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Sharma K, Zhang G, Hansen J, Bjornstad P, Lee HJ, Menon R, Hejazi L, Liu JJ, Franzone A, Looker HC, Choi BY, Fernandez R, Venkatachalam MA, Kugathasan L, Sridhar VS, Natarajan L, Zhang J, Sharma VS, Kwan B, Waikar SS, Himmelfarb J, Tuttle KR, Kestenbaum B, Fuhrer T, Feldman HI, de Boer IH, Tucci FC, Sedor J, Heerspink HL, Schaub J, Otto EA, Hodgin JB, Kretzler M, Anderton CR, Alexandrov T, Cherney D, Lim SC, Nelson RG, Gelfond J, Iyengar R. Endogenous adenine mediates kidney injury in diabetic models and predicts diabetic kidney disease in patients. J Clin Invest 2023; 133:e170341. [PMID: 37616058 PMCID: PMC10575723 DOI: 10.1172/jci170341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality; however, few mechanistic biomarkers are available for high-risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from the Chronic Renal Insufficiency Cohort (CRIC) study, the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D), and the American Indian Study determined whether urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in the CRIC study and SMART2D. ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in the CRIC study, SMART2D, and the American Indian study. Empagliflozin lowered UAdCR in nonmacroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology, and single-cell transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mTOR. Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.
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Affiliation(s)
- Kumar Sharma
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Guanshi Zhang
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Jens Hansen
- Department of Pharmacological Sciences and Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petter Bjornstad
- Division of Nephrology, Department of Medicine and Section of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hak Joo Lee
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Rajasree Menon
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Leila Hejazi
- Center for Precision Medicine and
- SygnaMap Inc., San Antonio, Texas, USA
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | - Helen C. Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Byeong Yeob Choi
- Center for Precision Medicine and
- Department of Population Health Sciences and
| | | | - Manjeri A. Venkatachalam
- Center for Precision Medicine and
- Department of Pathology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Luxcia Kugathasan
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Vikas S. Sridhar
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Loki Natarajan
- Herbert Wertheim School of Public Health and
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Jing Zhang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Varun S. Sharma
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Brian Kwan
- Department of Health Science, California State University, Long Beach, Long Beach, California, USA
| | - Sushrut S. Waikar
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jonathan Himmelfarb
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Katherine R. Tuttle
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Bryan Kestenbaum
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Tobias Fuhrer
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Ian H. de Boer
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | | | | | - Hiddo Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands
- The George Institute for Global Health, Sydney, Australia
| | - Jennifer Schaub
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Edgar A. Otto
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey B. Hodgin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher R. Anderton
- Center for Precision Medicine and
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - Theodore Alexandrov
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - David Cherney
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
- Diabetes Center, Admiralty Medical Center, Khoo Teck Puat Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Jonathan Gelfond
- Center for Precision Medicine and
- Department of Population Health Sciences and
| | - Ravi Iyengar
- Department of Pharmacological Sciences and Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sharma K, Zhang G, Hansen J, Bjornstad P, Lee HJ, Menon R, Hejazi L, Liu JJ, Franzone A, Looker HC, Choi BY, Fernandez R, Venkatachalam MA, Kugathasan L, Sridhar VS, Natarajan L, Zhang J, Sharma V, Kwan B, Waikar S, Himmelfarb J, Tuttle K, Kestenbaum B, Fuhrer T, Feldman H, de Boer IH, Tucci FC, Sedor J, Heerspink HL, Schaub J, Otto E, Hodgin JB, Kretzler M, Anderton C, Alexandrov T, Cherney D, Lim SC, Nelson RG, Gelfond J, Iyengar R. Role of endogenous adenine in kidney failure and mortality with diabetes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.31.23290681. [PMID: 37398187 PMCID: PMC10312877 DOI: 10.1101/2023.05.31.23290681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality, however, few mechanistic biomarkers are available for high risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from Chronic Renal Insufficiency Cohort (CRIC), Singapore Study of Macro-Angiopathy and Reactivity in Type 2 Diabetes (SMART2D), and the Pima Indian Study determined if urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in CRIC (HR 1.57, 1.18, 2.10) and SMART2D (HR 1.77, 1.00, 3.12). ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in CRIC (HR 2.36, 1.26, 4.39), SMART2D (HR 2.39, 1.08, 5.29), and Pima Indian study (HR 4.57, CI 1.37-13.34). Empagliflozin lowered UAdCR in non-macroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology and transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mammalian target of rapamycin (mTOR). Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.
