Ebscohost | 121855935 | Microalbuminuria; Comparison Of Losartan Potassium And Lisinopril In Treatment Of Patients With Type Ii Diabetes Mellitus.
MICROALBUMINURIA; COMPARISON OF LOSARTAN POTASSIUM AND LISINOPRIL IN TREATMENT OF PATIENTS WITH TYPE II DIABETES MELLITUS. Source: Professional Medical Journal . 2017, Vol. 24 Issue 2, p221-227. 7p. 3 Diagrams, 3 Charts. Author(s): Sandhu, Ghazanfar Ali; Tahir, Ghulam Abbas; Ahmad, Zaheer; Anjum, Aqeel Maqsood Abstract: Diabetes Mellitus is a rapidly increasing problem which is contributing to chronic illnesses like Cerebrovascular, Cardiovascular, Diabetic Retinopathy and End Stage Kidney Disease. These dreaded complications can be prevented if treated early. In patients with diabetes mellitus type 2, microalbuminuria is an independent and strong risk factor for cardiovascular mortality & morbidity and diabetic nephropathy. If diagnosed early, diabetic nephropathy can be treated at this stage. Angiotensin converting enzyme inhibitors (ACE Inhibitors) and Angiotensin Receptor Blockers (ARBs) are effective in prevention and treatment of microalbuminuria. Material & Methods: Study Design: randomized controlled trial. Setting: medical department, allied hospital, Faisalabad. Duration of study: Feb 2013 to July 2013. Sample size: 60 (30 in each group). Sampling technique: Non-probability consecutive sampling. Results: 60 patients were included in the study. 28(46.7%) were males and 32(53.3%) were females. Mean age of study population was 50.157.27 years. Albumin creatinine ratio (mcg/mg) at start of study was 19367.5 in Losartan potassium group and 209.572.00 in lisinopril group (independent sample t-test p value=0.302). Albumin creatinine ratio (mcg/ mg) at 12 weeks of study was 36.3354.68 in Losartan potassium group and 7283.42 in lisinopril group (independent sample t-test p value = 0.056). Paired sample t test applied to both treatment groups and p value was fo Continue reading >>
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Protecting Your Kidneys
Diabetic nephropathy (kidney disease) is the leading cause of kidney failure in the United States. That’s the bad news. The good news is that the outlook for protecting your kidneys has gotten much brighter over the past decade or so. There are now a number of measures you can take that have been scientifically proven to protect your kidneys and lower the risk of developing diabetes-related kidney disease. Here’s what the research shows. When good kidneys go bad Your kidneys, which are each about the size of your fist, are located near the middle of your back, just below the rib cage. By no coincidence, they are shaped like kidney beans. One of their jobs is to filter waste products and extra water from the bloodstream. This waste and excess water, in the form of urine, flow through tubes called ureters and into the bladder. The bladder stores urine until it is full enough to create the urge to urinate. How does this filtering process work? Each kidney is made up of about one million tiny filtering units called nephrons. Tiny blood vessels called arterioles deliver blood to the nephrons. Within each nephron, the blood vessels form a complex called a glomerulus. It is within these glomeruli that the filtering activity actually takes place. The filtered blood leaves through another arteriole and is eventually carried back to the heart. Meanwhile, the material filtered from the blood passes through a tubule, where it is converted to urine, and then carried to the bladder through the ureters. (See “The Function of a Kidney” for more information about kidney anatomy.) Diabetes sets the stage for kidney damage. Chronic high blood glucose levels, often in combination with high blood pressure, damage the glomeruli and progressively diminish kidney function. (High blood Continue reading >>
Other Dangerous Drugs For People With Diabetes
A major problem with all drugs is that busy doctors often ignore potentially damaging drug side effects. Often they aren't even aware that these side effects are listed in the drug's official FDA-required label (called the "Prescribing Information" online.). That is because most doctors get their information about drugs from reps sent out by pharmaceutical companies or doctors who are well-compensated by these companies to promote the latest, most expensive drugs to their peers. Unfortunately, all the major drug companies have a long record of suppressing information about damaging side effects of all their drugs. Periodically, one of these drugs will kill or injure enough people that it comes to the attention of the FDA and the media. Even then, the FDA will usually only post an "alert" and will allow the drug to continue to be sold. Busy doctors apparently don't read these alerts, as they continue to prescribe drugs that have generated serious alerts in quantities that result in billions of dollars of drug company revenue each year. Proof that doctors are woefully ignorant of the side effects of even the most heavily prescribed drugs was provided by this study: Physician Response to Patient Reports of Adverse Drug Effects: Implications For Patient-Targeted Adverse Effect Surveillance.Golomb, Beatrice A, et al. Drug Safety. 30(8):669-675, 2007. TIt was a study of a group of patients prescribed a statin drug that verified that doctors ignore patients' reports of even the most significant side effects. As reported, it found that Eighty-seven percent of patients reportedly spoke to their physician about the possible connection between statin use and their symptom....Physicians were reportedly more likely to deny than affirm the possibility of a connection. Rejection of a Continue reading >>
Ace Inhibitors And Protection Against Kidney Disease Progression In Patients With Type 2 Diabetes: What's The Evidence?
