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Kriechbaum SD, Birmes J, Wiedenroth CB, Gruen D, Vietheer J, Richter MJ, Guth S, Roller F, Liebetrau C, Hamm CW, Keller T, Rieth A. Exercise MR-proANP unmasks latent right heart failure in CTEPH. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic right heart failure is the major determinant of outcome in chronic thromboembolic pulmonary hypertension (CTEPH). Thus, its early detection is crucial for optimal patient management. Hemodynamic assessment with invasive right heart catheterization and the measurement of natriuretic peptides at rest are established diagnostic tools in this context. An elevated right atrial pressure (RAP) is a sensitive parameter of right right heart failure. Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a natriuretic peptide that reflects right atrial stress levels.
There is a growing recognition of exercise diagnostics in the assessment of right heart failure, particularly in patients with normal or borderline findings at rest. There are no data on the dynamics of MR-proANP in correlation to RAP during physical exercise.
Purpose
The present study was designed to investigate the dynamics of RAP and MR-proANP during physical exercise in patients with CTEPH and to determine whether these parameters might serve as a tool to measure exercise-dependent atrial stress as an indicator of right heart failure.
Methods
This observational cohort study included 100 CTEPH patients who underwent right heart catheterization during physical exercise (eRHC). Blood samples for MR-proANP measurement were taken prior, during, and after eRHC. MR-proANP levels were correlated to RAP levels at rest, at peak exercise (eRAP), and during recovery. RAP at rest ≤7 mmHg was defined as normal and eRAP >15 mmHg as suggestive of right heart failure.
Results
During eRHC mean RAP increased from 6±4 mmHg to 16±7 mmHg (p<0.001). MR-proANP levels and dynamics correlated with RAP at rest (rs=0.61; p<0.001; figure 1a) and at peak exercise (rs=0.66; p<0.001; Figure 1b). Furthermore, the relative percent increase in MR-proANP correlated with the relative percent increase in eRAP (rs=0.52; p<0.001; Figure 1c) Logistic regression analysis revealed the peak MR-proANP level (B=0.058; p=0.004) and the right atrial area (B=0.389; p<0.001) to be associated with eRAP dynamics. A peak MR-proANP level ≥139 pmol/L (AUC=0.81) and recovery level ≥159 pmol/L (AUC=0.82) predicted an eRAP >15 mmHg. Physical exercise unmasked RH failure in 39% of patients with normal RAP at rest; they were also characterized by a more distinct increase in MR-proANP levels (p=0.005) and higher peak (p<0.001) and recovery levels (p<0.001).
Conclusions
RAP and MR-proANP dynamics unmask manifest and latent right heart failure in CTEPH patients, which may be useful in estimating prognosis.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): SFB 1213 area CP-01 projectWilliam G. Kerckhoff-FoundationKerckhoff Heart Research Institute (KHFI)German Center for Cardiovascular Research (DZHK)
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Affiliation(s)
- S D Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - J Birmes
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - C B Wiedenroth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery , Bad Nauheim , Germany
| | - D Gruen
- University Hospital Giessen and Marburg, Medical Clinic I, Cardiology , Giessen , Germany
| | - J Vietheer
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - M J Richter
- University Hospital Giessen and Marburg, Medical Clinic II, Pneumology , Giessen , Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Department of Thoracic Surgery , Bad Nauheim , Germany
| | - F Roller
- University Hospital Giessen and Marburg, Radiology , Giessen , Germany
| | - C Liebetrau
- CCB am Markus Hospital, Cardiology , Frankfurt am Main , Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - T Keller
- University Hospital Giessen and Marburg, Medical Clinic I, Cardiology , Giessen , Germany
| | - A Rieth
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
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Kriechbaum SD, Peters K, Ajnwojner R, Wolter JS, Haas M, Roller F, Keller T, Rolf A, Hamm CW, Mayer E, Guth S, Liebetrau C. P2774Galectin-3, GDF-15, and ST2 in noninvasive assessment of myocardial remodelling in chronic thromboembolic pulmonary hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary artery obstruction leads to impaired pulmonary hemodynamics and secondary right heart failure, which is highly predictive of outcome. Thus, the extent of myocardial -especially right heart- remodelling is an indicator of disease severity.
