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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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101 to 125 of 213 Research Studies Displayed
Vemulakonda VM, Hamer MK, Kempe A
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
Although there are significant demographic and clinical variations in treatment decisions for infants with high-grade hydronephrosis concerning for ureteropelvic junction obstruction (UPJO), there has been little research on the roles of parents and surgeons in the surgical decision-making (DM) process. The purpose of this study was to understand parents' and surgeons' perceived roles in the surgical DM process for infants with high-grade hydronephrosis.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Hamer MK, Kempe A . Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives. J Pediatr Urol 2019 Oct;15(5):469.e1-69.e9. doi: 10.1016/j.jpurol.2019.05.027..
Keywords: Newborns/Infants, Shared Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
Stepkowski SM, Mierzejewska B, Fumo D
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
This retrospective study examined 6-year clinical outcomes for patients registered in a multiregional US Kidney Paired Donation (KPF) program. A total of 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchange were followed. Out of the 1121, 65% were transplanted with 37% of them in kidney paired donations, 10% with compatible live donors, and 18% with deceased donors. The remaining patients withdrew due to illness or death, or were still waiting (20%). There were similar survival rates with the different donor methods.
AHRQ-funded; HS020610.
Citation: Stepkowski SM, Mierzejewska B, Fumo D . The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study. Transpl Int 2019 Aug;32(8):839-53. doi: 10.1111/tri.13423..
Keywords: Kidney Disease and Health, Mortality, Outcomes, Transplantation
Sheetz KH, Woodside KJ, Shahinian VB
Trends in bariatric surgery procedures among patients with ESKD in the United States.
This study examined trends in bariatric surgery among patients with end-stage kidney disease (ESKD) in the United States. There was an almost ninefold increase in surgery between 2006 and 2016 for ESKD patients and also for sleeve gastrectomy surgery. ESKD patients showed similar complication rates compared with non-ESKD patients, but there were more readmissions.
AHRQ-funded; HS023597; HS000053.
Citation: Sheetz KH, Woodside KJ, Shahinian VB . Trends in bariatric surgery procedures among patients with ESKD in the United States. Clin J Am Soc Nephrol 2019 Aug 7;14(8):1193-99. doi: 10.2215/cjn.01480219..
Keywords: Obesity, Surgery, Kidney Disease and Health, Obesity: Weight Management, Hospital Readmissions, Adverse Events, Outcomes
Childrers CP, Dworsky JQ, Kominski G
A comparison of payments to a for-profit dialysis firm from government and commercial insurers.
The authors assessed differences in payments from government and commercial insurers to dialysis clinics through analysis of DaVita’s financial records. They found that, in 2017, commercial insurers paid one of the largest dialysis suppliers 4 times the rate of their government peers. They recommended that reducing payments from commercial insurers, perhaps through increased competition or fixing charges at a percent of Medicare reimbursement, may help alleviate excess spending on dialysis.
AHRQ-funded; HS025079.
Citation: Childrers CP, Dworsky JQ, Kominski G . A comparison of payments to a for-profit dialysis firm from government and commercial insurers. JAMA Intern Med 2019 Aug;179(8):1136-38. doi: 10.1001/jamainternmed.2019.0431..
Keywords: Payment, Health Insurance, Kidney Disease and Health, Medicare, Medicaid
Yanik MV, Seifert ME MV, Seifert ME, Locke JE
CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients.
Optimal management of immunosuppression in kidney transplantation requires a delicate balance of efficacy and toxicity. Tacrolimus (TAC) dose requirements are significantly impacted by genetic variation in CYP3A5 polymorphisms, however the impact that genotype has on clinical outcomes in the pediatric kidney transplant population remains unclear. In this study, the investigators evaluated a retrospective cohort of 98 pediatric kidney transplant recipients. In this paper, they report on their findings.
AHRQ-funded; HS013852.
Citation: Yanik MV, Seifert ME MV, Seifert ME, Locke JE . CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients. Pediatr Transplant 2019 Aug;23(5):e13494. doi: 10.1111/petr.13494..
Keywords: Children/Adolescents, Transplantation, Kidney Disease and Health, Genetics
Chang SH, Wang M, Liu X
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. The investigators study whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival. The investigators concluded that in the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT.
