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Sguanci M, Ferrara G, Palomares SM, Parozzi M, Godino L, Gazineo D, Anastasi G, Mancin S. Dysgeusia and Chronic Kidney Disease: A Scoping Review. J Ren Nutr 2024; 34:374-390. [PMID: 38729584 DOI: 10.1053/j.jrn.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Dysgeusia is a common altered taste perception in chronic kidney disease patients. The study aims to identify available treatments for educating, screening, and clinically managing dysgeusia in this population. A scoping review was conducted following the protocol of Arksey and O'Malley, incorporating the Joanna Briggs Institute methodology, and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Among the 424 identified records, 13 studies were included. Screening methodologies, educational strategies, particularly a hospital-based program focusing on salt reduction, showed a significant improvement in dysgeusia (P < .001). The identified clinical treatments exclusively included oral zinc supplementation, with dosages ranging from 50 to 220 mg, reporting heterogeneous results not consistent across different studies. The personalized management of dysgeusia associated with chronic kidney disease is crucial, requiring targeted education and treatment protocols to prevent and address nutritional complications such as malnutrition.
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Affiliation(s)
- Marco Sguanci
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Department of Medicine and Surgery, Research Unit of Nursing Science, University of Rome, Rome, Italy
| | - Gaetano Ferrara
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Nephrology and Dialysis Unit, Ramazzini Hospital, Carpi, Italy
| | - Sara Morales Palomares
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, Rende, Italy
| | - Mauro Parozzi
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Lea Godino
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Domenica Gazineo
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliano Anastasi
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; Department of Trauma, AOU G. Martino University Hospital, Messina, Italy
| | - Stefano Mancin
- Italian Nephrological Nursing Society (SIAN), Olbia, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
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Chae J, Cho HJ, Yoon SH, Kim DS. The association between continuous polypharmacy and hospitalization, emergency department visits, and death in older adults: a nationwide large cohort study. Front Pharmacol 2024; 15:1382990. [PMID: 39144630 PMCID: PMC11322047 DOI: 10.3389/fphar.2024.1382990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/04/2024] [Indexed: 08/16/2024] Open
Abstract
Background This study aimed to investigate the association between continuous polypharmacy and hospitalization, emergency department (ED) visits, and death. Methods This retrospective study utilized 6,443,896 patients aged between 65 and 84 years of National Health Insurance claims data from 2016 to 2018. Polypharmacy and excessive polypharmacy were defined as the concurrent use of 5 or more and 10 or more medications, respectively, for durations of both 90 days or more and 180 days or more within a 1-year observation period. The primary outcome measures included all-cause hospitalization, ED visits, and mortality. Multiple logistic regression models were used adjusting for patients' general characteristics, comorbidities, and history of hospitalization or ED visits. Results Among 2,693,897 patients aged 65-84 years who had used medicines for 180 days or more (2,955,755 patients taking medicines for 90 days or more), the adverse outcomes were as follows: 20.5% (20.3%) experienced hospitalization, 10.9% (10.8%) visited the ED, and 1% (1%) died, respectively. In patients who exhibited polypharmacy for more than 180 days, the adjusted odds ratio of adverse outcomes was 1.32 (95% confidence interval [CI], 1.31-1.33) for hospitalization, 1.32 (95% CI, 1.31-1.33) for ED visits, 1.63 (95% CI, 1.59-1.67) for death, and that in excessive polypharmacy patients for more than 180 days was 1.85 for hospitalization, 1.92 for ED visits, and 2.57 for death, compared to non-polypharmacy patients. Conclusion Our results suggest that polypharmacy in older adults might lead to negative health consequences. Thus, interventions to optimize polypharmacy may need to be implemented.
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Affiliation(s)
- Jungmi Chae
- Department of Research, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ho Jin Cho
- Department of Research, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Sang-Heon Yoon
- Department of Research, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Dong-Sook Kim
- Department of Health Administration, Kongju National University, Gongju, Republic of Korea
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Gavazova E, Staynova R, Grekova-Kafalova D. Managing polypharmacy through medication review tools - pros and cons. Folia Med (Plovdiv) 2024; 66:161-170. [PMID: 38690810 DOI: 10.3897/folmed.66.e117783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/01/2024] [Indexed: 05/03/2024] Open
Abstract
Inappropriate polypharmacy is a common occurrence in elderly patients, resulting in increased adverse drug reactions, nonadherence, and increased healthcare costs. Medication review and deprescribing are the primary strategies described in the literature for dealing with problematic polypharmacy. To effectively carry out the medication review, various tools have been developed. These tools can support medication review in a variety of ways. Some tools include a list of medications requiring detailed attention, while others guide medical professionals with principles and algorithms for reviewing and prescribing medicines. A third category of tools focuses on tracking and identifying symptoms that may be due to drug-related problems.
