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Koch-Weser S, Kennefick K, Tighiouart H, Wong JB, Gordon EJ, Isakova T, Rifkin D, Rossi A, Weiner DE, Ladin K. Development and Validation of the Rating of CKD Knowledge Among Older Adults (Know-CKD) With Kidney Failure. Am J Kidney Dis 2024; 83:569-577. [PMID: 38070590 DOI: 10.1053/j.ajkd.2023.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 01/27/2024]
Abstract
RATIONALE & OBJECTIVE Few older adults with kidney failure engage in shared decision making (SDM) for kidney replacement therapy. The lack of instruments to assess SDM-relevant knowledge domains may contribute to this. We assessed the reliability and validity of a new instrument, the Rating of CKD Knowledge Older Adults (Know-CKD). STUDY DESIGN Multistage process, including a stakeholder-engaged development phase, pilot testing, and validation of a knowledge instrument using a cross-sectional survey of older adults with CKD. SETTING & PARTICIPANTS 363 patients aged 70+years with nondialysis advanced chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2) in Boston, Chicago, Portland, ME, and San Diego from June 2018 and January 2020. EXPOSURE Educational level, higher literacy (Single Item Literacy Screener [SILS]) and numeracy (Subjective Numeracy Scale [SNS]), having participated in clinic-sponsored dialysis education, and self-reported "feeling informed" about options for treatment. OUTCOME Validity and reliability of the Know-CKD instrument. ANALYTICAL APPROACH Reliability was assessed with the Kuder-Richardson-20 coefficient. Construct validity was demonstrated by testing a priori hypotheses using t test, analysis of variance (ANOVA) tests, and linear regression analyses. RESULTS The mean (± SD) participant age was 77.6±5.9 years, and mean eGFR was 22.7±7.2mL/min/1.73m2; 281 participants (78%) self-reported as White. The 12-item Know-CKD assessment had good reliability (Kuder-Richardson-20 reliability coefficient=0.75), and a mean score of 58.2% ± 22.3 SD. The subscales did not attain acceptable reliability. The proportion answering correctly on each item ranged from 20.1% to 91.7%. In examining construct validity, the hypothesized associations held; Know-CKD significantly associated with higher education (β=6.98 [95% CI, 1.34-12.61], P=0.02), health literacy (β = -12.67 [95% CI, -19.49 to-5.86], P≤0.001), numeracy per 10% higher (β=1.85 [95% CI, 1.02-2.69], P≤0.001), and attendance at dialysis class (β=18.28 [95% CI, 13.30-23.27], P≤0.001). These associations were also observed for the subscales except for prognosis (not associated with literacy or numeracy). LIMITATIONS Know-CKD is only available in English and has been used only in research settings. CONCLUSIONS For older adults facing dialysis initiation decisions, Know-CKD is a valid, reliable, and easy to administer measure of knowledge. Further research should examine the relationship of kidney disease knowledge and SDM, patient satisfaction, and clinical outcomes. PLAIN-LANGUAGE SUMMARY The Rating of CKD Knowledge Among Older Adults (Know-CKD) study measures knowledge of chronic kidney disease (CKD) and is designed for older adults. Most existing knowledge measures for CKD focus on people of all ages and all CKD stages. This measure is useful because it will allow researchers to assess how well patient education efforts are working. Patient education is a way to help patients make decisions about their care. We describe how the measure was developed by a team of doctors, researchers, and patients, and how the measure performed among persons with advanced CKD aged 70 years and older. Know-CKD can inform efforts to improve shared decision-making research and practice for older patients with kidney disease.
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Affiliation(s)
- Susan Koch-Weser
- Department of Public Health & Community Medicine, School of Medicine, Tufts University, Boston
| | - Kristen Kennefick
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Hocine Tighiouart
- Tufts Clinical and Translational Science Institute, School of Medicine, Tufts University, Boston; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dena Rifkin
- Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Daniel E Weiner
- William B Schwartz MD Division of Nephrology, Tufts Medical Center, Boston
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts.
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İnceoğlu F, Deniz S, Yagin FH. Prediction of effective sociodemographic variables in modeling health literacy: A machine learning approach. Int J Med Inform 2023; 178:105167. [PMID: 37572386 DOI: 10.1016/j.ijmedinf.2023.105167] [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: 04/08/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Health literacy is becoming a more important concept for the effective use of health systems day by day. The main purpose of the study is to determine the importance levels of the variables by using Machine Learning methods in order to determine the main factors affecting health literacy, and to find the most important variables for health literacy. MATERIAL AND METHODS 1001 participants with a mean age of 18.05 ± 0.81 standard deviations were included in the study. The European Health Literacy Scale was used to determine the health literacy level of the participants. The scale cut-off point is 25, and 516 (51.5%) of the participants have low health literacy and 485 (48.5%) have a high level of health literacy. In the study, XGBoost, random forest, logistic regression models from machine learning methods were used and indexes were calculated. RESULTS When the results of XGBoost, random forest, logistic regression models were evaluated, it was found that the model with the best performance was XGBoost. Sensitivity, specificity, F1-score, AUROC and Brier score values for the XGBoost models were obtained as 0.979, 0.965, 0.973, 0.983, 0.054 respectively. CONCLUSION It was found that HL levels differed significantly in the variables of gender, age, class, family education, place of residence, economic situation, and covering health expenses (p < 0.05). According to the XGBoost model, it was found that the variable with the highest level of importance was reading the newspaper, while the variable with the lowest level of importance was the educational status of the mother. With the help of the established model, the basic variables that will affect the HL level were determined. The designed model will constitute the basic step of an supporting design system to improve physician-patient communication.
