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Choi SY, Choi SW, Lee S, So MW, Oh JS, Lim D. Efficacy and tolerability of febuxostat in gout patients on dialysis. Intern Med J 2021; 51:348-354. [DOI: 10.1111/imj.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 01/22/2023]
Affiliation(s)
- See Y. Choi
- Division of Rheumatology, Department of Internal Medicine University of Ulsan College of Medicine, Ulsan University Hospital Ulsan South Korea
| | - Seung W. Choi
- Division of Rheumatology, Department of Internal Medicine University of Ulsan College of Medicine, Ulsan University Hospital Ulsan South Korea
| | - Sunggun Lee
- Division of Rheumatology, Department of Internal Medicine Haeundae Paik Hospital, Inje University College of Medicine Busan South Korea
| | - Min W. So
- Division of Rheumatology, Department of Internal Medicine Pusan National University Yangsan Hospital Yangsan South Korea
| | - Ji S. Oh
- Department of Biomedical Informatics, Asan Medical Center University of Ulsan College of Medicine Seoul South Korea
| | - Doo‐Ho Lim
- Division of Rheumatology, Department of Internal Medicine University of Ulsan College of Medicine, Ulsan University Hospital Ulsan South Korea
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Association of Serum Uric Acid Concentration and Its Change with Cardiovascular Death and All-Cause Mortality. DISEASE MARKERS 2020; 2020:7646384. [PMID: 32076464 PMCID: PMC7008257 DOI: 10.1155/2020/7646384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023]
Abstract
Objective There is no consensus on the role of abnormal uric acid (UA) levels in the prognosis of patients undergoing hemodialysis. We therefore aimed to investigate the effects of changes in UA concentration on the risk of all-cause death and cardiac death in such patients. Method In this retrospective cohort study, patients admitted to two hemodialysis centers performing maintenance hemodialysis (MHD) in Wuhan First Hospital and Fourth Hospital Hemodialysis Center from January 1, 2007, to October 31, 2017, were included. Results In all, 325 patients undergoing MHD aged 59.7 ± 14.7 years, including 195 men (60%), were enrolled, with a median follow-up of 37 months. Serum UA (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability (p < 0.001) was significantly higher in the surviving group than in the death group. No significant difference was found in UA variability ( Conclusion Low UA levels were closely related to all-cause mortality in patients undergoing MHD. Although UA levels had no significant effect on cardiac death, they had a good predictive value for long-term prognosis in patients on MHD.
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Nagaoka Y, Tanaka Y, Yoshimoto H, Suzuki R, Ryu K, Ueda M, Akiyama M, Nagai M, Miyaoka Y, Kanda E, Iwai S, Nagaoka M, Kanno Y. The effect of small dose of topiroxostat on serum uric acid in patients receiving hemodialysis. Hemodial Int 2017; 22:388-393. [DOI: 10.1111/hdi.12620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Yume Nagaoka
- Department of Nephrology; Tokyo Medical University; Tokyo Japan
- Nagaoka Hospital; Kaminoyama Japan
| | | | | | - Rie Suzuki
- Department of Nephrology; Tokyo Medical University; Tokyo Japan
- Shinjuku Ishikawa Clinic; Tokyo Japan
- Department of Nephrology; Tokyo Yamate Medical Center; Tokyo Japan
| | - Kakei Ryu
- Department of Healthcare and Regulatory Sciences; Showa University School of Pharmacy; Tokyo Japan
| | - Mio Ueda
- Shinjuku Ishikawa Clinic; Tokyo Japan
| | - Minako Akiyama
- Department of Nephrology; Tokyo Yamate Medical Center; Tokyo Japan
| | - Miho Nagai
- Department of Nephrology; Tokyo Medical University; Tokyo Japan
| | | | - Eiichiro Kanda
- Department of Nephrology; Tokyo Kyosai Hospital; Tokyo Japan
| | - Shinnichi Iwai
- Department of Healthcare and Regulatory Sciences; Showa University School of Pharmacy; Tokyo Japan
| | | | - Yoshihiko Kanno
- Department of Nephrology; Tokyo Medical University; Tokyo Japan
