1
|
Hall RK, Kazancıoğlu R, Thanachayanont T, Wong G, Sabanayagam D, Battistella M, Ahmed SB, Inker LA, Barreto EF, Fu EL, Clase CM, Carrero JJ. Drug stewardship in chronic kidney disease to achieve effective and safe medication use. Nat Rev Nephrol 2024; 20:386-401. [PMID: 38491222 DOI: 10.1038/s41581-024-00823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
People living with chronic kidney disease (CKD) often experience multimorbidity and require polypharmacy. Kidney dysfunction can also alter the pharmacokinetics and pharmacodynamics of medications, which can modify their risks and benefits; the extent of these changes is not well understood for all situations or medications. The principle of drug stewardship is aimed at maximizing medication safety and effectiveness in a population of patients through a variety of processes including medication reconciliation, medication selection, dose adjustment, monitoring for effectiveness and safety, and discontinuation (deprescribing) when no longer necessary. This Review is aimed at serving as a resource for achieving optimal drug stewardship for patients with CKD. We describe special considerations for medication use during pregnancy and lactation, during acute illness and in patients with cancer, as well as guidance for the responsible use of over-the-counter drugs, herbal remedies, supplements and sick-day rules. We also highlight inequities in medication access worldwide and suggest policies to improve access to quality and essential medications for all persons with CKD. Further strategies to promote drug stewardship include patient education and engagement, the use of digital health tools, shared decision-making and collaboration within interdisciplinary teams. Throughout, we position the person with CKD at the centre of all drug stewardship efforts.
Collapse
Affiliation(s)
- Rasheeda K Hall
- Division of Nephrology, Department of Medicine, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | | | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, and Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
| |
Collapse
|
2
|
Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
|
3
|
Levin A, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Robinson KA, Wilson L, Wilson RF, Kasiske BL, Cheung M, Earley A, Stevens PE. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. Kidney Int 2024; 105:684-701. [PMID: 38519239 DOI: 10.1016/j.kint.2023.10.016] [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: 10/11/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 03/24/2024]
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) updates the KDIGO 2012 guideline and has been developed with patient partners, clinicians, and researchers around the world, using robust methodology. This update, based on a substantially broader base of evidence than has previously been available, reflects an exciting time in nephrology. New therapies and strategies have been tested in large and diverse populations that help to inform care; however, this guideline is not intended for people receiving dialysis nor those who have a kidney transplant. The document is sensitive to international considerations, CKD across the lifespan, and discusses special considerations in implementation. The scope includes chapters dedicated to the evaluation and risk assessment of people with CKD, management to delay CKD progression and its complications, medication management and drug stewardship in CKD, and optimal models of CKD care. Treatment approaches and actionable guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations which followed the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. The limitations of the evidence are discussed. The guideline also provides practice points, which serve to direct clinical care or activities for which a systematic review was not conducted, and it includes useful infographics and describes an important research agenda for the future. It targets a broad audience of people with CKD and their healthcare, while being mindful of implications for policy and payment.
Collapse
Affiliation(s)
- Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sofia B Ahmed
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bethany Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Anna Francis
- Department of Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rasheeda K Hall
- Division of Nephrology, Duke School of Medicine, Durham, North Carolina, USA
| | - Will G Herrington
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Edmund Lamb
- Department of Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Peter Lin
- Director of Primary Care Initiatives, Canadian Heart Research Center, Toronto, Ontario, Canada
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chavéz, Mexico City, Mexico
| | - Natasha McIntyre
- London Health Sciences Centre-Victoria Hospital, Western University, London, Ontario, Canada
| | - Kelly Morrow
- Department of Nutrition and Exercise Science, Bastyr University, Kenmore, Washington, USA; Osher Center for Integrative Medicine, University of Washington, Kenmore, Washington, USA
| | - Glenda Roberts
- UW Center for Dialysis Innovation & Kidney Research Institute, Seattle, Washington, USA
| | | | - Elke Schaeffner
- Division of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Shlipak
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rukshana Shroff
- Department of Paediatric Nephrology, UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Navdeep Tangri
- Division of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ifeoma Ulasi
- Department of Medicine, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
| | - Germaine Wong
- Western Renal Service, University of Sydney, Sydney, New South Wales, Australia
| | - Chih-Wei Yang
- Division of Nephrology, Chang Gung University, Taoyuan, Taiwan
| | - Luxia Zhang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Karen A Robinson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Renee F Wilson
- The Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bertram L Kasiske
- Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Paul E Stevens
- Department of Nephrology, Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK.
