Category Archives: Nephrol Dial Transplant

Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.

Related Articles

Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.

Nephrol Dial Transplant. 2017 Apr 10;:

Authors: van der Plas WY, Dulfer RR, Engelsman AF, Vogt L, de Borst MH, van Ginhoven TM, Kruijff S, Dutch Hyperparathryoid Study Group (DHSG)

Abstract
Background.: Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a systematic review to evaluate the impact of cinacalcet and PTx on QoL.
Methods.: A systematic literature search was performed using PubMed and EMBASE databases to identify relevant articles. The search was based on the following keywords: ‘parathyroidectomy’ or ‘cinacalcet’, ‘secondary hyperparathyroidism’ or ‘renal hyperparathyroidism’ combined with ‘quality of life’ or ‘SF-36’ or ‘symptomatology’. Only studies reporting on QoL at baseline and during follow-up were included. QoL scores were extracted from the selected manuscripts and weighted means were calculated. Due to a lack of available data on QoL improvement in patients using cinacalcet, a meta-analysis could not be performed.
Results.: In all, eight articles reached our inclusion criteria. Of this, five articles reported the effect of PTx on QoL. All PTx studies were observational and non-controlled. The physical component scores of the 36-item Medical Outcomes Study Short-Form Health Survey increased significantly with a weighted mean of 35.5% (P < 0.05). Mental component scores increased with 13.7% (P < 0.05). Parathyroidectomy assessment of symptom scores improved from 561 preoperatively to 302 postoperatively (-259 points; -46.2%). Visual analogue scale scores decreased significantly for skin itching (46.6%), joint pain (30.4%) and muscle weakness (28.7%) (P < 0.05). Three studies on the effect of cinacalcet on QoL were included, including one randomized controlled trial. None of these studies showed significant improvement of physical component and mental component scores.
Conclusions.: PTx improved QoL in patients treated for ESRD-related HPT, whereas cinacalcet did not. The difference in impact between PTx and cinacalcet on QoL has not been compared directly.

PMID: 28402557 [PubMed – as supplied by publisher]

Continue reading

Posted in Nephrol Dial Transplant | Tagged , | Leave a comment

Fibroblast growth factor 23 correlates with volume status in haemodialysis patients and is not reduced by haemodialysis.

Related Articles

Fibroblast growth factor 23 correlates with volume status in haemodialysis patients and is not reduced by haemodialysis.

Nephrol Dial Transplant. 2015 Nov…

Continue reading

Posted in Nephrol Dial Transplant | Tagged | Leave a comment

N-octanoyl dopamine treatment exerts renoprotective properties in acute kidney injury but not in renal allograft recipients.

Related Articles

N-octanoyl dopamine treatment exerts renoprotective properties in acute kidney injury but not in renal allograft recipients.

Nephrol Dial Transplant. 2015…

Continue reading

Posted in Nephrol Dial Transplant | Tagged | Leave a comment

Sodium restriction potentiates the renoprotective effects of combined vitamin D receptor activation and angiotensin-converting enzyme inhibition in established proteinuric nephropathy.

Related Articles

Sodium restriction potentiates the renoprotective effects of combined vitamin D receptor activation and angiotensin-converting enzyme inhibition in established proteinuric nephropathy.

Nephrol Dial Transplant. 2015 Aug 25;

Authors: Mirkovic K, Frenay AS, van den Born J, van Goor H, Navis G, de Borst MH, NIGRAM consortium

Abstract
BACKGROUND: Renin-angiotensin-aldosterone system (RAAS) blockade provides renoprotective effects in chronic kidney disease (CKD); yet progressive renal function loss remains common. Dietary sodium restriction potentiates the renoprotective effects of RAAS blockade. Vitamin D receptor activator (VDRA) treatment reduces proteinuria, inflammation and fibrosis, but whether these effects depend on sodium intake has not been studied. We hypothesized that the renoprotective effects of VDRA treatment, with or without RAAS blockade, are modulated by sodium intake.
METHODS: Six weeks after the induction of adriamycin nephrosis in Wistar rats, i.e. with established proteinuria, animals were treated with the VDRA paricalcitol, lisinopril, the combination, or vehicle; each treatment was given during either a high- (2% NaCl) or a low-sodium (0.05% NaCl) diet for 6 weeks. We assessed proteinuria, blood pressure, renal macrophage accumulation and renal expression of the pre-fibrotic marker alpha-smooth muscle actin (α-SMA) at the end of the treatment.
RESULTS: Both paricalcitol and lisinopril individually, as well as in combination, reduced proteinuria and glomerular and interstitial inflammation during a low-sodium diet, but not during a high-sodium diet. All interventions also reduced focal glomerulosclerosis and interstitial expression of α-SMA during the low-sodium diet, while similar trends were observed during the high-sodium diet. The renoprotective effects of paricalcitol were not accompanied by blood pressure reduction. As proteinuria was already abolished by lisinopril during the low-sodium diet, the addition of paricalcitol had no further effect on proteinuria or downstream inflammatory or pre-fibrotic changes.
CONCLUSION: The renoprotective effects of the VDRA paricalcitol are blood pressure independent but do depend on dietary sodium status. The combination of RAAS blockade, dietary sodium restriction and VDRA may be a promising intervention to further retard renal function loss in CKD.