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Borderie G, Foussard N, Larroumet A, Blanco L, Domenge F, Mohammedi K, Ducasse E, Caradu C, Rigalleau V. Albuminuric diabetic kidney disease predicts foot ulcers in type 2 diabetes. J Diabetes Complications 2023; 37:108403. [PMID: 36641879 DOI: 10.1016/j.jdiacomp.2023.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/24/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Diabetic Foot Ulcers (DFU) are feared among individuals with diabetic kidney disease (DKD), but it is unclear whether they are more frequent, especially in normoalbuminuric DKD. Five hundred and twenty patients admitted in our diabetology ward from 2007 to 2017 were followed up during 54 ± 26 months. New DFUs were registered, and their relationship with the initial renal status was analyzed by LogRank and multivariate Cox regression analysis. The 520 subjects were mainly men (57.9 %), 62 ± 9 years old, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 % (72 ± 19 mmol/mol), and complications: 33.7 % macroangiopathies, 22.1 % previous foot ulcers, 44.8 % DKD, 26.9 % retinopathies. Fifty-seven new DFU occurred, mainly in subjects with DKD. DKD was related to later DFU (HR: 1.79; 95%CI: 1.05-3.07), this relationship stayed significant adjusted for age, gender, and a history of previous DFU (HR: 3.61; 95%CI: 2.11-6.18), and further adjusted for the duration of diabetes, HbA1c, BMI, arterial hypertension, and dyslipidemia. Among the 233 subjects with DKD, 129 (55.3 %) had an isolated AER > 30 mg/24H, 41 (17.6 %) had an isolated eGFR<60 mL/min/1.73 m2, and 63 (27.0 %) cumulated both abnormalities. By Cox regression analysis adjusted for age and gender, albuminuric DKDs were related to later DFU: with eGFR≥60: HR: 1.91; 95%CI: 1.02-3.59, with eGFR<60: HR: 2.53; 95%CI: 1.25-5.10, whereas normoalbuminuric DKD was not: HR: 1.04; 95%CI: 0.35-3.07, despite similar rates of neuropathies, peripheral arterial diseases, and retinopathies. In people with type 2 diabetes, albuminuric DKD was associated with two to three folds increased risk of DFUs, whereas normoalbuminuric DKD was not.
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Affiliation(s)
- Gauthier Borderie
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Ninon Foussard
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Alice Larroumet
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Laurence Blanco
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Frédéric Domenge
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Eric Ducasse
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Caroline Caradu
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France.
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Farah RI, Al-Sabbagh MQ, Momani MS, Albtoosh A, Arabiat M, Abdulraheem AM, Aljabiri H, Abufaraj M. Diabetic kidney disease in patients with type 2 diabetes mellitus: a cross-sectional study. BMC Nephrol 2021; 22:223. [PMID: 34134654 PMCID: PMC8207700 DOI: 10.1186/s12882-021-02429-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Aim Diabetic kidney disease (DKD) is a major long-term complication of diabetes mellitus (DM). Given the paucity of data on DKD in Jordan, we aimed to evaluate the prevalence, characteristics and correlates of DKD in Jordanian patients with type 2 DM. Methods This cross-sectional study included 1398 adult patients with type 2 DM who sought medical advice in the endocrinology clinic between March and September 2019. Demographic, clinical and laboratory data were reviewed. DKD was defined as reduced eGFR, and/or albuminuria. Three regression models were constructed to identify factors associated with CKD stages, albuminuria and DKD. Results Overall, 701 (50.14%) patients had DKD, with a median age of 59.71 ± 11.36 years. Older age, high triglycerides, and low high-density lipoprotein were associated with DKD (multivariable odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.03, p < 0.01; OR: 1.1, 95% CI: 1.01–1.2; and OR: 0.98, 95% CI: 0.97–0.99, p < 0.01 respectively). Metformin and renin-angiotensin system blockers were negatively associated with albuminuria and chronic kidney disease stages (p < 0.01). Conclusion Our study demonstrated that approximately one half of patients with type 2 DM had DKD. Further studies are necessary to understand this high prevalence and the underlying factors. Future research are needed to assess implementing targeted community-based intervention.
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Affiliation(s)
- Randa I Farah
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan.
