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Том 21 №3 2019 год - Нефрология и диализ

Диета с ограничением белка: история, лечение преддиализных больных, влияние на режим заместительной почечной терапии. Обзор литературы

Ермоленко В.М.

DOI: 10.28996/2618-9801-2019-3-281-291

Аннотация: Диета с ограничением суточного потребления белка, изначально предложенная для улучшения качества жизни больных с нарушением функции почек, в настоящее время стала элементом нефропротективной терапии, позволяющей не только уменьшить интоксикацию, обусловленную как белковыми метаболитами (водород, гуанидины, фенол, индоксил сульфат, микроглобулин, конечные продукты гликирования и т.д.), так и другими уремическими токсинами, в норме выводимыми с мочой, но и замедлить прогрессирование уремии и отдалить начало заместительной почечной терапии. Использование малобелковой диеты в период ввода в диализную программу позволяет избегать рекомендуемого рядом авторов интенсивного диализа, что сохраняет на более длительный срок остаточную функцию почек, профилактируя в известной мере развитие осложнений, обусловленных уремическими токсинами и гипергидратацией. У больных старше 75 лет малобелковая диета с добавлением эссенциальных аминокислот и кетоаналогов делает возможным проведение разового или двукратного в неделю диализа, а у мотивированных пациентов - продолжить консервативную терапию, несмотря на крайне низкие значения скорости клубочковой фильтрации. Качество жизни пациентов на малобелковой диете с аминокислотными добавками не хуже, чем на диализе, а частота госпитализаций из-за различных осложнений, в частности, обусловленных проблемами сосудистого доступа, существенной меньше. Длительное, в течение нескольких лет пребывание на малобелковой диете с обязательным применением эссенциальных аминокислот и кетоаналогов не влияет отрицательно на азотистый баланс, не ухудшает нутритивный статус и антропометрические показатели пациентов, не вызывает снижения в крови уровня общего белка и альбумина и крайне редко осложняется белково-энергетической недостаточностью, не влияя на конечные исходы лечения. Основной причиной перевода больных на заместительную почечную терапию являются гипергидратация или гиперкалиемия. Малобелковая диета позволяет разнообразить не только режимы гемодиализа, но и постоянного амбулаторного перитонеального диализа. Различные аспекты применения малобелковой диеты представлены в предлагаемом обзоре.

Для цитирования: Ермоленко В.М. Диета с ограничением белка: история, лечение преддиализных больных, влияние на режим заместительной почечной терапии. Обзор литературы. Нефрология и диализ. 2019. 21(3):281-291. doi: 10.28996/2618-9801-2019-3-281-291

Весь текст

Ключевые слова: малобелковая диета, хроническая почечная недостаточность, гемодиализ, перитонеальный диализ, low-protein diet, chronic renal disease, hemodialysis, peritoneal dialysis

Список литературы:

1. Ермоленко В.М., Козлова Т.А., Михайлова Н.А. Значение малобелковой диеты в замедлении прогрессирования хронической почечной недостаточности (Обзор литературы). Нефрология и диализ. 2006; 8(4): 310-20.
2. Ibels L.S., Alfrey A.C., Haut L., Huffer W.E. Preservation of function in experimental renal disease by dietary restriction of phosphate. N Engl J Med. 1978; 298(3):122-6. DOI:10.1056/NEJM197801192980302.
3. Haut L.L., Alfrey A.C., Guggenheim S. et al. Renal toxicity of phosphate in rats. Kidney Int. 1980; 17(6):722-31. DOI: https://doi.org/10.1038/ki.1980.85.
4. Barsotti G., Morelli E., Guiducci A. et al. Reversal of hyperparathyroidism in severe uremics following very low-protein and low-phosphorus diet. Nephron. 1982; 30(4):310-3. DOI: 10.1159/000182506.
5. Klahr S., Tripathy K. Evaluation of renal function in malnutrition. Arch Intern Med. 1966; 118(4):322-5. DOI: 10.1001/archinte.1966.00290160022005.