ACE Inhibitors and Type 2 Diabetic Nephropathy How strong is the evidence that ACE inhibitors provide renal protection in patients with type 2 diabetes? Only a few, large-scale, randomized, well-controlled, multicenter studies have investigated whether ACE inhibitors delay the progression of renal disease in patients with type 2 diabetes,[ 6 , 10 ] and none of these studies have produced conclusive evidence of improvement in hard clinical end points ( Table ). Additionally, results from two smaller studies, that were placebo controlled and performed by the same group, demonstrated slowing in the rate of nephropathy progression from type 2 diabetes, but are inconclusive for ESRD development since they did not measure time to dialysis.[ 5 , 11 ] The following discussion categorizes these studies into those that demonstrated either positive or neutral findings compared with a control group. Positive Findings for ACE Inhibitors in Type 2 Diabetes. In a 7-year follow-up study of 94 normotensive patients with type 2 diabetes and microalbuminuria, Ravid et al.[ 5 ] showed that patients treated with enalapril maintained stable kidney function, expressed as reciprocal creatinine values, whereas kidney function in patients treated with placebo declined by 13%. Differences between the two treatment groups were significant from 2 years through the end of the study.[ 5 ] Similarly, in a study of 121 hypertensive patients with type 2 diabetes, Lebovitz et al.[ 7 ] showed that the rate of decline in GFR was significantly less in patients treated with enalapril compared with that in patients treated with conventional antihypertensive therapy (excluding ACE inhibitors).[ 7 ] However, the positive effect of enalapril on loss of GFR was seen only in patients with microalbuminuria (i.e., Continue reading >>
Nkf Kdoqi Guidelines
KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease GUIDELINE 3: MANAGEMENT OF HYPERTENSION IN DIABETES AND CHRONIC KIDNEY DISEASE Most people with diabetes and CKD have hypertension. Treatment of hypertension slows the progression of CKD. 3.1 Hypertensive people with diabetes and CKD stages 1-4 should be treated with an ACE inhibitor or an ARB, usually in combination with a diuretic. (A) 3.2 Target blood pressure in diabetes and CKD stages 1-4 should be < 130/80 mm Hg. (B) BACKGROUND The natural history of DKD is characterized by hypertension, along with increasing albuminuria and decreasing GFR. In both type 1 and type 2 diabetes, the natural history is similar, with the exception that onset of hypertension and vascular disease is earlier in the course of kidney disease in type 2 diabetes.147, 148 A large number of epidemiological studies and controlled trials have defined hypertension as a risk factor for progression of DKD, and antihypertensive treatment reduces this risk.3 The purpose of this guideline is to provide a focused update of the diabetes and CKD section of the NKF-KDOQI™ CPGs on Hypertension and Antihypertensive Agents in CKD.5 The rapidly emerging literature in this field was reviewed to update the guidelines. A major difference in the present guideline is that the recommendation for ACE-inhibitor or ARB treatment in normotensive people with diabetes and microalbuminuria or macroalbuminuria was placed in CPR 1. This change was made because very few normotensive patients were included in existing studies and data are limited primarily to surrogate outcomes (albuminuria/proteinuria). Studies in which albuminuria reduction by RAS inhibition was a specified outcome also were reviewed. Because th Continue reading >>
Diabetic Nephropathy - Treatment Overview
Diabetic nephropathy is treated with medicines that lower blood pressure and protect the kidneys. These medicines may slow down kidney damage and are started as soon as any amount of protein is found in the urine. The use of these medicines before nephropathy occurs may also help prevent nephropathy in people who have normal blood pressure. If you have high blood pressure, two or more medicines may be needed to lower your blood pressure enough to protect the kidneys. Medicines are added one at a time as needed. If you take other medicines, avoid ones that damage or stress the kidneys, especially nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. It is also important to keep your blood sugar within your target range. Maintaining blood sugar levels within your target range prevents damage to the small blood vessels in the kidneys. Limiting the amount of salt in your diet can help keep your high blood pressure from getting worse. You may also want to restrict the amount of protein in your diet. If diabetes has affected your kidneys, limiting how much protein you eat may help you preserve kidney function. Talk to your doctor or dietitian about how much protein is best for you. Initial treatment Medicines that are used to treat diabetic nephropathy are also used to control blood pressure. If you have a very small amount of protein in your urine, these medicines may reverse the kidney damage. Medicines used for initial treatment of diabetic nephropathy include: Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, enalapril, lisinopril, and ramipril. ACE inhibitors can lower the amount of protein being lost in the urine. Also, they may reduce your risk of heart and blood vessel (cardiovascular) disease. If you also have high blo Continue reading >>
Do Ace Inhibitors Prevent Nephropathy In Type 2 Diabetes Without Proteinuria?