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Onor IO, Ahmed F, Nguyen AN, Ezebuenyi MC, Obi CU, Schafer AK, Borghol A, Aguilar E, Okogbaa JI, Reisin E. Polypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy. Am J Med Sci 2024; 367:4-13. [PMID: 37832917 DOI: 10.1016/j.amjms.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
The rising prevalence of comorbidities in an increasingly aging population has sparked a reciprocal rise in polypharmacy. Patients with chronic kidney disease (CKD) have a greater burden of polypharmacy due to the comorbidities and complications associated with their disease. Polypharmacy in CKD patients has been linked to myriad direct and indirect costs for patients and the society at large. Pharmacists are uniquely positioned within the healthcare team to streamline polypharmacy management in the setting of CKD. In this article, we review the landscape of polypharmacy and examine its impacts through the lens of the ECHO model of Economic, Clinical, and Humanistic Outcomes. We also present strategies for healthcare teams to improve polypharmacy care through comprehensive medication management process that includes medication reconciliation during transitions of care, medication therapy management, and deprescribing. These pharmacist-led interventions have the potential to mitigate adverse outcomes associated with polypharmacy in CKD.
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Affiliation(s)
- IfeanyiChukwu O Onor
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA.
| | - Fahamina Ahmed
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; East Jefferson General Hospital-Family Medicine Clinic, Metairie, LA, USA
| | - Anthony N Nguyen
- Department of Pharmacy, Ochsner Health System, Jefferson, LA, USA
| | - Michael C Ezebuenyi
- Department of Pharmacy, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA
| | - Collins Uchechukwu Obi
- Medical Laboratory Science Department, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria
| | - Alison K Schafer
- Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Amne Borghol
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA; Department of Pharmacy, University Medical Center New Orleans, New Orleans, LA, USA
| | - Erwin Aguilar
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - John I Okogbaa
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA; Department of Medicine, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Efrain Reisin
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
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Salmen T, Serbanoiu LI, Bica IC, Serafinceanu C, Muzurović E, Janez A, Busnatu S, Banach M, Rizvi AA, Rizzo M, Pantea Stoian A. A Critical View over the Newest Antidiabetic Molecules in Light of Efficacy-A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:ijms24119760. [PMID: 37298707 DOI: 10.3390/ijms24119760] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/03/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
The increase in life expectancy without a decrease in the years lived without disability leads to the rise of the population aged over 65 years prone to polypharmacy. The novel antidiabetic drugs can improve this global therapeutic and health problem in patients with diabetes mellitus (DM). We aimed to establish the efficacy (A1c hemoglobin reduction) and safety of the newest antidiabetic drugs (considered so due to their novelty in medical practice use), specifically DPP-4i, SGLT-2i, GLP-1 Ra, and tirzepatide. The present meta-analysis followed the protocol registered at Prospero with the CRD42022330442 registration number. The reduction in HbA1c in the DPP4-i class for tenegliptin was 95% CI -0.54 [-1.1, 0.01], p = 0.06; in the SGLT2-iclass for ipragliflozin 95% CI -0.2 [-0.87, 0.47], p = 0.55; and for tofogliflozin 95% CI 3.13 [-12.02, 18.28], p = 0.69, while for tirzepatide it was 0.15, 95% CI [-0.50, 0.80] (p = 0.65). The guidelines for treatment in type 2 DM are provided from cardiovascular outcome trials that report mainly major adverse cardiovascular events and data about efficacy. The newest antidiabetic non-insulinic drugs are reported to be efficient in lowering HbA1c, but this effect depends between classes, molecules, or patients' age. The newest antidiabetic drugs are proven to be efficient molecules in terms of HbA1c decrease, weight reduction, and safety, but more studies are needed in order to characterize exactly their efficacy and safety profiles.