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Affiliation(s)
- Feyza İnceoğlu
- Malatya Turgut Ozal University, Medicine Faculty, Biostatistics, Malatya, Turkey.
| | - Serdar Deniz
- Malatya Turgut Ozal University, Medicine Faculty, Public Health, Malatya, Turkey.
| | - Fatma Hilal Yagin
- Inonu University, Medicine Faculty, Department of Biostatistics, and Medical Informatics, Malatya, Turkey.
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Chen NJ, Huang CM, Fan CC, Lu LT, Lin FH, Liao JY, Guo JL. User Evaluation of a Chat-Based Instant Messaging Support Health Education Program for Patients With Chronic Kidney Disease: Preliminary Findings of a Formative Study. JMIR Form Res 2023; 7:e45484. [PMID: 37725429 PMCID: PMC10548329 DOI: 10.2196/45484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Artificial intelligence-driven chatbots are increasingly being used in health care, but few chat-based instant messaging support health education programs are designed for patients with chronic kidney disease (CKD) to evaluate their effectiveness. In addition, limited research exists on the usage of chat-based programs among patients with CKD, particularly those that integrate a chatbot aimed at enhancing the communication ability and disease-specific knowledge of patients. OBJECTIVE The objective of this formative study is to gather the data necessary to develop an intervention program of chat-based instant messaging support health education for patients with CKD. Participants' user experiences will form the basis for program design improvements. METHODS Data were collected from April to November 2020 using a structured questionnaire. A pre-post design was used, and a total of 60 patients consented to join the 3-month program. Among them, 55 successfully completed the study measurements. The System Usability Scale was used for participant evaluations of the usability of the chat-based program. RESULTS Paired t tests revealed significant differences before and after intervention for communicative literacy (t54=3.99; P<.001) and CKD-specific disease knowledge (t54=7.54; P<.001). Within disease knowledge, significant differences were observed in the aspects of CKD basic knowledge (t54=3.46; P=.001), lifestyle (t54=3.83; P=.001), dietary intake (t54=5.51; P<.001), and medication (t54=4.17; P=.001). However, no significant difference was found in the aspect of disease prevention. Subgroup analysis revealed that while the findings among male participants were similar to those of the main sample, this was not the case among female participants. CONCLUSIONS The findings reveal that a chat-based instant messaging support health education program may be effective for middle-aged and older patients with CKD. The use of a chat-based program with multiple promoting approaches is promising, and users' evaluation is satisfactory. TRIAL REGISTRATION ClinicalTrials.gov NCT05665517; https://clinicaltrials.gov/study/NCT05665517.
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Affiliation(s)
- Nai-Jung Chen
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
- Department of Nursing, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chiu-Mieh Huang
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Chih Fan
- Department of Community Medicine, En Chu Kong Hospital, New Taipei, Taiwan
| | - Li-Ting Lu
- Department of Nursing, University of Kang Ning, Taipei, Taiwan
| | - Fen-He Lin
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
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Younes S, Mourad N, Safwan J, Dabbous M, Rahal M, Al Nabulsi M, Sakr F. Chronic kidney disease awareness among the general population: tool validation and knowledge assessment in a developing country. BMC Nephrol 2022; 23:266. [PMID: 35883118 PMCID: PMC9316863 DOI: 10.1186/s12882-022-02889-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Good knowledge and early identification of chronic kidney disease (CKD) can help in preventing disease progression in its early stages and reducing undesired outcomes. The aim of the current study was to assess the level of public knowledge about CKD, determine predictors of better knowledge, and to construct and validate a CKD knowledge scale for public health assessment and research use. Methods A community-based cross-sectional study was conducted using an electronic self-administered questionnaire. All people living in Lebanon and being 18 years of age and above were considered eligible for recruitment. CKD knowledge was assessed by a 37-item scale that was constructed by principal component analysis and then validated. The score of the CKD knowledge scale was computed from the extracted factors. A multivariable binomial logistic regression model evaluated the sociodemographic and clinical predictors of the knowledge score. Results A total of 1308 participants were included. The scale items converged over 9 factors with Eigenvalue greater than 1 and explaining 53.26% of the total variance, and the total scale had a high Cronbach’s alpha of 0.804. All items of the scale significantly correlated with the full scale with correlation coefficients ranging from 0.082 to 0.558. The ROC curve analysis determined an optimal cutoff point of better knowledge at 47.5 with 70.6% sensitivity and 44.2% specificity. The CKD knowledge score had a median of 51.00 (IQR 47.00–55.00). Higher knowledge score was significantly associated with old age (ORa = 1.018, 95% CI 1.006–1.030, P = 0.003),, occupation (ORa = 3.919, 95% CI 2.107–7.288, P < 0.001), and recent renal function assessment (ORa = 2.314, 95% CI 1.532–3.495, P < 0.001). However, a lower knowledge score was significantly associated with lower level of education (ORa = 0.462, 95% CI 0.327–0.653, P < 0.001). Conclusion A reliable tool to assess public knowledge and awareness about CKD was developed and validated. The overall knowledge was good, however, important gaps in CKD awareness were detected in some areas and subpopulations. Therefore, public health stakeholders need to implement targeted CKD educational activities to minimize the disease burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02889-2.