| |
Collapse
|
4
|
Kazancıoğlu R, Öztürk S, Turgutalp K, Gürsu M, Arıcı M, Oruç A, Ahbap E, Bek SG, Şengül E, Öğütmen MB, Genek DG, Aylı MD, Ayar Y, Onan E, Karadağ S, Aşıcıoğlu E, Yazıcı H, Altıparmak MR, Tokgöz B, Odabaş AR, Tonbul HZ, Sezer S, Yıldız A, Ateş K. COVID-19 Infection in Peritoneal Dialysis Patients: A Comparative Outcome Study with Patients on Hemodialysis and Patients without Kidney Disease. Turk J Nephrol 2022. [DOI: 10.5152/turkjnephrol.2021.21045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
5
|
Aytaş G, Kazancıoğlu R, Elçioğlu ÖC, Gürsu M, Artan AS, Yabacı A, Soysal P, Bilgi K, Özçelik S. Comparative Evaluation of Orthostatic Hypotension in Patients with Diabetic Nephropathy. Kidney Blood Press Res 2021; 46:574-580. [PMID: 34284392 DOI: 10.1159/000517316] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Orthostatic hypotension (OH) affects 5-20% of the population. Our study investigates the presence of OH in diabetic nephropathy (DNP) patients and the factors affecting OH in comparison with nondiabetic chronic kidney disease (NDCKD) patients. METHOD Patients presented to the nephrology clinic, and those who consented were included in the study. DNP was defined by kidney biopsy and/or clinical criteria. NDCKD patients of the same sex, age, and eGFR were matched to DNP patients. Demographic parameters and medications were obtained from the records. OH was determined by Mayo clinic criteria. The same researcher used an electronic device to measure blood pressure (BP). All samples were taken and analyzed the same day for biochemical and hematologic parameters and albuminuria. RESULTS 112 (51 F, 61 M, mean age: 62.56 ± 9.35 years) DNP and 94 (40 F, 54 M, mean age: 62.23 ± 10.08 years) NDCKD patients were included. There was no significant difference between DNP and NDCKD groups in terms of OH prevalence (70.5 vs. 61.7%, p = 0.181). Male patients had significantly higher OH prevalence than female patients (74.7 vs. 60.0%, p = 0.026). There was no significant difference in change in systolic BP between the groups (24.00 [10.00-32.00] mm Hg vs. 24.00 [13.75-30.25] mm Hg, p = 0.797), but the change in diastolic BP was significantly higher in the DNP group (8.00 [2.00-13.00] mm Hg vs. 6.00 [2.00-9.00] mm Hg, p = 0.025). In the DNP group, patients with OH had significantly higher uric acid levels than those without OH (7.18 ± 1.55 vs. 6.36 ± 1.65 mg/dL, p = 0.017). And, 73.7% of patients on calcium channel blockers developed OH (p = 0.015), and OH developed in 80.6% of 36 patients on alpha-blockers (p = 0.049). CONCLUSION OH prevalence is very high in CKD, and etiology of CKD does not have a statistically significant effect on the frequency of OH, despite a difference that could be meaningful clinically. Therefore, patients with CKD are checked for OH, with or without concurrent diabetes mellitus. Evaluation of postural BP changes should be a part of nephrology practice.
