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González-Parra E, Moreno-Gómez-Toledano R, Mas-Fontao S, Bosch RJ. Bisphenol A in renal insufficiency: how long will it be used? Is it time to avoid it? Nefrologia 2024; 44:313-316. [PMID: 38876887 DOI: 10.1016/j.nefroe.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 06/16/2024] Open
Affiliation(s)
- Emilio González-Parra
- Servicio de Nefrología, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid, Madrid, Spain.
| | - Rafael Moreno-Gómez-Toledano
- Universidad de Alcalá, Unidad de Fisiología, Departamento de Biología de Sistemas, Alcalá de Henares, Madrid, Spain; Unidad Mixta de Investigación, Universidad Francisco de Vitoria, Madrid, Spain; Servicio de Cardiología, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Sebastián Mas-Fontao
- Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Ricardo J Bosch
- Universidad de Alcalá, Unidad de Fisiología, Departamento de Biología de Sistemas, Alcalá de Henares, Madrid, Spain
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Sieck NE, Bruening M, van Woerden I, Whisner C, Payne-Sturges DC. Effects of Behavioral, Clinical, and Policy Interventions in Reducing Human Exposure to Bisphenols and Phthalates: A Scoping Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:36001. [PMID: 38477609 PMCID: PMC10936218 DOI: 10.1289/ehp11760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/09/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is growing interest in evidence-based interventions, programs, and policies to mitigate exposures to bisphenols and phthalates and in using implementation science frameworks to evaluate hypotheses regarding the importance of specific approaches to individual or household behavior change or institutions adopting interventions. OBJECTIVES This scoping review aimed to identify, categorize, and summarize the effects of behavioral, clinical, and policy interventions focused on exposure to the most widely used and studied bisphenols [bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF)] and phthalates with an implementation science lens. METHODS A comprehensive search of all individual behavior, clinical, and policy interventions to reduce exposure to bisphenols and phthalates was conducted using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. We included studies published between January 2000 and November 2022. Two reviewers screened references in CADIMA, then extracted data (population characteristics, intervention design, chemicals assessed, and outcomes) for studies meeting inclusion criteria for the present review. RESULTS A total of 58 interventions met the inclusion criteria. We classified interventions as dietary (n = 27 ), clinical (n = 13 ), policy (n = 14 ), and those falling outside of these three categories as "other" (n = 4 ). Most interventions (81%, 47/58) demonstrated a decrease in exposure to bisphenols and/or phthalates, with policy level interventions having the largest magnitude of effect. DISCUSSION Studies evaluating policy interventions that targeted the reduction of phthalates and BPA in goods and packaging showed widespread, long-term impact on decreasing exposure to bisphenols and phthalates. Clinical interventions removing bisphenol and phthalate materials from medical devices and equipment showed overall reductions in exposure biomarkers. Dietary interventions tended to lower exposure with the greatest magnitude of effect in trials where fresh foods were provided to participants. The lower exposure reductions observed in pragmatic nutrition education trials and the lack of diversity (sociodemographic backgrounds) present limitations for generalizability to all populations. https://doi.org/10.1289/EHP11760.
