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Lin DS, Wang T, Buranakitjaroen P, Chen C, Cheng H, Chia YC, Sukonthasarn A, Tay JC, Teo BW, Turana Y, Wang J, Kario K. Angiotensin receptor neprilysin inhibitor as a novel antihypertensive drug: Evidence from Asia and around the globe. J Clin Hypertens (Greenwich) 2020; 23:556-567. [PMID: 33305531 PMCID: PMC8029571 DOI: 10.1111/jch.14120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Hypertension is a worldwide epidemic that continues to grow, with a subset of patients responding poorly to current treatment available. This is especially relevant in Asia, which constitutes 61% of the global population. Hypertension in Asia is a unique entity that is often salt‐sensitive, nocturnal, and systolic predominant. Sacubitril/valsartan is a first‐in‐class angiotensin receptor neprilysin inhibitor that was first used in heart failure with reduced ejection fraction. Sacubitril inhibits neprilysin, a metallopeptidase that degrades natriuretic peptides (NPs). NPs exert sympatholytic, diuretic, natriuretic, vasodilatory, and insulin‐sensitizing effects mostly via cyclic guanosine monophosphate (cGMP)‐mediated pathways. As an antihypertensive agent, sacubitril/valsartan has outperformed angiotensin II receptor type 1 blockers (ARBs), with additional reductions of office systolic blood pressures ranging between 5 and 7 mmHg, in multiple studies in Asia and around the globe. The drug was well tolerated even in the elderly or those with chronic kidney disease. Its mechanisms of actions are particularly attractive for treatment of hypertension in Asia. Sacubitril/valsartan offers a novel, dual class, single‐molecule property that may be considered as first‐line antihypertensive therapy. Further investigations are needed to validate its safety for long‐term use and to explore other potentials such as in the management of insulin resistance and obesity, which often coexist with hypertension in Asia.
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Affiliation(s)
- Donna S.‐H. Lin
- Department of Internal Medicine Cardiovascular Center and Division of Cardiology National Taiwan University Hospital Taipei City Taiwan
| | - Tzung‐Dau Wang
- Department of Internal Medicine Cardiovascular Center and Division of Cardiology National Taiwan University Hospital Taipei City Taiwan
- Department of Internal Medicine Division of Hospital Medicine National Taiwan University Hospital Taipei City Taiwan
| | - Peera Buranakitjaroen
- Department of Medicine Division of Hypertension Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Chen‐Huan Chen
- Institute of Public Health and Community Medicine Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
- Department of Medicine Division of Cardiology Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
| | - Hao‐Min Cheng
- Institute of Public Health and Community Medicine Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
- Department of Medicine Division of Cardiology Taipei Veterans General Hospital Taipei Taiwan
- Faculty of Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
- Department of Medical Education Center for Evidence‐based Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Yook Chin Chia
- Department of Medical Sciences School of Healthcare and Medical Sciences Sunway University Bandar Sunway Selangor Darul Ehsan Malaysia
- Department of Primary Care Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Apichard Sukonthasarn
- Department of Internal Medicine Cardiology Division Faculty of Medicine Chiang Mai University Thailand
| | - Jam Chin Tay
- Department of General Medicine Tan Tock Seng Hospital Singapore Singapore
| | - Boon Wee Teo
- Department of Medicine Division of Nephrology Yong Loo Lin School of Medicine Singapore Singapore
| | - Yuda Turana
- School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia Jakarta Indonesia
| | - Ji‐Guang Wang
- Department of Hypertension Centre for Epidemiological Studies and Clinical Trials the Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of Medicine Shanghai China
| | - Kazuomi Kario
- Department of Medicine Division of Cardiovascular Medicine Jichi Medical University School of Medicine Tochigi Japan
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Acute Kidney Injury in Subjects With Chronic Kidney Disease Undergoing Total Joint Arthroplasty. Am J Med Sci 2019; 358:45-50. [PMID: 31079840 DOI: 10.1016/j.amjms.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/14/2019] [Accepted: 04/03/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) has been associated with higher incidence of complications after total joint arthroplasty (TJA) but the incidence, risk factors and outcomes of acute kidney injury (AKI) in this setting remains insufficiently understood. METHODS We assessed the impact of baseline CKD on the risk of developing AKI after TJA performed between 1/2012 and 12/2016 in a single-center, retrospective cohort study. CKD was defined by estimated glomerular filtration rate <60 mL/min/1.73 m2 on 2 separate occasions within 3 months prior TJA. AKI was defined using a modified Kidney Disease: Improving Global Outcomes criteria based on serum creatinine (sCr) only to assess the severity of AKI. Complete AKI recovery was defined as the lowest post-AKI sCr within 20% of pre-AKI sCr values and partial recovery if within 30%, all within 90 days after TJA. RESULTS Twenty-four percent of the 1,212 subjects undergoing TJA had pre-existing CKD. The overall incidence of AKI in the CKD subjects was 30%; of these, 55% had stage-1 AKI, 1% had stage-2 AKI and 44% had stage-3 AKI. AKI was more common in African Americans, those with diabetes or heart failure, requiring perioperative transfusions or receiving diuretics before surgery. While 82% of the AKI subjects achieved complete recovery of kidney function, 4% had only partial recovery and 14% did not reach a post-AKI sCr level within 30% of pre-AKI values. The incidence (P < 0.001) but not the severity (P = 0.202) of AKI correlated with stages of baseline CKD. CONCLUSIONS The presence of CKD was associated with a high incidence of AKI after TJA. In these subjects, more than half the cases of AKI were of mild degree and had a favorable outcome. However, 18% of them did not have complete recovery of kidney function. Stages of baseline CKD were associated with increased incidence but not severity of AKI after TJA.