PMID: 26311058 [PubMed – as supplied by publisher]

Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Drugs meeting the molecular basis of diabetic kidney disease: bridging from molecular mechanism to personalized medicine.

Related Articles
Drugs meeting the molecular basis of diabetic kidney disease: bridging from molecular mechanism to personalized medicine.
Nephrol Dial Transplant. 2015 Aug;30(suppl 4):iv105-iv112
Authors: Lambers Hee… Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Prognostic clinical and molecular biomarkers of renal disease in type 2 diabetes.

Related Articles

Prognostic clinical and molecular biomarkers of renal disease in type 2 diabetes.

Nephrol Dial Transplant. 2015 Aug;30(suppl 4):iv86-iv95

Authors: Pena MJ, de Zeeuw D, Mischak H, Jankowski J, Oberbauer R, Woloszczuk W, Benner J, Dallmann G, Mayer B, Mayer G, Rossing P, Lambers Heerspink HJ

Abstract
Diabetic kidney disease occurs in ∼25-40% of patients with type 2 diabetes. Given the high risk of progressive renal function loss and end-stage renal disease, early identification of patients with a renal risk is important. Novel biomarkers may aid in improving renal risk stratification. In this review, we first focus on the classical panel of albuminuria and estimated glomerular filtration rate as the primary clinical predictors of renal disease and then move our attention to novel biomarkers, primarily concentrating on assay-based multiple/panel biomarkers, proteomics biomarkers and metabolomics biomarkers. We focus on multiple biomarker panels since the molecular processes of renal disease progression in type 2 diabetes are heterogeneous, rendering it unlikely that a single biomarker significantly adds to clinical risk prediction. A limited number of prospective studies of multiple biomarkers address the predictive performance of novel biomarker panels in addition to the classical panel in type 2 diabetes. However, the prospective studies conducted so far have small sample sizes, are insufficiently powered and lack external validation. Adequately sized validation studies of multiple biomarker panels are thus required. There is also a paucity of studies that assess the effect of treatments on novel biomarker panels and determine whether initial treatment-induced changes in novel biomarkers predict changes in long-term renal outcomes. Such studies can not only improve our healthcare but also our understanding of the mechanisms of actions of existing and novel drugs and may yield biomarkers that can be used to monitor drug response. We conclude that this will be an area to focus research on in the future.

PMID: 26209743 [PubMed – as supplied by publisher]

Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review.

Related Articles

Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review.

Nephrol Dial Transplant. 2015 Aug;30(suppl 4):iv6-iv16

Authors: Brück K, Jager KJ, Dounousi E, Kainz A, Nitsch D, Ärnlöv J, Rothenbacher D, Browne G, Capuano V, Ferraro PM, Ferrieres J, Gambaro G, Guessous I, Hallan S, Kastarinen M, Navis G, Gonzalez AO, Palmieri L, Romundstad S, Spoto B, Stengel B, Tomson C, Tripepi G, Völzke H, Wiȩcek A, Gansevoort R, Schöttker B, Wanner C, Vinhas J, Zoccali C, Van Biesen W, Stel VS, European CKD Burden Consortium

Abstract
BACKGROUND: Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods.
METHODS: For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers.
RESULTS: We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m(2) in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval.
CONCLUSIONS: The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.

PMID: 26209739 [PubMed – as supplied by publisher]

Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Will the future lie in multitude? A critical appraisal of biomarker panel studies on prediction of diabetic kidney disease progression.