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Affiliation(s)
- Nicole E. Sieck
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Meg Bruening
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Irene van Woerden
- Department of Community and Public Health, Idaho State University, Pocatello, Idaho, USA
| | - Corrie Whisner
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland, USA
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Cambien G, Dupuis A, Guihenneuc J, Bauwens M, Belmouaz M, Ayraud-Thevenot S. Endocrine disruptors in dialysis therapies: A literature review. ENVIRONMENT INTERNATIONAL 2023; 178:108100. [PMID: 37481953 DOI: 10.1016/j.envint.2023.108100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
Endocrine disrupting chemicals (EDCs) were defined as "an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects". These compounds are mainly eliminated by the renal route. However, patients with end-stage kidney disease treated by dialysis (ESKDD) can no longer eliminate these EDCs efficiently. Furthermore, EDCs exposure could occur via leaching from medical devices used in dialysis therapy. As a result, ESKDD patients are overexposed to EDCs. The aims of this study were to summarize EDCs exposure of ESKDD patients and to evaluate the factors at the origin of this exposure. To handle these objectives, we performed a literature review. An electronic search on PubMed, Embase and Web of science databases was performed. Twenty-six studies were finally included. The EDCs reported in these studies were Bisphenol A (BPA), Bisphenol S (BPS), Bisphenol B (BPB), Nonylphenol, Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), and Butylbenzyl phthalate (BBP). Regarding the environment of dialysis patients, BPA, BPB, BPS, DEHP, DBP and nonylphenol have been found. Environmental exposure affects EDCs blood levels in ESKDD patients who are overexposed to BPA, BPS, BPB and DEHP. For ESKDD patients, dialyzers with housing in polycarbonate and fibers in polysulfone seem to overexpose them to BPA. Regarding dialysis therapy, peritoneal dialysis seems to decrease patient exposure vs hemodialysis therapy, and hemodiafiltration therapy seems to reduce this exposure vs hemodialysis therapy. Regarding DEHP, levels tend to increase during dialysis and when DEHP plasticizer is used in PVC devices. Finally, in the European Union a regulation on medical devices was adopted on 5 April 2017 and has been applied recently. This regulation will regulate EDCs in medical devices and thereby contribute to reconsideration of their conceptions and, finally, to reduction of ESKDD patients' exposure.
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Affiliation(s)
- Guillaume Cambien
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Antoine Dupuis
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Jérémy Guihenneuc
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
| | - Marc Bauwens
- Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France.
| | - Mohamed Belmouaz
- Digestiv, Urology, Nephrology, Endocrinology Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France.
| | - Sarah Ayraud-Thevenot
- Université de Poitiers, CNRS, EBI, F-86000, Poitiers, France; Université de Poitiers, CHU de Poitiers, INSERM, Centre d'investigation clinique CIC1402, Axe Santé environnementale, Poitiers, France; Biology-Pharmacy-Public Health Department, University Hospital of Poitiers, 2 Rue de La Miletrie, 86021 Poitiers CEDEX, France; Faculty of Medicine and Pharmacy, University of Poitiers, TSA 51115, 86073 Poitiers Cedex, France.
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Haq Z, Wang X, Cheng Q, Dias GF, Moore C, Piecha D, Kotanko P, Ho CH, Grobe N. Bisphenol A and Bisphenol S in Hemodialyzers. Toxins (Basel) 2023; 15:465. [PMID: 37505734 PMCID: PMC10467069 DOI: 10.3390/toxins15070465] [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: 05/26/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Bisphenol A (BPA)-based materials are used in the manufacturing of hemodialyzers, including their polycarbonate (PC) housings and polysulfone (PS) membranes. As concerns for BPA's adverse health effects rise, the regulation on BPA exposure is becoming more rigorous. Therefore, BPA alternatives, such as Bisphenol S (BPS), are increasingly used. It is important to understand the patient risk of BPA and BPS exposure through dialyzer use during hemodialysis. Here, we report the bisphenol levels in extractables and leachables obtained from eight dialyzers currently on the market, including high-flux and medium cut-off membranes. A targeted liquid chromatography-mass spectrometry strategy utilizing stable isotope-labeled internal standards provided reliable data for quantitation with the standard addition method. BPA ranging from 0.43 to 32.82 µg/device and BPS ranging from 0.02 to 2.51 µg/device were detected in dialyzers made with BPA- and BPS-containing materials, except for the novel FX CorAL 120 dialyzer. BPA and BPS were also not detected in bloodline controls and cellulose-based membranes. Based on the currently established tolerable intake (6 µg/kg/day), the resulting margin of safety indicates that adverse effects are unlikely to occur in hemodialysis patients exposed to BPA and BPS quantified herein. With increasing availability of new data and information about the toxicity of BPA and BPS, the patient safety limits of BPA and BPS in those dialyzers may need a re-evaluation in the future.