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Fülöp T, Soliman K, Tapolyai M. On blood pressure effect of acute osmolar load. J Clin Hypertens (Greenwich) 2019; 21:438-439. [PMID: 30648788 DOI: 10.1111/jch.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tibor Fülöp
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Medical Services, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Karim Soliman
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mihály Tapolyai
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, South Carolina.,Hemodialysis Unit Hatvan, Fresenius Medical Care Hungary Kft, Hatvan, Hungary
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Lee MJ, Kim EH, Bae SJ, Choe J, Jung CH, Lee WJ, Kim HK. Protective role of skeletal muscle mass against progression from metabolically healthy to unhealthy phenotype. Clin Endocrinol (Oxf) 2019; 90:102-113. [PMID: 30290006 DOI: 10.1111/cen.13874] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Metabolically healthy individuals are known to be resistant to cardiovascular disease development. However, a considerable fraction of those individuals shows deteriorated metabolic health over time. Although skeletal muscle is the primary insulin-responsive target organ, a longitudinal investigation of the skeletal muscle mass in relation to the development of metabolically unhealthy phenotype has not been performed. We aimed to evaluate whether greater skeletal muscle mass is an independent protective factor for the development of metabolically unhealthy phenotype. DESIGN, PARTICIPANTS AND MEASUREMENTS We conducted a retrospective cohort study with 9033 metabolically healthy volunteers who underwent routine health examinations in 2012 and a follow-up examination in 2016. Obesity was defined as Asian-Pacific body mass index criterion ≥25 kg/m2 . Subjects with fewer than two risk factors (elevated blood pressure, triglyceride, glucose, high-sensitivity C-reactive protein, insulin resistance and decreased high-density lipoprotein cholesterol levels) were characterized as metabolically healthy using Wildman criteria. RESULTS At the 4-year follow-up, approximately one-fourth of the nonobese participants and half of the participants with obesity showed metabolic deterioration. In nonobese men and women, higher appendicular skeletal muscle mass (ASM)/weight at baseline was significantly associated with decreased risk of metabolic deterioration. Compared to the lowest quartile of ASM/weight, the adjusted odds ratios (95% confidence intervals) of the highest quartile were 0.68 (0.52-0.89) in nonobese men and 0.64 (0.46-0.90) in nonobese women. However, this association was not observed in obese subjects. CONCLUSIONS Greater skeletal muscle mass at baseline is significantly associated with maintenance of metabolically healthy status, especially in nonobese individuals.
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Affiliation(s)
- Min Jung Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Jin Bae
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Association between preoperative hydration status and acute kidney injury in patients managed surgically for kidney tumours. Int Urol Nephrol 2018; 50:1211-1217. [DOI: 10.1007/s11255-018-1901-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022]
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Pisoni R, Hamrahian M, Fülöp T. Creatine kinase, sodium retention, and blood pressure: Is there a link? J Clin Hypertens (Greenwich) 2018; 20:342-344. [DOI: 10.1111/jch.13177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Roberto Pisoni
- Division of Nephrology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
- Medical Services; Ralph H. Johnson VA Medical Center; Charleston SC USA
| | - Mehrdad Hamrahian
- Division of Nephrology; Department of Medicine; Thomas Jefferson University; Pennsylvania PA USA
| | - Tibor Fülöp
- Division of Nephrology; Department of Medicine; Medical University of South Carolina; Charleston SC USA
- Medical Services; Ralph H. Johnson VA Medical Center; Charleston SC USA
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Dasgupta K, Sapir-Pichhadze R, Khan N. Powerful diuretics: A common denominator in landmark hypertension and type 2 diabetes mellitus trials. J Clin Hypertens (Greenwich) 2017; 20:136-142. [PMID: 29265730 DOI: 10.1111/jch.13151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kaberi Dasgupta
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Yeşiltepe A, Dizdar OS, Gorkem H, Dondurmacı E, Ozkan E, Koç A, Oguz Baktır A, Gunal AI. Maintenance of negative fluid balance can improve endothelial and cardiac functions in primary hypertensive patients. Clin Exp Hypertens 2017; 39:579-586. [PMID: 28613081 DOI: 10.1080/10641963.2017.1291663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.
