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Peterle VCU, Novaes MRCG, Junior PEB, Júnior JCG, Magalhães Cavalcante RT, da Silva Junior JB, Portela RC, de Paula AP. Osteoporotic hip fracture-Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil. PLoS One 2022; 17:e0272006. [PMID: 35960782 PMCID: PMC9374234 DOI: 10.1371/journal.pone.0272006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures. METHOD Retrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software. RESULT The mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period. CONCLUSION Hip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality.
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Affiliation(s)
| | | | | | - João Carlos Geber Júnior
- Department of Internal Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ray Costa Portela
- Escola Superior de Ciências da Saúde (Escs/Fepecs), Brasília, DF, Brazil
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ana Patricia de Paula
- Escola Superior de Ciências da Saúde (Escs/Fepecs), Brasília, DF, Brazil
- Universidade de Brasilia, Brasília, DF, Brazil
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Diabetes Mellitus and Dental Implants: A Systematic Review and Meta-Analysis. MATERIALS 2022; 15:ma15093227. [PMID: 35591561 PMCID: PMC9105616 DOI: 10.3390/ma15093227] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/15/2022] [Accepted: 04/28/2022] [Indexed: 01/08/2023]
Abstract
The present review aimed to evaluate the impact of diabetes mellitus on dental implant failure rates and marginal bone loss (MBL). An electronic search was undertaken in three databases, plus a manual search of journals. Meta-analyses were performed as well as meta-regressions in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. The review included 89 publications. Altogether, there were 5510 and 62,780 implants placed in diabetic and non-diabetic patients, respectively. Pairwise meta-analysis showed that implants in diabetic patients had a higher failure risk in comparison to non-diabetic patients (OR 1.777, p < 0.001). Implant failures were more likely to occur in type 1 diabetes patients than in type 2 (OR 4.477, p = 0.032). The difference in implant failure between the groups was statistically significant in the maxilla but not in the mandible. The MBL mean difference (MD) between the groups was 0.776 mm (p = 0.027), with an estimated increase of 0.032 mm in the MBL MD between groups for every additional month of follow-up (p < 0.001). There was an estimated decrease of 0.007 in OR for every additional month of follow-up (p = 0.048). In conclusion, implants in diabetic patients showed a 77.7% higher risk of failure than in non-diabetic patients.
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Wei K, Song G, Xi L, Chen J, Sun C, Chen P, Wei Y, Wang L, Kong X, Li Y, Xu D, Jia X. Association of plasma neutrophil gelatinase-associated lipocalin and thoracic aorta calcification in maintenance hemodialysis patients with and without diabetes. BMC Nephrol 2022; 23:156. [PMID: 35459121 PMCID: PMC9026670 DOI: 10.1186/s12882-022-02773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin (NGAL) is not only a bone-derived factor involved in metabolism, but also a biomarker of kidney disease and cardiovascular pathophysiology. We conducted this cross-sectional observational study to explore relationships between plasma NGAL and thoracic aorta calcification (TAC) in maintenance hemodialysis (MHD) patients with and without diabetes. Methods Plasma NGAL was measured by ELISA, TAC was evaluated via computed tomography scan using a 3D quantification method or chest radiography aortic arch calcification score. Spearman correlation, Logistic regression and Partial correlation analysis were used to describe the correlations between NGAL and TAC. Results Plasma NGAL levels were lower in MHD patients with diabetes compared to those without diabetes (49.33(42.37, 55.48) vs 56.78(44.37, 674.13) ng/mL, P = 0.026). In MHD patients without diabetes, lg (NGAL) was positively correlated with ARC value(R = 0.612, P = 0.003) analyzed by Spearman correlation; for partial correlation analysis, lg (NGAL) was positively correlated with ARC value, after adjusting for age and sex (R = 0.550, P = 0.015), adjusting for age, sex and CHD (R = 0.565, P = 0.015), adjusting for age, sex, CHD and Alb (R = 0.536, P = 0.027), or adjusting for age, sex, CHD, Alb, and dialyzer membrane (polysulfone) (R = 0.590, P = 0.016); however, when adjusting for age, sex, CHD, Alb and Ca, the correlation between lg (NGAL) and ARC value disappeared. Positive correlation were found between NGAL and Ca (R = 0.644, P < 0.001), Ca and ACR (R = 0.534, P = 0.013) in Spearman coefficient analysis. Conclusion There were positive correlations among plasma NGAL, serum Ca and ARC in MHD patients without diabetes; which suggests that NGAL is possibly a participant in cardiovascular calcification, in non-diabetic MHD. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02773-z.