6. Ichikawa I., Purkerson M.L., Yates J., Klahr S. Dietary protein intake conditions the degree of renal vasoconstriction in acute renal failure caused by ureteral obstruction. Am J Physiol. 1985; 249: F54-F57. DOI:https://doi.org/10.1152/ajprenal.1985.249.1.F54.
7. Rigalleau V., Blanchetier V., Combe C. et al. A low-protein diet improves insulin sensitivity of endogenous glucose production in predialytic uremic patients. Am J ClinNutr. 1997; 65(5):1512-6. DOI: 10.1093/ajcn/65.5.1512.
8. Nath K.A., Hostetter M.K., Hostetter T.H. Ammonia-complement interaction in the pathogenesis of progressive renal injury. Kidney Int Suppl. 1989; 27: S52-4.
9. Warner J.H. The therapeutic perspective: medical practice, knowledge and identity in America, 1820-1885. Cambridge, Harvard University Press. 1986; pp. 91-92, 98-99.
10. Watson C.W., Lyon G. A preliminary note on the influence of a meat diet on the kidneys. J Physiol. 1906; 34:19-21.
11. Newburgh L.H. The production of Bright's disease by feeding high protein diets. Arch. Intern. Med. 1919; 24:359-377.
12. Chanutin A., Ferris E.B. Experimental renal insufficiency produced by partial nephrectomy. I. Control diet. Arch Intern Med (Chic). 1932; 49(5):767-787. DOI:10.1001/archinte.1932.00150120057006.
13. Chanutin A. Experimental renal insufficiency produced by partial nephrectomy. III. Diets containing whole dried liver, liver residue and liver extract. Arch Intern Med (Chic). 1934; 54(5):720-745. DOI: 10.1001/archinte.1934.00160170063006.
14. Blatherwick N.R., Medlar E.M., Connolly J.M., Bradshaw P.J. Nephritis in unilaterally nephrectomized white rats living upon high protein diets. J Biol Chem. 1931; 92:84.
15. Walser M. Is there a role for protein restriction in the treatment of chronic renal failure? Blood Purif. 2000; 18:304-312. DOI: 10.1159/000014453.
16. Giordano C. Use of exogenous and endogenous urea for protein in normal and uremic subjects. J Lab Clin Med. 1963; 62: 231-46.
17. Berlyne G., Shaw A., Nilwarngkur S. Dietary treatment of chronic renal failure. Experience with modified Giovannetti diet. Nephron. 1965; 2:129-147. DOI:10.1159/000179399.
18. Kopple J.D., Coburn J.W. Metabolic studies of low-protein diets in uremia. I. Nitrogen and potassium. Medicine (Baltimore). 1973; 52:583-595. DOI:10.1097/00005792-197311000-00004
19. Walser M. Dietary proteins and their relationship to kidney disease. In: Dietary proteins in health and disease. G.U. Liepa, editor. Washington, DC: American Oil Chemists Society. 1992; p.168-178.
20. Giovanetti S., Maggiore Q. A low-nitrogen diet with proteins of high biological value for severe chronic uremia. Lancet. 1964; 1:1000-1003. DOI:https://doi.org/10.1016/S0140-6736(64)91919-1.
21. Fröhling P.T., Schmicker R., Kokot F. et al. Influence of phosphate restriction, keto-acids and vitamin D on the progression of chronic renal failure. Proc Eur Dial Transplant Assoc Eur Ren Assoc. 1985; 21:561-6.
22. Barsotti G., Cristofano C., Morelli E. et al. Serum oxalis acid in uremia: effect of a low-protein diet supplemented with essential amino acids and ketoanalogues. Nephron 1984; 38:54-56. DOI: 10.1159/000183278.
23. Barsotti G., Ciardella F., Morelli E. et al. Restoration of blood levels of testosterone in male uremics following a low-protein diet supplemented with essential amino acids and ketoanalogues. Contr Nephrol. 1985; 49:63-69.
