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Afsar B, Afsar RE, Caliskan Y, Lentine KL. A holistic review of sodium intake in kidney transplant patients: More questions than answers. Transplant Rev (Orlando) 2024; 38:100859. [PMID: 38749098 DOI: 10.1016/j.trre.2024.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024]
Abstract
Kidney transplantation (KT) is the best treatment option for end-stage kidney disease (ESKD). Acute rejection rates have decreased drastically in recent years but chronic kidney allograft disease (CKAD) is still an important cause of allograft failure and return to dialysis. Thus, there is unmet need to identify and reverse the cause of CKAD. Additionally, cardiovascular events after KT are still leading causes of morbidity and mortality. One overlooked potential contributor to CKAD and adverse cardiovascular events is increased sodium/salt intake in kidney transplant recipients (KTRs). In general population, the adverse effects of high sodium intake are well known but in KTRs, there is a paucity of evidence despite decades of experience with KT. Limited research showed that sodium intake is high in most KTRs. Moreover, excess sodium intake is associated with elevated blood pressure and albuminuria in some studies involving KTRs. There is also experimental evidence suggesting that increased sodium intake is associated with histologic graft damage. Critical knowledge gaps still remain, including the exact amount of sodium restriction needed in KTRs to optimize outcomes and allograft survival. Additionally, best methods to measure sodium intake and practices to follow-up are not clarified in KTRs. To meet these deficits, prospective long term studies are warranted in KTRs. Moreover, preventive measures must be determined and implemented both at individual and societal levels to achieve sodium restriction in KTRs.
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Affiliation(s)
- Baris Afsar
- Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
| | - Rengin Elsurer Afsar
- Suleyman Demirel University, School of Medicine, Department of Nephrology, 32260, Cunur, Isparta, Türkiye; Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
| | - Yasar Caliskan
- Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
| | - Krista L Lentine
- Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA
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Prognostic and Diagnostic Value of Endocan in Kidney Diseases. Int J Nephrol 2022; 2022:3861092. [PMID: 35321346 PMCID: PMC8938144 DOI: 10.1155/2022/3861092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022] Open
Abstract
Endocan, previously called endothelial cell-specific molecule-1, is a soluble proteoglycan that is predominantly expressed in vascular endothelial cells of the lungs and kidneys. It is upregulated by proinflammatory cytokines and plays a critical role in inflammatory, proliferative, and neovascularization processes. The utility of endocan as a biomarker in a wide spectrum of diseases is being increasingly acknowledged. In this review, we summarize the current evidence concerning the role of endocan in kidney diseases, with emphasis on its prognostic and diagnostic value. It seems that the determination of plasma endocan levels may provide useful prognostic information in many types of renal failure such as chronic kidney disease, IgA nephropathy, and diabetic nephropathy. Endocan could additionally improve the early diagnostic evaluation of acute kidney disease, chronic renal allograft injury, and acute rejection after kidney transplantation, thus contributing to endothelial cell injury monitoring in a timely manner.
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3
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Endothelial Dysfunction and 6-Year Risk of Mortality in Kidney Transplant Recipients. Transplant Direct 2021; 8:e1262. [PMID: 34912949 PMCID: PMC8670577 DOI: 10.1097/txd.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Endothelial dysfunction is an early and potentially reversible stage in the atherosclerotic process. We assessed endothelial dysfunction noninvasively in kidney transplant recipients (KTRs) and evaluated the association with mortality and graft outcomes. Methods Flow-mediated dilation (FMD) was measured in arteria brachialis by ultrasound, with baseline diameters obtained at rest and maximal diameters obtained during reactive hyperemia occurring after 5 min of forearm occlusion. FMD% is the percentage difference of flow-mediated dilation relative to baseline. Endpoints on mortality and graft outcomes were collected from The Norwegian Renal Registry. The distribution of risk according to FMD levels was assessed in Cox regression using a restricted cubic spline function. FMD was dichotomized using receiver operating characteristic analysis to identify optimal cut points at maximal sensitivity and specificity. Results From a total of 269 KTRs in 2012, 152 (56.5%) were eligible and examined 10 wk after transplantation, and 145 had successful FMD measurements. During a mean follow-up of 6.5 y, 26 patients died, 11 lost their graft, and 34 experienced either graft loss or death. Mortality increased with lower FMD levels until about 5% dilation and did not change with further reduction in FMD% (P for nonlinearity <0.01). An optimal cut point of FMD ≤5.36% defined impaired endothelial function and FMD% below this level, was associated with fatal outcome, hazard ratio (HR), 9.80 (1.29-74.62), P = 0.03, uncensored graft loss, HR, 7.80 (1.83-33.30), P = 0.01, but an association with death-censored graft loss was lost after adjusting for pulse pressure, HR, 4.58 (0.55-37.92), P = 0.16. Conclusions We found that impaired FMD is strongly associated with mortality in KTRs.
