10.1111/aor.12927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/13/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023]
Abstract
The specific timing for discontinuing renal replacement therapy (RRT) in acute kidney injury (AKI) patients is debatable. The predictive abilities of variables at the time of discontinuation of RRT for the long-term prognoses of patients have not been explored. This study aimed to explore the prognostic factors upon discontinuation of RRT for long-term chronic dialysis and death of patients with acute RRT-requiring AKI, thus improving decision making regarding the discontinuation of RRT and the follow-up of patients thereafter. A cohort of 302 AKI patients who required acute RRT and remained alive and free of dialysis for at least 30 days after discharge from January 2009 to December 2012 were followed up. The predictive abilities of general characteristics, RRT details, and variables upon discontinuation of RRT for long-term chronic dialysis and all-cause death were evaluated using Cox proportional hazards models. Kaplan-Meier analysis with a log-rank test was used to compare the survival curves between the strata of levels of good predictors upon discontinuation of RRT. After a median follow-up time of 4.1 years, 20 (6.6%) patients initiated chronic dialysis and 56 (18.5%) patients died. A higher CysC level upon discontinuation of RRT (HR 1.520, 95% CI 1.082-2.135; P = 0.016), comorbid chronic kidney disease, and a higher non-renal Charlson comorbidity index (CCI) were independently predictive for chronic dialysis. The hemoglobin level upon discontinuation of RRT was inversely predictive of death (HR 0.986, 95% CI 0.973-0.999; P = 0.035), and comorbid malignancy, the presence of multiple organ dysfunction syndrome, and a higher non-renal CCI also predicted death. Urine output upon discontinuation of RRT was marginally inversely predictive of death (HR 0.997, 95% CI 0.994-1.000; P = 0.056). Patients who discontinued RRT with CysC levels <2.97 mg/L, hemoglobin levels >85 g/L, and urine output >1130 mL/24 h showed significantly higher non-chronic dialysis and survival rates according to a log-rank test. Our study suggested that upon discontinuation of RRT, higher serum CysC levels had the most promising predictive value for long-term chronic dialysis, and lower hemoglobin levels predicted long-term death; lower urine output also marginally predicted long-term death. Based on the remission of the comprehensive condition, lower CysC levels and higher hemoglobin levels and urine output should be considered in the decision to stop RRT. Patients showing worse levels of these indices upon discontinuation of RRT should undergo stricter follow-up and treatment to improve long-term outcomes.
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Affiliation(s)
- Tingting Yang
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Si Sun
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Liping Lin
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Mei Han
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Qiang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Xiaoxi Zeng
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Yuliang Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Yupei Li
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Baihai Su
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Songmin Huang
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
| | - Lichuan Yang
- Division of Nephrology, West China Hospital of Sichuan University, Sichuan, People's Republic of China
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Steubl D, Hettwer S, Dahinden P, Wolf P, Luppa P, Wagner CA, Küchle C, Schmaderer C, Renders L, Heemann U, Roos M. Influence of high-flux hemodialysis and hemodiafiltration on serum C-terminal agrin fragment levels in end-stage renal disease patients. Transl Res 2014; 164:392-9. [PMID: 24907476 DOI: 10.1016/j.trsl.2014.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 12/16/2022]
Abstract
C-terminal agrin fragment (CAF, 22 kDa) has been shown to be a promising new rapid biomarker for kidney function. This study evaluated the influence of hemodialysis (HD) and hemodiafiltration (HDF) treatment on serum CAF concentrations in patients with end-stage renal disease (ESRD). A total of 36 patients with ESRD undergoing chronic HD/HDF treatment were enrolled (21 high-flux-HD/Fx60 membrane, 7 high-flux-HD/Elisio19H membrane, and 8 HDF/Elisio19H membrane). On a midweek session, blood samples were obtained before, at halftime, and post-treatment. Dialysate samples were obtained 4 times during treatment. Serum and dialysate CAF, cystatin C, urea, and creatinine concentrations were measured. Reduction ratios (RRs), total solute removal, overall dialytic clearance, and instantaneous dialytic clearance at halftime were calculated and compared. Although HD/Elisio19H and HDF/Elisio19H treatments significantly reduced CAF concentrations (RR 46.6 ± 9.1% and 57.6 ± 11.7%, respectively, P = 0.018 and P = 0.001), HD/Fx60 treatment did not remove CAF from serum (RR 2.4 ± 15.4%, P = 0.25), there was no relevant CAF detection in dialysate. In the HD/Fx60 group, the RR of CAF was significantly lower compared with cystatin C, urea, and creatinine, in which significant removal was detected (37.9 ± 14.8%, 65.0 ± 10.7%, and 56.0 ± 9.8%, respectively, P < 0.001). CAF is a new biomarker for kidney function whose serum concentration is not influenced by conventional high-flux HD using Fx60 membrane. It might therefore represent a promising dialysis-independent biomarker for evaluation of kidney function, for example, in acute kidney failure.
