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Carey NP, Curtis F, Eisenbeisz ML, Akbari S, Sambharia M, Jalal DI, Wilkinson TJ. Does home blood pressure monitoring improve blood pressure-related outcomes in people living with chronic kidney disease? A systematic review. J Clin Hypertens (Greenwich) 2024; 26:314-329. [PMID: 38523586 PMCID: PMC11007799 DOI: 10.1111/jch.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024]
Abstract
High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre- and post-data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta-analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high-level tailored support. Overall, the quality of n = 7/18 studies was rated as "good"; n = 6/18 were "fair," and n = 5/18 were rated as "poor." Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%-98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%-92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%-100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.
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Affiliation(s)
- Nathan P. Carey
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
| | - Ffion Curtis
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- Liverpool Reviews and Implementation Group (LRiG), Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - McKenna L. Eisenbeisz
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Sadaf Akbari
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Meenakshi Sambharia
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Diana I. Jalal
- Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
- Center for Access & Delivery Research and Evaluation (CADRE)Iowa City VA HCSIowa CityIowaUSA
| | - Thomas J. Wilkinson
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
- NIHR Leicester Biomedical Research CentreLeicesterUK
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Yamada M, Wachsmuth J, Sambharia M, Griffin BR, Swee ML, Reisinger HS, Lund BC, Girotra SR, Sarrazin MV, Jalal DI. The prevalence and treatment of hypertension in Veterans Health Administration, assessing the impact of the updated clinical guidelines. J Hypertens 2023; 41:995-1002. [PMID: 37071434 PMCID: PMC10158602 DOI: 10.1097/hjh.0000000000003424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 01/27/2023] [Accepted: 02/20/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Hypertension is the most common risk factor for cardiovascular disease (CVD). Several guidelines have lowered diagnostic blood pressure (BP) thresholds and treatment targets for hypertension. We evaluated the impact of the more stringent guidelines among Veterans, a population at high risk of CVD. METHODS We conducted a retrospective analysis of Veterans with at least two office BP measurements between January 2016 and December 2017. Prevalent hypertension was defined as diagnostic codes related to hypertension, prescribed antihypertensive drugs, or office BP values according to the BP cutoffs at least 140/90 mmHg (Joint National Committee 7 [JNC 7]), at least 130/80 mmHg [American College of Cardiology/American Heart Association (ACC/AHA)], or the 2020 Veterans Health Administration (VHA) guideline (BP ≥130/90 mmHg). Uncontrolled BP was defined per the VHA guideline as mean SBP ≥130 mmHg or DBP ≥90 mmHg. RESULTS The prevalence of hypertension increased from 71% for BP at least 140/90 to 81% for BP at least 130/90 mmHg and further to 87% for BP at least 130/80 mmHg. Among Veterans with known hypertension ( n = 2 768 826), a majority [ n = 1 818 951 (66%)] were considered to have uncontrolled BP per the VHA guideline. Lowering the treatment targets for SBP and DBP significantly increased the number of Veterans who would require initiation of or intensification of pharmacotherapy. The majority of Veterans with uncontrolled BP and at least one CVD risk factor remained uncontrolled after 5 years of follow-up. CONCLUSION Lowering the BP diagnostic and treatment cutoffs increases the burden on healthcare systems significantly. Targeted interventions are needed to achieve the BP treatment goals.
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Affiliation(s)
- Masaaki Yamada
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
| | - Jason Wachsmuth
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
| | | | - Benjamin R. Griffin
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
| | - Melissa L. Swee
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
- Institute for Clinical and Translational Science, Iowa City, Iowa
| | - Brian C. Lund
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
| | - Saket R. Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mary V. Sarrazin
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
| | - Diana I. Jalal
- Center for Access & Delivery Research and Evaluation, Iowa City VAMC
- The University of Iowa Roy J. and Lucille A Carver, College of Medicine
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Griffin BR, Vaughan-Sarrazin M, Perencevich E, Yamada M, Swee M, Sambharia M, Girotra S, Reisinger HS, Jalal D. Risk Factors for Death Among Veterans Following Acute Kidney Injury. Am J Med 2023; 136:449-457. [PMID: 36708794 PMCID: PMC10765959 DOI: 10.1016/j.amjmed.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/08/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acute kidney injury is prevalent among hospitalized veterans, and associated with increased risk of death following discharge. However, risk factors for death following acute kidney injury have not been well defined. We developed a mortality prediction model using Veterans Health Administration data. METHODS This retrospective cohort study included inpatients from 2013 through 2018 with a creatinine increase of ≥0.3 mg/dL. We evaluated 45 variables for inclusion in our final model, with a primary outcome of 1-year mortality. Bootstrap sampling with replacement was used to identify variables selected in >60% of models using stepwise selection. Best sub-sets regression using Akaike information criteria was used to identify the best-fitting parsimonious model. RESULTS A total of 182,683 patients were included, and 38,940 (21.3%) died within 1 year of discharge. The 10-variable model to predict mortality included age, chronic lung disease, cancer within 5 years, unexplained weight loss, dementia, congestive heart failure, hematocrit, blood urea nitrogen, bilirubin, and albumin. Notably, acute kidney injury stage, chronic kidney disease, discharge creatinine, and proteinuria were not selected for inclusion. C-statistics in the primary validation cohorts were 0.77 for the final parsimonious model, compared with 0.52 for acute kidney injury stage alone. CONCLUSION We identified risk factors for long-term mortality following acute kidney injury. Our 10-variable model did not include traditional renal variables, suggesting that non-kidney factors contribute to the risk of death more than measures of kidney disease in this population, a finding that may have implications for post-acute kidney injury care.