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Affiliation(s)
- Kai Wei
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Gesheng Song
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Linhe Xi
- Department of Plastic and Reconstruction, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, China
| | - Juan Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Chuancai Sun
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Ping Chen
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Yong Wei
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Li Wang
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Yang Li
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China.,Shandong Provincial Insititute of Nephrology, Jinan, China
| | - Xiaoyan Jia
- Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), No.16766, Jingshi Road, Jinan, 250014, China. .,Shandong Provincial Insititute of Nephrology, Jinan, China.
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Hauge SC, Frost M, Hansen D. Understanding Bone Disease in Patients with Diabetic Kidney Disease: a Narrative Review. Curr Osteoporos Rep 2020; 18:727-736. [PMID: 33048275 DOI: 10.1007/s11914-020-00630-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Both diabetes and kidney disease associate with the development of bone disease and an increased risk of fragility fractures. The etiologies of bone disease in patients with diabetic kidney disease (DKD) are multiple and complex. This review explores the association between DKD and bone disease and discusses how the presence of both diabetes and kidney disease may impair bone quality and increase fracture risk. Diagnostic tools as well as future research areas are also discussed. RECENT FINDINGS Patients with DKD have an increased risk of fragility fracture, most pronounced in patients with type 1 diabetes, and in DKD a high prevalence of adynamic bone disease is found. Recent studies have demonstrated disturbances in the interplay between bone regulating factors in DKD, such as relative hypoparathyroidism and alterations of bone-derived hormones including fibroblast growth factor-23 (FGF-23), sclerostin and klotho, which lead to bone disease. This review examines the current knowledge on bone disease in patients with DKD, clinical considerations for patient care, as well as subjects for future research.
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Affiliation(s)
- Sabina Chaudhary Hauge
- Department of Nephrology, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Ditte Hansen
- Department of Nephrology, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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Souza Gomes TP, Veloso FLDM, Antunes Filho J, Mourão FC, Nascif NHT, Loures EDA, Labronici PJ, Mendes Júnior AF. Obesidade, Diabetes Mellitus tipo 2 e fragilidade óssea: uma revisão narrativa. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Durante anos a obesidade foi vista como um fator protetor para fraturas e osteoporose. Diversos estudos, no entanto, contestam esta tese, descrevendo que a obesidade na verdade afeta negativamente o sistema esquelético, em especial a homeostase óssea, diminuindo a rigidez do tecido ósseo e aumentando o risco de fraturas. A obesidade e o diabetes estão frequentemente associados no mesmo paciente, e a compreensão da alteração do tecido ósseo nestas duas condições clínicas é fundamental para o melhor cuidado destes pacientes, principalmente devido ao risco aumentado de fraturas, que estão associadas a maior número de complicações no seu tratamento. O presente estudo, em revisão narrativa, descreve a relação entre obesidade e homeostase óssea, a fragilidade óssea nos pacientes obesos, diabéticos ou não, e a relação entre obesidade e fraturas.