Angiotensin-converting enzyme (ACE) inhibitors make a significant difference for patients with diabetes as a whole. If patients both with and without microalbuminuria are included together, ACE inhibitors significantly reduce the progression of the albumin excretion rate (strength of recommendation [SOR]: A, based on multiple randomized controlled trials) and the development of overt nephropathy (SOR: A, based on 1 randomized controlled trial). However, studying diabetes without microalbuminuria separately, the effect of ACE inhibitors on progression to nephropathy does not reach statistical significance. This applies to both type 1 and 2 diabetes (SOR: A, based on randomized controlled trials with heterogenous results). Results are contradictory regarding whether ACE inhibition delays new onset of diabetic microalbuminuria. There are 3 prospective randomized controlled trials studying the effect of ACE inhibitors on albumin excretion for patients with diabetes who do not have microalbuminuria. A 2-year randomized controlled trial compared lisinopril (Prinivil; Zestril) 10 mg/d with placebo in 530 normotensive adults (aged 20–59 years) with insulin-dependent diabetes, defined as those diagnosed with diabetes before age 36 and using continuous insulin therapy within 1 year of diagnosis. At the beginning of the study, 90 patients had microalbuminuria—defined as an albumin excretion rate (AER) >29 mg/24 hr—and 440 patients did not. When the results for all patients who had and did not have microalbuminuria were combined, there was a significantly smaller rise in the AER for the lisinopril group vs the placebo group (3.2 mg/24 hr lower; P=.03). However, for the patients without initial microalbuminuria, the reduction in the rise of AER with lisinopril was not signific Continue reading >>
Controlling Hypertension In Patients With Diabetes
Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Nearly one in four adults in the United States has hypertension, and more than 10 million adults have diabetes.1 Moreover, hypertension is twice as common in persons with diabetes as it is in others.2 Obesity may be a common link between the two disorders, but other factors such as insulin resistance3 and autonomic dysfunction4 may also be involved. Excess weight with truncal obesity, hypertension, impaired glucose tolerance, insulin resistance, and dyslipidemia are among the components of the metabolic syndrome, which has been associated with an increased risk of coronary heart disease.5 In general, only 25 percent of patients with hypertension have adequate control of their blood pressure.6 Blood pressure goals are lower, and thus more difficult to achieve, in patients who also have diabetes. Elevated blood pressure is known to contribute to diabetic microvascular and macrovascular complications (Table 1).4,7,8 Fortunately, reductions in blood pressure can decrease the risk of these complications.8 TABLE 1 Microvascular complications Renal d Continue reading >>
Lisinopril. A Review Of Its Pharmacology And Use In The Management Of The Complications Of Diabetes Mellitus.