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Affiliation(s)
- Samar Younes
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon.
| | - Nisreen Mourad
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Marah Al Nabulsi
- School of Pharmacy, Lebanese International University, Bekaa, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
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Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One 2022; 17:e0271524. [PMID: 35839272 PMCID: PMC9286266 DOI: 10.1371/journal.pone.0271524] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages. METHODS The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021. RESULTS The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties. CONCLUSION This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fatemeh Zarei
- Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
| | - Ramin Mozafari Kermani
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Rahele Rostami
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
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Tsai MD, Tsai JP, Chen ML, Chang LC. Frailty, Health Literacy, and Self-Care in Patients with Chronic Kidney Disease in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095350. [PMID: 35564744 PMCID: PMC9102108 DOI: 10.3390/ijerph19095350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is a chronic and often irreversible disease that requires active self-care to mitigate adverse outcomes. This study aimed to analyze the associations of demographic and disease data, frailty, health literacy (HL), and CKD self-care (CKDSC) in patients with CKD. We conducted a cross-sectional study at two hospitals in Taiwan. A total of 144 CKD patients with a mean age of 66.8 ± 9.1 years were included in the study. Among them, 79.2% were in CKD G3, and the mean time since diagnosis of CKD was 86 ± 48 months. Approximately 62.5% were identified as non-frail. The mean of HL and CKDSC were 11.76 ± 4.10 and 62.12 ± 9.31. In multivariate linear regression analysis, age ≥ 65 years (odds ratio (OR) = 5.67, 95% confidence interval (CI) 1.59–9.75), non-frailty (OR = 2.19, 95% CI 0.02–5.40), and high critical HL (OR = 1.43, 95% CI 0.13–2.90) showed significant positive correlation with CKDSC. Therefore, management of patients with CKD should focus on the young population, reinforcing health education strategies that improve critical HL and preventing frailty that may interfere with self-care. In addition, the patient’s social support resources should be expanded to achieve the goal of CKDSC.
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Affiliation(s)
- Mu-Dan Tsai
- Department of Nursing, Douliou Tzu Chi Hospital, Yunlin City 64041, Taiwan;
| | - Jen-Pi Tsai
- Department of Nephrology, Dalin Tzu Chi Hospital, Chiayi City 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Min-Li Chen
- School of Nursing, Chang Gung University of Science and Technology, Chiayi City 61363, Taiwan;
| | - Li-Chun Chang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City 33303, Taiwan
- Chang Gung Memorial Hospital, Keelung 20401, Taiwan
- Department of Nursing, Chang Gung University, Taoyuan City 33302, Taiwan
- Correspondence:
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Fukui A, Takeshita K, Nakashima A, Maruyama Y, Yokoo T. Chronic Kidney Disease Patients Visiting Various Hospital Departments: An Analysis in a Hospital in Central Tokyo, Japan. J Pers Med 2022; 12:jpm12010039. [PMID: 35055354 PMCID: PMC8778196 DOI: 10.3390/jpm12010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 12/04/2022] Open
Abstract
To further improve care for chronic kidney disease (CKD) patients, healthcare providers’ awareness of CKD must be raised. Proteinuria testing is essential for CKD care, and collaboration with specialists is recommended for advanced cases. We reviewed data from the electronic medical records of outpatients at our hospital to analyze the clinical departments visited by CKD patients, and the frequency of proteinuria testing and referrals to nephrologists. We defined CKD as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or a urine protein concentration (U-pro) ≥ +1. We found that 31.1% of the CKD tests in September 2021 were performed in clinical departments other than internal medicine. Furthermore, within 1 year, 68.0% of CKD patients identified in September 2020 underwent a urine dipstick test, and 33.7% underwent a quantitative test for urinary protein or albumin. Additionally, 27.5% of individuals with an eGFR < 30 mL/min/1.73 m2 or U-pro ≥ +1 identified by non-nephrology departments in September 2020 visited the nephrology department within 1 year. Repeated assessments of these quality indicators may be useful for progress management in improving CKD care. Because CKD patients visited various departments in our hospital, campaigns to raise CKD awareness must reach a wide range of healthcare providers in hospitals.
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Affiliation(s)
- Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (A.N.); (Y.M.); (T.Y.)
- Correspondence: ; Tel.: +81-3-3433-1111
| | - Kohei Takeshita
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (A.N.); (Y.M.); (T.Y.)
| | - Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (A.N.); (Y.M.); (T.Y.)
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (A.N.); (Y.M.); (T.Y.)
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