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Mundt P, Tharmaseelan H, Hertel A, Rotkopf LT, Nörenberg D, Riffel P, Schoenberg SO, Froelich MF, Ayx I. Periaortic adipose radiomics texture features associated with increased coronary calcium score-first results on a photon-counting-CT. BMC Med Imaging 2023; 23:97. [PMID: 37495950 PMCID: PMC10373379 DOI: 10.1186/s12880-023-01058-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Cardiovascular diseases remain the world's primary cause of death. The identification and treatment of patients at risk of cardiovascular events thus are as important as ever. Adipose tissue is a classic risk factor for cardiovascular diseases, has been linked to systemic inflammation, and is suspected to contribute to vascular calcification. To further investigate this issue, the use of texture analysis of adipose tissue using radiomics features could prove a feasible option. METHODS In this retrospective single-center study, 55 patients (mean age 56, 34 male, 21 female) were scanned on a first-generation photon-counting CT. On axial unenhanced images, periaortic adipose tissue surrounding the thoracic descending aorta was segmented manually. For feature extraction, patients were divided into three groups, depending on coronary artery calcification (Agatston Score 0, Agatston Score 1-99, Agatston Score ≥ 100). 106 features were extracted using pyradiomics. R statistics was used for statistical analysis, calculating mean and standard deviation with Pearson correlation coefficient for feature correlation. Random Forest classification was carried out for feature selection and Boxplots and heatmaps were used for visualization. Additionally, monovariable logistic regression predicting an Agatston Score > 0 was performed, selected features were tested for multicollinearity and a 10-fold cross-validation investigated the stability of the leading feature. RESULTS Two higher-order radiomics features, namely "glcm_ClusterProminence" and "glcm_ClusterTendency" were found to differ between patients without coronary artery calcification and those with coronary artery calcification (Agatston Score ≥ 100) through Random Forest classification. As the leading differentiating feature "glcm_ClusterProminence" was identified. CONCLUSION Changes in periaortic adipose tissue texture seem to correlate with coronary artery calcium score, supporting a possible influence of inflammatory or fibrotic activity in perivascular adipose tissue. Radiomics features may potentially aid as corresponding biomarkers in the future.
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Affiliation(s)
- Peter Mundt
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Hishan Tharmaseelan
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Alexander Hertel
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lukas T Rotkopf
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- Department of Radiology, German Cancer Research Centre, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Philipp Riffel
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Isabelle Ayx
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Adar A, Onalan O, Cakan F, Keles H, Akbay E, Akıncı S, Coner A, Haberal C, Muderrisoglu H. Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method. Acta Cardiol 2022; 77:943-949. [PMID: 36189879 DOI: 10.1080/00015385.2022.2121537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT using transthoracic echocardiography (TTE). The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width. METHODS PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21 mm/m2 or greater was considered to have aortic dilation. RESULTS A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n = 96) and the normal ascending aorta diameter group (n = 225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445-6.251)) were significantly associated with AAD. CONCLUSIONS This is the first study which evaluated PAT measured by TTE. We found a significant association between PAT measured by TTE and ascending aorta width.
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Affiliation(s)
- Adem Adar
- Department of Cardiology, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Orhan Onalan
- Department of Cardiology, Karabuk University Faculty of Medicine, Karabuk, Turkey.,Department of Radiology, Karabuk University Faculty of Medicine, Alanya, Turkey
| | - Fahri Cakan
- Department of Cardiology, Karabuk University Faculty of Medicine, Karabuk, Turkey.,Department of Radiology, Karabuk University Faculty of Medicine, Alanya, Turkey
| | - Hakan Keles
- Department of Cardiovascular Surgery, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Ertan Akbay
- Department of Cardiology, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Sinan Akıncı
- Department of Cardiology, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Ali Coner
- Department of Cardiology, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Cevahir Haberal
- Department of Cardiovascular Surgery, Baskent University Faculty of Medicine, Alanya, Turkey
| | - Haldun Muderrisoglu
- Department of Cardiology, Baskent University Faculty of Medicine, Alanya, Turkey
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Yilmaz Z, İnce H, Aydin E, Yildirim Y, Yilmaz Aydin F, Yüksel E, Karabulut A, Dursun L, Kadiroğlu AK, Yilmaz ME. Relationship Between Epicardial Adipose Tissue and Body Composition as Determined by Multi-Frequency Bioelectrical Impedance Analysis in Patients with Stage 5 Chronic Kidney Disease. Med Sci Monit 2020; 26:e920233. [PMID: 32029697 PMCID: PMC7020765 DOI: 10.12659/msm.920233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The main cause of mortality among chronic kidney disease (CKD) patients is cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is considered to be novel cardiovascular risk factor. We assessed EAT in non-dialyzed stage 5 CKD patients and explored the association of EAT with body composition as determined by multi-frequency BIA. Material/Methods The present included 70 stage 5 CKD patients who had not undergone dialysis and 40 healthy control subjects. EAT thickness was assessed by echocardiography. Hydration status and body composition were evaluated by multi-frequency bioelectrical impedance analysis. Results Stage 5 CKD patients had significantly higher EAT thickness than healthy subjects (6.56±1.18 vs. 4.05±1.45, p<0.001). Fat tissue mass, systolic blood pressure (SBP), age, fat tissue index, and body mass index were positively correlated with EAT thickness in the CKD patient group (p<0.05). Lean tissue mass, lean tissue index (LTI), and high-density lipoprotein (HDL) were negatively correlated with EAT thickness in the CKD patient group (p<0.05). Stepwise multiple regression analysis showed that age, SBP, and LTI were independently associated with EAT thickness in CKD patients. Conclusions We found significantly higher EAT thickness in stage 5 CKD patients who were not on dialysis compared to healthy controls. EAT was significantly associated with age, SBP, and LTI in CKD patients. Interventions to reduce the risk factors associated with EAT thickness might protect against CVD disease in CKD patients.