Related Articles
Will the future lie in multitude? A critical appraisal of biomarker panel studies on prediction of diabetic kidney disease progression.
Nephrol Dial Transplant. 2015 Aug;30(suppl 4):iv96-iv104
Authors:… Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Utility of the CKD273 peptide classifier in predicting chronic kidney disease progression.

Utility of the CKD273 peptide classifier in predicting chronic kidney disease progression.
Nephrol Dial Transplant. 2015 Mar 19;
Authors: Critselis E, Lambers Heerspink H
Abstract
BACKGROUND: Chronic … Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

B-cell therapy in antineutrophil cytoplasmic antibody-associated vasculitis.

B-cell therapy in antineutrophil cytoplasmic antibody-associated vasculitis.
Nephrol Dial Transplant. 2015 Mar 9;
Authors: Kallenberg CG, Hauser T
Abstract
Until recently, standard of care for patient… Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Vitamin D receptor activator and dietary sodium restriction to reduce residual urinary albumin excretion in chronic kidney disease (ViRTUE study): rationale and study protocol.

Vitamin D receptor activator and dietary sodium restriction to reduce residual urinary albumin excretion in chronic kidney disease (ViRTUE study): rationale and study protocol.

Nephrol Dial Transplant. 2015 Mar 4;

Authors: Keyzer CA, de Jong MA, Fenna van Breda G, Vervloet MG, Laverman GD, Hemmelder M, Janssen WM, Lambers Heerspink HJ, Navis G, de Borst MH, for the Holland Nephrology Study (HONEST) Network

Abstract
Optimal albuminuria reduction is considered essential to halting chronic kidney disease (CKD) progression. Both vitamin D receptor activator (VDRA) treatment and dietary sodium restriction potentiate the efficacy of renin-angiotensin-aldosterone-system (RAAS) blockade to reduce albuminuria. The ViRTUE study addresses whether a VDRA in combination with dietary sodium restriction provides further albuminuria reduction in non-diabetic CKD patients on top of RAAS blockade. The ViRTUE study is an investigator-initiated, prospective, multi-centre, randomized, double-blind (paricalcitol versus placebo), placebo-controlled trial targeting stage 1-3 CKD patients with residual albuminuria of >300 mg/day due to non-diabetic glomerular disease, despite angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. During run-in, all subjects switched to standardized RAAS blockade (ramipril 10 mg/day) and blood pressure titrated to <140/90 mmHg according to a standardized protocol. Eligible patients are subsequently enrolled and undergo four consecutive study periods in random order of 8 weeks each: (i) paricalcitol (2 µg/day) combined with a liberal sodium diet (∼200 mmol Na(+)/day, i.e. mean sodium intake in the general population), (ii) paricalcitol (2 µg/day) combined with dietary sodium restriction (target: 50 mmol Na(+)/day), (iii) placebo combined with a liberal sodium diet and (iv) placebo combined with dietary sodium restriction. Data are collected at the end of each study period. The primary outcome is 24-h urinary albumin excretion. Secondary study outcomes are blood pressure, renal function (estimated glomerular filtration rate), plasma renin activity and, in a sub-population (N = 9), renal haemodynamics (measured glomerular filtration rate and effective renal plasma flow). A sample size of 50 patients provides 90% power to detect a 23% reduction in albuminuria, assuming a 25% dropout rate. Further reduction of residual albuminuria by combination of VDRA treatment and sodium restriction during single-agent RAAS-blockade will justify long-term studies on cardiorenal outcomes and safety.
CLINICAL TRIAL REGISTRATION: NTR2898 (Dutch trial register).

PMID: 25744274 [PubMed – as supplied by publisher]

Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Maintenance therapy in antineutrophil cytoplasmic antibody-associated vasculitis: who needs what and for how long?

Maintenance therapy in antineutrophil cytoplasmic antibody-associated vasculitis: who needs what and for how long?
Nephrol Dial Transplant. 2015 Jan 20;
Authors: de Joode AA, Sanders JS, Rutgers A, Stegeman CA
Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes.

Vitamin D analogues to target residual proteinuria: potential impact on cardiorenal outcomes.
Nephrol Dial Transplant. 2015 Jan 20;
Authors: Humalda JK, Goldsmith DJ, Thadhani R, de Borst MH
Abstract
Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Baseline characteristics in the Bardoxolone methyl EvAluation in patients with Chronic kidney disease and type 2 diabetes mellitus: the Occurrence of renal eveNts (BEACON) trial.

