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  • 1
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    Dietary Factors and Prevention: Risk of End-Stage Kidney Disease by Fruit and Vegetable Consumption
    S. Karger AG ; 2021
    In:  American Journal of Nephrology Vol. 52, No. 5 ( 2021), p. 356-367
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 52, No. 5 ( 2021), p. 356-367
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The association between fruit and vegetable (FV) intake and the risk of end-stage kidney disease (ESKD) has not been examined in the general population and fully explored in chronic kidney disease (CKD). We prospectively evaluated this relationship in US representative sample of adults and evaluated consistency by the presence or absence, and severity, of CKD. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We used data from the Third National Health and Nutrition Examination Survey (1988–1994) linked with the US Renal Data System, including 14,725 adults aged ≥20 years and with follow-up for ESKD through 2008. Daily FV intake was ascertained using a food frequency questionnaire. We examined the association between selected categories of FV intake and ESKD using a Fine Gray competing risk model adjusting for sociodemographics, lifestyle, clinical and nutritional factors, estimated glomerular filtration rate, and albuminuria. We evaluated whether risk varied in individuals with severe versus any CKD. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 230 participants (1.5%) developed ESKD during follow-up. In the adjusted model, compared to highest intake, those in lowest categories of FV intake had a higher risk of ESKD, for & #x3c;2 times/day (1.45 [1.24–1.68], 2 to & #x3c;3 times/day (1.40 [1.18–1.61]), 3 to & #x3c;4 times/day (1.25 [1.04–1.46]), and 4 to & #x3c;6 times/day (1.14 [0.97–1.31]). There was suggestion of heterogeneity ( 〈 i 〉 p 〈 /i 〉 for interaction = 0.03) with possible stronger inverse association in patients with CKD than those without CKD. After stratification, we obtained similar strong inverse association when we examined ESKD incidence across intake of FVs in participants with CKD stages 1–4 ( 〈 i 〉 n 〈 /i 〉 = 5,346) and specifically in those with CKD stages 3–4 ( 〈 i 〉 n 〈 /i 〉 = 1,084). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Low intake of FVs was associated with higher risk of ESKD in US adults with and without CKD, supporting an emerging body of literature on the potential benefits of plant-rich diets for prevention of ESKD.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000514754
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 2
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    Soluble P-Selectin Levels Are Associated with Cardiovascular Mortality and Sudden Cardiac Death in Male Dialysis Patients
    S. Karger AG ; 2011
    In:  American Journal of Nephrology Vol. 33, No. 3 ( 2011), p. 224-230
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 33, No. 3 ( 2011), p. 224-230
    Abstract: 〈 i 〉 Background/Aims: 〈 /i 〉 P-selectin is released by activated platelets and endothelium contributing to inflammation and thrombosis. We evaluated the association between soluble P-selectin and atherosclerotic cardiovascular disease (ASCVD) in dialysis patients. 〈 i 〉 Methods: 〈 /i 〉 We measured soluble P-selectin in serum from 824 incident dialysis patients. Using Cox proportional hazards models, we modeled the association of P-selectin levels with ASCVD events, cardiovascular mortality and sudden cardiac death. 〈 i 〉 Results: 〈 /i 〉 After adjustment for demographics, comorbidity and traditional cardiovascular risk factors, higher P-selectin levels were associated with increased risk of ASCVD and cardiovascular mortality among males (p = 0.02 and p = 0.01, respectively), but not females (p = 0.52 and p = 0.31, respectively; p interaction = 0.003), over a median of 38.2 months. Higher P-selectin was associated with a greater risk of sudden cardiac death among males (p = 0.05). The associations between increasing P-selectin and cardiovascular mortality as well as sudden cardiac death in males persisted after adjustment for C-reactive protein, interleukin-6, serum albumin and platelet count (p = 0.01 and p = 0.03, respectively). The risk for sudden cardiac death was more than 3 times greater for males in the highest tertile of soluble P-selectin compared with the lowest tertile after adjustment (HR: 3.19; 95% CI: 1.18 – 8.62; p = 0.02). 〈 i 〉 Conclusion: 〈 /i 〉 P-selectin is associated with ASCVD, cardiovascular mortality and sudden cardiac death among male dialysis patients.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000324517