24. Aparicio M., Vincendeau Ph., Gin H. et al. Effect of a low-protein diet on chemiluminescence production by leukocytes from uremic patients. Nephron 1988; 48:315-318. DOI: 10.1159/000184950.
25. Aparicio M., Bouchet J., Gin H. et al. Effect of a low-protein diet on urinary albumin excretion in uremic patients. Nephron 1988; 50:288-291. DOI: 10.1159/000185189.
26. Cupisti A., Carulli G., Polidori R. et al. Superoxide anion prodution and dietary treatment in chronic renal failure. Nephron. 1991; 57:119-120. DOI:10.1159/000186233.
27. Di Iorio B.R., Minutolo R., De Nicola L. et al. Supplemented very low protein diet ameliorates responsiveness to erythropoietin in chronic renal failure. Kidney Int. 2003; 64:1822-1828. DOI: 10.1046/j.1523-1755.2003.00282.x.
28. Chauveau P., Barthe N., Rigalleau V. et al. Outcome of nutritional status and body composition of uremic patients on a very low protein diet. Am J Kidney Dis. 1999; 34(3):500-7. DOI: https://doi.org/10.1016/S0272-6386(99)70078-8.
29. Chauveau P., Vendrely B., El Haggan W. et al. Body composition of patients on a very low-protein diet: a two-year survey with DEXA. J Ren Nutr. 2003; 13(4):282-7. DOI:https://doi.org/10.1016/S1051-2276(03)00117-1.
30. Piccoli G.B., Leone F., Attini R. et al. Association of low-protein supplemented diets with fetal growth in pregnant women with CKD. Clin J Am Soc Nephrol. 2014; 9(5):864-73. DOI: 10.2215/CJN.06690613.
31. Cianciaruso B., Pota A., Bellizzi V. et al. Effect of a low-versus moderate-protein diet on progression of CKD: follow-up of a randomized controlled trial. Am J Kidney Dis. 2009; 54(6):1052-61. DOI: 10.1053/j.ajkd.2009.07.021
32. Dukkipati R., Noori N., Feroze U., Kopple J.D. Dietary protein intake in patients with advanced chronic kidney disease and on dialysis. Semin Dial. 2010; 23(4):365-72. DOI: 10.1111/j.1525-139X.2010.00753.x.
33. Klahr S., Levey A.S., Beck G.J. et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of diet in Renal Disease Study Group. N Engl J Med. 1994; 330(13):877-84. DOI:10.1056/NEJM199403313301301.
34. Fouque D. Should we still prescribe a low protein diet in chronic kidney disease? Nephrol Ther. 2006; 2(7):419-21. DOI: 10.1016/j.nephro.2006.10.002.
35. Mitch W.W. Dietary protein restriction and progressive renal insufficiency. Am J Kidney Dis. 1997; 30(2):297-8; discussion 299-300. DOI:https://doi.org/10.1016/S0272-6386(97)90069-X.
36. Hostetter T.H., Meyer T.W., Rennke H.G., Brenner B.M. Chronic effects of dietary protein in the rat with intact and reduced renal mass. Kidney Int. 1986; 30(4):509-17. DOI: 10.1038/ki.1986.215.
37. El-Nahas A.M., Paraskevakou H., Zoob S. et al. Effect of dietary protein restriction on the development of renal failure after subtotal nephrectomy in rats. Clin Sci (Lond). 1983; 65(4):399-406. DOI: 10.1042/cs0650399.
38. Kleinknecht C., Salusky I., Broyer M., Gubler M.C. Effect of various protein diets on growth, renal function, and survival of uremic rats. Kidney Int. 1979; 15(5):534-41. DOI: 10.1038/ki.1979.68.
39. Bellizzi V., Di Iorio B.R., De Nicola L. et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int. 2007; 71(3):245-51. DOI: 10.1038/sj.ki.5001955.
40. Kontessis P.A., Bossinakou I., Sarika L. et al. Renal, metabolic, and hormonal responses to proteins of different origin in normotensive, nonproteinuric type I diabetic patients. Diabetes Care. 1995; 18(9):1233. DOI: 10.2337/diacare.18.9.1233.