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Affiliation(s)
- Benjamin R Griffin
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City.
| | - Mary Vaughan-Sarrazin
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Eli Perencevich
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Masaaki Yamada
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Melissa Swee
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Meenakshi Sambharia
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Saket Girotra
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Heather S Reisinger
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
| | - Diana Jalal
- Center for Access Delivery & Research and Evaluation (CADRE) Center, Iowa VA Health Care System, Iowa City; Department of Medicine, University of Iowa Carver College of Medicine, Iowa City
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Mann L, Ten Eyck P, Wu C, Story M, Jenigiri S, Patel J, Honkanen I, O’Connor K, Tener J, Sambharia M, Fraer M, Nourredine L, Somers D, Nizar J, Antes L, Kuppachi S, Swee M, Kuo E, Huang CL, Jalal DI, Griffin BR. CVVHD results in longer filter life than pre-filter CVVH: Results of a quasi-randomized clinical trial. PLoS One 2023; 18:e0278550. [PMID: 36630406 PMCID: PMC9833553 DOI: 10.1371/journal.pone.0278550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Filter clotting is a major issue in continuous kidney replacement therapy (CKRT) that interrupts treatment, reduces delivered effluent dose, and increases cost of care. While a number of variables are involved in filter life, treatment modality is an understudied factor. We hypothesized that filters in pre-filter continuous venovenous hemofiltration (CVVH) would have shorter lifespans than in continuous venovenous hemodialysis (CVVHD). METHODS This was a single center, pragmatic, unblinded, quasi-randomized cluster trial conducted in critically ill adult patients with severe acute kidney injury (AKI) at the University of Iowa Hospitals and Clinics (UIHC) between March 2020 and December 2020. Patients were quasi-randomized by time block to receive pre-filter CVVH (convection) or CVVHD (diffusion). The primary outcome was filter life, and secondary outcomes were number of filters used, number of filters reaching 72 hours, and in-hospital mortality. RESULTS In the intention-to-treat analysis, filter life in pre-filter CVVH was 79% of that observed in CVVHD (mean ratio 0.79, 95% CI 0.65-0.97, p = 0.02). Median filter life (with interquartile range) in pre-filter CVVH was 21.8 (11.4-45.3) and was 26.6 (13.0-63.5) for CVVHD. In addition, 11.8% of filters in pre-filter CVVH were active for >72 hours, versus 21.2% in the CVVHD group. Finally, filter clotting accounted for the loss of 26.7% of filters in the CVVH group compared to 17.5% in the CVVHD group. There were no differences in overall numbers of filters used or mortality between groups. CONCLUSIONS Among critically patients with severe AKI requiring CKRT, use of pre-filter CVVH resulted in significantly shorter filter life compared to CVVHD. TRIAL REGISTRATION ClinicalTrials.gov, NCT04762524. Registered 02/21/21-Retroactively registered, https://clinicaltrials.gov/ct2/show/NCT04762524?cond=The+Impact+of+CRRT+Modality+on+Filter+Life&draw=2&rank=1.