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
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  • 3
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    Effect of Food Insecurity on Chronic Kidney Disease in Lower-Income Americans
    S. Karger AG ; 2014
    In:  American Journal of Nephrology Vol. 39, No. 1 ( 2014), p. 27-35
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 39, No. 1 ( 2014), p. 27-35
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The relation of food insecurity (inability to acquire nutritionally adequate and safe foods) and chronic kidney disease (CKD) is unknown. We examined whether food insecurity is associated with prevalent CKD among lower-income individuals in both the general US adult population and an urban population. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We conducted cross-sectional analyses of lower-income participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2008 (n = 9,126) and the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 1,239). Food insecurity was defined based on questionnaires and CKD was defined by reduced estimated glomerular filtration rate or albuminuria; adjustment was performed with multivariable logistic regression. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In NHANES, the age-adjusted prevalence of CKD was 20.3, 17.6, and 15.7% for the high, marginal, and no food insecurity groups, respectively. Analyses adjusting for sociodemographics and smoking status revealed high food insecurity to be associated with greater odds of CKD only among participants with either diabetes (OR = 1.67, 95% CI: 1.14-2.45 comparing high to no food insecurity groups) or hypertension (OR = 1.37, 95% CI: 1.03-1.82). In HANDLS, the age-adjusted CKD prevalence was 5.9 and 4.6% for those with and without food insecurity, respectively (p = 0.33). Food insecurity was associated with a trend towards greater odds of CKD (OR = 1.46, 95% CI: 0.98-2.18) with no evidence of effect modification across diabetes, hypertension, or obesity subgroups. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Food insecurity may contribute to disparities in kidney disease, especially among persons with diabetes or hypertension, and is worthy of further study.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000357595
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 4
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    Inpatient Hemodialysis Initiation: Reasons, Risk Factors and Outcomes
    S. Karger AG ; 2009
    In:  Nephron Clinical Practice Vol. 114, No. 1 ( 2009-10-9), p. c19-c28
    Details
    In: Nephron Clinical Practice, S. Karger AG, Vol. 114, No. 1 ( 2009-10-9), p. c19-c28
    Abstract: 〈 i 〉 Background/Aims: 〈 /i 〉 Inpatient initiation of chronic hemodialysis is considered undesirable because of cost and possible harms of hospitalization. We examined the patient characteristics and outcomes associated with inpatient initiation. 〈 i 〉 Methods: 〈 /i 〉 In a prospective cohort study of incident dialysis patients, the independent association of inpatient hemodialysis initiation with patient outcomes was assessed in multivariable analyses with adjustment for patient characteristics and propensity for inpatient initiation. 〈 i 〉 Results: 〈 /i 〉 A total of 410 of 652 (63%) hemodialysis patients began as inpatients; uremia and volume overload were the most commonly documented reasons. Compared to outpatients, inpatients were more likely to be unmarried, report less social support, have multiple comorbidities and be referred to a nephrologist 4 months or less prior to initiation. Inpatient initiation was protective for subsequent all-cause hospitalization (incidence rate ratio (IRR) = 0.92, confidence interval (CI) 0.89–0.94); this was most pronounced among those who had the highest propensity for inpatient initiation (IRR = 0.66, CI 0.56–0.78), including those referred late to nephrology. Similar results were found for infectious hospitalization. Mortality [hazard ratio = 1.03, CI 0.82–1.30] and cardiovascular events were not significantly different for inpatients versus outpatients. 〈 i 〉 Conclusion: 〈 /i 〉 Inpatient hemodialysis initiation has a protective association with hospitalization among those patients referred late to nephrology, with multiple comorbidities and/or little social support.