41. Ruilope L.M., Casal M.C., Praga M. et al. Additive antiproteinuric effect of converting enzyme inhibition and a low protein intake. J Am Soc Nephrol. 1992; 3(6):1307-11.
42. Gansevoort R.T., de Zeeuw D., de Jong P.E. Additive antiproteinuric effect of ACE inhibition and a low-protein diet in human renal disease. Nephrol Dial Transplant. 1995; 10(4):497-504. DOI:10.1093/ndt/10.4.497.
43. Kempner W. Treatment of hypertensive vascular disease with rice diet. Am J Med. 1948; 4(4):545-77. DOI: https://doi.org/10.1016/0002-9343(48)90441-0.
44. Klemmer P, Grim C.E., Luft F.C. Who and what drove Walter Kempner? The rice diet revisited. Hypertension. 2014; 64(4):684-8. DOI:10.1161/HYPERTENSIONAHA.114.03946.
45. Hansen H.P., Tauber-Lassen E., Jensen B.R., Parving H.H. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int. 2002; 62(1):220-8. DOI: https://doi.org/10.1046/j.1523-1755.2002.00421.x.
46. Bull G.M, Joekes A.M., Lowe K.G. Conservative treatment of anuric uraemia. Lancet. 1949; 2(6571):229-234. DOI: https://doi.org/10.1016/S0140-6736(49)91240-4.
47. Addis T. Glomerular nephritis: diagnosis and treatment. The MacMillan Company. New York. 1948; p. 28.
48. Palmer G., Schnermann G. Integrated Control of Na Transport along the Nephron. Clin J Am Soc Nephrol. 2015; 10(4):676-87. DOI: 10.2215/CJN.12391213.
49. Smith H.W. The kidney: structure and function in health and disease. Oxford University Press. New York, USA. 1951; p. 1049.
50. Peters J., Van Slyke D. Quantitative clinical chemistry. Interpretations. 2nd ed. Vol.1. The Williams and Wilkins Company. Baltimore. 1946; p. 1041. DOI:https://doi.org/10.1016/0002-9343(47)90224-6.
51. Fishberg A.M. Hypertension and Nephritis. 4th ed. Lea and Febiger. Philadelphia. 1939; p. 195-196.
52. Merrill J.P. The treatment of renal failure: therapeutic principles in the management of acute and chronic uremia. Grune and Stratton Inc. London. 1955; 134-155.
53. Moe S.M., Zidehsarai M.P., Chambers M.A. et al. Vegetarian compared with meat dietary protein source and phosphorus homeostasis in chronic kidney disease.Clin J Am SocNephrol. 2011; 6(2):257-64. DOI: 10.2215/CJN.05040610.
54. Chauveau P., Fouque D., Combe C. et al. Acidosis and nutritional status in hemodialyzed patients. French Study Group for Nutrition in Dialysis. Semin Dial. 2000; 13(4):241-6. DOI: 10.1046/j.1525-139x.2000.00066.x.
55. De Brito-Ashurst I., Varagunam M., Raftery M.J., Yaqoob M.M. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009; 20(9):2075-84. DOI: 10.1681/ASN.2008111205.
56. Teplan V., Schück O., Knotek A. et al. Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on low-protein diet: Czech multicenter study. Am J Kidney Dis. 2003; 41(3 Suppl 1):S26-30. DOI: 10.1053/ajkd.2003.50079.
57. Mircescu G., Gârneaţă L., Stancu S.H., Căpuşă C. Effects of a supplemented hypoproteic diet in chronic kidney disease. J Ren Nutr. 2007; 17(3):179-88. DOI:10.1053/j.jrn.2006.12.012.
58. Cianciaruso B., Pota A., Pisani A. et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5 - a randomized controlled trial. Nephrol Dial Transplant. 2008; 23(2):636-44. DOI: 10.1093/ndt/gfm576.