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Affiliation(s)
- Zahin Haq
- Renal Research Institute, New York, NY 10065, USA
| | - Xin Wang
- Renal Research Institute, New York, NY 10065, USA
| | - Qiuqiong Cheng
- Fresenius Medical Care North America, Waltham, MA 02451, USA
| | | | - Christoph Moore
- Fresenius Medical Care (Germany), 61352 Bad Homburg, Germany
| | - Dorothea Piecha
- Fresenius Medical Care (Germany), 61352 Bad Homburg, Germany
| | - Peter Kotanko
- Renal Research Institute, New York, NY 10065, USA
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Chih-Hu Ho
- Fresenius Medical Care North America, Ogden, UT 84404, USA
| | - Nadja Grobe
- Renal Research Institute, New York, NY 10065, USA
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Strategies to Protect Dialysis Patients against Bisphenol A. Biomolecules 2021; 11:biom11091375. [PMID: 34572587 PMCID: PMC8471555 DOI: 10.3390/biom11091375] [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: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
Bisphenol A (BPA), also known as 2,2,-bis(4-hydroxyphenyl) propane, is a common component of plastics worldwide. However, it has been shown to act as an endocrine disruptor with some hormonal functions. Furthermore, high levels of BPA have been related to the development of cardiovascular events and the activation of carcinogenesis pathways. Patients with chronic kidney disease (CKD) have higher serum concentrations of BPA due to their impaired renal function. This situation is aggravated in CKD patients requiring dialysis, because the BPA content of dialysis devices (such as, for example, the filters) is added to the lack of excretion. In addition to the development of BPA-free dialysis filters, some techniques can contribute to the reduction of BPA levels in these patients. The aim of this review is to illustrate the impact of BPA on dialysis patients and suggest some strategies to reduce its inherent risks.
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Shen Y, Liu T, Shi Y, Zhuang F, Lu J, Zhu Q, Ding F. Bisphenol A analogs in patients with chronic kidney disease and dialysis therapy. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 185:109684. [PMID: 31541948 DOI: 10.1016/j.ecoenv.2019.109684] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/04/2019] [Accepted: 09/15/2019] [Indexed: 05/26/2023]
Abstract
Bisphenol A (BPA) accumulates in patients with chronic kidney disease (CKD), and hemodialysis filters may contribute to bisphenol burden in patients on hemodialysis (HD). The serum levels of BPA and three BPA analogs, namely, bisphenol B (BPB), bisphenol S (BPS), and bisphenol F (BPF), in 58 patients with CKD, 66 patients on dialysis therapy and 30 healthy control were investigated. The content of four bisphenols (BPs) was also examined in three types of dialysis filters, followed by an in vitro elution experiment to test the release of BPs from the dialysis filters. The serum levels of BPA (r = -0.746, p < 0.05) and BPS (r = -0.433, p < 0.05) in 58 CKD patients and 30 healthy control were correlated with the decrease in estimated glomerular filtration rate. The serum levels of BPs in the HD patients were higher than those in the peritoneal dialysis patients (p < 0.05). In the in vitro study on the BP contents in dialysis filters, BPA was the main form of the BPs in the polysulfone membrane (20.86 ± 1.18 ng/mg) and in the polyamide membrane (18.70 ± 2.88 ng/mg), and a modicum of BPS (0.01 ± 0.01 ng/mg) was detected in the polyethersulfone membrane. The results of the elution experiment were in accordance with the results of BPs content in the dialysis filters. Insufficient renal function may lead to BPs accumulation in patients with CKD, and BPs in dialysis products may cause BPs burden in patients on HD.
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Affiliation(s)
- Yue Shen
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Tingyan Liu
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yuanyuan Shi
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Feng Zhuang
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jianxin Lu
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Qiuyu Zhu
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Feng Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.
