1
|
Asakawa S, Shibata S. Anti-adrenergic agents and the risk of postoperative acute kidney injury. Hypertens Res 2024; 47:796-798. [PMID: 38135846 DOI: 10.1038/s41440-023-01546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Shinichiro Asakawa
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi City, Tokyo, Japan.
| | - Shigeru Shibata
- Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi City, Tokyo, Japan.
| |
Collapse
|
2
|
Chen JJ, Lee TH, Kuo G, Yen CL, Chen SW, Chu PH, Fan PC, Chien-Chia Wu V, Chang CH. Acute Kidney Disease After Acute Decompensated Heart Failure. Kidney Int Rep 2022; 7:526-536. [PMID: 35257065 PMCID: PMC8897687 DOI: 10.1016/j.ekir.2021.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/09/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Acute kidney disease (AKD) represents a continuum of kidney injury for 7 to 90 days after acute kidney injury (AKI). The incidence and prognosis of AKD after acute decompensated heart failure (ADHF) are currently unclear. The aims of this study were to explore the incidence of AKD and the transition from AKI to AKD, to identify risk factors for AKD and develop a prediction model for any-stage AKD, and to evaluate the prognosis of AKD. Methods A total of 7519 patients admitted for ADHF between January 1, 2008, and December 31, 2018, from a multi-institutional database were identified. The composite outcomes after ADHF were stage 3 AKD and all-cause death. The prognosis impact of AKD, including major adverse kidney events (MAKEs), all-cause death, and heart failure hospitalization (HFH), during 5 years of follow-up was analyzed. Results The overall incidence of AKI and AKD after ADHF was 9% and 21.2%, respectively; 39.4% of the patients diagnosed with having AKI during ADHF subsequently developed AKD whereas 19.4% of the patients without an identified AKI episode subsequently developed AKD. The predictive scoring models revealed C-statistics of 0.726 (95% CI: 0.712–0.740) for any-stage AKD and 0.807 (95% CI: 0.793–0.821) for the composite of stage 3 AKD and death. Finally, AKD was associated with higher risks of all-cause death, MAKE, and HFH during the 5 years of follow-up (P < 0.001). Conclusion AKD after ADHF are associated with adverse outcomes. Our model could help in identification of patients at risk for AKD development, especially in those who did not have an index AKI episode.
Collapse
|
3
|
Lee TH, Fan PC, Chen JJ, Wu VCC, Lee CC, Yen CL, Kuo G, Hsu HH, Tian YC, Chang CH. A validation study comparing existing prediction models of acute kidney injury in patients with acute heart failure. Sci Rep 2021; 11:11213. [PMID: 34045629 PMCID: PMC8159983 DOI: 10.1038/s41598-021-90756-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022] Open
Abstract
Acute kidney injury (AKI) is a common complication in acute heart failure (AHF) and is associated with prolonged hospitalization and increased mortality. The aim of this study was to externally validate existing prediction models of AKI in patients with AHF. Data for 10,364 patients hospitalized for acute heart failure between 2008 and 2018 were extracted from the Chang Gung Research Database and analysed. The primary outcome of interest was AKI, defined according to the KDIGO definition. The area under the receiver operating characteristic (AUC) curve was used to assess the discrimination performance of each prediction model. Five existing prediction models were externally validated, and the Forman risk score and the prediction model reported by Wang et al. showed the most favourable discrimination and calibration performance. The Forman risk score had AUCs for discriminating AKI, AKI stage 3, and dialysis within 7 days of 0.696, 0.829, and 0.817, respectively. The Wang et al. model had AUCs for discriminating AKI, AKI stage 3, and dialysis within 7 days of 0.73, 0.858, and 0.845, respectively. The Forman risk score and the Wang et al. prediction model are simple and accurate tools for predicting AKI in patients with AHF.
Collapse
Affiliation(s)
- Tao Han Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan ROC
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan ROC
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan ROC
| | - Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist., Taoyuan City, 33305, Taiwan ROC.