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Affiliation(s)
- Teodor Salmen
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Liviu-Ionut Serbanoiu
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana-Cristina Bica
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian Serafinceanu
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Ljubljanska, 81000 Podgorica, Montenegro
- Faculty of Medicine, University of Montenegro, Kruševac bb, 81000 Podgorica, Montenegro
| | - Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Stefan Busnatu
- Cardiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 93-338 Lodz, Poland
| | - Ali Abbas Rizvi
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL 32827, USA
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Roux C, Verollet K, Prouvot J, Prelipcean C, Pambrun E, Moranne O. Choosing the right chronic medication for hemodialysis patients. A short ABC for the dialysis nephrologist. J Nephrol 2023; 36:521-536. [PMID: 36472789 DOI: 10.1007/s40620-022-01477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adapting drug treatments for patients on hemodialysis with multiple chronic pathologies is a complex affair. When prescribing a medication, the risk-benefit analysis usually focuses primarily on the indication of the drug class prescribed. However, the pharmacokinetics of the chosen drug should also be taken into account. The purpose of our review was to identify the drugs to be favored in each therapeutic class, according to their safety and pharmacokinetic profiles, for the most common chronic diseases in patients on chronic hemodialysis. METHODS We conducted a narrative review of the literature using Medline and Web of Science databases, targeting studies on the most commonly-prescribed drugs for non-communicable diseases in patients on chronic hemodialysis. RESULTS The search identified 1224 articles, 95 of which were further analyzed. The main classes of drugs included concern the cardiovascular system (anti-hypertensives, anti-arrhythmics, anti-thrombotics, hypocholesterolemics), the endocrine and metabolic pathways (anti-diabetics, gastric anti-secretory, anticoagulant, thyroid hormones, anti-gout) and psychiatric and neurological disorders (antidepressants, anxiolytics, antipsychotics and anti-epileptics). CONCLUSION We report on the most often prescribed drugs for chronic pathologies in patients on chronic hemodialysis. Most of them require adaptation, and in some cases one better alternative stands out among the drug class. More pharmacokinetic data are needed to define the pharmacokinetics in the various dialysis techniques.
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Affiliation(s)
- Clarisse Roux
- Service Pharmacie, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France.
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France.
| | - Kristelle Verollet
- Service Pharmacie, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Julien Prouvot
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Camelia Prelipcean
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Emilie Pambrun
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France
| | - Olivier Moranne
- Institut Desbrest d'Epidemiologie et Santé publique (IDESP), INSERM, Montpellier, France.
- Service Néphrologie Dialyse Apherese, Hopital Universitaire de Nimes, CHU Carémeau, Nîmes, France.
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Cho HJ, Chae J, Yoon S, Kim D. Factors related to polypharmacy and hyper-polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea. Clin Transl Sci 2022; 16:193-205. [PMID: 36401587 PMCID: PMC9926077 DOI: 10.1111/cts.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Polypharmacy may cause adverse health outcomes in the elderly. This study examined the prevalence of continuous polypharmacy and hyper-polypharmacy, factors associated with polypharmacy, and the most frequently prescribed medications among older adults in South Korea. This was a retrospective observational study using National Health Insurance claims data. In total, 7,358,953 Korean elderly patients aged 65 years and older were included. Continuous polypharmacy and hyper-polypharmacy were defined as the use of ≥5 and ≥10 medications, respectively, for both ≥90 days and ≥180 days within 1 year. A multivariate logistic regression analysis was conducted with adjustment for general characteristics (sex, age, insurance type), comorbidities (12 diseases, number of comorbidities, and Elixhauser Comorbidity Index [ECI] classification), and healthcare service utilization. Among 7.36 million elderly patients, 47.8% and 36.9% had polypharmacy for ≥90 and ≥180 days, and 11.9% and 7.1% of patients exhibited hyper-polypharmacy for ≥90 and ≥180 days, respectively. Male sex, older age, insurance, comorbidities (cardio-cerebrovascular disease, diabetes mellitus, depressive disorder, dementia, an ECI score of ≥3), and healthcare service utilization were associated with an increased probability of polypharmacy. The therapeutic class with the most prescriptions was drugs for acid-related disorders (ATC A02). The number of outpatient visit days more strongly influenced polypharmacy than hospitalizations and ED visits. This study provides health policymakers with important evidence about the critical need to reduce polypharmacy among older adults.
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Affiliation(s)
- Ho Jin Cho
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Jungmi Chae
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Sang‐Heon Yoon
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Dong‐Sook Kim
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
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Aucella F, Corsonello A, Soraci L, Fabbietti P, Prencipe MA, Gatta G, Lattanzio F, Cortese L, Pagnotta MR, Antonelli Incalzi R. A focus on CKD reporting and inappropriate prescribing among older patients discharged from geriatric and nephrology units throughout Italy: A nationwide multicenter retrospective cross-sectional study. Front Pharmacol 2022; 13:996042. [PMID: 36313342 PMCID: PMC9614038 DOI: 10.3389/fphar.2022.996042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.
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Affiliation(s)
- Filippo Aucella
- SC di Nefrologia e Dialisi, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | | | - Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
- *Correspondence: Luca Soraci,
| | - Paolo Fabbietti
- Laboratory of Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona, Italy
| | - Michele Antonio Prencipe
- SC di Nefrologia e Dialisi, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Gatta
- SC di Nefrologia e Dialisi, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy
| | | | - Livio Cortese
- Department of Geriatrics, Campus Biomedico, Rome, Italy
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Geriatric Nephrology. Crit Care Nurs Clin North Am 2022; 34:421-430. [DOI: 10.1016/j.cnc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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