AHRQ-funded; HS022330.
Citation: Chang SH, Wang M, Liu X . Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States. Transplantation 2019 Aug;103(8):1663-74. doi: 10.1097/tp.0000000000002574..
Keywords: Access to Care, Disparities, Kidney Disease and Health, Outcomes, Policy, Transplantation
Ross KH, Jaar BG, Lea JP
Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study.
This retrospective cohort study examined long-term outcomes among Medicare patients with end-stage renal disease (ESRD) during the first year of hemodialysis. The goal was to determine hospital readmission patterns in the first year of dialysis and outcomes in the second year. Data from the United States Renal Data System (USRDS) was used and readmission patterns were summarized as either no readmission within 30 days, at least one admission, but not within 30 days, and admission with at least one readmission within 30 days. About half of all patients did not get readmitted (51%), but 18.5% were readmitted within 30 days, and 30.5% were admitted but not within 30 days. Those who were readmitted within 30 days had the highest long-term risk of mortality, hospitalization and lower likelihood of kidney transplantation compared to patients who were not admitted or readmitted.
AHRQ-funded; HS025018.
Citation: Ross KH, Jaar BG, Lea JP . Long-term outcomes among Medicare patients readmitted in the first year of hemodialysis: a retrospective cohort study. BMC Nephrol 2019 Jul 29;20(1):285. doi: 10.1186/s12882-019-1473-0..
Keywords: Dialysis, Elderly, Hospital Readmissions, Kidney Disease and Health, Medicare, Outcomes
Setodji CM, Peipert JD, Hays RD
Differential item functioning of the CAHPS(R) In-Center Hemodialysis Survey.
End-stage renal disease patients' experience of care is an integral part of the assessment of the quality of the care provided at hemodialysis centers and is needed to promote patient choice, quality improvement, and accountability. The purpose of this study was to evaluate the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS(R)) survey and its equivalence in different age, gender, race, and education subgroups.
AHRQ-funded; HS016980; HS016978.
Citation: Setodji CM, Peipert JD, Hays RD . Differential item functioning of the CAHPS(R) In-Center Hemodialysis Survey. Qual Life Res 2019 Jul 26;28(11):3117-35. doi: 10.1007/s11136-019-02250-5.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Kidney Disease and Health, Quality of Care, Patient Experience, Quality Improvement
Paje D, Rogers MAM, Conlon A
Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: a prospective cohort study.
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD). The purpose of this study was to describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate [GFR] <45 mL/min/1.73 m2).
AHRQ-funded; HS025891.
Citation: Paje D, Rogers MAM, Conlon A . Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: a prospective cohort study. Ann Intern Med 2019 Jul 2;171(1):10-18. doi: 10.7326/m18-2937..
Keywords: Kidney Disease and Health, Guidelines, Evidence-Based Practice, Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs)
Hart A, Gustafson SK, Wey A
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
The purpose of this study was to determine the association between the timing of Medicare loss and immunosuppressive medication fills and kidney allograft loss. Findings indicated that the medication possession ratio (MPR) was lower for recipients with early or late Medicare loss compared with no coverage loss for all immunosuppressive medication types. When recipients were matched by age, posttransplant timing of Medicare loss, and donor risk, the hazard of allograft loss was significantly higher after Medicare loss, with no difference in the hazard for on-time Medicare loss.
AHRQ-funded; HS024527.
Citation: Hart A, Gustafson SK, Wey A . The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes. Am J Transplant 2019 Jul;19(7):1964-71. doi: 10.1111/ajt.15293..
Keywords: Kidney Disease and Health, Medicare, Medication, Outcomes, Patient-Centered Outcomes Research, Transplantation
Kilambi V, Bui K, Hazen GB
Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees.
This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Hazen GB . Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees. Transplantation 2019 May;103(5):980-89. doi: 10.1097/tp.0000000000002585..
Keywords: Transplantation, Kidney Disease and Health, Shared Decision Making
Assimon MM, Brookhart MA, Flythe JE
Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis.