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan ROC.
| |
Collapse
|
4
|
Dass B, Dimza M, Singhania G, Schwartz C, George J, Bhatt A, Radhakrishnan N, Bansari A, Bozorgmehri S, Mohandas R. Renin-Angiotensin-Aldosterone System Optimization for Acute Decompensated Heart Failure Patients (ROAD-HF): Rationale and Design. Am J Cardiovasc Drugs 2020; 20:373-380. [PMID: 31797310 DOI: 10.1007/s40256-019-00389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The long-term benefits of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on outcomes in patients with chronic congestive heart failure are well-known, making them one of the most widely prescribed medications. However, the administration of ACEIs/ARBs in acute decompensated heart failure (ADHF) can increase the risk of morbidity and mortality secondary to worsening renal function (WRF). A decrease in estimated glomerular filtration rate (eGFR) during the treatment of ADHF has been associated with an increase in mortality proportional to the degree of WRF. AIM The aim of our study is to determine whether withholding ACEIs/ARBs during the initial 72 h of admission in patients with ADHF will prevent WRF and allow more effective diuresis. METHODS Four hundred and thirty patients will be randomized to the intervention (withholding ACEIs/ARBs) or control (continue/start ACEIs/ARBs) arms for 72 h. Primary outcomes include rates of acute kidney injury (AKI), patient global assessment, and change in kinetic eGFR over 72 h, while secondary outcomes include change in weight, fluid balance, change in signs and symptoms of congestion, change in renal function, change in urinary biomarkers (tissue inhibitor of metalloproteinases 2 [TIMP-2] × insulin-like growth factor-binding protein 7 [IGFBP7]), patients experiencing treatment failure, hospital length of stay (LOS), cost analysis, mortality within 30 days, and hospital readmissions over 30 days and 1 year. CONCLUSION This prospective clinical trial will prove if withholding ACEIs/ARBs will prevent AKI in ADHF. It will help us understand the complex interactions between the heart and kidney, and delineate the best treatment strategy for ADHF. Holding ACEIs/ARBs might help preserve renal function, and decrease hospital LOS, readmission rates, and cost of care in ADHF. REGISTRATION ClinicalTrials.gov identifier: NCT03695120.
Collapse
|
5
|
Sanchez-Serna J, Hernandez-Vicente A, Garrido-Bravo IP, Pastor-Perez F, Noguera-Velasco JA, Casas-Pina T, Rodriguez-Serrano AI, Núñez J, Pascual-Figal D. Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure. Eur J Intern Med 2020; 77:66-72. [PMID: 32127300 DOI: 10.1016/j.ejim.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/06/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated heart failure (HF). Currently, AKI definitions consider creatinine levels at admission as reference of baseline renal function (RF). However, renal impairment may already be present at admission. We aimed to study the impact on AKI detection of considering outpatient RF as reference. METHODS In a cohort of 458 patients hospitalized for decompensated HF, we studied the occurrence of AKI using the standardized KDIGO criteria and grading (stages: 1, 2, 3), and considering two different definitions according to the RF used as reference or baseline: the latest outpatient measurement prior to admission vs. the first measurement at admission. We compared the prevalence, timing and prognostic value for both AKI definitions. RESULTS The definition based on outpatient RF was associated with an increase in overall AKI detection from 20.1% to 33.8% (p < 0.001), and from 3.1% to 5.0% for advanced stages (2-3) (p < 0.001); additionally, 12.5% of patients already had criteria of AKI at admission (36.8% of AKI cases). Both definitions were associated with longer hospital stay. However, only AKI already present at admission, as based on pre-hospital creatinine, was independently associated with all-cause death, in-hospital and after discharge, and death or HF readmission in the follow-up: 1 stage (HR 2.72, 95%CI 1.83-4.06, p < 0.001) and 2-3 stage (HR 7.29, 95%CI, 3.02-17.64, p < 0.001). CONCLUSIONS Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since it improves early identification of AKI and has implications for risk assessment.