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Bohling R, Grafals M, Moreau K, You Z, Tommerdahl KL, Bjornstad P, Stenson EK, Andrews E, Ramirez-Renteria L, Kendrick J. A Pilot Study of the Safety and Efficacy of Alkali Therapy on Vascular Function in Kidney Transplant Recipients. Kidney Int Rep 2021; 6:2323-2330. [PMID: 34514193 PMCID: PMC8419116 DOI: 10.1016/j.ekir.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Metabolic acidosis is associated with cardiovascular events, graft function, and mortality in kidney transplant recipients (KTRs). We examined the effect of alkali therapy on vascular endothelial function in KTRs. Methods We performed an 18-week, randomized, double-blind, placebo-controlled crossover pilot study examining the effect of sodium bicarbonate therapy versus placebo on vascular function in 20 adult KTRs at least 1 year from transplant with an estimated glomerular filtration rate (eGFR) ≥45 ml/min per 1.73 m2 and a serum bicarbonate level of 20 to 26 mEq/L. Each treatment period was 8 weeks in duration with a 2-week washout period between treatments. The primary outcome was change in brachial artery flow-mediated dilation (FMD) between sodium bicarbonate treatment and placebo. Results Twenty patients completed the study and were included in the primary analysis. The mean (SD) baseline eGFR of participants was 75 (22) ml/min per 1.73 m2, respectively. Serum bicarbonate levels did not increase significantly with treatment (0.3 [1.5] mEq/L, P = 0.37). Sodium bicarbonate therapy was not associated with worsening blood pressure, weight gain, or hypokalemia. There was no significant increase in FMD after 8 weeks of sodium bicarbonate therapy compared to placebo (mean change in FMD 2.2%, 95% CI -0.1 to 4.6, P = 0.06). There were no significant changes in high-sensitivity C-reactive protein, interleukin-6, eGFR, or urinary albumin-to-creatinine ratio during treatment. Urinary ammonium excretion decreased by 9 mmol/d (P=0.003), with sodium bicarbonate. Conclusions Sodium bicarbonate therapy is safe and feasible in KTRs, and our results strengthen the need for a larger randomized controlled trial.
