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Hambrick HR, Cervantes F, Dong M, Tang P, Arbough T, Vinks AA, Mizuno T, Goldstein SL, Kaplan J, Girdwood, ST. Ceftriaxone Pharmacokinetics and Pharmacodynamic Target Attainment for Three Pediatric Patients Receiving Continuous Kidney Replacement Therapy. J Pediatr Pharmacol Ther 2024; 29:180-187. [PMID: 38596427 PMCID: PMC11001209 DOI: 10.5863/1551-6776-29.2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/16/2023] [Indexed: 04/11/2024]
Abstract
Ceftriaxone is used commonly for sepsis, including in children requiring continuous kidney replacement therapy (CKRT). No reports exist of pharmacokinetic (PK) parameters for children receiving ceftriaxone on CKRT. We enrolled children admitted to our pediatric intensive care unit (PICU) who received CKRT for >24 hours and received >1 dose of ceftriaxone while on and off CKRT. We measured free ceftriaxone -concentrations from residual blood samples then used Bayesian estimation with PK modeling software to generate concentration-time profiles and determine PK parameters and the percentage of time free ceftriaxone concentrations were above 1× or 4× MIC (% fT >MIC). Three patients aged 2 to 17 years were included; all were anuric at CKRT initiation and received 50 mg/kg (max 2000 mg) ceftriaxone every 12 to 24 hours. Total ceftriaxone clearance (CL) was 0.50 to 3.67 L/hr while receiving CKRT and 0.29 to 2.71 L/hr while off, indicating CKRT provided 25% to 42% of total ceftriaxone CL. All achieved 100% fT >1× and 4× MIC using an estimated MIC (1 mg/L) for patients 1 to 2 (no culture data) and a measured MIC (0.016 mg/L) for patient 3. Therefore, CKRT contributed significantly to total ceftriaxone clearance in 3 children though the dosing strategies used in each patient attained PD targets.
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Affiliation(s)
- H. Rhodes Hambrick
- Division of Nephrology and Hypertension (HRH, SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Francisco Cervantes
- Department of Medical Education (FC), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Min Dong
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Peter Tang
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Pathology and Laboratory Medicine (PT), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Trent Arbough
- Department of Anesthesiology (TA), University of Kentucky College of Medicine, Lexington, KY
| | - Alexander A. Vinks
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tomoyuki Mizuno
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension (HRH, SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Acute Care Nephrology (SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jennifer Kaplan
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine (JK), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Sonya Tang Girdwood,
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Hospital Medicine (STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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2
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Liu M, Fan Y, Chen J, Yang J, Gao L, Wu X, Xu X, Zhang Y, Yue P, Cao W, Ji Z, Su X, Wen S, Kong J, Zhou G, Li B, Dong Y, Liu A, Bao F. Efficacy and Safety of Treatments for Different Stages of Syphilis: a Systematic Review and Network Meta-Analysis of Randomized Controlled Trials and Observational Studies. Microbiol Spectr 2022; 10:e0297722. [PMID: 36377935 PMCID: PMC9769634 DOI: 10.1128/spectrum.02977-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
Parenteral penicillin is the first-line regimen for treating syphilis. However, allergic reactions and poor drug tolerance still present challenging problems with respect to use of this antibiotic. This study aimed to evaluate the efficacy and safety of ceftriaxone, erythromycin, minocycline, tetracycline, and doxycycline for syphilis treatment, compared with penicillin, to determine which antibiotic could be a better substitute for penicillin. This study included 17 articles, comprising 3 randomized controlled trials (RCTs) and 14 observational studies and involving 4,485 syphilis patients. Estimated risk ratios (RRs) and 95% confidence interval (CIs) were used to compare the serological response rates. At the 6- and 12-month follow-ups, the serological response rates were compared by direct meta-analysis and network meta-analysis (NMA). Based on direct meta-analysis, the serological response rates at the 3- and 24-month follow-ups were compared. Our NMA showed a higher serological response rate for ceftriaxone than for penicillin at the 6-month follow-up (RR of 1.12, 95% CI of 1.02 to 1.23). Ceftriaxone was equally effective as penicillin for syphilis in terms of serological response rates, and it was a better substitute for penicillin than ceftriaxone, erythromycin, minocycline, tetracycline, or doxycycline. However, more large-scale, high-quality, double-blind trials are still needed to determine whether ceftriaxone can safely replace penicillin for the treatment of syphilis when necessary. IMPORTANCE Parenteral penicillin is the first-line regimen for syphilis treatment. However, allergic reactions and poor drug tolerance still present emerging threatening problems with respect to use of this antibiotic. Our results showed a higher serological response rate for ceftriaxone than for penicillin at the 6-month follow-up. Sufficient data are not available for demonstrating significant differences in the efficacy of the other four antibiotics (erythromycin, minocycline, tetracycline, and doxycycline) for treating syphilis. In the clinical treatment of syphilis in patients who are allergic to penicillin or for whom penicillin is not available, ceftriaxone appears to be a better alternative treatment. This meta-analysis provides a reference for clinical treatment of syphilis. Currently, a lack of sufficient evidence to guide antibiotic treatment of syphilis exists, and a need for more high-quality RCTs is still present. This network meta-analysis can lay a foundation for further research.