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Affiliation(s)
- Lewis Mann
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Patrick Ten Eyck
- University of Iowa Institute for Clinical and Translational Science, Iowa City, Iowa, United States of America
| | - Chaorong Wu
- University of Iowa Institute for Clinical and Translational Science, Iowa City, Iowa, United States of America
| | - Maria Story
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Sree Jenigiri
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Jayesh Patel
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Iiro Honkanen
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Kandi O’Connor
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Janis Tener
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Meenakshi Sambharia
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Mony Fraer
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Lama Nourredine
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Douglas Somers
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Jonathan Nizar
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Lisa Antes
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Sarat Kuppachi
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Melissa Swee
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Elizabeth Kuo
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Chou-Long Huang
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
| | - Diana I. Jalal
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States of America
| | - Benjamin R. Griffin
- Division of Nephrology & Hypertension, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States of America
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States of America
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Sambharia M, Freese ME, Donato F, Bathla G, Abukhiran IMM, Dantuma MI, Mansilla MA, Thomas CP. Suspected Autosomal Recessive Polycystic Kidney Disease but Cerebellar Vermis Hypoplasia, Oligophrenia Ataxia, Coloboma, and Hepatic Fibrosis (COACH) Syndrome in Retrospect, A Delayed Diagnosis Aided by Genotyping and Reverse Phenotyping: A Case Report and A Review of the Literature. Nephron Clin Pract 2023; 148:264-272. [PMID: 36617405 DOI: 10.1159/000527991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Abstract
The clinical features of cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, and hepatic fibrosis (COACH) characterize the rare autosomal recessive multisystem disorder called COACH syndrome. COACH syndrome belongs to the spectrum of Joubert syndrome and related disorders (JSRDs) and liver involvement distinguishes COACH syndrome from the rest of the JSRD spectrum. Developmental delay and oculomotor apraxia occur early but with time, these can improve and may not be readily apparent or no longer need active medical management. Congenital hepatic fibrosis and renal disease, on the other hand, may develop late, and the temporal incongruity in organ system involvement may delay the recognition of COACH syndrome. We present a case of a young adult presenting late to a Renal Genetics Clinic for evaluation of renal cystic disease with congenital hepatic fibrosis, clinically suspected to have autosomal recessive polycystic kidney disease. Following genetic testing, a reevaluation of his medical records from infancy, together with reverse phenotyping and genetic phasing, led to a diagnosis of COACH syndrome.
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Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Margaret E Freese
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Francisco Donato
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Girish Bathla
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | | | - Maisie I Dantuma
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
| | - M Adela Mansilla
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
| | - Christie P Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, Iowa, USA
- Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Veterans Affairs Medical Center, Iowa City, Iowa, USA
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Sambharia M, Rastogi P, Thomas CP. Monogenic focal segmental glomerulosclerosis: A conceptual framework for identification and management of a heterogeneous disease. Am J Med Genet C Semin Med Genet 2022; 190:377-398. [PMID: 35894442 PMCID: PMC9796580 DOI: 10.1002/ajmg.c.31990] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 01/29/2023]
Abstract
Focal segmental glomerulosclerosis (FSGS) is not a disease, rather a pattern of histological injury occurring from a variety of causes. The exact pathogenesis has yet to be fully elucidated but is likely varied based on the type of injury and the primary target of that injury. However, the approach to treatment is often based on the degree of podocyte foot process effacement and clinical presentation without sufficient attention paid to etiology. In this regard, there are many monogenic causes of FSGS with variable presentation from nephrotic syndrome with histological features of primary podocytopathy to more modest degrees of proteinuria with limited evidence of podocyte foot process injury. It is likely that genetic causes are largely underdiagnosed, as the role and the timing of genetic testing in FSGS is not established and genetic counseling, testing options, and interpretation of genotype in the context of phenotype may be outside the scope of practice for both nephrologists and geneticists. Yet most clinicians believe that a genetic diagnosis can lead to targeted therapy, limit the use of high-dose corticosteroids as a therapeutic trial, and allow the prediction of the natural history and risk for recurrence in the transplanted kidney. In this manuscript, we emphasize that genetic FSGS is not monolithic in its presentation, opine on the importance of genetic testing and provide an algorithmic approach to deployment of genetic testing in a timely fashion when faced with a patient with FSGS.
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Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal MedicineUniversity of IowaIowa CityIowaUSA
| | - Prerna Rastogi
- Department of PathologyUniversity of IowaIowa CityIowaUSA
| | - Christie P. Thomas
- Division of Nephrology, Department of Internal MedicineUniversity of IowaIowa CityIowaUSA,Department of PediatricsUniversity of IowaIowa CityIowaUSA,The Iowa Institute of Human GeneticsUniversity of IowaIowa CityIowaUSA,Medical ServiceVeterans Affairs Medical CenterIowa CityIowaUSA
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Sambharia M, Gattineni J, Noureddine L, Mansilla MA, Thomas CP. Familial hyperkalemic hypertension: hyperkalemia not hypertension defines dominant KLHL3 disease and may permit earlier recognition and tailored therapy. J Nephrol 2022; 35:1737-1742. [PMID: 35000137 DOI: 10.1007/s40620-021-01217-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/28/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Meenakshi Sambharia
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jyothsna Gattineni
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Lama Noureddine
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - M Adela Mansilla
- The Iowa Institute of Human Genetics, University of Iowa, Iowa City, IA, 52242, USA
| | - Christie P Thomas
- Division of Nephrology, Department of Internal Medicine, SE419 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA. .,Department of Pediatrics, University of Iowa, Iowa City, IA, 52242, USA. .,Veterans Affairs Medical Center, Iowa City, IA, 52242, USA.
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