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Guaricci AI, Sturdà F, Russo R, Basile P, Baggiano A, Mushtaq S, Fusini L, Fazzari F, Bertandino F, Monitillo F, Carella MC, Simonini M, Pontone G, Ciccone MM, Grandaliano G, Vezzoli G, Pesce F. Assessment and management of heart failure in patients with chronic kidney disease. Heart Fail Rev 2024; 29:379-394. [PMID: 37728751 PMCID: PMC10942934 DOI: 10.1007/s10741-023-10346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Heart failure (HF) and chronic kidney disease (CKD) are two pathological conditions with a high prevalence in the general population. When they coexist in the same patient, a strict interplay between them is observed, such that patients affected require a clinical multidisciplinary and personalized management. The diagnosis of HF and CKD relies on signs and symptoms of the patient but several additional tools, such as blood-based biomarkers and imaging techniques, are needed to clarify and discriminate the main characteristics of these diseases. Improved survival due to new recommended drugs in HF has increasingly challenged physicians to manage patients with multiple diseases, especially in case of CKD. However, the safe administration of these drugs in patients with HF and CKD is often challenging. Knowing up to which values of creatinine or renal clearance each drug can be administered is fundamental. With this review we sought to give an insight on this sizable and complex topic, in order to get clearer ideas and a more precise reference about the diagnostic assessment and therapeutic management of HF and CKD.
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Affiliation(s)
- Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy.
| | - Francesca Sturdà
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Roberto Russo
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Fulvio Bertandino
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Francesco Monitillo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Giuseppe Grandaliano
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vezzoli
- Department of Nephrology and Dialysis, Vita Salute San Raffaele University, 20132, Milan, Italy
| | - Francesco Pesce
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124, Bari, Italy
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Timóteo AT, Mano TB. Efficacy of peritoneal dialysis in patients with refractory congestive heart failure: a systematic review and meta-analysis. Heart Fail Rev 2023; 28:1053-1063. [PMID: 36738391 PMCID: PMC10403434 DOI: 10.1007/s10741-023-10297-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Refractory congestive heart failure (RCHF) is a common complication in the natural history of advanced heart failure. Peritoneal dialysis (PD) is a possible alternative in those patients, but studies are scarce, and mostly with small samples. We conducted this meta-analysis to evaluate the effects of PD in patients with RCHF. Articles published before July 2020 in the following databases: PubMed, Web of Science, and CENTRAL. Mean differences (MD) and 95% confidence intervals (CIs) were computed to generate a pooled effect size with a random effects model. We also assessed heterogeneity, risk of bias, publication bias, and quality of evidence. Twenty observational studies (n = 769) were included, with a "before and after intervention" design. PD was associated with a significant reduction in NYHA functional class (MD -1.37, 95% CI -0.78 to -1.96) and length of hospitalisation (MD -34.8, 95% CI -20.6 to -48.9 days/patient/year), a small but significant increase in left ventricular ejection fraction (MD 4.3, 95%CI 1.9 to 6.8%) and a non-significant change in glomerular filtration rate (MD -3.0, 95% CI -6.0 to 0 mL/min/1.73m2). Heterogeneity among studies was significant and overall risk of bias was rated from moderate to critical. No significant publication bias was found, and the overall quality of evidence was very low for all outcomes. PD in patients with RCHF improved functional class, length of hospitalisation, and ventricular functional, and had no impact in renal function. Further randomised clinical trials are warranted to confirm our results that showed some limitations.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Rua Santa Marta, 1169-025, Lisbon, Portugal.
- NOVA Medical School, Lisbon, Portugal.
| | - Tânia Branco Mano
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Rua Santa Marta, 1169-025, Lisbon, Portugal
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Tong Y, Wang H, Cao X, Cai G, Chen X, Zhou J. Research hotspots and emerging trends of automated peritoneal dialysis: A bibliometric analysis from 2000 to 2020. Semin Dial 2023; 36:117-130. [PMID: 35352408 DOI: 10.1111/sdi.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implementation of automated peritoneal dialysis (APD) has considerably increased in many countries. We conducted a bibliometric analysis to evaluate the accumulating studies on APD in the last two decades quantitatively and qualitatively. METHODS Publications regarding APD research between 2000 and 2020 were retrieved from the Web of Science Core Collection database by using the index term "automated peritoneal dialysis." CiteSpace, VOSviewer, and an online platform were employed to analyze the number of publications and the collaboration relationships between countries, institutions, authors, and co-cited journals. Cluster analysis and burst keywords detection were performed on co-cited references and keywords, respectively. RESULTS We obtained a record of 545 publications related to APD in total. The United States was the country that contributes most, and Baxter Healthcare Corporation was the leading institution. Peritoneal Dialysis International was the most active journals in this field. Claudio Ranco was the most productive author, and Simon J Davies ranked the first in the cited authors. Co-cited reference cluster analysis and high frequency keywords showed that survival, ultrafiltration and peritonitis are continuous hot topics. While remote monitoring (RM) and telemedicine may be APD research frontiers according to burst keywords detection. CONCLUSION This bibliometric study provides comprehensive overview on the publications of APD over the past two decades. These findings help to identify the hotspots and explore new directions for future research. RM has become an emerging trend in APD field.