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Alshahawey M, Shahin SM, Elsaid TW, Sabri NA. Effect of Febuxostat on the Endothelial Dysfunction in Hemodialysis Patients: A Randomized, Placebo-Controlled, Double-Blinded Study. Am J Nephrol 2017; 45:452-459. [PMID: 28463849 DOI: 10.1159/000471893] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/03/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Endothelial dysfunction is an important risk factor for cardiovascular diseases to occur in end-stage renal disease patients. Febuxostat, being a novel xanthine oxidase inhibitor, is apparently having a beneficial role in improving the endothelial dysfunction; however, data among hemodialysis patients are still limited. METHODS A prospective, placebo-controlled, block-randomized, double-blinded study was carried out to evaluate the effect of oral febuxostat on the endothelial dysfunction in hemodialysis patients. Fifty-seven eligible hemodialysis patients were randomly assigned to either the drug group (40 mg thrice weekly) or the placebo group. Serum Asymmetric dimethylarginine (ADMA), Serum uric acid (UA), and serum high sensitivity C-reactive protein (hsCRP) were measured at baseline and at the end of a 2-month study. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and the occurrence of pancytopenia were tested as safety parameters at baseline and at the end of study. RESULTS Serum UA significantly decreased from 7.5 ± 0.8 to 5.1 ± 1.2 mg/dL in the febuxostat group, while it did not change significantly in the placebo group. Treatment with febuxostat resulted in a significant decrease in the serum ADMA level from 1.027 ± 0.116 to 0.944 ± 0.104 µmol/L and the serum hsCRP level from 12.5 ± 1.65 to 12.1 ± 1.70 mg/L. Testing of serum ALT, serum AST, and pancytopenia revealed no significant difference in both groups. CONCLUSION Febuxostat appears to improve hyperuricemia and endothelial dysfunction and ameliorate inflammation in hemodialysis patients with no safety concerns.
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Vargas-Santos AB, Neogi T. Management of Gout and Hyperuricemia in CKD. Am J Kidney Dis 2017; 70:422-439. [PMID: 28456346 DOI: 10.1053/j.ajkd.2017.01.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/21/2017] [Indexed: 02/07/2023]
Abstract
Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.
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Affiliation(s)
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA.
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Abstract
INTRODUCTION Febuxostat, a nonpurine xanthine oxidase inhibitor, is approved as the first-line urate-lowering therapy in gout patients with normal renal function or mild to moderate renal impairment. The most common adverse effects of febuxostat are liver function test abnormalities, diarrhea, and skin rash. However, there is insufficient data in patients with severe renal impairment and end-stage renal disease (ESRD). We report the first case, to our knowledge, in which agranulocytosis developed after febuxostat treatment in an ESRD patient. CLINICAL PRESENTATION A 67-year-old woman with gout and ESRD received febuxostat 40 mg a day for 2.5 months. She subsequently complicated with febrile neutropenia and the absolute neutrophil count was only 14/μL. After broad-spectrum antibiotics treatment and no more exposure to febuxostat for 17 days, her infection and neutrophil count recovered. Bone marrow study during neutropenic period showed myeloid hypoplasia without evidence of hematologic neoplasms. CONCLUSION As febuxostat use may become more common in the population of advanced renal failure, clinicians should be aware of this rare but potentially life-threatening adverse effect. Based on our experience, close monitoring hemogram and immediate discontinuation of this medication may prevent serious consequences.
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Affiliation(s)
- Xue Er Poh
- Medical Department, Chung Shan Medical University, Taichung
- Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Te Lee
- Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sung-Nan Pei
- Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Febuxostat and Increased Dialysis as a Treatment for Severe Tophaceous Gout in a Hemodialysis Patient. Case Rep Nephrol 2016; 2016:9106935. [PMID: 27200198 PMCID: PMC4856909 DOI: 10.1155/2016/9106935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
Uric acid accumulates in renal failure and is thought to be a uremic toxin—that is, higher levels of uric acid are more damaging to the kidneys. Urate crystals can precipitate in the kidney tubules, cause urate stones, and promote inflammatory changes in the renal interstitium and vascular endothelium. Uric acid is also a small non-protein-bound molecule and therefore easily dialyzable. Here, we present the case of an anuric hemodialysis patient with severe tophaceous gout who regained some renal function and whose gout burden significantly decreased resulting in marked improvement in functional status using a new gout medication, febuxostat, and increased frequency of dialysis.