Collapse
Affiliation(s)
- Juan Sanchez-Serna
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Alvaro Hernandez-Vicente
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Iris P Garrido-Bravo
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Francisco Pastor-Perez
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | | | - Teresa Casas-Pina
- Servicio de Bioquimica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana I Rodriguez-Serrano
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Julio Núñez
- Servicio de Cardiologia, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| |
Collapse
|
6
|
Hodgson LE, Selby N, Huang TM, Forni LG. The Role of Risk Prediction Models in Prevention and Management of AKI. Semin Nephrol 2019; 39:421-430. [DOI: 10.1016/j.semnephrol.2019.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
7
|
Xu FB, Cheng H, Yue T, Ye N, Zhang HJ, Chen YP. Derivation and validation of a prediction score for acute kidney injury secondary to acute myocardial infarction in Chinese patients. BMC Nephrol 2019; 20:195. [PMID: 31146701 PMCID: PMC6543657 DOI: 10.1186/s12882-019-1379-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 05/13/2019] [Indexed: 12/16/2022] Open
Abstract
Background Acute kidney injury (AKI) is a major complication of acute myocardial infarction(AMI), which can significantly increase mortality. This study is to analyze the related risk factors and establish a prediction score of acute kidney injury in order to take early measurement for prevention. Methods The medical records of 6014 hospitalized patients with AMI in Beijing Anzhen Hospital from January 2010 to December 2016 were retrospectively analyzed. These patients were randomly assigned into two cohorts: one was for the derivation of prediction score (n = 4252) and another for validation (n = 1762). The criterion for AKI was defined as an increase in serum creatinine of ≥ 0.3 mg/dL or ≥ 50% from baseline within 48 h. On the basis of odds ratio obtained from multivariate logistic regression analysis, a prediction score of acute kidney injury after AMI was built up. Results In this prediction score, risk score 1 point included hypertension history, heart rate > 100 bpm on admission, peak serum troponin I ≥ 100 μg/L, and time from admission to coronary reperfusion > 120 min; risks score 2 points included Killip classification ≥ class 3 on admission; and maximum dosage of intravenous furosemide ≥ 60 mg/d; risks score 3 points only included shock during hospitalization. In addition, when baseline estimated glomerular filtration rate (eGFR) was less than 90 ml/min·1.73 m2, every 10 ml/min·1.73 m2 reduction of eGFR increased risk score 1 point. Youden index showed that the best cut-off value for prediction of AKI was 3 points with a sensitivity of 71.1% and specificity 74.2%. The datasets of derivation and validation both displayed adequate discrimination (an area under the ROC curve, 0.79 and 0.81, respectively) and satisfactory calibration (Hosmer–Lemeshow statistic test, P = 0.63 and P = 0.60, respectively). Conclusions In conclusion, a prediction score for AKI secondary to AMI in Chinese patients was established, which may help to prevent AKI early.
Collapse
Affiliation(s)
- Feng-Bo Xu
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hong Cheng
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Tong Yue
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Nan Ye
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - He-Jia Zhang
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yi-Pu Chen
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
8
|
Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0177-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
9
|
He J, Hu Y, Zhang X, Wu L, Waitman LR, Liu M. Multi-perspective predictive modeling for acute kidney injury in general hospital populations using electronic medical records. JAMIA Open 2018; 2:115-122. [PMID: 30976758 PMCID: PMC6447093 DOI: 10.1093/jamiaopen/ooy043] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/25/2018] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives Acute kidney injury (AKI) in hospitalized patients puts them at much higher risk for developing future health problems such as chronic kidney disease, stroke, and heart disease. Accurate AKI prediction would allow timely prevention and intervention. However, current AKI prediction researches pay less attention to model building strategies that meet complex clinical application scenario. This study aims to build and evaluate AKI prediction models from multiple perspectives that reflect different clinical applications. Materials and Methods A retrospective cohort of 76 957 encounters and relevant clinical variables were extracted from a tertiary care, academic hospital electronic medical record (EMR) system between November 2007 and December 2016. Five machine learning methods were used to build prediction models. Prediction tasks from 4 clinical perspectives with different modeling and evaluation strategies were designed to build and evaluate the models. Results Experimental analysis of the AKI prediction models built from 4 different clinical perspectives suggest a realistic prediction performance in cross-validated area under the curve ranging from 0.720 to 0.764. Discussion Results show that models built at admission is effective for predicting AKI events in the next day; models built using data with a fixed lead time to AKI onset is still effective in the dynamic clinical application scenario in which each patient's lead time to AKI onset is different. Conclusion To our best knowledge, this is the first systematic study to explore multiple clinical perspectives in building predictive models for AKI in the general inpatient population to reflect real performance in clinical application.