Purpose
The aim of the present study was to assess growth differentiation factor-15 (GDF-15), galectin-3, and suppression of tumorigenicity 2 (ST2) as non-invasive biomarkers of myocardial remodelling in patients suffering from CTEPH.
Methods
We analysed the serum levels of GDF-15, galectin-3 and ST2 in a cohort of 64 CTEPH patients and in a control group of 25 patients without cardiovascular disease. The biomarker levels were further correlated with clinical, laboratory, and hemodynamic data, including 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (meanPAP), pulmonary vascular resistance (PVR), and right atrial pressure (RAP).
Results
The biomarker levels in the control group were: galectin-3: 3.5 ng/l (IQR 2.7–4.0), GDF-15: 92.6 pg/ml (IQR 78.5–129.1), and ST2: 48.65 ng/l (IQR 35.5–57.0). CTEPH patients had higher levels of GDF-15 (196.7 pg/ml; IQR 128.4–302.8; p<0.001) and ST2 (52.6 ng/l; IQR 44.5–71.9; p=0.05) but not galectin-3 (3.4 ng/l; IQR 2.7–4.3; p=0.84). In the CTEPH cohort, patients with a meanPAP >35 mmHg (GDF-15: p=0.01; ST2: p=0.04) and patients with a PVR >500 dyn sec cm–5 (GDF-15: p=0.004; ST2: p=0.002) had significantly increased biomarker levels. For the detection of a meanPAP >35mmHg, ROC analysis revealed an AUC of 0.71 for GDF-15 and 0.67 for ST2. The level of GDF-15 correlated with the level of NT-proBNP (rrs=0.69; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=−0.47; p≤0.001). The level of ST2 correlated with the level of NT-proBNP (rrs=0.67; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=-0.31; p=0.02).
Conclusion
Our results demonstrate that GDF-15 and ST2, non-invasive biomarkers of myocardial remodelling, are significantly elevated in patients suffering from CTEPH. The correlation of biomarker levels with established outcome predictors suggests a use as indicators of disease severity.
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Affiliation(s)
- S D Kriechbaum
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - K Peters
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - R Ajnwojner
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - J S Wolter
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - M Haas
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - F Roller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - A Rolf
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - E Mayer
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - C Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
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Klaus T, Roller F, Alejandre-Lafont E, Breithecker A, Krombach G, Schneider C. Quantifizierung arteriosklerotischer Gefäßwandverkalkungen zur Prognoseabschätzung vor endovaskulärer Revaskularisation infrapoplitealer Arterien. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Klaus
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
| | - F Roller
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
| | - E Alejandre-Lafont
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
| | - A Breithecker
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
| | - G Krombach
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
| | - C Schneider
- Universitätsklinikum Giessen, Diagnostische und Interventionelle Radiologie, Giessen
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Kähling C, Langguth T, Roller F, Kroll T, Krombach G, Knitschke M, Streckbein P, Howaldt H, Wilbrand JF. A retrospective analysis of preoperative staging modalities for oral squamous cell carcinoma. J Craniomaxillofac Surg 2016; 44:1952-1956. [DOI: 10.1016/j.jcms.2016.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/04/2016] [Accepted: 09/19/2016] [Indexed: 10/21/2022] Open
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Roller F, Harth S, Tanislav C, Schneider C, Krombach G. Natives T1-Mapping bei Patienten mit Morbus Anderson-Fabry zur Diagnostik einer kardialen Beteiligung. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Roller F, Harth S, Litzlbauer D, Krombach G. Dosisreduktion in der Stamm-CT-Bildgebung bei Tumorpatienten: Vergleich von Dual-Source CT-Untersuchungen der ersten Generation und der dritten Generation bei identischen Patienten im Verlauf. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schäfer SB, Moritz R, Mayer E, Gall H, Roller F, Breithecker A, Krombach GA. Biplanare Angiografie im Vergleich zur monoplanaren Angiografie, zur präoperativen Abgrenzung der betroffenen Gefäße bei Patienten mit chronisch thromboembolische pulmonale Hypertonie (CTEPH). ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hecker A, Schneck E, Röhrig R, Roller F, Hecker B, Holler J, Koch C, Hecker M, Reichert M, Lichtenstern C, Krombach GA, Padberg W, Weigand MA. The impact of early surgical intervention in free intestinal perforation: a time-to-intervention pilot study. World J Emerg Surg 2015; 10:54. [PMID: 26550026 PMCID: PMC4636838 DOI: 10.1186/s13017-015-0047-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/23/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSES An abdominal inflammatory focus is the second most often source of sepsis with a high risk of death in surgical intensive care units. By establishing evidence-based bundled strategies the surviving sepsis campaign provided an optimized rapid and continuous treatment of these emergency patients. Hereby the hospital mortality decreased from 35 to 30 %. Sepsis treatment is based on three major therapeutic elements: surgical treatment (source control), antiinfective treatment, and supportive care. The international guidelines of the surviving sepsis campaign were updated recently and recommend rapid diagnosis of the infection and source control within the first 12 h after the diagnosis (grade 1c). Interestingly this recommendation is mainly based on studies on soft tissue infections. METHODS In this retrospective analysis 76 septic patients with an intraabdominal inflammatory focus were included. All patients underwent surgery at different time-points after diagnosis. RESULTS With 80 % patients of the early intervention group had an improved overall survival (vs. 73 % in the late intervention group). CONCLUSIONS Literature on the time dependency of early source control is rare and in part contradicting. Results of this pilot study reveal that immediate surgical intervention might be of advantage for septic emergency patients. Further multi-center approaches will be necessary to evaluate, whether the TTI has any impact on the outcome of septic patients with intestinal perforation.