Related Articles
Baseline characteristics in the Bardoxolone methyl EvAluation in patients with Chronic kidney disease and type 2 diabetes mellitus: the Occurrence of renal eveNts (BEACON) trial.
Nephrol Dial Transplant. 2013… Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Multicentre prospective validation of a urinary peptidome-based classifier for the diagnosis of type 2 diabetic nephropathy.

Related Articles

Multicentre prospective validation of a urinary peptidome-based classifier for the diagnosis of type 2 diabetic nephropathy.

Nephrol Dial Transplant. 2014 Aug;29(8):1563-70

Authors: Siwy J, Schanstra JP, Argiles A, Bakker SJ, Beige J, Boucek P, Brand K, Delles C, Duranton F, Fernandez-Fernandez B, Jankowski ML, Al Khatib M, Kunt T, Lajer M, Lichtinghagen R, Lindhardt M, Maahs DM, Mischak H, Mullen W, Navis G, Noutsou M, Ortiz A, Persson F, Petrie JR, Roob JM, Rossing P, Ruggenenti P, Rychlik I, Serra AL, Snell-Bergeon J, Spasovski G, Stojceva-Taneva O, Trillini M, von der Leyen H, Winklhofer-Roob BM, Zürbig P, Jankowski J

Abstract
BACKGROUND: Diabetic nephropathy (DN) is one of the major late complications of diabetes. Treatment aimed at slowing down the progression of DN is available but methods for early and definitive detection of DN progression are currently lacking. The ‘Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria trial’ (PRIORITY) aims to evaluate the early detection of DN in patients with type 2 diabetes (T2D) using a urinary proteome-based classifier (CKD273).
METHODS: In this ancillary study of the recently initiated PRIORITY trial we aimed to validate for the first time the CKD273 classifier in a multicentre (9 different institutions providing samples from 165 T2D patients) prospective setting. In addition we also investigated the influence of sample containers, age and gender on the CKD273 classifier.
RESULTS: We observed a high consistency of the CKD273 classification scores across the different centres with areas under the curves ranging from 0.95 to 1.00. The classifier was independent of age (range tested 16-89 years) and gender. Furthermore, the use of different urine storage containers did not affect the classification scores. Analysis of the distribution of the individual peptides of the classifier over the nine different centres showed that fragments of blood-derived and extracellular matrix proteins were the most consistently found.
CONCLUSION: We provide for the first time validation of this urinary proteome-based classifier in a multicentre prospective setting and show the suitability of the CKD273 classifier to be used in the PRIORITY trial.

PMID: 24589724 [PubMed – indexed for MEDLINE]

Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties.

Related Articles
Glucose-lowering drugs in patients with chronic kidney disease: a narrative review on pharmacokinetic properties.
Nephrol Dial Transplant. 2014 Jul;29(7):1284-300
Authors: Arnouts P, Bolignano D, Nis… Continue reading

Posted in Nephrol Dial Transplant | Leave a comment

A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease.

Related Articles
A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease.
Nephrol Dial Transplant. 2014 Sep;29(suppl 4):iv142-iv153
Authors: Casteleijn NF, Visser F… Continue reading

Posted in Nephrol Dial Transplant | Tagged , | Leave a comment

Building a network of ADPKD reference centres across Europe: the EuroCYST initiative.

Related Articles

Building a network of ADPKD reference centres across Europe: the EuroCYST initiative.

Nephrol Dial Transplant. 2014 Sep;29 Suppl 4:iv26-iv32

Authors: Petzold K, Gansevoort RT, Ong AC, Devuyst O, Rotar L, Eckardt KU, Köttgen A, Pirson Y, Remuzzi G, Sandford R, Tesar V, Ecder T, Chaveau D, Torra R, Budde K, Le Meur Y, Wüthrich RP, Serra AL