Collapse
Affiliation(s)
- Gamze Aytaş
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Rümeyza Kazancıoğlu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ömer C Elçioğlu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Meltem Gürsu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - A Serra Artan
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayşegül Yabacı
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Pinar Soysal
- Department of Geriatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Kadir Bilgi
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Semra Özçelik
- Department of Medical Education, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
6
|
Sozio SM, Kazancıoğlu R, Küçükdurmaz F, Koç MM, Arici DS, DiBiase RM, Greene JA, Beach MC. Transforming a U.S. scholarly concentrations program internationally: lessons learned. BMC Med Educ 2019; 19:115. [PMID: 31023300 PMCID: PMC6485131 DOI: 10.1186/s12909-019-1545-7] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Scholarly Concentrations programs in U.S. medical schools aim to instill passion for critical thinking and promote careers in academic medicine. The rise of these programs has seen variable goals, structure, and outcomes. Transformation of these programs internationally is in its infancy. METHODS We describe implementation of the Johns Hopkins School of Medicine Scholarly Concentrations program, offering Basic Science, Clinical Science, Medical Ethics/Healing Arts, History of Medicine, and Public Health/Community Service, at Bezmiâlem Vakif University in Istanbul, Turkey. Over six modules in the preclinical years, students develop a faculty-mentored experience which encourages the acquisition of attitudes and skills for self-directed, lifelong learning and scholarship. This culminates in abstract and project presentation. We report program characteristics (context and logistics) and outcomes (student engagement and experiences). RESULTS The Scholarly Concentrations program at Bezmiâlem began in 2014, with nearly two completed cohorts of students. In comparison to Johns Hopkins, students at Bezmiâlem begin at an earlier age (thus do not have as much prior research experience) and are subsequently evaluated for residency in terms of test scores rather than scholarship and publications, but have a similar level of intellectual curiosity and desire to take ownership of their project. Eighty-two percent of Bezmiâlem students stated the project they pursued was either their own idea or was an idea they formed after meeting with their mentor. Students at Bezmialem were more likely to choose Clinical Science projects (p = 0.009). Only 5% of Bezmiâlem students in end-of-course survey felt dissatisfied with the level of ownership they experienced with their project, a frequency similar to that seen by Johns Hopkins students (2%). CONCLUSIONS Scholarly Concentrations programs play an important role in U.S. medical schools, and these programs can be successfully implemented internationally. The Scholarly Concentrations program at Johns Hopkins has been transformed to a program at Bezmiâlem in Istanbul, the first program outside North America or the European Union. When designing these programs, one must consider the context, logistics, student engagement, and outcomes. While long-term outcomes are needed, this can serve as a model for implementation elsewhere.
Collapse
Affiliation(s)
- Stephen M. Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 301 Mason Lord Dr, Suite 2500, Baltimore, MD 21224 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD USA
| | | | - Fatih Küçükdurmaz
- Department of Orthopedics and Traumatology, Marmara University, Istanbul, Turkey
| | | | | | - Rebecca M. DiBiase
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 301 Mason Lord Dr, Suite 2500, Baltimore, MD 21224 USA
| | - Jeremy A. Greene
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 301 Mason Lord Dr, Suite 2500, Baltimore, MD 21224 USA
- Department of History of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Mary Catherine Beach
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, 301 Mason Lord Dr, Suite 2500, Baltimore, MD 21224 USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD USA
- Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| |