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Affiliation(s)
- Dominik Steubl
- Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany.
| | | | | | - Petra Wolf
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, München, Germany
| | - Peter Luppa
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, München, Germany
| | - Carsten A Wagner
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Claudius Küchle
- Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany
| | | | - Lutz Renders
- Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany
| | - Marcel Roos
- Abteilung für Nephrologie, Klinikum rechts der Isar, München, Germany
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Delaney MP, Stevens PE, Witham HJ, Judge C, Eaglestone GL, Carter JL, Bassett P, Lamb EJ. Serum Cystatin C Does Not Predict Mortality or Treatment Failure in Peritoneal Dialysis: A Prospective Study. Perit Dial Int 2014; 36:94-100. [PMID: 25185011 DOI: 10.3747/pdi.2014.00071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/19/2014] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Small solute clearance, especially that derived from residual renal function (RRF), is an independent risk factor for death in peritoneal dialysis (PD) patients. Assessment of solute clearance is time-consuming and prone to multiple errors. Cystatin C is a small protein which has been used as a glomerular filtration rate (GFR) marker. We investigated whether serum cystatin C concentrations are related to mortality in patients receiving PD. ♦ METHODS New and prevalent PD patients (n = 235) underwent assessment of Kt/Vurea, RRF, weekly creatinine clearance (CCr), normalized protein catabolic rate (nPCR) and a peritoneal equilibration test (PET) at intervals. Blood was collected simultaneously for cystatin C measurement. Patients were followed for a median of 1,429 days (range 12 to 2,964 days) until death or study closure. Cause of death was recorded where given. Cox regression was performed to determine whether cystatin C had prognostic value either independently or with adjustment for other factors (age, sex, dialysis modality, diabetic status, cardiovascular comorbidity, Kt/V, CCr, RRF, nPCR or 4 h dialysate to plasma creatinine ratio (4 h D/Pcr) during the PET). The primary outcomes were all-cause mortality and treatment failure. ♦ RESULTS There were 93 deaths. Increasing age and 4 h D/Pcr ratio, decreased RRF and presence of diabetes were significantly [p < 0.05] negatively associated with survival and treatment failure. Serum cystatin C was not related to either outcome. ♦ CONCLUSIONS Serum cystatin C concentration does not predict mortality or treatment failure in patients receiving PD.
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Affiliation(s)
- Michael P Delaney
- Kent Kidney Care Centre and Clinical Biochemistry, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Paul E Stevens
- Kent Kidney Care Centre and Clinical Biochemistry, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Helen J Witham
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Caroline Judge
- Kent Kidney Care Centre and Clinical Biochemistry, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Gillian L Eaglestone
- Kent Kidney Care Centre and Clinical Biochemistry, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | - Joanne L Carter
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK
| | | | - Edmund J Lamb
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK
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Leelahavanichkul A, Souza ACP, Street JM, Hsu V, Tsuji T, Doi K, Li L, Hu X, Zhou H, Kumar P, Schnermann J, Star RA, Yuen PST. Comparison of serum creatinine and serum cystatin C as biomarkers to detect sepsis-induced acute kidney injury and to predict mortality in CD-1 mice. Am J Physiol Renal Physiol 2014; 307:F939-48. [PMID: 25143457 DOI: 10.1152/ajprenal.00025.2013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Acute kidney injury (AKI) dramatically increases sepsis mortality, but AKI diagnosis is delayed when based on serum creatinine (SCr) changes, due in part, to decreased creatinine production. During experimental sepsis, we compared serum cystatin C (sCysC), SCr, and blood urea nitrogen (BUN) to inulin glomerular filtration rate (iGFR) before or 3-18 h after cecal ligation and puncture (CLP)-induced sepsis in CD-1 mice. sCysC had a faster increase and reached peak levels more rapidly than SCr in both sepsis and bilateral nephrectomy (BiNx) models. sCysC was a better surrogate of iGFR than SCr during sepsis. Combining sCysC with SCr values into a composite biomarker improved correlation with iGFR better than any biomarker alone or any other combination. We determined the renal contribution to sCysC handling with BiNx. sCysC and SCr were lower post-BiNx/CLP than post-BiNx alone, despite increased inflammatory and nonrenal organ damage biomarkers. Sepsis decreased CysC production in nephrectomized mice without changing body weight or CysC space. Sepsis decreased sCysC production and increased nonrenal clearance, similar to effects of sepsis on SCr. sCysC, SCr, and BUN were measured 6 h postsepsis to link AKI with mortality. Mice with above-median sCysC, BUN, or SCr values 6 h postsepsis died earlier than mice with below-median values, corresponding to a substantial AKI association with sepsis mortality in this model. sCysC performs similarly to SCr in classifying mice at risk for early mortality. We conclude that sCysC detects AKI early and better reflects iGFR in CLP-induced sepsis. This study shows that renal biomarkers need to be evaluated in specific contexts.