Collapse
Affiliation(s)
- Jianqin He
- School of Information Science and Technology, Guangdong University of Foreign Studies, Guangzhou, China.,Big Data Decision Institute, Jinan University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Tianhe, Guangzhou, China
| | - Yong Hu
- Big Data Decision Institute, Jinan University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Tianhe, Guangzhou, China
| | - Xiangzhou Zhang
- Big Data Decision Institute, Jinan University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Tianhe, Guangzhou, China
| | - Lijuan Wu
- Big Data Decision Institute, Jinan University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Big Data Precision Healthcare, Tianhe, Guangzhou, China
| | - Lemuel R Waitman
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Mei Liu
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, Missouri, USA
| |
Collapse
|
10
|
Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese clinical practice guideline for acute kidney injury 2016. Clin Exp Nephrol 2018; 22:985-1045. [PMID: 30039479 PMCID: PMC6154171 DOI: 10.1007/s10157-018-1600-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention is necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
Collapse
Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Department of Surgery, Kidney Center, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa, Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| |
Collapse
|
11
|
Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. J Intensive Care 2018; 6:48. [PMID: 30123509 PMCID: PMC6088399 DOI: 10.1186/s40560-018-0308-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
Collapse
Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Kidney Center, Department of Surgery, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505 Japan
| |
Collapse
|
12
|
Llauger L, Jacob J, Miró Ò. Renal function and acute heart failure outcome. Med Clin (Barc) 2018; 151:281-290. [PMID: 29884452 DOI: 10.1016/j.medcli.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022]
Abstract
The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters.
Collapse
Affiliation(s)
- Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Vic (Barcelona), España.
| | - Javier Jacob
- Servicio de Urgencias, Hospital Clínic de Barcelona, Barcelona, España
| | - Òscar Miró
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| |
Collapse
|
13
|
Davis SE, Lasko TA, Chen G, Siew ED, Matheny ME. Calibration drift in regression and machine learning models for acute kidney injury. J Am Med Inform Assoc 2018; 24:1052-1061. [PMID: 28379439 DOI: 10.1093/jamia/ocx030] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/13/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Predictive analytics create opportunities to incorporate personalized risk estimates into clinical decision support. Models must be well calibrated to support decision-making, yet calibration deteriorates over time. This study explored the influence of modeling methods on performance drift and connected observed drift with data shifts in the patient population. Materials and Methods Using 2003 admissions to Department of Veterans Affairs hospitals nationwide, we developed 7 parallel models for hospital-acquired acute kidney injury using common regression and machine learning methods, validating each over 9 subsequent years. Results Discrimination was maintained for all models. Calibration declined as all models increasingly overpredicted risk. However, the random forest and neural network models maintained calibration across ranges of probability, capturing more admissions than did the regression models. The magnitude of overprediction increased over time for the regression models while remaining stable and small for the machine learning models. Changes in the rate of acute kidney injury were strongly linked to increasing overprediction, while changes in predictor-outcome associations corresponded with diverging patterns of calibration drift across methods. Conclusions Efficient and effective updating protocols will be essential for maintaining accuracy of, user confidence in, and safety of personalized risk predictions to support decision-making. Model updating protocols should be tailored to account for variations in calibration drift across methods and respond to periods of rapid performance drift rather than be limited to regularly scheduled annual or biannual intervals.