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Affiliation(s)
- Zülfükar Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Hasan İnce
- Department of Internal Medicine, Selahattin Eyyübi State Hospital, Diyarbakir, Turkey
| | - Emre Aydin
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Yasar Yildirim
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Fatma Yilmaz Aydin
- Department of Internal Medicine, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Enver Yüksel
- Department of Nephrology, Gazi Yasargil Education Research Hospital, Diyarbakir, Turkey
| | - Aziz Karabulut
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Lezgin Dursun
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Ali Kemal Kadiroğlu
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mehmet Emin Yilmaz
- Department of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Epicardial Adipose Tissue and Renal Disease. J Clin Med 2019; 8:jcm8030299. [PMID: 30832377 PMCID: PMC6463003 DOI: 10.3390/jcm8030299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 01/09/2023] Open
Abstract
Epicardial adipose tissue (EAT) is derived from splanchnic mesoderm, localized anatomically between the myocardium and pericardial visceral layer, and surrounds the coronary arteries. Being a metabolically active organ, EAT secretes numerous cytokines, which moderate cardiovascular morphology and function. Through its paracrine and vasocrine secretions, EAT may play a prominent role in modulating cardiac function. EAT protects the heart in normal physiological conditions by secreting a variety of adipokines with anti-atherosclerotic properties, and in contrast, secretes inflammatory molecules in pathologic conditions that may play a dynamic role in the pathogenesis of cardiovascular diseases by promoting atherosclerosis. Considerable research has been focused on comparing the anatomical and biochemical features of EAT in healthy people, and a variety of disease conditions such as cardiovascular diseases and renal diseases. The global cardiovascular morbidity and mortality in renal disease are high, and there is a paucity of concrete evidence and societal guidelines to detect early cardiovascular disease (CVD) in this group of patients. Here we performed a clinical review on the existing evidence and knowledge on EAT in patients with renal disease, to evaluate its application as a reliable, early, noninvasive biomarker and indicator for CVD, and to assess its significance in cardiovascular risk stratification.
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Gok Oguz E, Akoglu H, Ulusal Okyay G, Karaveli Gursoy G, Yildirim T, Merhametsiz O, Cimen T, Canbakan B, Yeter E, Ayli MD. Increased serum renalase in peritoneal dialysis patients: Is it related to cardiovascular disease risk? Nefrologia 2017; 37:189-194. [PMID: 28160962 DOI: 10.1016/j.nefro.2016.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 10/12/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Renalase, with possible monoamine oxidase activity, is implicated in degradation of catecholamines; which suggests novel mechanisms of cardiovascular complications in patients with chronic kidney diseases. Epicardial adipose tissue (EAT) has been found to correlate with cardiovascular diseases (CVD) in dialysis patients. The present study aimed to evaluate the association of serum renalase levels with EAT thickness and other CVD risk factors in peritoneal dialysis (PD) patients. METHODS The study included 40 PD patients and 40 healthy controls. All subjects underwent blood pressure and anthropometric measurements. Serum renalase was assessed by using a commercially available assay. Transthoracic echocardiography was used to measure EAT thickness and left ventricular mass index (LVMI) in all subjects. RESULTS The median serum renalase level was significantly higher in the PD patients than in the control group [176.5 (100-278.3) vs 122 (53.3-170.0)ng/ml] (p=0.001). Renalase was positively correlated with C-reactive protein (r=0.705, p<0.001) and negatively correlated with RRF (r=-0.511, p=0.021). No correlation was observed between renalase and EAT thickness or LVMI. There was a strong correlation between EAT thickness and LVMI in both the PD patients and the controls (r=0.848, p<0.001 and r=0.640, p<0.001 respectively). CONCLUSIONS This study indicates that renalase is associated with CRP and residual renal function but not with EAT thickness as CVD risk factors in PD patients.
