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Roblero MFS, Rubio MAB, González-Moya M, Varela JC, Alba AP, Gumpert JV, Cigarrán S, Vidau P, Marcos SG, Luquin PA, Piera EC, Mariño AG, Espigares MJ, Molina MD, Molina P. Experience in Spain with the first patients in home hemodialysis treated with low-flow dialysate monitors. Nefrologia 2022; 42:460-470. [PMID: 36400687 DOI: 10.1016/j.nefroe.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/12/2021] [Indexed: 06/16/2023] Open
Abstract
Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Pedro Vidau
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | | | - Mariola D Molina
- Departamento de Matemáticas, Universidad de Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Pablo Molina
- Hospital Universitari Dr Peset, FISABIO, Departamento de Medicina, Universitat de València, Valencia, Spain
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2
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Slon Roblero MF, Bajo Rubio MA, González-Moya M, Calviño Varela J, Pérez Alba A, Villaro Gumpert J, Cigarrán S, Vidau P, García Marcos S, Abáigar Luquin P, Coll Piera E, Gascón Mariño A, Espigares MJ, Molina MD, Molina P. Experience in Spain with the first patients in home hemodialysis treated with low-flow dialysate monitors. Nefrologia 2021; 42:S0211-6995(21)00144-2. [PMID: 34393002 DOI: 10.1016/j.nefro.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Pedro Vidau
- Hospital Universitario Central de Asturias, Oviedo, España
| | | | | | | | | | | | - Mariola D Molina
- Departamento de Matemáticas, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
| | - Pablo Molina
- Hospital Universitari Dr Peset, FISABIO, Departamento de Medicina, Universitat de València, Valencia, España
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Torregrosa V, Andrés A, Avila A, de Juan J, del PIno D, Fernández E, García JDD, Hernández D, Luño J, Martínez I, Paniagua J, Posadas M, Rodríguez J, Santamaría R, Torra R, Torras J, Vidau P. SP024PREFINE: RESULTS OF A SPANISH SCREENING FOR FABRY DISEASE IN 10,000 PATIENTS IN DIALYSIS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp024] [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: 11/12/2022] Open
Affiliation(s)
| | - Amado Andrés
- Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain
| | - Ana Avila
- Servicio de Nefrología, Hospital Dr. Peset, Valencia, Spain
| | - Joaquín de Juan
- Servicio de Nefrología, Hospital Virgen de la Salud, Elda (Alicante), Spain
| | | | - Elvira Fernández
- Servicio de Nefrología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Juan de Dios García
- Servicio de Genética, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), Spain
| | - Domingo Hernández
- Servicio de Nefrología, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Jose Luño
- Servicio de Nefrología, Hospital Gregorio Marañón, Madrid, Spain
| | - Isabel Martínez
- Servicio de Nefrología, Hospital Galdakao, Galdakao (Vizcaya), Spain
| | - Jose Paniagua
- Servicio de Nefrología, Hospital del Bierzo, Ponferrada (León), Spain
| | - Manuel Posadas
- Instituto de Investigación en Enfermedades Raras, Instituto Carlos III, Madrid, Spain
| | - Jose Rodríguez
- Servicio de Nefrología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Roser Torra
- Servicio de Nefrología, Fundació Puigvert, Barcelona, Spain
| | - Joan Torras
- Servicio de Nefrología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Pedro Vidau
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Del Pino M, Andrés A, Bernabéu AÁ, de Juan-Rivera J, Fernández E, de Dios García Díaz J, Hernández D, Luño J, Fernández IM, Paniagua J, Posada de la Paz M, Rodríguez-Pérez JC, Santamaría R, Torra R, Ambros JT, Vidau P, Torregrosa JV. Fabry Nephropathy: An Evidence-Based Narrative Review. Kidney Blood Press Res 2018; 43:406-421. [PMID: 29558749 DOI: 10.1159/000488121] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/09/2018] [Indexed: 11/19/2022] Open
Abstract
Fabry disease (FD) is a rare, X-linked disorder caused by mutations in the GLA gene encoding the enzyme α-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, endothelial cells, epithelial cells, and tubular cells contribute to the renal symptoms of FD, which manifest as proteinuria and reduced glomerular filtration rate leading to renal insufficiency. A correct diagnosis of FD, although challenging, has considerable implications regarding treatment, management, and counseling. The diagnosis may be confirmed by demonstrating the enzyme deficiency in males and by identifying the specific GLA gene mutation in male and female patients. Treatment with enzyme replacement therapy, as part of the therapeutic strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline, particularly in the early stages of the disease. Emergent treatments for FD include the recently approved chaperone molecule migalastat for patients with amenable mutations. The objective of this report is to provide an updated overview on Fabry nephropathy, with a focus on the most relevant aspects of its epidemiology, diagnosis, pathophysiology, and treatment options.