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Affiliation(s)
- Meixiao Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yuxin Fan
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jingjing Chen
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jiaru Yang
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Li Gao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xinya Wu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xin Xu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yu Zhang
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Peng Yue
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Wenjing Cao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Zhenhua Ji
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Xuan Su
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Shiyuan Wen
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Jing Kong
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Guozhong Zhou
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Bingxue Li
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Yan Dong
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
| | - Aihua Liu
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
| | - Fukai Bao
- The Institute for Tropical Medicine, Faculty of Basic Medical Science, Kunming Medical University, Kunming, China
- Yunnan Province Key Laboratory of Children's Major Diseases Research, The Affiliated Children Hospital, Kunming Medical University, Kunming, China
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Tang Girdwood S, Pavia K, Paice K, Hambrick HR, Kaplan J, Vinks AA. β-lactam precision dosing in critically ill children: Current state and knowledge gaps. Front Pharmacol 2022; 13:1044683. [PMID: 36532752 PMCID: PMC9752101 DOI: 10.3389/fphar.2022.1044683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
There has been emerging interest in implementing therapeutic drug monitoring and model-informed precision dosing of β-lactam antibiotics in critically ill patients, including children. Despite a position paper endorsed by multiple international societies that support these efforts in critically ill adults, implementation of β-lactam precision dosing has not been widely adopted. In this review, we highlight what is known about β-lactam antibiotic pharmacokinetics and pharmacodynamics in critically ill children. We also define the knowledge gaps that present barriers to acceptance and implementation of precision dosing of β-lactam antibiotics in critically ill children: a lack of consensus on which subpopulations would benefit most from precision dosing and the uncertainty of how precision dosing changes outcomes. We conclude with opportunities for further research to close these knowledge gaps.
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Affiliation(s)
- Sonya Tang Girdwood
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,*Correspondence: Sonya Tang Girdwood,
| | - Kathryn Pavia
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Kelli Paice
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - H. Rhodes Hambrick
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Jennifer Kaplan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Alexander A. Vinks
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Onogi C, Osada A, Imai K, Mimura T, Saka Y, Urahama Y, Oishi H, Naruse T. Two cases of ceftriaxone-induced encephalopathy treated by hemoperfusion in hemodialysis patients. Hemodial Int 2022; 26:E27-E30. [PMID: 35441472 PMCID: PMC9545014 DOI: 10.1111/hdi.13018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/19/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
Ceftriaxone is a third‐generation cephalosporin commonly used to treat infection. However, encephalopathy is an emerging adverse effect of ceftriaxone infusion. These patients present with various symptoms, including those of neurotoxicity, that typically resolve 1 week after discontinuation of ceftriaxone. We experienced two cases of ceftriaxone‐induced encephalopathy that were successfully treated by rapid removal of ceftriaxone by hemoperfusion.