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Chen Z, Zhang S, Zhang J, Zhang Y, Xue L, Miao L. rs9263726 is a specific genetic marker for allopurinol-induced severe cutaneous adverse reactions in Chinese patients. Per Med 2015; 12:585-592. [PMID: 29750609 DOI: 10.2217/pme.15.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Screening of an easily detectable biomarker to replace the HLA allele B variant (HLA-B*58:01) testing for predicting allopurinol-induced severe cutaneous adverse reactions (SCARs) in eastern Chinese patients. Methods: Six SNPs and the HLA-B*58:01 were analyzed in 17 patients with allopurinol-induced SCARs and in 151 control patients. SNPs were analyzed by pyrosequencing, and HLA-B*58:01 was evaluated by sequencing-based techniques. Consistency between sequencing-based HLA-B*58:01 testing and pyrosequencing-based rs9263726 testing was investigated in 262 individuals. Results: A significant association with allopurinol-induced SCARs was found at rs9263726 (odds ratio: 108.8) and HLA-B*58:01 (odds ratio: 108.8). The kappa values between sequencing-based HLA-B*58:01 testing and pyrosequencing-based rs9263726 testing were 0.96 (>0.75), demonstrating they were well coincident with each other. Conclusion: rs9263726 was a useful surrogate of HLA-B*58:01 testing for prescreening allopurinol-induced SCARs in eastern Chinese patients.
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Affiliation(s)
- Zhiyao Chen
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Shichao Zhang
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
- College of Pharmaceutical Sciences, Soochow University, Suzhou, 215006, China
| | - Jingjing Zhang
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yan Zhang
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Ling Xue
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Liyan Miao
- Department of Clinical Pharmacology Research Lab, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Stamp LK, Chapman PT. Urate-lowering therapy: current options and future prospects for elderly patients with gout. Drugs Aging 2015; 31:777-86. [PMID: 25256017 DOI: 10.1007/s40266-014-0214-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gout is increasingly seen in the elderly population, in large part due to physiological decline in renal function with age, and as a result of therapy for comorbidities, in particular the use of diuretic therapies for hypertension and congestive heart failure. Urate-lowering therapy (ULT) is the cornerstone of successful long-term gout management with the aim of achieving a sustained reduction in urate (<0.36 mmol/L, or lower [<0.30 mmol/L] in those with tophi). After decades during which there has been relatively little interest in developing new agents to treat gout, the last 5-10 years has seen a plethora of new agents with several now used in routine clinical practice. There has also been a renewed focus on the optimal use of established ULT, specifically allopurinol, which remains the first-line therapy for most patients. There is emerging data on its use in patients with renal impairment and better recognition of risk factors of the rare but potentially lethal allopurinol hypersensitivity syndrome (AHS). Febuxostat, a new xanthine oxidase inhibitor, is now established in everyday practice. Uricosuric agents may be indicated in certain patient groups, whilst a new class of recombinant uricases (pegloticase) given by intravenous infusion may achieve dramatic and rapid urate-lowering effects. Cost and other factors have thus far limited its use to the very severe cases. Furthermore, increased understanding of urate metabolism has led to the development of a number of drugs currently under clinical evaluation. Common therapeutic targets are the urate transporters in the kidney and alternative xanthine oxidase inhibition pathways. These advances bode well for the better management of gout and hyperuricaemia in our elderly patients.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, P. O. Box 4345, Christchurch, 8140, New Zealand,
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Abstract
PURPOSE OF REVIEW Recent interest in gout has led to development of new drugs for acute gout and long-term urate-lowering, as well as interest in improving the use of older drugs. The patients' comorbidities and concomitant medications may contribute to the risk of adverse drug reactions with anti-gout therapies. This review will highlight recent data on the safety of drugs used in gout. RECENT FINDINGS Colchicine has a narrow therapeutic index, and low doses are effective with less gastrointestinal toxicity. There are significant interactions between colchicine and CYP3A4 and P-glycoprotein inhibitors, and the colchicine dose must be reduced. Allopurinol and febuxostat have similar adverse effect profiles. Recent data have highlighted the risk association of HLA-B5801 in some ethnic groups and of allopurinol starting dose in allopurinol hypersensitivity syndrome. Further long-term cardiovascular safety data in patients with cardiovascular disease or cardiovascular risk factors receiving febuxostat and allopurinol are pending. Infusion reactions are common in patients receiving pegloticase, particularly in patients with pre-infusion serum urate above 0.36mmol/l (6 mg/dl). SUMMARY In general, treatments for gout are well tolerated, although clinicians must keep in mind the potential for drug interactions and the contribution of comorbidities to the potential for adverse effects with gout therapies.