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Affiliation(s)
- María Del Pino
- Nephrology Service, Hospital Torrecardenas, Almeria, Spain
| | - Amado Andrés
- Division of Nephrology, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Elvira Fernández
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Juan de Dios García Díaz
- Clinical Genetics Unit, Department of Internal Medicine University Hospital Príncipe de Asturias Alcalá de Henares, Madrid, Spain
| | - Domingo Hernández
- Nephrology Department, Carlos Haya Regional University Hospital and University of Málaga, IBIMA, REDinREN (RD16/0009/0006), Málaga, Spain
| | - José Luño
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - José Paniagua
- Nephrology Service, Hospital El Bierzo, Ponferrada, Spain
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research, SpainRDR and CIBERER, Institute of Health Carlos III, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- University Hospital of Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria (Las Palmas), Las Palmas, Spain
| | - Rafael Santamaría
- Nephrology Department, Reina Sofia University Hospital, Maimonides Institute for Research in Biomedicine of Cordoba and University of Cordoba, Red de Investigación Renal (RedinRen), Cordoba, Spain
| | - Roser Torra
- Inherited Kidney Disorders, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Joan Torras Ambros
- Nephrology Service, Experimental Nephrology Laboratory, Hospital de Bellvitge, IDIBELL, Barcelona, Spain
| | - Pedro Vidau
- Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep-Vicent Torregrosa
- Nephrology and Renal Transplant Department, Hospital Clinic, University of Barcelona, RedInRen, Barcelona, Spain
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del Pino MD, Vidau P, Torregrosa V, Torras J, Santamaria R, Rodriguez JC, Posada M, Paniagua J, Martinez MI, Luño J, Hernandez D, Garcia JDD, Fernandez E, de Juan J, Avila A, Andres A. SP038PREFINE PROJECT: STRATEGIC PLAN TO IMPROVE KNOWLEDGE & RECOGNITION OF FABRY DISEASE AMONG SPANISH NEPHROLOGISTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx138.sp038] [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: 11/12/2022] Open
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6
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Gaspar P, Herrera J, Rodrigues D, Cerezo S, Delgado R, Andrade CF, Forascepi R, Macias J, del Pino MD, Prados MD, de Alegria PR, Torres G, Vidau P, Sá-Miranda MC. Frequency of Fabry disease in male and female haemodialysis patients in Spain. BMC Med Genet 2010; 11:19. [PMID: 20122163 PMCID: PMC2837018 DOI: 10.1186/1471-2350-11-19] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 02/01/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fabry disease (FD), an X-linked lysosomal storage disorder, is caused by a reduced activity of the lysosomal enzyme alpha-galactosidase A. The disorder ultimately leads to organ damage (including renal failure) in males and females. However, heterozygous females usually present a milder phenotype with a later onset and a slower progression. METHODS A combined enzymatic and genetic strategy was used, measuring the activity of alpha-galactosidase A and genotyping the alpha-galactosidase A gene (GLA) in dried blood samples (DBS) of 911 patients undergoing haemodialysis in centers across Spain. RESULTS GLA alterations were found in seven unrelated patients (4 males and 3 females). Two novel mutations (p.Gly346AlafsX347 and p.Val199GlyfsX203) were identified as well as a previously described mutation, R118C. The R118C mutation was present in 60% of unrelated patients with GLA causal mutations. The D313Y alteration, considered by some authors as a pseudo-deficiency allele, was also found in two out of seven patients. CONCLUSIONS Excluding the controversial D313Y alteration, FD presents a frequency of one in 182 individuals (0.55%) within this population of males and females undergoing haemodialysis. Moreover, our findings suggest that a number of patients with unexplained and atypical symptoms of renal disease may have FD. Screening programmes for FD in populations of individuals presenting severe kidney dysfunction, cardiac alterations or cerebrovascular disease may lead to the diagnosis of FD in those patients, the study of their families and eventually the implementation of a specific therapy.