Abstract
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic inherited kidney disease, affecting an estimated 600 000 individuals in Europe. The disease is characterized by age-dependent development of a multiple cysts in the kidneys, ultimately leading to end-stage renal failure and the need of renal replacement therapy in the majority of patients, typically by the fifth or sixth decade of life. The variable disease course, even within the same family, remains largely unexplained. Similarly, assessing disease severity and prognosis in an individual with ADPKD remains difficult. Epidemiological studies are limited due to the fragmentation of ADPKD research in Europe.
METHODS: The EuroCYST initiative aims: (i) to harmonize and develop common standards for ADPKD research by starting a collaborative effort to build a network of ADPKD reference centres across Europe and (ii) to establish a multicentric observational cohort of ADPKD patients. This cohort will be used to study factors influencing the rate of disease progression, disease modifiers, disease stage-specific morbidity and mortality, health economic issues and to identify predictive disease progression markers. Overall, 1100 patients will be enrolled in 14 study sites across Europe. Patients will be prospectively followed for at least 3 years. Eligible patients will not have participated in a pharmaceutical clinical trial 1 year before enrolment, have clinically proven ADPKD, an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m(2) and above, and be able to provide written informed consent. The baseline visit will include a physical examination and collection of blood, urine and DNA for biomarker and genetic studies. In addition, all participants will be asked to complete questionnaires detailing self-reported health status, quality of life, socioeconomic status, health-care use and reproductive planning. All subjects will undergo annual follow-up. A magnetic resonance imaging (MRI) scan will be carried out at baseline, and patients are encouraged to undergo a second MRI at 3-year follow-up for qualitative and quantitative kidney and liver assessments.
CONCLUSIONS: The ADPKD reference centre network across Europe and the observational cohort study will enable European ADPKD researchers to gain insights into the natural history, heterogeneity and associated complications of the disease as well as how it affects the lives of patients across Europe.

PMID: 25165183 [PubMed – in process]

Continue reading

Posted in Nephrol Dial Transplant | Tagged , | Leave a comment

Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival-an analysis of data from the ERA-EDTA Registry.

Related Articles

Renal replacement therapy for autosomal dominant polycystic kidney disease (ADPKD) in Europe: prevalence and survival-an analysis of data from the ERA-EDTA Registry.

Nephrol Dial Transplant. 2014 Sep;29 Suppl 4:iv15-iv25

Authors: Spithoven EM, Kramer A, Meijer E, Orskov B, Wanner C, Abad JM, Aresté N, Alonso de la Torre R, Caskey F, Couchoud C, Finne P, Heaf J, Hoitsma A, de Meester J, Pascual J, Postorino M, Ravani P, Zurriaga O, Jager KJ, Gansevoort RT, ERA-EDTA Registry, EuroCYST Consortium, WGIKD, ERA-EDTA Registry

Abstract
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the fourth most common renal disease requiring renal replacement therapy (RRT). Still, there are few epidemiological data on the prevalence of, and survival on RRT for ADPKD.
METHODS: This study used data from the ERA-EDTA Registry on RRT prevalence and survival on RRT in 12 European countries with 208 million inhabitants. We studied four 5-year periods (1991-2010). Survival analysis was performed by the Kaplan-Meier method and by Cox proportional hazards regression.
RESULTS: From the first to the last study period, the prevalence of RRT for ADPKD increased from 56.8 to 91.1 per million population (pmp). The percentage of prevalent RRT patients with ADPKD remained fairly stable at 9.8%. Two-year survival of ADPKD patients on RRT (adjusted for age, sex and country) increased significantly from 89.0 to 92.8%, and was higher than for non-ADPKD subjects. Improved survival was noted for all RRT modalities: haemodialysis [adjusted hazard ratio for mortality during the last versus first time period 0.75 (95% confidence interval 0.61-0.91), peritoneal dialysis 0.55 (0.38-0.80) and transplantation 0.52 (0.32-0.74)]. Cardiovascular mortality as a proportion of total mortality on RRT decreased more in ADPKD patients (from 53 to 29%), than in non-ADPKD patients (from 44 to 35%). Of note, the incidence rate of RRT for ADPKD remained relatively stable at 7.6 versus 8.3 pmp from the first to the last study period, which will be discussed in detail in a separate study.
CONCLUSIONS: In ADPKD patients on RRT, survival has improved markedly, especially due to a decrease in cardiovascular mortality. This has led to a considerable increase in the number of ADPKD patients being treated with RRT.

PMID: 25165182 [PubMed – in process]

Continue reading

Posted in Nephrol Dial Transplant | Tagged , | Leave a comment

Bilateral cysts in the choroid plexus in a patient with autosomal dominant polycystic kidney disease.

Related Articles

Bilateral cysts in the choroid plexus in a patient with autosomal dominant polycystic kidney disease.

Nephrol Dial Transplant. 2014 Aug 7;

Continue reading

Posted in Nephrol Dial Transplant | Tagged | Leave a comment