59. Kasiske B.L., Lakatua J.D., Ma J.Z., Louis T.A. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis. 1998; 31(6):954-61. DOI: https://doi.org/10.1053/ajkd.1998.v31.pm9631839.
60. Fouque D., Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev. 2009; 8(3):CD001892. DOI:10.1002/14651858.CD001892.pub3.
61. Pedrini M.T., Levey A.S., Lau J. et al. The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases: a meta-analysis. Ann Intern Med. 1996; 124(7):627-32. DOI: 10.7326/0003-4819-124-7-199604010-00002.
62. Levey A.S., Greene T., Beck G.J. et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol. 1999; 10(11):2426-39.
63. Prakash S., Pande D.P., Sharma S. et al. Randomized, double-blind, placebo-controlled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure. J Ren Nutr. 2004; 14(2):89-96. DOI: https://doi.org/10.1053/j.jrn.2004.01.008.
64. Garneata L., Stancu A., Dragomir D. et al. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression. J Am Soc Nephrol. 2016; 27(7):2164-76. DOI: 10.1681/ASN.2015040369.
65. Fouque D., Wang P., Laville M., Boissel J.P. Low protein diets delay end-stage renal disease in non-diabetic adults with chronic renal failure. Nephrol Dial Transplant. 2000; 15(12):1986-92. DOI: 10.1093/ndt/15.12.1986
66. Bellizzi V. Low-protein diet or nutritional therapy in chronic kidney disease? Blood Purif. 2013; 36(1):41-6. DOI: 10.1159/000350585.
67. Coresh J., Walser M., Hill S. Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis. J Am Soc Nephrol. 1995; 6(5):1379-85.
68. Bellizzi V., Chiodini P., Cupisti A. et al. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study. Nephrol Dial Transplant. 2015; 30(1):71-7. DOI:10.1093/ndt/gfu251.
69. Da Silva-Gane M., Wellsted D., Greenshields H. et al. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012; 7(12):2002-9. DOI: 10.2215/CJN.01130112.
70. Brunori G., Viola B.F., Parrinello G. et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis. 2007; 49(5):569-80. DOI:10.1053/j.ajkd.2007.02.278.
71. Chandna S.M., Da Silva-Gane M., Marshall C. et al. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011; 26(5):1608-14. DOI: 10.1093/ndt/gfq630.
72. Brown M.A., Collett G.K., Josland E.A. et al. CKD in elderly patients managed without dialysis: survival, symptoms, and quality of life. Clin J Am Soc Nephrol. 2015; 10(2):260-8. DOI: 10.2215/CJN.03330414.
73. Scalone L., Borghetti F., Brunori G. et al. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients. Nephrol Dial Transplant. 2010; 25(3):907-13. DOI: 10.1093/ndt/gfp572.
74. Dyck P.J., Johnson W.J., Nelson R.A. et al. Uremic neuropathy. III. Controlled study of restricted protein and fluid diet and infrequent hemodialysis versus conventional hemodialysis treatment. Mayo Clin Proc. 1975; 50(11):641-9.
75. Mitch W.E., Sapir D.G. Evaluation of reduced dialysis frequency using nutritional therapy. Kidney Int. 1981; 20(1):122-6. DOI: https://doi.org/10.1038/ki.1981.113.
76. Locatelli F., Andrulli S., Pontoriero G. et al. Supplemented low-protein diet and once-weekly hemodialysis. Am J Kidney Dis. 1994; 24(2):192-204. DOI:https://doi.org/10.1016/S0272-6386(12)80181-8.
77. Morelli E., Baldi R., Barsotti G. et al. Combined therapy for selected chronic uremic patients: infrequent hemodialysis and nutritional management. Nephron. 1987; 47(3): 161-6. DOI: 10.1159/000184484.
78. Caria S., Cupisti A., Sau G., Bolasco P. The incremental treatment of ESRD: a low-protein diet combined with weekly hemodialysis may be beneficial for selected patients. BMC Nephrol. 2014; 15:172. DOI: 10.1186/1471-2369-15-172.