This retrospective cohort study compared cardiac safety of selective serotonin reuptake inhibitors (SSRIs) among individuals receiving maintenance hemodialysis. These individuals may be particularly susceptible to lethal cardiac consequences of drug-induced QT prolongation due to a substantial cardiovascular disease burden and their use of many medications. Data from a cohort of Medicare beneficiaries receiving hemodialysis included in the US Renal Data system registry from 2007-2014 was used. Researchers compared the 1-year risk of death among hemodialysis patients taking different SSRIs. Use of higher QT-prolonging potential SSRIs (citalopram, escitalopram) was associated with a higher risk of sudden cardiac death than patients taking lower risk SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline). The association was higher among elderly individuals, females, patients with conduction disorders, and those treated with other non-SSRI QT-prolonging medications.
AHRQ-funded; HS026801.
Citation: Assimon MM, Brookhart MA, Flythe JE . Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis. J Am Soc Nephrol 2019 Apr;30(4):611-23. doi: 10.1681/asn.2018101032..
Keywords: Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Chronic Conditions
Warsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H . Limited health literacy and adverse outcomes among kidney transplant candidates. Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Dunn T, Saeed MJ, Shpigel A
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
This study examined whether the use of preoperative cardiac stress testing of patients undergoing kidney transplantation reduced 30-day- death and myocardial infarction post-transplantation. ESRD patients 40 years or older with primary Medicare insurance between 2006 and 2013 were identified using the United States Renal Data System. In a matched cohort of 17,304 patients, there was little difference in 30-day post-transplantation mortality and myocardial infarction between those receiving a stress test and those who did not.
AHRQ-funded; HS019455.
Citation: Dunn T, Saeed MJ, Shpigel A . The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation. PLoS One 2019 Feb;14(2):e0211161. doi: 10.1371/journal.pone.0211161..
Keywords: Transplantation, Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Surgery
Novogrodsky E, Yaghoubian A, Connor SE
The role of media in non-directed (altruistic) living kidney donation.
This study sought to characterize how non-directed living kidney donors use media and informational resources over the course of their kidney donation journey. The investigators conducted semi-structured interviews with non-directed donors (NDDs) who initiated kidney transplant chains. The investigators concluded that media and informational resources play an important role in the process of donation for NDDs, including inspiring interest in donation through personal narratives.
AHRQ-funded; HS000029.
Citation: Novogrodsky E, Yaghoubian A, Connor SE . The role of media in non-directed (altruistic) living kidney donation. Health Commun 2019 Feb;34(2):259-67. doi: 10.1080/10410236.2017.1405480..
Keywords: Kidney Disease and Health, Transplantation, Shared Decision Making, Communication, Education: Patient and Caregiver
Nguyen OK, Vazquez MA, Charles MA
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
This paper discusses costs and mortality associated with undocumented immigrants with end-stage renal disease (ESRD). If the patient has insurance, the costs and mortality rates are much lower than those who receive emergency-only dialysis.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Vazquez MA, Charles MA . Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease. JAMA Intern Med 2019 Feb;179(2):175-83. doi: 10.1001/jamainternmed.2018.5866..
Keywords: Dialysis, Kidney Disease and Health, Healthcare Costs, Mortality, Patient-Centered Outcomes Research
Althoff KN, Gebo KA, Moore RD
Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies.
Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes.
AHRQ-funded; 90047713.
Citation: Althoff KN, Gebo KA, Moore RD . Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies. Lancet HIV 2019 Feb;6(2):e93-e104. doi: 10.1016/s2352-3018(18)30295-9.
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Keywords: Cancer, Cardiovascular Conditions, Chronic Conditions, Kidney Disease and Health, Human Immunodeficiency Virus (HIV), Heart Disease and Health, Risk
Yuo TH, Wallace JR, Fish L
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
This study compared outcomes of different revascularization surgeries among end stage renal disease (ESRD) patients with peripheral arterial disease (PAD). There is a high risk of complications for this surgery. Outcomes of endovascular revascularization (ER) and open surgical revascularisation (OSR) were compared. Outcomes measured included mortality and major amputation. There is a lower mortality risk for ER versus OSR. OSR has better 30-day limb salvage although there are similar long-term outcomes.
AHRQ-funded; HS019486.
Citation: Yuo TH, Wallace JR, Fish L . Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis. Eur J Vasc Endovasc Surg 2019 Feb;57(2):248-57. doi: 10.1016/j.ejvs.2018.09.008..