    Type of Medium: Online Resource
    ISSN: 1660-2110
    URL: Article
    DOI: 10.1159/000245066
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 2098336-0
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  • 5
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    Albuminuria Testing by Race and Ethnicity among Patients with Hypertension with and without Diabetes
    S. Karger AG ; 2019
    In:  American Journal of Nephrology Vol. 50, No. 1 ( 2019), p. 48-54
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 50, No. 1 ( 2019), p. 48-54
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Detection of chronic kidney disease (CKD) with urine albumin-to-creatinine ratio (UACR) among patients with hypertension (HTN) provides an opportunity for early treatment, potentially mitigating risk of CKD progression and cardiovascular complications. Differences in UACR testing patterns among racial/ethnic populations at risk for CKD could contribute to known disparities in CKD complications. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We examined the prevalence of UACR testing among low-income adult primary care patients with HTN, defined by a new administrative code for HTN or 2 clinic blood pressures & #x3e;140/90 mm Hg between January 1, 2014, and January 1, 2017, in one public health-care delivery system with a high prevalence of end-stage kidney disease among race/ethnic minorities. Logistic regression was used to identify odds of UACR testing within 1 year of a HTN diagnosis, overall, and by racial/ethnic subgroup, adjusted for demographic factors, estimated glomerular filtration rate, and HTN severity. Models were also stratified by diabetes status. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The cohort ( 〈 i 〉 n 〈 /i 〉 = 16,414) was racially/ethnically diverse (16% White, 21% Black, 34% Asian, 19% Hispanic, and 10% other) and 51% female. Only 35% of patients had UACR testing within 1 year of a HTN diagnosis. Among individuals without diabetes, odds of UACR testing were higher among Asians, Blacks, and Other subgroups compared to Whites (adjusted OR [aOR] 1.19; 95% CI 1.00–1.42 for Blacks; aOR 1.33; 1.13–1.56 for Asians; aOR 1.30; 1.04–1.60 for Other) but were not significantly different between Hispanics and Whites (aOR 1.17; 0.97–1.39). Among individuals with diabetes, only Asians had higher odds of UACR testing compared to Whites (aOR 1.35; 1.12–1.63). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Prevalence of UACR testing among low-income patients with HTN is low in one public health-care delivery system, with higher odds of UACR testing among racial/ethnic minority subgroups compared to Whites without diabetes and similar odds among those with diabetes. If generalizable, less albuminuria testing may not explain higher prevalence of kidney failure in racial/ethnic minorities.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000500706
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
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  • 6
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    Association of Clinic Vascular Access Monitoring Practices with Clinical Outcomes in Hemodialysis Patients
    S. Karger AG ; 2006
    In:  Nephron Clinical Practice Vol. 104, No. 4 ( 2006-8-11), p. c151-c159
    Details
    In: Nephron Clinical Practice, S. Karger AG, Vol. 104, No. 4 ( 2006-8-11), p. c151-c159
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Early identification of access dysfunctions may be associated with improved patient outcomes. We examined whether patient outcomes were associated with vascular access monitoring practices in an incident dialysis cohort. 〈 i 〉 Methods: 〈 /i 〉 We conducted a national prospective cohort study and analyzed 363 hemodialysis patients who had a first permanent vascular access (arteriovenous fistula or graft) by 6 months after the start of dialysis. Multivariate methods were used to examine associations between monitoring practices and 6-month Kt/V (reaching Kt/V ≧1.2), access intervention, access failure, and 2-year septicemia and all-cause hospitalization and mortality. 〈 i 〉 Results: 〈 /i 〉 Patients who received monitoring weekly or more often (49%) were more likely to have an access intervention (adjusted RH = 1.40, 95% CI, 1.07–1.84) than those who received monitoring less frequently. Additionally, patients treated at clinics that reported performing regular access monitoring (80% of patients) were less likely to be hospitalized for septicemia (IRR = 0.35, 95% CI, 0.21–0.61) or for any cause (IRR = 0.77, 95% CI, 0.60–0.99). There were no statistically significant differences between patients exposed to different vascular access monitoring practices in access failure, achievement of Kt/V, or survival. 〈 i 〉 Conclusion: 〈 /i 〉 Frequent monitoring of dialysis access may initially increase the number of interventions but is beneficial to longer-term outcomes, including septicemia-related and all-cause hospitalization.