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Akimoto T, Morishita Y, Ito C, Iimura O, Tsunematsu S, Watanabe Y, Kusano E, Nagata D. Febuxostat for hyperuricemia in patients with advanced chronic kidney disease. Drug Target Insights 2014; 8:39-43. [PMID: 25210423 PMCID: PMC4134003 DOI: 10.4137/dti.s16524] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 02/07/2023] Open
Abstract
Febuxostat is a nonpurine xanthine oxidase (XO) inhibitor, which recently received marketing approval. However, information regarding the experience with this agent among advanced chronic kidney disease (CKD) patients is limited. In the current study, we investigated the effects of oral febuxostat in patients with advanced CKD with asymptomatic hyperuricemia. We demonstrated, for the first time, that not only the serum levels of uric acid (UA) but also those of 8-hydroxydeoxyguanosine, an oxidative stress marker, were significantly reduced after six months of febuxostat treatment, with no adverse events. These results encouraged us to pursue further investigations regarding the clinical impact of lowering the serum UA levels with febuxostat in advanced CKD patients in terms of concomitantly reducing oxidative stress via the blockade of XO. More detailed studies with a larger number of subjects and assessments of the effects of multiple factors affecting hyperuricemia, such as age, sex, and dietary habits, would shed light on the therapeutic challenges of treating asymptomatic hyperuricemia in patients with various stages of CKD.
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Affiliation(s)
- Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan. ; Green Town Clinic, Tochigi, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan. ; Kumakura Clinic, Tochigi, Japan. ; Yuki Clinic, Ibaraki, Japan
| | - Chiharu Ito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan. ; Kumakura Clinic, Tochigi, Japan. ; Yuki Clinic, Ibaraki, Japan
| | | | | | - Yuko Watanabe
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Eiji Kusano
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
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Ito K, Ueda Y, Miyazawa H, Kaku Y, Hirai K, Hoshino T, Nabata A, Mori H, Yoshida I, Ookawara S, Tabei K. Acute severe liver dysfunction induced by febuxostat in a patient undergoing hemodialysis. CEN Case Rep 2014; 3:158-161. [PMID: 28509193 DOI: 10.1007/s13730-014-0109-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022] Open
Abstract
A 58-year-old man with chronic kidney disease (CKD) was admitted to our hospital for hemodialysis (HD) therapy. He had been administered allopurinol (100 mg/day) before hospitalization, and we replaced it with febuxostat (10 mg/day), a new xanthine oxidase inhibitor. Levels of aspartate aminotransferase, alanine transaminase (ALT), and lactate dehydrogenase were within the normal ranges in the morning before febuxostat administration, but 6 h after administration, these parameters increased markedly to approximately 10 times the levels before administration. Although we stopped administering febuxostat, his serum potassium levels increased at a rate of 1 mmol/L every 12 h, and he had to undergo HD daily to lower the serum potassium levels. The levels of liver function test parameters peaked on the fourth hospital day (ALT, 1134 IU/L; AST, 1485 IU/L; and LDH, 1869 IU/L) and recovered to normal ranges on the 13th hospital day. In this case, febuxostat appeared to have a relationship with acute liver dysfunction in the clinical course. Therefore, it would be important to check liver function test parameters frequently after febuxostat initiation and also to initiate a lower than usual dose of febuxostat, especially in patients with CKD and those who are undergoing HD.
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Affiliation(s)
- Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Kaku
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Hoshino
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Aoi Nabata
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Honami Mori
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Izumi Yoshida
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kaoru Tabei
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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