Collapse
|
7
|
Gürsu M, Uzun S, Kazancıoğlu R, Öztürk S. Acute Kidney Injury and Chronic Kidney Disease: A Bidirectional Road. Haseki 2017. [DOI: 10.4274/haseki.3527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
8
|
Üstündağ S, Doğan E, Duranay M, Kazancıoğlu R, Çelik V, Ünsal A, Altıntepe L, Dursun B, Akbaş E, Özdener F, Yıldız A. Subcutaneous C.E.R.A. for the Treatment of Chronic Renal Anemia in Predialysis Patients. Balkan Med J 2016; 33:322-30. [PMID: 27308077 DOI: 10.5152/balkanmedj.2016.141173] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We investigated the efficacy, safety and tolerability of once-monthly administration of C.E.R.A. in erythropoiesis stimulating agents (ESAs) naive predialysis patients with CKD for anemia treatment. STUDY DESIGN Single arm, open label study. METHODS A total of 75 patients (mean (SD) age was 52.8 (16.4) years, 76.0% were female) were included in this study conducted between 12 August 2008 and 30 October 2009 in 9 centers across Turkey. The mean change in Hb concentration (g/dL) between baseline (week 0) and the efficacy evaluation period (EEP) was the primary efficacy parameter evaluated in three consecutive periods including a dose titration period (DTP; with initial 1.2 μg/kg dose of C.E.R.A., subcutaneously, 28 weeks), EEP (8 weeks) and a long-term safety period (16 weeks). RESULTS Our analysis revealed an improvement in Hb levels from baseline value of 9.4 (0.4) g/dL to time adjusted average level of 11.4 (0.7) g/dL in EEP in the per protocol (PP) population and from 9.3 (0.5) g/dL to 11.1 (1.0) g/dL in intent-to-treat (ITT) population. Mean (SD) change in Hb levels from baseline to EEP was 2.0 (0.7) g/dl in the PP population (primary endpoint) and 1.7 (1.1) g/dL in the ITT population. The percentage of patients whose Hb concentrations remained within the target range of 10.0-12.0 g/dL throughout the EEP was 43.9% (95% CI: 28.5-60.3%) in the PP population and 38.7% (95% CI: 27.6% to 50.6%) in the ITP population. A total of 206 adverse events (AE) were reported in 77.0% of patients with hypertension (20%) as the most frequent AE. CONCLUSION Once-monthly subcutaneous C.E.R.A. administration is effective and safe in the treatment of anemia in pre-dialysis patients with CKD, who are not currently treated with ESAs.
Collapse
Affiliation(s)
- Sedat Üstündağ
- Department of Internal Medicine, Division of Nephrology, Trakya University School of Medicine, Edirne, Turkey
| | - Ekrem Doğan
- Selahaddin Eyyubi University Faculty of Health Sciences, Diyarbakır, Turkey
| | - Murat Duranay
- Clinic of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Rümeyza Kazancıoğlu
- Clinic of Nephrology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Vedat Çelik
- Clinic of Nephrology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Abdülkadir Ünsal
- Clinic of Nephrology, Sişli Etfal Training and Research Hospital, İstanbul, Turkey
| | | | - Belda Dursun
- Department of Internal Medicine, Division of Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | | | | | - Alaattin Yıldız
- Department of Internal Medicine, Division of Nephrology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| |
Collapse
|
9
|
Öztürk S, Gündoğdu YP, Gürsu M, Yamak M, Özkan O, Şar F, Yenigün M, Kazancıoğlu R. Use of Herbal Products in Type 2 Diabetic Patients. Haseki 2015. [DOI: 10.4274/haseki.2295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
10
|
Tatlı E, Gürsu M, Aydın Z, Uzun S, Karadağ S, Cebeci E, Pehlivanoğlu F, Savaş Ö, Kazancıoğlu R. Peritonitis due to Candida Guilliermondii in a Patient on Continuous Ambulatory Peritoneal Dialysis. Haseki 2015. [DOI: 10.4274/haseki.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
11
|
Özkan O, Öztürk S, Karadağ S, Gürsu M, Şumnu A, Cebeci E, Sevim Y, Uzun S, Aydın Z, Kazancıoğlu R. The Factors Effective on Bone Mineral Density in
Peritoneal Dialysis Patients. Electron J Gen Med 2013. [DOI: 10.29333/ejgm/82214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Karadağ S, Gürsu M, Öztürk S, Gürdal A, Basınoğlu F, Aydın Z, Uzun S, Şumnu A, Atalay E, Oflaz H, Kazancıoğlu R. Periton Diyalizi Hastalarında Yeni Bir Endotel Fonksiyonu Belirteci: Apelin. Haseki 2013. [DOI: 10.4274/haseki.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|