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Affiliation(s)
- Paulo Gaspar
- Unidade de Biologia do Lisossoma e do Peroxissoma, Instituto de Biologia Molecular e Celular, Universidade do Porto, Porto, Portugal
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Sánchez JE, Ortega T, Rodríguez C, Díaz-Molina B, Martín M, Garcia-Cueto C, Vidau P, Gago E, Ortega F. Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant 2009; 25:605-10. [PMID: 19783594 DOI: 10.1093/ndt/gfp484] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major health problem in developed countries. HF is a progressive, lethal disorder, even with adequate treatment. There exists a vicious circle in the pathophysiology of HF that perpetuates and magnifies the problem. Concomitant fluid accumulation may worsen the congestive HF, it is responsible for numerous hospitalizations and it is an important cause of mortality. In this situation, any means of fluid removal may aid in the management of these patients. The objective of this study was to evaluate the efficacy of peritoneal dialysis (PD) in the treatment of refractory HF in terms of functional status, hospitalization and mortality. We also determined the improvement in health-related quality of life with the use of PD, and examined the economic consequences of its use. METHODS We conducted a single centre, prospective, non-randomized study involving patients showing symptoms and signs of congestive HF refractory to maximum tolerable drug treatment. All of them were treated with PD. We analysed physical and biochemical determinations, functional status (according to the NYHA classification) and echocardiogram parameters. Also, to determine the efficacy of the technique we compared the perceived state of health (measured by the EQ5D) to PD patients respect to those reported with conservative therapies. Finally, we carried out a cost-utility evaluation measured by the incremental cost-utility ratio between these two options. RESULTS Seventeen patients (65% men, 64 +/- 9 years) were included in the study, and 12 were still undergoing PD treatment at the end of the follow-up period (15 +/- 9 months). All patients improved their NYHA functional status (65% two classes; the rest, one; P < 0.001), with an important improvement in their pulmonary artery systolic pressure (44 +/- 12 versus 27 +/- 9 mmHg; P = 0.007), but no changes in left ventricular ejection fraction. Hospitalization rates underwent a dramatic reduction (from 62 +/- 16 to 11 +/- 5 days/patient/year; P = 0.003) before and after PD treatment. PD treatment raised life expectancy of 82% after 12 months of treatment, and 70% and 56% after 18 and 24 months, respectively, much better outcomes than those reported about conservative therapies, which only use diverse diuretic regimens. PD was associated with a higher perception state of health than the conservative therapy (0.6727 versus 0.4305; P < 0.01). Finally, we found that PD is cost-effective compared with the conservative therapy. CONCLUSIONS We demonstrate that congestive HF programmes should consider offering PD in hope of seeing better functional status, reduced morbidity and mortality, better quality of life as well as reduced health care costs.
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Affiliation(s)
- Jose E Sánchez
- Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
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8
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Díez Ojea B, Rodríguez Suárez C, Vidau P, Gago E, Díaz Molina B, Martín Fernández M, García Cueto C. [Peritoneal dialyisis role in heart failure treatment, experience in our center]. Nefrologia 2007; 27:605-611. [PMID: 18045037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Peritoneal dialysis is a renal replacement therapy indicated in patients with an unstable hemodynamic status. It has been used, by ultrafiltration, preferably in those patients with congestive heart failure refractory to conventional medical therapy. We present the experience of our center with five patients who were affected by severe congestive heart failure [Class IV on the New York Heart Association (NYHA) scale] and diverse stages of chronic renal failure, who received this therapy. Icodextrin has been used as an osmotic agent to induce ultrafiltration. The follow-up period ranged between 5 and 14 months (9.8 +/- 3.7 months). The results that we have found are similar to those of other studies: we observed a significant improvement in quality of life and a reduction in morbidity and hospitalization rates in all our patients. But it seems to be necessary to make a prospective randomized controlled trial with more number of individuals to confirm these promising facts, to clarify the impact on the survival, and to analyze the cost-benefit for treating patients suffering from refractory, end stage congestive heart failure.
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Affiliation(s)
- B Díez Ojea
- Sección de Nefrología, Hospital Valle del Nalón, Riaño-Langreo (Asturias).
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9
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Santos-Juanes J, Lopez-Escobar M, Galache C, Telenti M, Vidau P, Badillo A, Rio JSD. Haemorrhagic cellulitis caused by Salmonella enteritidis. ACTA ACUST UNITED AC 2005; 37:309-10. [PMID: 15804669 DOI: 10.1080/00365540410021225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Soft tissue infections are rare manifestations of extra-intestinal salmonellosis and occur more frequently in immunocompromized patients [1-4]. We report haemorrhagic cellulitis in an immunosuppressed patient with sepsis caused by a non-typhoid Salmonella.
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Affiliation(s)
- Jorge Santos-Juanes
- Department of Dermatology-II, The Hospital Central de Asturias, Oviedo, Spain.
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10
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Navascués RA, Vidau P, Palacios L, Pousa M. [Purpura de Schonlein-Henoch in patient with fibrosis qistica]. Nefrologia 2003; 23:272. [PMID: 12891945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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11
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Herrera J, Vidau P, Macías JF. [Mean ambulatory arterial pressure in the elderly]. Nefrologia 2002; 22 Suppl 3:77-85. [PMID: 12014308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- J Herrera
- Unidad de Hipertensión, Servicio de Nefrología, Hospital General de Asturias, Oviedo
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12
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Peral V, Vidau P, Herrera J, Rodriguez C, Tricas L, Tomé R, Arroyo F. Development of panhypogammaglobulinaemia in a patient with systemic lupus erythematosus. Nephrol Dial Transplant 1994; 9:709-12. [PMID: 7970101 DOI: 10.1093/ndt/9.6.709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- V Peral
- Department of Nephrology, Hospital General de Asturias, Oviedo, Spain
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