Lisinopril. A review of its pharmacology and use in the management of the complications of diabetes mellitus. Adis International Limited, Auckland, New Zealand. [email protected] Lisinopril, like other ACE inhibitors, lowers blood pressure and preserves renal function in hypertensive patients with non-insulin-dependent or insulin-dependent diabetes mellitus (NIDDM or IDDM) and early or overt nephropathy, without adversely affecting glycaemic control or lipid profiles. On available evidence, renoprotective effects appear to be greater with lisinopril than with comparator calcium channel blockers, diuretics and beta-blockers, despite similar antihypertensive efficacy. As shown by the EUCLID (EUrodiab Controlled trial of Lisinopril in Insulin-Dependent Diabetes) trial, lisinopril is also renoprotective in normotensive patients with IDDM and microalbuminuria. The effect in normotensive patients with normoalbuminuria was smaller than in those with microalbuminuria, and no conclusions can yet be made about its use in patients with normoalbuminuria. In complications other than nephropathy, lisinopril has shown some benefit. Progression to retinopathy was slowed during 2 years' lisinopril therapy in the EUCLID study. Although not yet fully published, these results provide the most convincing evidence to date for an effect of an ACE inhibitor in retinopathy. The drug may also improve neurological function, but this finding is preliminary. Lastly, post hoc analysis of the GISSI-3 trial indicates that lisinopril reduces 6-week mortality rates in diabetic patients when begun as early treatment after an acute myocardial infarction. The tolerability profile of lisinopril is typical of ACE inhibitors and appears to be similar in diabetic and nondiabetic individuals. Hypoglycaemia has Continue reading >>
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Prevention And Treatment Of Diabetic Renal Disease In Type 2 Diabetes: The Benedict Study
Abstract Diabetic nephropathy (DN) is the leading cause of end-stage renal failure in Western countries and carries an increased risk for cardiovascular mortality. Studies have identified a number of factors that play a part in the development of DN. Among them, hypertension and proteinuria are the most important. In the early stages of DN, when albumin is present in the urine in very low quantities (microalbuminuria) and an increase is seen in BP, there is no loss of filtrate and patients respond well to prophylactic measures. Microalbuminuria is considered an early marker of DN. Prevention of the onset of microalbuminuria, therefore, could be considered as the primary means of preventing DN. The Bergamo Nephrologic Diabetes Complication Trial (BENEDICT) was a prospective, randomized, double-blind, parallel-group study that was organized in two phases. Phase A included 1204 patients and was aimed at assessing the efficacy of the angiotensin-converting enzyme (ACE) inhibitor trandolapril, the non-dihydropyridine calcium channel blocker verapamil, and the trandolapril plus verapamil combination as compared with placebo in prevention of microalbuminuria in hypertensive patients with type 2 diabetes and normal urinary albumin excretion rate. Phase B was aimed at assessing the efficacy of the combination as compared with trandolapril alone in prevention of macroalbuminuria in patients with microalbuminuria. The BENEDICT Phase A study showed that DN can be prevented by ACE inhibitor therapy. The beneficial effect of ACE inhibition is not enhanced by combined non-dihydropyridine calcium channel blocker therapy. The apparent advantage of ACE inhibitors over other agents includes a protective effect on the kidney against the development of microalbuminuria, which is a major ris Continue reading >>
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Generic Name: Lisinopril Tablets (lyse IN oh pril) Brand Name: Prinivil, Zestril Warning Do not take if you are pregnant. Use during pregnancy may cause birth defects or loss of the unborn baby. If you get pregnant or plan on getting pregnant while taking this medicine (lisinopril tablets), call your doctor right away. Uses of Lisinopril Tablets: It is used to treat high blood pressure. It is used to help heart function after a heart attack. It is used to treat heart failure (weak heart). It may be given to you for other reasons. Talk with the doctor. What do I need to tell my doctor BEFORE I take Lisinopril Tablets? For all patients taking this medicine: If you have an allergy to lisinopril or any other part of this medicine (lisinopril tablets). If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs. If you have ever had a very bad or life-threatening reaction called angioedema. Signs may be swelling of the hands, face, lips, eyes, tongue, or throat; trouble breathing; trouble swallowing; unusual hoarseness. If you are taking a drug that has aliskiren in it and you also have high blood sugar (diabetes) or kidney problems. Check with your doctor or pharmacist if you are not sure if a drug you take has aliskiren in it. If you have taken a drug that has sacubitril in it in the last 36 hours. If you are breast-feeding. Do not breast-feed while you take this medicine. Children: If your child has kidney disease. If your child is younger than 6 years of age. Do not give this medicine (lisinopril tablets) to a child younger than 6 years of age. This is not Continue reading >>