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Affiliation(s)
- Asada Leelahavanichkul
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ana Carolina P Souza
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Jonathan M Street
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Victor Hsu
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Takayuki Tsuji
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Kent Doi
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Lingli Li
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Xuzhen Hu
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Hua Zhou
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Parag Kumar
- Pharmacy Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; and
| | - Jürgen Schnermann
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Robert A Star
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
| | - Peter S T Yuen
- Renal Diagnostics and Therapeutics Unit, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, and
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Bouman CSC, Royakkers AANM, Schultz MJ. The removal of cystatin C during continuous venovenous hemofiltration. Intensive Care Med 2011. [PMCID: PMC3195814 DOI: 10.1007/s00134-011-2348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Insufficient performance of serum cystatin C as a biomarker for acute kidney injury of postrenal etiology. Intensive Care Med 2011; 38:170-1. [PMID: 21965103 DOI: 10.1007/s00134-011-2384-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2011] [Indexed: 01/07/2023]
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Cystatin C is not a reliable marker of residual glomerular filtration rate during continuous renal replacement therapy. Intensive Care Med 2011; 37:1893-4; author reply 1897-8. [PMID: 21850530 PMCID: PMC3195767 DOI: 10.1007/s00134-011-2346-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2011] [Indexed: 10/31/2022]
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Abstract
The diagnosis of acute kidney injury (AKI) is usually based on measurements of blood urea nitrogen (BUN) and serum creatinine. BUN and serum creatinine are not very sensitive or specific for the diagnosis of AKI because they are affected by many renal and nonrenal factors that are independent of kidney injury or kidney function. Biomarkers of AKI that are made predominantly by the injured kidney have been discovered in preclinical studies. In clinical studies of patients with AKI, some of these biomarkers (eg, interleukin-18, neutrophil gelatinase-associated lipocalin, and kidney injury molecule-1) have been shown to increase in the urine before the increase in serum creatinine. These early biomarkers of AKI are being tested in different types of AKI and in larger clinical studies. Biomarkers of AKI may also predict long-term kidney outcomes and mortality.
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Delaney MP, Stevens PE, Al Hasani M, Stowe HJ, Judge C, Lamb EJ. Relationship of serum cystatin C to peritoneal and renal clearance measures in peritoneal dialysis: a cross-sectional study. Am J Kidney Dis 2008; 51:278-84. [PMID: 18215705 DOI: 10.1053/j.ajkd.2007.08.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 08/23/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clinical management of peritoneal dialysis patients includes assessments of peritoneal and renal clearances of the low-molecular-weight endogenous solutes creatinine and urea. Cystatin C is a low-molecular-weight protein used as a glomerular filtration rate marker. We investigated whether serum cystatin C concentration is related to peritoneal and renal clearances of creatinine and urea. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 119 patients undergoing peritoneal dialysis in a single dialysis unit. PREDICTOR Peritoneal, renal, and total clearance of urea as Kt/V(urea) and creatinine as weekly creatinine clearance (C(Cr)). Residual renal function (RRF) as the average of renal clearances of urea and creatinine. OUTCOMES & MEASUREMENTS Serum concentrations of cystatin C measured by using a particle-enhanced nephelometric immunoassay. RESULTS Serum cystatin C concentration was related inversely to RRF (Spearman rank correlation coefficient [r(s)] = -0.65; P < 0.001), total weekly C(Cr) (r(s) = -0.52; P < 0.001), and total Kt/V(urea) (r(s) = -0.23; P = 0.01). In a multiple regression model, weight, normalized protein catabolic rate, and RRF had independent effects on serum cystatin C concentrations. Additional multiple regression models showed that only the renal components of Kt/V(urea) and weekly C(Cr) contributed to serum cystatin C concentrations. LIMITATIONS Absence of reference GFR method. CONCLUSIONS Serum cystatin C concentrations reflect predominantly renal, not peritoneal, clearance. Serum cystatin C measurement may be a simple and practical alternative to measurement of RRF.
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Affiliation(s)
- Michael P Delaney
- Department of Renal Medicine, East Kent Hospitals NHS Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK
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Cystatin C as a Marker of Renal Function in Critically III Patients at Risk for or with Acute Renal Failure. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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