| | | | - Munther S Momani
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Asma Albtoosh
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Majd Arabiat
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | | | | | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.,Department of Urology, Medical University of Vienna, Vienna, Austria
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Dai Q, Chen N, Zeng L, Lin XJ, Jiang FX, Zhuang XJ, Lu ZY. Clinical features of and risk factors for normoalbuminuric diabetic kidney disease in hospitalized patients with type 2 diabetes mellitus: a retrospective cross-sectional study. BMC Endocr Disord 2021; 21:104. [PMID: 34022855 PMCID: PMC8141213 DOI: 10.1186/s12902-021-00769-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Normoalbuminuric diabetic kidney disease (NADKD) is a newly defined DKD, the clinical features and pathogenesis for which are still being understood. This study aimed to investigate the features and risk factors for NADKD in patients with type 2 diabetes mellitus (T2DM). METHODS A retrospective cross-sectional study was conducted. The related clinical and laboratory data of patients with T2DM hospitalized between August 2012 and January 2020 were collected for statistical analysis. We classified the patients with T2DM into four groups on the basis of the presence or absence of albuminuria and reduced estimated glomerular filtration rate (eGFR). Analysis of variance, the Kruskal-Wallis test, and the chi-square test were used to compare the groups. Binary logistic regression analyses with a forward stepwise method were performed to explore the risk factors for renal dysfunction in hospitalized patients with normoalbuminuric T2DM. RESULTS Among the 1620 patients evaluated, 500 (30.9%) had DKD, of which 9% had NADKD. The prevalence of stroke, cardiovascular events, carotid plaque, and peripheral arterial disease in NADKD was significantly higher than in a non-DKD control group (normoalbuminuric T2DM patients with eGFR of ≥60 ml/min/1.73 m2). Regression analyses revealed that three significant independent factors were associated with NADKD: age (OR = 1.089, confidence interval [CI] 95% [1.055-1.123], p < 0.001), previous use of renin-angiotensin system inhibitors (RASIs; OR = 2.330, CI 95% [1.212-4.481], p = 0.011), and glycated hemoglobin (HbA1c; OR = 0.839, CI 95% [0.716-0.983], p = 0.03). CONCLUSIONS NADKD is mainly associated with macrovascular rather than microvascular complications. NADKD is more common in patients with normoalbuminuric T2DM with older age, previous use of RASIs, and good glycemic control.
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Affiliation(s)
- Qi Dai
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Nan Chen
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Ling Zeng
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Xin-Jie Lin
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Feng-Xiu Jiang
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Xiong-Jie Zhuang
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
| | - Ze-Yuan Lu
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033 China
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Yang Y, Xu P, Liu Y, Chen X, He Y, Feng J. Vascular inflammation, atherosclerosis, and lipid metabolism and the occurrence of non-high albuminuria diabetic kidney disease: A cross-sectional study. Diab Vasc Dis Res 2021; 18:1479164121992524. [PMID: 33567895 PMCID: PMC8482348 DOI: 10.1177/1479164121992524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM Atherosclerosis involves vascular endothelial damage and lipid metabolism disorder, which is closely related to the occurrence and development of diabetic kidney disease (DKD). However, studies on non-high albuminuria DKD (NHADKD) with an albumin to creatinine ratio (ACR) <30 mg/g are rare. This study is to investigate the relationship between atherogenic factors and the occurrence of NHADKD. METHODS Serum lipid indicators, lipoprotein-associated phospholipase A2 (Lip-PLA2) and homocysteine levels were measured in 1116 subjects to analyze their relationship with NHADKD. RESULTS Among all subjects, Lip-PLA2 had the closest but relatively weak correlation with ACR (r = 0.297, p < 0.001) and only homocysteine was moderately correlated with eGFR (r = -0.465, p < 0.001). However, in patients with NHADKD, these atherosclerotic factors were weakly correlated or uncorrelated with eGFR (max. |r| = 0.247). Stratified risk analysis showed that when ACR was <10 mg/g, homocysteine [OR = 6.97(4.07-11.95)], total cholesterol (total-Chol) [OR = 6.04(3.03-12.04)], and high-density lipoprotein cholesterol (HDL-Chol) [OR = 5.09(2.99-8.64)] were risk factors for NHADKD. There was no significant difference of OR between these three factors (Z = 0.430-1.044, all p > 0.05). When ACR was ⩾10mg/g, homocysteine [OR = 17.26(9.67-30.82)] and total-Chol [OR = 5.63(2.95-10.76)] were risk factors for NHADKD, and ORhomocysteine was significantly higher than ORtotal-Chol (Z = 3.023, p < 0.05). CONCLUSIONS The occurrence of NHADKD may be related to the levels of homocysteine, total-Chol, HDL-Chol, and Lip-PLA2 in blood. Among them, homocysteine may be most closely related to NHADKD.
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Affiliation(s)
- Yuwei Yang
- Department of Laboratory Medicine,
Mianyang Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Mianyang, China
| | - Peng Xu
- Department of Laboratory Medicine,
Mianyang Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Mianyang, China
| | - Yan Liu
- Department of Laboratory Medicine, Pidu
District People’s Hospital, Chengdu, China
| | - Xiaohong Chen
- Department of Laboratory Medicine,
Mianyang Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Mianyang, China
| | - Yiyang He
- Department of Laboratory Medicine,
Mianyang Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Mianyang, China
| | - Jiafu Feng
- Department of Laboratory Medicine,
Mianyang Central Hospital, School of Medicine, University of Electronic Science and
Technology of China, Mianyang, China
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Wang H, Lou Y, Ma Y, Shan X. Estimating the glomerular filtration rate and tubular dysfunction in an elderly population with normoalbuminuria in China. Clin Chim Acta 2019; 495:377-381. [DOI: 10.1016/j.cca.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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