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Affiliation(s)
- Yan Tong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Hong Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Jianhui Zhou
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Luo PT, Li W, Li XY, Zhang Y, Du B, Cui WP. Impact of peritoneal dialysis modality on patient and PD survival: A systematic review. ARCH ESP UROL 2022; 43:128-138. [PMID: 36476184 DOI: 10.1177/08968608221140788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77–0.99], p = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63–0.90], p = 0.00), published in Asia (HR 0.76 [95% CI, 0.67–0.86], p < 0.001) or Europe (HR 0.81 [95% CI, 0.74–0.89], p < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68–0.99], p = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], p = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], p = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
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Affiliation(s)
- Pei-Ting Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xin-Yang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yu Zhang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bing Du
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wen-Peng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
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Shi X, Du H, Zhang Z, Zhou Y. Clinical outcomes of automated versus continuous ambulatory peritoneal dialysis for end-stage kidney disease: protocol of a systematic review and meta-analysis. BMJ Open 2022; 12:e065795. [PMID: 36323481 PMCID: PMC9639101 DOI: 10.1136/bmjopen-2022-065795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION An increasing number of studies comparing automated peritoneal dialysis (APD) with continuous ambulatory peritoneal dialysis (CAPD) in clinical outcomes have been published since the publication of a systematic review and meta-analysis including three randomised controlled trials in 2007. We will conduct a systematic review and meta-analysis to explore more clinical outcomes of APD versus CAPD for end-stage kidney disease. METHODS AND ANALYSIS The protocol is conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Three databases-PubMed, EMBASE and the Cochrane Library-will be searched comprehensively from inception to 16 June 2022, without language restriction. Studies reporting clinical outcomes comparing APD with CAPD will be included. Two independent reviewers will screen the titles and abstracts and then obtain and assess full texts of potential relevant articles for eligibility following the inclusion and exclusion criteria. The methodological quality of included observational studies will be assessed by using the Newcastle-Ottawa Scale. The risk of bias of included randomised controlled studies will be assessed by using the Cochrane Risk of Bias tool. Relative risk for dichotomous outcomes and standard mean difference for continuous outcomes with corresponding 95% CIs will be pooled for summary effects. Cochrane Q test and I 2 values will be used to assess heterogeneity between studies. To assess and explore the source of heterogeneity, subgroup analyses and sensitivity analyses will be conducted, and meta-regression, funnel plot and Egger's test will be performed if there are no less than 10 studies. Analyses will be performed using STATA software, V.13.0 (STATA Corporation, College Station, Texas, USA). ETHICS AND DISSEMINATION Ethics approval is not applicable as no personal information is collected from patients. The results will be published in a peer-reviewed journal or disseminated in relevant academic conferences. PROSPERO REGISTRATION NUMBER CRD42022311401.
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Affiliation(s)
- Xinmiao Shi
- Department of Clinical Affairs, Fresenius Medical Care Shanghai Co, Beijing Branch, Beijing, China
| | - Hui Du
- Department of Clinical Affairs, Fresenius Medical Care Shanghai Co, Beijing Branch, Beijing, China
| | - Zhouhang Zhang
- Department of Clinical Affairs, Fresenius Medical Care Shanghai Co, Beijing Branch, Beijing, China
| | - Yun Zhou
- Department of Clinical Affairs, Fresenius Medical Care Shanghai Co, Shanghai, China
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Yip JYC. Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report. SAGE Open Nurs 2021; 7:23779608211037496. [PMID: 34869856 PMCID: PMC8642045 DOI: 10.1177/23779608211037496] [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: 11/21/2020] [Revised: 06/03/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Peritonitis remains the primary cause of treatment failure among patients with
end-stage kidney disease on continuous ambulatory peritoneal dialysis. However, detailed
case analyses illustrating the application of current research in clinical practice
remain scant. This case report aimed to elucidate the roles of dialysis nurses in a
hospital setting in the management of a 62-year-old male patient with a history of
kidney failure secondary to amyloidosis. Case Presentation The patient was diagnosed with continuous ambulatory peritoneal dialysis-associated
peritonitis. Management and Outcomes Dialysis nurses applied evidence-based practices in the management of the patient’s
exit-site infection, imbalanced nutrition, and psychosocial concerns. The patient was
discharged after 7 days, with a comprehensive treatment regimen, including an
individualized peritoneal dialysis protocol adjusted to his daily schedules, education
on self-care techniques, and continual nutritional management to prevent recurrence and
improve his overall health. This case report shows that admissions for continuous
ambulatory peritoneal dialysis-associated peritonitis require evidence-based nursing
interventions specific to, and geared toward, each patient’s prioritized health
problems. Discussion Peritonitis cases are preventable with appropriate nursing interventions that can lower
the chance of treatment failure and long-term impact caused by an abrupt switch to
hemodialysis. To successfully manage patients with continuous ambulatory peritoneal
dialysis-associated peritonitis, dialysis nurses should appreciate the intricacies of
the analyses underpinning their professional practices in promoting the patient’s
self-care techniques.