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Affiliation(s)
- Rachel Bohling
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Monica Grafals
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kerrie Moreau
- Division of Geriatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Eastern Colorado VA Geriatric Research, Education and Clinical Center, Aurora, Colorado, USA
| | - Zhiying You
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kalie L Tommerdahl
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Petter Bjornstad
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Pediatrics, Section of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Erin K Stenson
- Department of Pediatrics, Section of Critical Care Medicine, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Emily Andrews
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lorena Ramirez-Renteria
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Kendrick
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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The Causes of Kidney Allograft Failure: More Than Alloimmunity. A Viewpoint Article. Transplantation 2020; 104:e46-e56. [DOI: 10.1097/tp.0000000000003012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Eide IA, Reinholt FP, Jenssen T, Hartmann A, Schmidt EB, Åsberg A, Bergan S, Brabrand K, Svensson M. Effects of marine n-3 fatty acid supplementation in renal transplantation: A randomized controlled trial. Am J Transplant 2019; 19:790-800. [PMID: 30125457 DOI: 10.1111/ajt.15080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 01/25/2023]
Abstract
Marine n-3 fatty acids (FAs) may exert beneficial effects on inflammation, fibrosis, and endothelial function, which could preserve renal graft function. In this randomized controlled trial, 132 Norwegian renal transplant recipients received either 2.6 g of marine n-3 FAs or olive oil (control) daily for 44 weeks, in addition to standard care. Thirty patients did not complete the trial. The primary endpoint was change (Δ) in measured glomerular filtration rate (mGFR) during follow-up. We found no significant difference in Δ mGFR between the marine n-3 FA group and controls (6.7 vs 3.8 mL/min per 1.73 m2 , P = .15). Significant beneficial effects from marine n-3 FA supplementation were, however, seen in secondary endpoints plasma triglycerides, plasma high-sensitivity C-reactive protein, and brachial artery flow-mediated dilation. In the per-protocol population, the renal graft indices percent interstitial fibrosis and Chronic Allograft Damage Index also were significantly lower in the marine n-3 FA group. The cumulative incidence of adverse events did not differ between the marine n-3 FA group (n = 218) and controls (n = 240). In conclusion, marine FA supplementation did not improve renal function compared with controls, but was safe, lowered plasma triglyceride and high-sensitivity C-reactive protein levels, and improved endothelial function (Clinical.Trials.gov identifier NCT01744067).
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Affiliation(s)
- Ivar A Eide
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Renal Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Finn P Reinholt
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Trond Jenssen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anders Hartmann
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anders Åsberg
- Department of Renal Medicine, Akershus University Hospital, Lørenskog, Norway.,Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Knut Brabrand
- Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - My Svensson
- Department of Renal Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, The University of Oslo, Oslo, Norway
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Kahn J, Ram LM, Eberhard K, Groselj-Strele A, Obermayer-Pietsch B, Müller H. Calcification score evaluation in patients listed for renal transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Judith Kahn
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Leona Marleen Ram
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics; Center for Medical Research; Medical University of Graz; Graz Austria
| | - Andrea Groselj-Strele
- Core Facility Computational Bioanalytics; Center for Medical Research; Medical University of Graz; Graz Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Helmut Müller
- Division of Transplantation Surgery; Department of Surgery; Medical University of Graz; Graz Austria
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Seliger SL, Salimi S, Pierre V, Giffuni J, Katzel L, Parsa A. Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults. BMC Nephrol 2016; 17:82. [PMID: 27412615 PMCID: PMC4944235 DOI: 10.1186/s12882-016-0303-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/07/2016] [Indexed: 02/07/2023] Open
Abstract
Background Impairment in glomerular endothelial function likely plays a major role in the development of albuminuria and CKD progression. Glomerular endothelial dysfunction may reflect systemic microvascular dysfunction, accounting in part for the greater cardiovascular risk in patients with albuminuria. Prior studies of vascular function in CKD have focused on conduit artery function or those with ESRD, and have not examined microvascular endothelial function with albuminuria. Methods We conducted a cross-sectional study among older hypertensive male veterans with stage 1–4 CKD, and hypertensive controls without CKD. Microvascular function was quantified by two distinct Laser-Doppler flowmetry (LDF) measures: peak responses to 1) post-occlusive reactive hyperemia (PORH) and 2) thermal hyperemia (TH), measured on forearm skin. Associations of each LDF measure with albuminuria, eGFR, and CKD status were estimated using correlation coefficients and multiple linear regression, accounting for potential confounders. Results Among 66 participants (mean age 69.2 years), 36 had CKD (mean eGFR 46.1 cc/min/1.73 m2; 30.6 % with overt albuminuria). LDF responses to PORH and TH were 43 and 39 % significantly lower in multivariate analyses among those with macroalbuminuria compared to normoalbuminuria, (β= − 0.42, p = 0.009 and β= −0.37, p = 0.01, respectively). Those with CKD had a 23.9 % lower response to PORH compared to controls (p = 0.02 after adjustment). In contrast, TH responses did not differ between those with and without CKD. Conclusions Microvascular endothelial function was strongly associated with greater albuminuria and CKD, independent of diabetes and blood pressure. These findings may explain in part the excess systemic cardiovascular risk associated with albuminuria and CKD.