Collapse
Affiliation(s)
- Sharon E Davis
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Thomas A Lasko
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Guanhua Chen
- Department of Biostatistics, Vanderbilt University School of Medicine
| | - Edward D Siew
- Geriatric Research Education and Clinical Care Service, VA Tennessee Valley Healthcare System, Nashville, TN, USA.,Division of Nephrology, Vanderbilt University School of Medicine, Vanderbilt Center for Kidney Disease and Integrated Program for AKI, Nashville, TN, USA
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University School of Medicine.,Geriatric Research Education and Clinical Care Service, VA Tennessee Valley Healthcare System, Nashville, TN, USA.,Division of General Internal Medicine, Vanderbilt University School of Medicine
| |
Collapse
|
14
|
Hodgson LE, Sarnowski A, Roderick PJ, Dimitrov BD, Venn RM, Forni LG. Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations. BMJ Open 2017; 7:e016591. [PMID: 28963291 PMCID: PMC5623486 DOI: 10.1136/bmjopen-2017-016591] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Critically appraise prediction models for hospital-acquired acute kidney injury (HA-AKI) in general populations. DESIGN Systematic review. DATA SOURCES Medline, Embase and Web of Science until November 2016. ELIGIBILITY Studies describing development of a multivariable model for predicting HA-AKI in non-specialised adult hospital populations. Published guidance followed for data extraction reporting and appraisal. RESULTS 14 046 references were screened. Of 53 HA-AKI prediction models, 11 met inclusion criteria (general medicine and/or surgery populations, 474 478 patient episodes) and five externally validated. The most common predictors were age (n=9 models), diabetes (5), admission serum creatinine (SCr) (5), chronic kidney disease (CKD) (4), drugs (diuretics (4) and/or ACE inhibitors/angiotensin-receptor blockers (3)), bicarbonate and heart failure (4 models each). Heterogeneity was identified for outcome definition. Deficiencies in reporting included handling of predictors, missing data and sample size. Admission SCr was frequently taken to represent baseline renal function. Most models were considered at high risk of bias. Area under the receiver operating characteristic curves to predict HA-AKI ranged 0.71-0.80 in derivation (reported in 8/11 studies), 0.66-0.80 for internal validation studies (n=7) and 0.65-0.71 in five external validations. For calibration, the Hosmer-Lemeshow test or a calibration plot was provided in 4/11 derivations, 3/11 internal and 3/5 external validations. A minority of the models allow easy bedside calculation and potential electronic automation. No impact analysis studies were found. CONCLUSIONS AKI prediction models may help address shortcomings in risk assessment; however, in general hospital populations, few have external validation. Similar predictors reflect an elderly demographic with chronic comorbidities. Reporting deficiencies mirrors prediction research more broadly, with handling of SCr (baseline function and use as a predictor) a concern. Future research should focus on validation, exploration of electronic linkage and impact analysis. The latter could combine a prediction model with AKI alerting to address prevention and early recognition of evolving AKI.
Collapse
Affiliation(s)
- Luke Eliot Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Alexander Sarnowski
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Paul J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Borislav D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Richard M Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - Lui G Forni
- Intensive Care Department, The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
15
|
Hodgson LE, Dimitrov BD, Roderick PJ, Venn R, Forni LG. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS). BMJ Open 2017; 7:e013511. [PMID: 28274964 PMCID: PMC5353262 DOI: 10.1136/bmjopen-2016-013511] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). DESIGN, SETTING AND PARTICIPANTS External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). METHODS Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. RESULTS HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). CONCLUSIONS On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate risk prediction.
Collapse
Affiliation(s)
- L E Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - B D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - P J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - R Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - L G Forni
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
16
|
Abstract
Acute kidney injury is a frequent complication of acute heart failure syndromes, portending an adverse prognosis. Acute cardiorenal syndrome represents a unique form of acute kidney injury specific to acute heart failure syndromes. The pathophysiology of acute cardiorenal syndrome involves renal venous congestion, ineffective forward flow, and impaired renal autoregulation caused by neurohormonal activation. Biomarkers reflecting different aspects of acute cardiorenal syndrome pathophysiology may allow patient phenotyping to inform prognosis and treatment. Adjunctive vasoactive, neurohormonal, and diuretic therapies may relieve congestive symptoms and/or improve renal function, but no single therapy has been proved to reduce mortality in acute cardiorenal syndrome.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Department of Critical Care Medicine, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lakhmir S Chawla
- Division of Intensive Care Medicine, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA; Division of Nephrology, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA.