Treatment Of Hypertension In Patients With Diabetes
Seven-year incidence of cardiovascular risk in type 2 diabetes mellitus. CVD indicates cardiovascular disease; MI, myocardial infarction. Adapted from Haffner et al. 6 Angiotensin IIgenerated reactive oxygen (O2) species and Rho-kinase (ROK) activation in impaired glucose utilization in skeletal muscle. Akt indicates protein kinase C; AT1-R, angiotensin type-1 receptor; GLUT4, glucose transporter 4; IRS, insulin receptor substrate; NADPH, nicotinamide adenine dinucleotide phosphate; NO, nitric oxide; NOS, nitric oxide synthase; ONOO, peroxynitrite; PH, pleckstrin homology domain; P13-K, phosphatidylinositol-3-kinase. Reprinted with permission from the American Physiological Society. 20 United Kingdom Prospective Diabetes Study 38. 25 CVD indicates cardiovascular disease. Events in patients with diabetes mellitus at baseline in relation to tight diastolic pressure control (HOT Trial). 26 CV indicates cardiovascular; MI, myocardial infarction. Treatment algorithm: antihypertensive therapy in the patient with diabetes. In patients with a creatinine level of 1.8 mg/dL or greater (159.1 mol/L), thiazide diuretics are not effective and loop diuretics may be substituted. ARBs indicates angiotensin receptor blockers; ACE, angiotensin-converting enzyme; MI, myocardial infarction. Mechanism of Insulin Resistance in Hypertension Cardiovascular Disease Risk Factors Associated With Cardiometabolic Syndrome Continue reading >>
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Definition and Causes Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality. Prevalence and Risk Factors Diabetes has become the primary cause of end-stage renal disease (ESRD) in the United States, and the incidence of type 2 diabetes mellitus continues to grow in the United States and worldwide. Approximately 44% of new patients entering dialysis in the United States are diabetics. Early diagnosis of diabetes and early intervention are critical in preventing the normal progression to renal failure seen in many type 1 and a significant percentage of type 2 diabetics. In the United States, approximately 20.8 million people, or 7.0% of the population, are estimated to have diabetes, with a growing incidence. Roughly one third of this population, 6.2 million, is estimated to be undiagnosed with type 2 diabetes. The prevalence of diabetes is higher in certain racial and ethnic groups, affecting approximately 13% of African Americans, 9.5% of Hispanics, and 15% of Native Americans, primarily with type 2 diabetes.1, 2 Approximately 20% to 30% of all diabetics will develop evidence of nephropathy, although a higher percentage of type 1 patients progress to ESRD. Pathophysiology and Natural History The common progression from microalbuminuria to overt nephropathy has led many to consider microalbuminuria to define early or incipient Continue reading >>
Management Of Hypertension In Patients With Diabetes Mellitus: Defining The Role Of Lisinopril
Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) 80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP 90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or conventional antihypertensive therapy (thiazide diuretics Continue reading >>
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A Pharmacodynamic/pharmacokinetic Study Of Aleglitazar In Patients With Type 2 Diabetes Mellitus On Treatment With Lisinopril
You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. A Pharmacodynamic/Pharmacokinetic Study of Aleglitazar in Patients With Type 2 Diabetes Mellitus on Treatment With Lisinopril The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT01398267 Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information This randomized, double-blind, placebo-controlled, parallel-group study will evaluate the effect of aleglitazar on renal function, the renin-angiotensin system and the pharmacokinetics of lisinopril in patients with type 2 diabetes mellitus treated with lisinopril. Patients on a stable dose of lisinopril (20 mg daily orally) for 2 weeks will be randomized to receive either aleglitazar (150 mcg orally daily) or placebo in addition to lisinopril for 4 weeks. Drug: aleglitazar Drug: lisinopril Drug: placebo A Randomized, Double-blind, Placebo-controlled, Parallel Group Study to Investigate the Effects of Aleglitazar 150 g in Type 2 Diabetic Patients Treated With Lisinopril 20 mg on Renal Function, the Renin-angiotensin System and the Pharmacokinetics of Lisinopril 150 mcg orally daily, 4 weeks (Day 15 to Day 43) 20 mg orally daily, 6 weeks (Day 1 to Day 43) 20 mg orally daily, 6 weeks (Day 1 to Day 43) aleglitazar matching placebo orally daily, 4 weeks (Day 15 to Day 43) Glomerular filtration rate (mGFR), measured as iohexol clearance [TimeFrame:4 weeks] Estimated glomerular filtration rate, using Continue reading >>
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