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Affiliation(s)
- Ebru Gok Oguz
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey.
| | - Hadim Akoglu
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Gulay Ulusal Okyay
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Guner Karaveli Gursoy
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Tolga Yildirim
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Ozgur Merhametsiz
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Tolga Cimen
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Basol Canbakan
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
| | - Ekrem Yeter
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - M Deniz Ayli
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Nephrology, Ankara, Turkey
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6
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Assessment of the relationship between serum paraoxonase activity and epicardial adipose tissue in hemodialysis patients. Int Urol Nephrol 2016; 49:329-335. [DOI: 10.1007/s11255-016-1465-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
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7
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Eroglu E, Kocyigit I, Unal A, Korkar H, Karakukcu C, Orscelik O, Sipahioglu MH, Tokgoz B, Oymak O. Serum paraoxonase activity is associated with epicardial fat tissue in renal transplant recipients. Int Urol Nephrol 2015; 47:1409-14. [PMID: 26184836 DOI: 10.1007/s11255-015-1051-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
AIMS Cardiovascular disease is a major cause of mortality in renal transplant recipients. Paraoxonase-1 (PON-1) has been shown to protect against atherosclerosis by modifying lipoproteins. Epicardial fat tissue (EFT) has been proposed as a new cardiovascular risk factor. The aim of this study was to investigate the relationship between PON-1 activity and EFT in renal transplant recipients. METHODS Eighty renal transplant recipients were enrolled in this cross-sectional study. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. EFT was measured by echocardiography. RESULTS The mean age of the patients was 40.4 ± 12.3 years and mean post transplant follow-up duration was 57.2 ± 46 months. Mean PON-1 activity was 68.5 ± 30 U/L. PON-1 activity was positively correlated with age and body mass index and negatively correlated with parathyroid hormone, dialysis duration and EFT. The mean EFT thickness was 0.64 ± 0.17 cm. Multiple linear regression analysis was used to define independent determinants of EFT in renal transplant recipients. According to linear regression analysis, PON-1 levels and age were found to be independent predictors of EFT. CONCLUSION Reduced PON-1 activity was negatively associated with EFT and PON-1 activity independently predicts EFT in renal transplant recipients.
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Affiliation(s)
- Eray Eroglu
- Department of Internal Medicine, Erciyes University Medical School, Kayseri, Turkey,
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Cordeiro AC, Amparo FC, Oliveira MAC, Amodeo C, Smanio P, Pinto IMF, Lindholm B, Stenvinkel P, Carrero JJ. Epicardial fat accumulation, cardiometabolic profile and cardiovascular events in patients with stages 3-5 chronic kidney disease. J Intern Med 2015; 278:77-87. [PMID: 25556720 DOI: 10.1111/joim.12344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been hypothesized that epicardial adipose tissue (EAT) exerts pathogenic effects on cardiac structures. We analysed the associations between EAT and both cardiovascular (CV) disease risk factors and CV events in patients with chronic kidney disease (CKD). PATIENTS AND METHODS We included 277 nondialysed patients [median age 61, interquartile range (IQR) 53-68 years; 63% men] with stages 3-5 CKD in this cross-sectional evaluation. EAT and abdominal visceral adipose tissue (VAT) were assessed by computed tomography. Patients were followed for median 32 (IQR 20-39) months, and the composite of fatal and nonfatal CV events was recorded. RESULTS With increasing EAT quartiles, patients were older, had higher glomerular filtration rate, body mass index, waist, VAT and coronary calcification, higher levels of haemoglobin, triglycerides, albumin, C-reactive protein and leptin and higher prevalence of left ventricular hypertrophy and myocardial ischaemia; total and high-density lipoprotein cholesterol, 25-hydroxy-vitamin D and 1, 25-dihydroxy-vitamin D progressively decreased. Associations between EAT and cardiac alterations were not independent of VAT. During follow-up, 58 CV events occurred. A 1-SD higher EAT volume was associated with an increased risk of CV events in crude [hazard ratio (HR) 1.41, 95% confidence interval (CI) (1.12-1.78) and adjusted (HR 1.55, 95% CI 1.21-1.99) Cox models. However, adding EAT to a standard CV disease risk prediction model did not result in a clinically relevant improvement in prediction. CONCLUSION Epicardial adipose tissue accumulation in patients with CKD increases the risk of CV events independent of general adiposity. This is consistent with the notion of a local pathogenic effect of EAT on the heart or heart vessels, or both. However, EAT adds negligible explanatory power to standard CV disease risk factors.
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Affiliation(s)
- A C Cordeiro
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - F C Amparo
- Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - M A C Oliveira
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - C Amodeo
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - P Smanio
- Department of Nuclear Medicine, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - I M F Pinto
- Department of Radiology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - B Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - P Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J J Carrero
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Carrero JJ, Avesani CM. Pros and Cons of Body Mass Index as a Nutritional and Risk Assessment Tool in Dialysis Patients. Semin Dial 2014; 28:48-58. [DOI: 10.1111/sdi.12287] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Juan Jesús Carrero
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Center for Molecular Medicine; Department of Molecular Medicine and Surgery; Karolinska Institutet; Stockholm Sweden
| | - Carla Maria Avesani
- Department of Applied Nutrition; Nutrition Institute; Rio de Janeiro State University; Rio de Janeiro Brazil
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