    Type of Medium: Online Resource
    ISSN: 1660-2110
    URL: Article
    DOI: 10.1159/000094961
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2006
    detail.hit.zdb_id: 2098336-0
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  • 7
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    Healthy Behaviors, Risk Factor Control and Awareness of Chronic Kidney Disease
    S. Karger AG ; 2013
    In:  American Journal of Nephrology Vol. 37, No. 2 ( 2013), p. 135-143
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 37, No. 2 ( 2013), p. 135-143
    Abstract: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 The association between chronic kidney disease (CKD) awareness and healthy behaviors is unknown. We examined whether CKD self-recognition is associated with healthy behaviors and achieving risk-reduction targets known to decrease risk of cardiovascular morbidity and CKD progression. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 CKD awareness, defined as a ‘yes’ response to ‘Has a doctor or other health professional ever told you that you had kidney disease?’, was examined among adults with CKD (eGFR 〈 60 ml/min/1.73 m 〈 sup 〉 2 〈 /sup 〉 ) who participated in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Odds of participation in healthy behaviors (tobacco avoidance, avoidance of regular nonsteroidal anti-inflammatory drug use, and physical activity) and achievement of risk-reduction targets (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, systolic blood pressure control and glycemic control among those with diabetes) among those aware versus unaware of their CKD were determined by logistic regression, controlling for sociodemographics, access to care and comorbid conditions. Systolic blood pressure control was defined as 〈 130 mm Hg (primary definition) or 〈 140 mm Hg (secondary definition). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 2,615 participants, only 6% (n = 166) were aware of having CKD. Those who were aware had 82% higher odds of tobacco avoidance compared to those unaware (adjusted OR = 1.82, 95% CI 1.02–3.24). CKD awareness was not associated with other healthy behaviors or achievement of risk-reduction targets. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Awareness of CKD was only associated with participation in one healthy behavior and was not associated with achievement of risk-reduction targets. To encourage adoption of healthy behaviors, a better understanding of barriers to participation in CKD-healthy behaviors is needed.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000346712
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 8
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    Assessment of Printed Patient-Educational Materials for Chronic Kidney Disease
    S. Karger AG ; 2013
    In:  American Journal of Nephrology Vol. 38, No. 3 ( 2013), p. 184-194
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 38, No. 3 ( 2013), p. 184-194
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (superior = 70-100; adequate = 40-69; inadequate = 〈 40). Linear regression was used to determine the impact of literacy level on mean rating. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We reviewed 69 PEMs from 19 organizations, divided into 113 content area sections. Most (79%) PEM sections were ‘adequate' (mean rating, 58.3%). Inclusion of patient-centered content and opportunities for patient interaction were associated with ‘superior' ratings. Mean ratings (SD) were similar across content areas: basics of CKD, 58.9% (9.1); risk factors for CKD development, 57.0% (12.3); risk factors for CKD progression, 58.5% (12.0); CKD complications, 62.3% (15.7), and self-management strategies, 62.2% (12.3). ≤6th grade literacy level (vs. 〉 6th grade) was associated with an 11.7 point higher mean rating. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000354314
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 9
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    Race, Mineral Homeostasis and Mortality in Patients with End-Stage Renal Disease on Dialysis
    S. Karger AG ; 2015
    In:  American Journal of Nephrology Vol. 42, No. 1 ( 2015), p. 25-34
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 42, No. 1 ( 2015), p. 25-34
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Abnormalities in mineral homeostasis are ubiquitous in patients on dialysis, and influenced by race. In this study, we determine the race-specific relationship between mineral parameters and mortality in patients initiating hemodialysis. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We measured the levels of fibroblast growth factor 23 (FGF23) and 25-hydroxyvitamin D (25 D) in 184 African American and 327 non-African American hemodialysis patients who enrolled between 1995 and 1998 in the Choices for Healthy Outcomes in Caring for ESRD Study. Serum calcium, phosphorus, parathyroid hormone (PTH) and total alkaline phosphatase levels were averaged from clinical measurements during the first 4.5 months of dialysis. We evaluated the associated prospective risk of mortality using multivariable Cox proportional hazards models stratified by race. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 PTH and total alkaline phosphatase levels were higher, whereas calcium, phosphorus, FGF23 and 25 D levels were lower in African Americans compared to those of non-African Americans. Higher serum phosphorus and FGF23 levels were associated with greater mortality risk overall; however, phosphorus was only associated with risk among African Americans (HR 5.38, 95% CI 2.14-13.55 for quartile 4 vs. 1), but not among non-African Americans (p-interaction = 0.04). FGF23 was associated with mortality in both groups, but more strongly in African Americans (HR 3.91, 95% CI 1.74-8.82 for quartiles 4 vs. 1; p-interaction = 0.09). Serum calcium, PTH, and 25 D levels were not consistently associated with mortality. The lowest and highest quartiles of total alkaline phosphatase were associated with higher mortality risk, but this did not differ by race (p-interaction = 0.97). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Aberrant phosphorus homeostasis, reflected by higher phosphorus and FGF23, may be a risk factor for mortality in patients initiating hemodialysis, particularly among African Americans.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000438999
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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  • 10
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    Vascular Calcification Markers and Hemodialysis Vascular Access Complications
    S. Karger AG ; 2018
    In:  American Journal of Nephrology Vol. 48, No. 5 ( 2018), p. 330-338
    Details
    In: American Journal of Nephrology, S. Karger AG, Vol. 48, No. 5 ( 2018), p. 330-338
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94] ) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes ( 〈 i 〉 p 〈 /i 〉 interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.
    Type of Medium: Online Resource
    ISSN: 0250-8095 , 1421-9670
    URL: Article
    DOI: 10.1159/000493549
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
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