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Affiliation(s)
- Chikao Onogi
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Akinori Osada
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Kentaro Imai
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Tetsushi Mimura
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Yosuke Saka
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
| | | | - Hideto Oishi
- Department of Nephrology, Komaki City Hospital, Komaki, Japan
| | - Tomohiko Naruse
- Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan
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5
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Ceftriaxone-associated encephalopathy in a patient with high levels of ceftriaxone in blood and cerebrospinal fluid. Int J Infect Dis 2022; 116:223-225. [DOI: 10.1016/j.ijid.2022.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/21/2022] Open
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Li L, Li X, Xia Y, Chu Y, Zhong H, Li J, Liang P, Bu Y, Zhao R, Liao Y, Yang P, Lu X, Jiang S. Recommendation of Antimicrobial Dosing Optimization During Continuous Renal Replacement Therapy. Front Pharmacol 2020; 11:786. [PMID: 32547394 PMCID: PMC7273837 DOI: 10.3389/fphar.2020.00786] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Continuous Renal Replacement Therapy (CRRT) is more and more widely used in patients for various indications recent years. It is still intricate for clinicians to decide a suitable empiric antimicrobial dosing for patients receiving CRRT. Inappropriate doses of antimicrobial agents may lead to treatment failure or drug resistance of pathogens. CRRT factors, patient individual conditions and drug pharmacokinetics/pharmacodynamics are the main elements effecting the antimicrobial dosing adjustment. With the development of CRRT techniques, some antimicrobial dosing recommendations in earlier studies were no longer appropriate for clinical use now. Here, we reviewed the literatures involving in new progresses of antimicrobial dosages, and complied the updated empirical dosing strategies based on CRRT modalities and effluent flow rates. The following antimicrobial agents were included for review: flucloxacillin, piperacillin/tazobactam, ceftriaxone, ceftazidime/avibactam, cefepime, ceftolozane/tazobactam, sulbactam, meropenem, imipenem, panipenem, biapenem, ertapenem, doripenem, amikacin, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin, azithromycin, tigecycline, polymyxin B, colistin, vancomycin, teicoplanin, linezolid, daptomycin, sulfamethoxazole/trimethoprim, fluconazole, voriconazole, posaconzole, caspofungin, micafungin, amphotericin B, acyclovir, ganciclovir, oseltamivir, and peramivir.
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Affiliation(s)
- Lu Li
- Department of Pharmacy, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xin Li
- Department of Pharmacy, Second Hospital of Jilin University, Changchun, China
| | - Yanzhe Xia
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanqi Chu
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Haili Zhong
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pei Liang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China
| | - Yishan Bu
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, China
| | - Rui Zhao
- School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yun Liao
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Yang
- Department of Pharmacy, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xiaoyang Lu
- Department of Pharmacy, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Saiping Jiang
- Department of Pharmacy, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Telles JP, Cieslinski J, Gasparetto J, Tuon FF. Efficacy of Ceftriaxone 1 g daily Versus 2 g daily for The Treatment of Community-Acquired Pneumonia: A Systematic Review with Meta-Analysis. Expert Rev Anti Infect Ther 2019; 17:501-510. [PMID: 31179786 DOI: 10.1080/14787210.2019.1627872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Ceftriaxone has been recommended as a first-line treatment for various infections; however, the doses for pneumonia have not been a consensus in randomized clinical trials. To compare ceftriaxone 1 g daily efficacy to other ceftriaxone dosing regimens in community-acquired pneumonia. Area covered: We performed a systematic review and meta-analysis on PubMed, Web of Science, Scopus, and LILACS. Randomized controlled trials of ceftriaxone in community-acquired pneumonia were included. Outcomes included clinical cure in modified intention-to-treatment, clinically and microbiologically evaluable patients. Expert opinion: Ceftriaxone dosages of 1 g daily are as safe and effective as other antibiotic regimens for community-acquired pneumonia. Twenty-four articles fulfilled the inclusion criteria. Twelve studies evaluated ceftriaxone regimens at a dosage of 2 g daily and 12 studies evaluated ceftriaxone at a dosage of 1 g daily. The odds-ratio of clinical cure in the modified intention-to-treatment patients administered either ceftriaxone (4666 patients) or a comparator (4411 patients) was 0.98 (95% CI [0.82-1.17]). Comparator regimens showed similar efficacy to ceftriaxone regimens of 1 g daily, with an odds ratio of 1.03 (95% CI [0.88-1.20]). Dosages higher than ceftriaxone 1 g daily did not result in improved clinical outcomes for community-acquired pneumonia patients (OR 1.02, 95% CI [0.91-1.14]).
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Affiliation(s)
- João Paulo Telles
- a Department of Infectious Diseases , AC Camargo Cancer Center , São Paulo , Brazil
| | - Juliette Cieslinski
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Juliano Gasparetto
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
| | - Felipe Francisco Tuon
- b Division of Infectious Diseases, School of Medicine , Pontifícia Universidade Católica do Paraná , Curitiba , Brazil
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Inoue Y, Doi Y, Arisato T, Sugioka S, Koga K, Nishioka K, Sugawara A. Three Cases of Hemodialysis Patients Receiving High-Dose Ceftriaxone: Serum Concentrations and Its Neurotoxicity. Kidney Int Rep 2017; 2:984-987. [PMID: 29270508 PMCID: PMC5733829 DOI: 10.1016/j.ekir.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Yui Inoue
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Tetsuya Arisato
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Sayaka Sugioka
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Kenichi Koga
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Keisuke Nishioka
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
| | - Akira Sugawara
- Department of Nephrology, Osaka Red Cross Hospital, Osaka, Japan
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