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Affiliation(s)
- Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA. .,Medicine, VA Maryland Healthcare System, Baltimore, USA.
| | - Shabnam Salimi
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | | | - Jamie Giffuni
- GRECC, VA Maryland Healthcare System, Baltimore, USA
| | - Leslie Katzel
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA.,GRECC, VA Maryland Healthcare System, Baltimore, USA
| | - Afshin Parsa
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Room N3W143, Baltimore, MD, 21201, USA.,Medicine, VA Maryland Healthcare System, Baltimore, USA
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Khan A, Nasr P, El-Charabaty E, El-Sayegh S. An Insight Into the Immunologic Events and Risk Assessment in Renal Transplantation. J Clin Med Res 2016; 8:367-72. [PMID: 27081421 PMCID: PMC4817575 DOI: 10.14740/jocmr2411w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2015] [Indexed: 12/30/2022] Open
Abstract
Organ transplantation has always been considered to be the optimal therapeutic intervention in patients with end-stage organ failure. In the US, approximately 615,000 patients are diagnosed with end-stage renal disease and less than 30% have received a kidney transplant. One of the crucial drawbacks in successful renal transplantation is allograft rejection. Survival rates among transplant recipients have greatly improved due to better understanding of transplant biology and more effective immunosuppressive agents. Post-transplant immune monitoring and optimization of the immunosuppressive therapy using non-invasive biomarkers can effectively predict impending graft rejection and may spare the need for renal biopsy. This article provides an insight into the immunomodulations of renal transplant recipients. It depicts the immune system including several types of kidney rejection and reviews the biomarkers that may serve in near future, as surveillance tools for graft monitoring. Finally, a summary on the main immunosuppressive drugs used in kidney transplant both in the induction and maintenance phases is also covered.
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Affiliation(s)
- Asif Khan
- Department of Medicine, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Patricia Nasr
- Department of Medicine, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Elie El-Charabaty
- Department of Nephrology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA
| | - Suzanne El-Sayegh
- Department of Nephrology, Staten Island University Hospital, 475 Seaview Ave., Staten Island, NY 10305, USA
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Clinical Significance of Preexisting Microcalcification in the Iliac Artery in Renal Transplant Recipients. Transplantation 2015; 99:811-7. [DOI: 10.1097/tp.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dahle DO, Jenssen T, Holdaas H, Åsberg A, Soveri I, Holme I, Mjøen G, Eide IA, Pihlstrøm H, Dörje C, Halden TAS, Hartmann A. Uric acid and clinical correlates of endothelial function in kidney transplant recipients. Clin Transplant 2014; 28:1167-76. [DOI: 10.1111/ctr.12435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Dag Olav Dahle
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Trond Jenssen
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
- Metabolic and Renal Research Group; UiT The Arctic University of Norway; Tromsø Norway
| | - Hallvard Holdaas
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Anders Åsberg
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
- Department of Phamaceutical Biosciences; School of Pharmacy; University of Oslo; Oslo Norway
| | - Inga Soveri
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - Ingar Holme
- Department of Biostatistics; Epidemiology and Health Economics; Oslo University Hospital Ullevål; Oslo Norway
| | - Geir Mjøen
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Ivar A. Eide
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Hege Pihlstrøm
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Christina Dörje
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Thea A. S. Halden
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
| | - Anders Hartmann
- Department of Transplant Medicine; Oslo University Hospital Rikshospitalet; Oslo Norway
- Insitiute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
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Su YH, Shu KH, Hu CP, Cheng CH, Wu MJ, Yu TM, Chuang YW, Huang ST, Chen CH. Serum Endocan Correlated With Stage of Chronic Kidney Disease and Deterioration in Renal Transplant Recipients. Transplant Proc 2014; 46:323-7. [DOI: 10.1016/j.transproceed.2013.10.057] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/02/2013] [Indexed: 10/25/2022]
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