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Affiliation(s)
- Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - E Schneck
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - R Röhrig
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - F Roller
- Department of Radiology, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - B Hecker
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - J Holler
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - C Koch
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M Hecker
- Department of Internal Medicine, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M Reichert
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - C Lichtenstern
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - G A Krombach
- Department of Radiology, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - W Padberg
- Department of General and Thoracic Surgery, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
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Roller F, Harth S, Schneider C, Krombach G. Natives T1-Mapping zur Visualisierung und Quantifizierung von septaler Fibrose bei Patienten mit chronisch thrombembolischer pulmonaler Hypertonie (CTEPH). ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schneider C, Brumberg A, Roller F, Rixe J, Roth P, Krombach G. Akutes Nierenversagen in der multimodalen Evaluation vor und nach perkutanem Aortenklappenersatz: Inzidenz und Risikofaktoren. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Roller F, Harth S, Schneck F, Rixe J, Krombach G, Schneider C. CTA der Koronararterien: Prävalenz des persistierenden foramen ovale (PFO) und anderer Formen von atrialen Septumdefekten (ASD). ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Roller F, Harth S, Schneck F, Rixe J, Krombach G, Schneider C. Vorhersage des Revaskularisationserfolges bei CTO der Koronararterien mittels CTA: Entwicklung und initiale Evaluation eines Scoringsystems. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Roller F, Litzlbauer H, Krombach G. Magic Bullet: Transmediastinale Schussverletzung. ROFO-FORTSCHR RONTG 2013; 186:282-5. [DOI: 10.1055/s-0033-1355501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roller F, Litzlbauer HD, Krombach GA, Schneider C. Split-Bolus-Technik in der Computertomografie polytraumatisierter Patienten: Kontrastierung und diagnostische Sicherheit. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roller F, Schneider C, Krombach G. Seltener Fall der bildgebenden Dokumentation eines rapide wachsenden primären kardialen Lymphoms. ROFO-FORTSCHR RONTG 2012; 185:160-2. [DOI: 10.1055/s-0032-1325385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Roller F, Krombach GA, Schneider C, Schuhbäck A, Rolf A. MR imaging of the heart: Analysis of secondary findings in additional chest sequence. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0031-1300909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Roller F, Heidland A. [Potatoe egg diet and mixed low protein diet: subjective evaluation (author's transl)]. Med Klin 1976; 71:112-5. [PMID: 814395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Earlier own studies concerning nutritional state (protein metabolism) have shown a superiority of mixed low protein diet - combined with essential amino acids (EAA) - to potatoe egg diet (PE). As a sequal to these studies now the subjective evaluation of the two kinds of diet was investigated. The following results are obtained: Compliance with mixed low protein diet is easier though drug intake is increased. Contrary to potatoe egg diet it seldom causes psychic stress (93 to 33% respectively). Therefore it probably can be strictly adhered to for a longer time and is subjectively told to cause an improvement of the physical condition. For that reason in future the mixed low protein diet in combination with EAA should be preferred in the phase of predialysis or transplantation. A successful treatment presumes a relative constancy of the residual glomerular filtration.
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