79. Duenhas M., Gonçalves E., Dias M. et al. Reduction of morbidity related to emergency access to dialysis with very low protein diet supplemented with ketoacids (VLPD+KA). Clin Nephrol. 2013; 79(5):387-93. DOI: 10.5414/CN107460.
80. Nakao T., Kanazawa Y., Takahashi T. Once-weekly hemodialysis combined with low-protein and low-salt dietary treatment as a favorable therapeutic modality for selected patients with end-stage renal failure: a prospective observational study in Japanese patients.BMC Nephrol. 2018; 19(1):151. DOI: 10.1186/s12882-018-0941-2.
81. Chen X. Recent progress of nephrology in China 2009-2011. Peking. People's Military Medical Press; 2011.
82. Lin X., Yan Y., Ni Z. et al. Clinical outcome of twice-weekly hemodialysis patients in Shanghai. Blood Purif. 2012; 33(1-3):66-72. DOI: 10.1159/000334634.
83. Bieber B., Qian J., Anand S. et al. Two-times weekly hemodialysis in China: frequency, associated patient and treatment characteristics and quality of life in the China dialysis outcomes and practice patterns study. Nephrol Dial Transplant. 2014; 29(9):1770-7. DOI: 10.1093/ndt/gft472.
84. Mathew A., Obi Y., Rhee C.M. et al. Treatment frequency and mortality among incident hemodialysis patients in the United States comparing incremental with standard and more frequent dialysis. Kidney Int. 2016; 90(5):1071-1079. DOI:10.1016/j.kint.2016.05.028.
85. Couchoud C., Kooman J., Finne P. et al. Quality European Studies Working Group on Dialysis Adequacy. From registry data collection to international comparisons: examples of haemodialysis duration and frequency. Nephrol Dial Transplant. 2009; 24(1):217-24. DOI: 10.1093/ndt/gfn442.
86. Elamin S., Abu-Aisha H. Reaching target hemoglobin level and having a functioning arteriovenous fistula significantly improve one year survival in twice weekly hemodialysis. Arab J Nephrol Transplant. 2012; 5(2):81-6.
87. Zhang M., Wang M., Li H. et al. Association of initial twice-weekly hemodialysis treatment with preservation of residual kidney function in ESRD patients. Am J Nephrol. 2014; 40(2):140-50. DOI: 10.1159/000365819.
88. Dworkin L.D., Benstein J.A., Parker M. et al. Calcium antagonists and converting enzyme inhibitors reduce renal injury by different mechanisms. Kidney Int. 1993; 43(4):808-14. DOI: https://doi.org/10.1038/ki.1993.114.
89. Musu M., Finco G., Antonucci R. et al. Acute nephrotoxicity of NSAID from the foetus to the adult. Eur Rev Med Pharmacol Sci. 2011; 15(12):1461-72.
90. Obi Y., Streja E., Rhee C.M. et al. Incremental hemodialysis, residual kidney function, and mortality risk in incident dialysis patients: a cohort study. Am J Kidney Dis. 2016; 68(2):256-265. DOI: 10.1053/j.ajkd.2016.01.008.
91. Cornelis T., Kotanko P., Goffin E. et al. Can intensive hemodialysis prevent loss of functionality in the elderly ESRD patient? Semin Dial. 2011; 24(6):645-52. DOI:10.1111/j.1525-139X.2011.00995.x.
92. Cornelis T., van der Sande F.M., Kooman J.P. Balancing transition to dialysis: the urgent need for more intensive hemodialysis. Kidney Int. 2013; 83(5):967-8. DOI:10.1038/ki.2013.17.
93. Hall Y.N., Larive B., Painter P. et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol. 2012; 7(5):782-94. DOI: 10.2215/CJN.10601011.
94. Collins A.J., Foley R.N., Chavers B. et al. US Renal data system 2013 annual data report. Am J Kidney Dis. 2014; 63(1 Suppl):e1-e20. DOI: 10.1053/j.ajkd.2013.11.001.

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