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Affiliation(s)
- Jeffrey Yuk Chiu Yip
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
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Roumeliotis A, Roumeliotis S, Leivaditis K, Salmas M, Eleftheriadis T, Liakopoulos V. APD or CAPD: one glove does not fit all. Int Urol Nephrol 2020; 53:1149-1160. [PMID: 33051854 PMCID: PMC7553382 DOI: 10.1007/s11255-020-02678-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022]
Abstract
The use of Automated Peritoneal Dialysis (APD) in its various forms has increased over the past few years mainly in developed countries. This could be attributed to improved cycler design, apparent lifestyle benefits and the ability to achieve adequacy and ultrafiltration targets. However, the dilemma of choosing the superior modality between APD and Continuous Ambulatory Peritoneal Dialysis (CAPD) has not yet been resolved. When it comes to fast transporters and assisted PD, APD is certainly considered the most suitable Peritoneal Dialysis (PD) modality. Improved patients’ compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis have been also associated with APD. However, concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep are APD’s setbacks. Besides APD superiority over CAPD in fast transporters, the other medical advantages of APD still remain controversial. In any case, APD should be readily available for all patients starting PD and the most important indication for its implementation remains patient’s choice.
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Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 1, St. Kyriakidi Street, 54636, Thessaloníki, Greece.
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Thaweethamcharoen T, Sritippayawan S, Noparatayaporn P, Aiyasanon N. Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai Patients With End-Stage Renal Disease. Value Health Reg Issues 2020; 21:181-187. [PMID: 32044691 DOI: 10.1016/j.vhri.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/18/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous ambulatory peritoneal dialysis (CAPD) is the first option for patients with end-stage renal disease under the benefit package of Thailand. Nevertheless, automated peritoneal dialysis (APD) may benefit these patients in terms of both medical and quality-of-life aspects, but it is more expensive. The economic evidence for the comparison between CAPD and APD is not inconclusive. Thus, this study aims to evaluate the cost-effectiveness of CAPD compared with APD in PD patients. OBJECTIVES To assess the health-related quality of life and costs between patients treated with CAPD and APD. METHODS A Markov model was developed to evaluate the cost-effectiveness of CAPD and APD from the societal perspective. Costs and outcomes were calculated over a lifetime horizon and discounted at an annual rate of 3%. The outcomes were presented as quality-adjusted life-years (QALYs) of CAPD and APD. Utility scores were calculated from the utility values of the 5-level EuroQol questionnaire. A probabilistic sensitivity analysis using 5000 Monte Carlo simulations was performed to evaluate the stability of the results. RESULTS The costs of APD and CAPD were 12 868 080 and 11 144 786 Thai baht, respectively, whereas the QALYs were 24.28 and 24.72 QALYs, respectively. APD was more costly but less effective than CAPD. The most sensitive parameter was direct medical cost of outpatient visits. When the willingness-to-pay threshold was 160 000 Thai baht per QALY, the probability of APD providing a cost-effective alternative to CAPD was 19%. CONCLUSION APD was not a cost-effective strategy as compared with CAPD at the current Thai threshold. These findings should encourage clinicians and policy makers to encompass the use of CAPD as a good value for money for PD treatment.
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Affiliation(s)
- Tanita Thaweethamcharoen
- Siriraj Health Technology Assessment Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchai Sritippayawan
- Renal Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaporn Noparatayaporn
- Siriraj Health Technology Assessment Unit, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Pharmacy Department, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Nipa Aiyasanon
- Renal Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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