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Metabolic and bone profile in postmenopausal women with and without type 2 diabetes: a cross-sectional study. ACTA ACUST UNITED AC 2019; 57:61-67. [PMID: 30447149 DOI: 10.2478/rjim-2018-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Current studies support the implication of metabolic changes associated with type 2 diabetes in altering bone metabolism, structure and resistance. OBJECTIVE We conducted a cross-sectional study on postmenopausal women aimed to analyze the differences in metabolic and bone profile in patients with and without type 2 diabetes Methods. We analyzed the metabolic and bone profile in postmenopausal women with and without type 2 diabetes (T2DM). Clinical, metabolic, hormonal parameters, along with lumbar, hip and femoral bone mineral density (BMD) and trabecular bone score (TBS) were evaluated. RESULTS 56 women with T2DM(63.57±8.97 years) and 83 non-T2DM (60.21±8.77 years) were included. T2DM patients presented a higher value of body mass index (BMI) and BMD vs. control group (p = 0.001; p = 0.03-lumbar level, p = 0.07-femoral neck and p = 0.001-total hip). Also, BMI correlated positively with lumbar-BMD and glycated hemoglobin (HbA1c) (r = 0.348, p = 0.01; r = 0.269, p = 0.04), correlation maintained even after age and estimated glomerular filtration rate (eGFR) adjustment (r = 0.383, p = 0.005; r = 0.237, p = 0.08). Diabetic patients recorded lower levels of 25(OH)D(p = 0.05), bone markers (p ≤ 0.05) and TBS(p = 0.07). For the entire patient group we found a negative correlation between HbA1c level and bone markers: r = -0.358, p = 0.0005-osteocalcin, r = -0.40, p = 0.0005-P1NP, r = -0.258, p = 0.005-crosslaps. CONCLUSIONS Our results indicate the presence of altered bone microarchitecture in T2DZ patients according to the TBS score, combined with lower levels of bone markers, with a statistically significant negative correlation between HbA1c level and bone markers.
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Vianna AGD, de Lacerda CS, Pechmann LM, Polesel MG, Marino EC, Borba VZC, Barreto FDC. Vildagliptin has the same safety profile as a sulfonylurea on bone metabolism and bone mineral density in post-menopausal women with type 2 diabetes: a randomized controlled trial. Diabetol Metab Syndr 2017; 9:35. [PMID: 28515791 PMCID: PMC5433032 DOI: 10.1186/s13098-017-0232-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Several antidiabetic therapies affect bone metabolism. Sulfonylureas have the lowest impact on bone among oral antidiabetics. The objective of this study is to compare the effects of vildagliptin and gliclazide modified release (MR) on bone turnover markers (BTMs) and bone mineral density (BMD) in postmenopausal women with uncontrolled type 2 diabetes (T2D). METHODS Forty-two postmenopausal women with uncontrolled T2D were randomly allocated into vildagliptin or gliclazide MR (control) groups. The primary endpoint was the change in the BTMs in months 6 and 12 compared with the baseline. The secondary endpoint was the variation in the BMD, which was assessed via dual-energy X-ray absorptiometry at the lumbar spine, femoral neck and total hip at baseline and month 12. RESULTS After a 12-month treatment, the BTM serum carboxy-terminal telopeptide of type 1 collagen increased 0.001 ± 0.153 ng/mL in the vildagliptin group versus 0.008 ± 0.060 ng/mL in the gliclazide MR group (p = 0.858). The serum osteocalcin, serum amino-terminal propeptide of procollagen type I and urinary amino-terminal telopeptide of type 1 collagen remained stable in both groups, and there was no statistically significant difference between the effect of vildagliptin and gliclazide MR on these variables. The lumbar spine BMD did not change in the vildagliptin or gliclazide MR groups after a 12-month treatment (0.000 ± 0.025 g/cm2 versus -0.008 ± 0.036, respectively, p = 0.434). Furthermore, there was a similar lack of change in the femoral neck and total hip BMD values in both treatments. CONCLUSIONS Bone turnover markers and BMD remained unchanged after a 12-month treatment in both groups, which suggests that vildagliptin has the same safety profile as gliclazide MR on bone metabolism. Trial Registration ClinicalTrials.gov number NCT01679899.