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Overexposure to Bisphenol A and Its Chlorinated Derivatives of Patients with End-Stage Renal Disease during Online Hemodiafiltration. Biomolecules 2019; 9:biom9090403. [PMID: 31443526 PMCID: PMC6770677 DOI: 10.3390/biom9090403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 01/10/2023] Open
Abstract
The health safety conditions governing the practice of online hemodiafiltration (OL-HDF) do not yet incorporate the risks related to the presence of endocrine disruptors such as bisphenol A (BPA). The aim of this study was to assess, for the first time, the exposure to BPA but also to its chlorinated derivatives (ClxBPA) (100 times more estrogenic than BPA) during OL-HDF. We demonstrated that BPA is transmitted by the different medical devices used in OL-HDF: ultrafilters, dialysis concentrate cartridges (and not only dialyzers, as previously described). Moreover, BPA has been found in dialysis water as well as in ultrapure dialysate and replacement fluid due to contamination of water coming from municipal network. Indeed, due to contaminations provided by both ultrafilters and water, high levels of BPA were determined in the infused replacement fluid (1033 ng.L−1) from the beginning of the session. Thus, our results demonstrate that dialysis water must be considered as an important exposure source to endocrine disruptors, especially since other micropollutants such as ClxBPA have also been detected in dialysis fluids. While assessment of the impact of this exposure remains to be done, these new findings should be taken into account to assess exposure risks in end-stage renal disease patients.
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Mas S, Bosch-Panadero E, Abaigar P, Camarero V, Mahillo I, Civantos E, Sanchez-Ospina D, Ruiz-Priego A, Egido J, Ortiz A, González-Parra E. Influence of dialysis membrane composition on plasma bisphenol A levels during online hemodiafiltration. PLoS One 2018. [PMID: 29529055 PMCID: PMC5846770 DOI: 10.1371/journal.pone.0193288] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Bisphenol A (BPA) is an ubiquitous environmental toxin that is also found in dialyzers. Online hemodiafiltration (OL-HDF) more efficiently clears high molecular weight molecules, and this may improve BPA clearance. However, the BPA contents of dialysis membranes may be a source of BPA loading during OL-HDF. Methods A prospective study assessed plasma BPA levels in OL-HDF patients using BPA-free (polynephron) or BPA-containing (polysulfone) dialyzers in a crossover design with two arms, after a run-in OL-HDF period of at least 6 months with the same membrane: 31 patients on polynephron at baseline were switched to polysulfone membranes for 3 months (polynephron-to-polysulfone) and 29 patients on polysulfone were switched to polynephron for 3 months (polysulfone-to-polynephron). Results After a run-in OL-HDF period of at least 6 months with the same membrane, baseline pre-dialysis BPA was lower in patients on polynephron (8.79±7.97 ng/ml) than in those on polysulfone (23.42±20.38 ng/mL, p<0.01), but still higher than in healthy controls (<2 ng/mL). After 3 months of polynephron-to-polysulfone switch, BPA was unchanged (8.98±7.88 to 11.14±15.98 ng/mL, ns) while it decreased on the polysulfone-to-polynephron group (23.42±20.38 to 11.41±12.38 ng/mL, p<0.01). Conclusion OL-HDF for 3 months with BPA-free dialyzer membranes was associated to a significant decrease in predialysis BPA levels when compared to baseline BPA levels while on a BPA-containing membrane.
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Affiliation(s)
- Sebastian Mas
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- * E-mail: (SM); (EGP)
| | | | - Pedro Abaigar
- Division of Nephrology, Hospital Universitario de Burgos, Burgos, Spain
| | - Vanesa Camarero
- Division of Nephrology, Hospital Universitario de Burgos, Burgos, Spain
| | - Ignacio Mahillo
- Department of Biostatistics and Epidemiology, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - Esther Civantos
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Didier Sanchez-Ospina
- Division of Nephrology and Hypertension, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - Alberto Ruiz-Priego
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - Jesus Egido
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
- Division of Nephrology and Hypertension, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, UAM, Madrid, Spain
| | - Alberto Ortiz
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Division of Nephrology and Hypertension, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, UAM, Madrid, Spain
- Kidney Research Network (REDINREN), Madrid, Spain
| | - Emilio González-Parra
- Renal, Vascular and Diabetes Laboratory, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Division of Nephrology and Hypertension, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, UAM, Madrid, Spain
- Kidney Research Network (REDINREN), Madrid, Spain
- * E-mail: (SM); (EGP)
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