| |
Collapse
|
17
|
Sutherland SM, Chawla LS, Kane-Gill SL, Hsu RK, Kramer AA, Goldstein SL, Kellum JA, Ronco C, Bagshaw SM. Utilizing electronic health records to predict acute kidney injury risk and outcomes: workgroup statements from the 15(th) ADQI Consensus Conference. Can J Kidney Health Dis 2016; 3:11. [PMID: 26925247 PMCID: PMC4768420 DOI: 10.1186/s40697-016-0099-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023] Open
Abstract
The data contained within the electronic health record (EHR) is "big" from the standpoint of volume, velocity, and variety. These circumstances and the pervasive trend towards EHR adoption have sparked interest in applying big data predictive analytic techniques to EHR data. Acute kidney injury (AKI) is a condition well suited to prediction and risk forecasting; not only does the consensus definition for AKI allow temporal anchoring of events, but no treatments exist once AKI develops, underscoring the importance of early identification and prevention. The Acute Dialysis Quality Initiative (ADQI) convened a group of key opinion leaders and stakeholders to consider how best to approach AKI research and care in the "Big Data" era. This manuscript addresses the core elements of AKI risk prediction and outlines potential pathways and processes. We describe AKI prediction targets, feature selection, model development, and data display.
Collapse
Affiliation(s)
- Scott M Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University, 300 Pasteur Drive, Room G-306, Stanford, CA 94304 USA
| | - Lakhmir S Chawla
- Departments of Medicine and Critical Care, George Washington University Medical Center, Washington, DC USA
| | - Sandra L Kane-Gill
- Departments of Pharmacy, Critical Care Medicine and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA USA
| | - Raymond K Hsu
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA USA
| | - Andrew A Kramer
- Prescient Healthcare Consulting, LLC, Charlottesville, VA USA
| | - Stuart L Goldstein
- Division of Pediatric Nephrology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Sean M Bagshaw
- Division of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
18
|
Cheng H, Chen YP. Clinical prediction scores for type 1 cardiorenal syndrome derived and validated in chinese cohorts. Cardiorenal Med 2014; 5:12-9. [PMID: 25759696 DOI: 10.1159/000369479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/23/2014] [Indexed: 12/14/2022] Open
Abstract
Type 1 cardiorenal syndrome is one of the major diseases threatening human life in China. The incidence of acute kidney injury (AKI) associated with acute heart failure (AHF), acute myocardial infarction (AMI), cardiac surgery, and coronary angiography has been reported to be 32.2, 14.7, 40.2, and 4.5%, respectively. In the past 2 years, we derived and validated 4 risk scores for the prediction of AKI associated with the above acute heart diseases as well as for examination and treatment in Chinese cohorts. A univariable comparison and a subsequent multivariate logistic regression analysis of the potential predictive variables of AKI in the derivation set were conducted and used to establish the prediction scores, which were then verified in the validation set. The area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow goodness-of-fit statistic test were performed to assess the discrimination and calibration of the prediction scores, respectively. These 4 prediction scores all showed adequate discrimination (area under the ROC curve, ≥0.70) and good calibration (p > 0.05). Both Forman's risk score (for AKI associated with AHF) and Mehran's risk score (for AKI associated with coronary angiography) are widely applied around the world. The external validation of these 2 risk scores was performed in our patients, but their discriminative power was quite low (area under the ROC curve, 0.65 and 0.57, respectively). Therefore, these prediction scores derived from Chinese cohorts might be more accurate than those derived from different races when they are applied in Chinese patients.
Collapse
Affiliation(s)
- Hong Cheng
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Yi-Pu Chen
- Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
19
|
Abstract
China has a large population and a high prevalence of chronic kidney disease (CKD). The increasing incidence of obesity and type 2 diabetes mellitus, coupled with an ageing population, will exacerbate the burden of CKD unless effective control and prevention strategies are implemented. The unmet challenges of managing the growing number of patients with end-stage renal disease (ESRD) in China are reflected by the lower rate of patients receiving dialysis relative to many Western countries, owing to a lack of financial and clinical resources, and inequalities in access to health care across regions and populations. The feasibility of expanding peritoneal dialysis is being examined, and ongoing health-care reforms provide an invaluable opportunity to improve the status and quality of dialysis for patients with ESRD in China. The Chinese Society of Nephrology (CSN) advocates for efforts focused on preventing CKD coupled with early detection, treatment, and adequate follow-up to reduce mortality and the long-term burden of CKD. In addition, rapid advances in nephrology research, from basic science to clinical epidemiology, as well as broad communication and collaboration between the CSN and other international nephrology societies, will promote the development of nephrology in China.
Collapse
Affiliation(s)
- Zhi-Hong Liu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhong Shan Road, Nanjing 210002, China.
| |
Collapse
|