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Affiliation(s)
- Andre Gustavo Daher Vianna
- Pontifical Catholic University of Parana, Rua Imaculada Conceição, 1155-Bloco Medicina-Prado Velho, Curitiba, Parana Zip code: 80215-901 Brazil
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433-4° andar-Mercês, Curitiba, Paraná Zip code: 80810-040 Brazil
| | - Claudio Silva de Lacerda
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433-4° andar-Mercês, Curitiba, Paraná Zip code: 80810-040 Brazil
- Division of Endocrinology, Department of Internal Medicine, Federal University of Paraná, Avenida Agostinho Leão Junior, 285-Alto da Gloria, Curitiba, Paraná Zip code: 80030-110 Brazil
| | - Luciana Muniz Pechmann
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433-4° andar-Mercês, Curitiba, Paraná Zip code: 80810-040 Brazil
| | - Michelle Garcia Polesel
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433-4° andar-Mercês, Curitiba, Paraná Zip code: 80810-040 Brazil
| | - Emerson Cestari Marino
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433-4° andar-Mercês, Curitiba, Paraná Zip code: 80810-040 Brazil
| | - Victoria Zeghbi Cochenski Borba
- Division of Endocrinology, Department of Internal Medicine, Federal University of Paraná, Avenida Agostinho Leão Junior, 285-Alto da Gloria, Curitiba, Paraná Zip code: 80030-110 Brazil
| | - Fellype de Carvalho Barreto
- Division of Nephrology, Department of Internal Medicine, Federal University of Paraná, Rua General Carneiro, 181-Alto da Gloria, Curitiba, Paraná Zip code: 80060-900 Brazil
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Sanches CP, Vianna AGD, Barreto FDC. The impact of type 2 diabetes on bone metabolism. Diabetol Metab Syndr 2017; 9:85. [PMID: 29075333 PMCID: PMC5649056 DOI: 10.1186/s13098-017-0278-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
Diabetes complications and osteoporotic fractures are two of the most important causes of morbidity and mortality in older patients and share many features including genetic susceptibility, molecular mechanisms, and environmental factors. Type 2 diabetes mellitus (T2DM) compromises bone microarchitecture by inducing abnormal bone cell function and matrix structure, with increased osteoblast apoptosis, diminished osteoblast differentiation, and enhanced osteoclast-mediated bone resorption. The linkage between these two chronic diseases creates a possibility that certain antidiabetic therapies may affect bone quality. Both glycemic and bone homeostasis are under control of common regulatory factors. These factors include insulin, accumulation of advanced glycation end products, peroxisome proliferator-activated receptor gamma, gastrointestinal hormones (such as the glucose-dependent insulinotropic peptide and the glucagon-like peptides 1 and 2), and bone-derived hormone osteocalcin. This background allows individual pharmacological targets for antidiabetic therapies to affect the bone quality due to their indirect effects on bone cell differentiation and bone remodeling process. Moreover, it's important to consider the fragility fractures as another diabetes complication and discuss more deeply about the requirement for adequate screening and preventive measures. This review aims to briefly explore the impact of T2DM on bone metabolic and mechanical proprieties and fracture risk.
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Affiliation(s)
- Claudia Pinheiro Sanches
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433, 4° andar, Mercês, Curitiba, Paraná ZIP Code: 80810-040 Brazil
| | - Andre Gustavo Daher Vianna
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Rua Alcides Munhoz, 433, 4° andar, Mercês, Curitiba, Paraná ZIP Code: 80810-040 Brazil
- Pontifical Catholic University of Parana, Rua Imaculada Conceição, 1155 , Bloco Medicina, Prado Velho, Curitiba, Paraná ZIP Code: 80215-901 Brazil
| | - Fellype de Carvalho Barreto
- Division of Nephrology, Department of Internal Medicine, Federal University of Paraná, Rua General Carneiro 181, Alto da Gloria, Curitiba, Paraná ZIP Code: 80060-900 Brazil
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