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Affiliation(s)
- Ali Yeşiltepe
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Oguzhan Sıtkı Dizdar
- b Department of Internal Medicine and Clinical Nutrition , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Hasan Gorkem
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Engin Dondurmacı
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Eyup Ozkan
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Koç
- d Department of Radiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ahmet Oguz Baktır
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Ihsan Gunal
- e Department of Internal Medicine Division of Nephrology , Kayseri Training and Research Hospital , Kayseri , Turkey
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Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH. Outcomes of diuretic use in pre-dialysis CKD patients with moderate renal deterioration attending tertiary care referral center. Clin Exp Nephrol 2017; 21:1011-1023. [PMID: 28271257 DOI: 10.1007/s10157-017-1397-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/19/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Diuretic therapy has been the mainstay of treatment in chronic kidney disease (CKD) patients, primarily for hypertension and fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. The current study is aimed to determine the outcomes of diuretic therapy. METHODOLOGY A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by Bioimpedance analysis (BIA). RESULTS A total 312 patients (mean age 64.5 ± 6.43) were enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39 (27%) patients, respectively, while 36 (25%) were prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control was observed with combination therapy (-19.3 mmHg, p < 0.001) followed by furosemide [-10.6 mmHg with 80 mg thrice daily (p < 0.001)], -9.3 mmHg with 40-60 mg (p < 0.001) and -5.9 mmHg with 20-40 mg (p = 0.02) while HCTZ offered minimal SBP control [-3.7 mmHg with 12.5-25 mg (p = 0.04)]. Decline in extracellular water (ECW) ranged from -1.5 L(p = 0.01) with thiazide diuretics to -3.8 L(p < 0.001) with combination diuretics. Decline in eGFR was maximum (-3.4 ml/min/1.73 m2, p = 0.01) with combination diuretics and least with thiazide diuretics (-1.6 ml/min/1.73 m2, p = 0.04). Progression to RRT was observed in 36 patients. CONCLUSION It is cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing of diuretics should be done by keeping in view benefit versus harm for each patient.
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Affiliation(s)
- Yusra Habib Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, 11800,, Gelugor, Penang, Malaysia. .,Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kubang Kerain, Kelantan, Malaysia.
| | - Azmi Sarriff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, 11800,, Gelugor, Penang, Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kubang Kerain, Kelantan, Malaysia
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, 11800,, Gelugor, Penang, Malaysia
| | - Tauqeer Hussain Mallhi
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, 11800,, Gelugor, Penang, Malaysia.,Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kubang Kerain, Kelantan, Malaysia
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Abstract
The population of elderly individuals is increasing worldwide. With aging, various hormonal and kidney changes occur, both affecting water homeostasis. Aging is a risk factor for chronic kidney disease (CKD) and many features of CKD are reproduced in the aging kidney. Dehydration and hyperosmolarity can be triggered by diminished thirst perception in this population. Elderly with dementia are especially susceptible to abnormalities of their electrolyte and body water homeostasis and should be (re-)assessed for polypharmacy. Hypo- and hypernatremia can be life threatening and should be diagnosed and treated promptly, following current practice guidelines. In severe cases of acute symptomatic hyponatremia, a rapid bolus of 100 to 150 ml of intravenous 3% hypertonic saline is appropriate to avert catastrophic outcomes; for asymptomatic hyponatremia, a very gradual correction is preferred. In summary, the body sodium (Na+) balance is regulated by a complex interplay of environmental and individual factors. In this review, we attempt to provide an overview on this topic, including dehydration, hyponatremia, hypernatremia, age-related kidney changes, water and sodium balance, and age-related changes in the vasopressin and renin-angiotensin-aldosterone system.
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Affiliation(s)
- Christian A Koch
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Mississippi Medical Center, Jackson, MS, USA.
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA.
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Tibor Fulop
- FMC Extracorporeal Life Support Center, Fresenius Medical Care; Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
- Department of Medicine, Division of Nephrology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
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Henson ZK, Fülöp T. Dietary Salt Restriction: How Much Education Is Enough? J Clin Hypertens (Greenwich) 2016; 18:383-4. [DOI: 10.1111/jch.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Zeb K. Henson
- Division of General Medicine and Hypertension; Department of Internal Medicine; University of Mississippi Medical Center; Jackson MS
| | - Tibor Fülöp
- Division of Nephrology; Department of Internal Medicine; University of Mississippi Medical Center; Jackson MS
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Jung HW, Kim KI. Response to safer and kulcu. J Am Geriatr Soc 2015; 63:1051. [PMID: 25989585 DOI: 10.1111/jgs.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hee-Won Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,College of Medicine, Seoul National University, Seoul, Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,College of Medicine, Seoul National University, Seoul, Korea
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