Keywords: Adverse Events, Cardiovascular Conditions, Comparative Effectiveness, Dialysis, Evidence-Based Practice, Kidney Disease and Health, Mortality, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery
Lee T, Qian J, Thamer M
Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients.
In this study, the investigators assessed clinically relevant arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). The investigators concluded that while AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes were uniformly worse in females. They suggest that clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Qian J, Thamer M . Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients. Am J Nephrol 2019;49(1):11-19. doi: 10.1159/000495261..
Keywords: Elderly, Sex Factors, Surgery, Kidney Disease and Health, Disparities, Outcomes, Patient-Centered Outcomes Research
Adisa O, Jaar BG, Masud T
Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients.
In this study, the investigators examined whether social worker-assessed factors were associated with 30-day readmission among prevalent hemodialysis patients. Data on 14 factors were extracted from the first available psychosocial assessment performed by social workers at three metropolitan Atlanta dialysis centers. The authors indicated that results suggested psychosocial issues may be associated with risk of 30-day readmission among dialysis patients.
AHRQ-funded; HS025018.
Citation: Adisa O, Jaar BG, Masud T . Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients. BMC Nephrol 2018 Dec 17;19(1):360. doi: 10.1186/s12882-018-1162-4..
Keywords: Kidney Disease and Health, Hospital Readmissions
Lee T, Qian J, Thamer M
Tradeoffs in vascular access selection in elderly patients initiating hemodialysis with a catheter.
In this study the investigators evaluated clinically relevant vascular access outcomes in elderly patients receiving an arteriovenous fistulas (AVF) or arteriovenous grafts AVG after hemodialysis therapy initiation. The investigators found that in elderly hemodialysis patients initiating hemodialysis therapy with a catheter, the optimal vascular access selection depended on tradeoffs between shorter catheter dependence and less frequent interventions to make the vascular access (AVG) functional versus longer access patency and fewer interventions after successful use of the vascular access (AVF).
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Qian J, Thamer M . Tradeoffs in vascular access selection in elderly patients initiating hemodialysis with a catheter. Am J Kidney Dis 2018 Oct;72(4):509-18. doi: 10.1053/j.ajkd.2018.03.023..
Keywords: Dialysis, Kidney Disease and Health, Elderly, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Wahl TS, Graham LA, Morris MS
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
This retrospective cohort study investigated whether preoperative proteinuria is associated with surgical outcomes including postoperative acute kidney injury (AKI) and readmission. The cohort used were undergoing elective inpatient surgery at 119 Veterans Affairs facilities from October 2007 to September 2014. The data collected was for a 7-month period in 2016. A higher probability of 30-day unplanned readmission was associated with preoperative proteinuria and postoperative AKI.
AHRQ-funded; HS013852.
Citation: Wahl TS, Graham LA, Morris MS . Association between preoperative proteinuria and postoperative acute kidney injury and readmission. JAMA Surg 2018 Sep;153(9):e182009. doi: 10.1001/jamasurg.2018.2009..
Keywords: Kidney Disease and Health, Injuries and Wounds, Adverse Events, Surgery, Risk, Hospital Readmissions, Outcomes
Shetterly Shetterly, S Flory, J
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
This study used data from FDA’s Sentinel System to determine if augmenting a diagnosis-based chronic kidney disease cohort with patients identified through laboratory results impacted cohort characteristics and outcomes. They divided the cohort into three different groups to compare demographic, clinical, and health care utilization characteristics. They observed mortality rates between the different groups.
AHRQ-funded; HS023898.
Citation: Shetterly Shetterly, S Flory, J . Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease. Pharmacoepidemiol Drug Saf 2018 Aug;27(8):872-77. doi: 10.1002/pds.4583..
Keywords: Diagnostic Safety and Quality, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE), Medication, Adverse Events
Plantinga LC, Masud T, Lea JP
Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study.
This study examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions. The study results suggested that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.

AHRQ-funded; HS025018.
Citation: Plantinga LC, Masud T, Lea JP . Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study. BMC Nephrol 2018 Jul 31;19(1):186. doi: 10.1186/s12882-018-0983-5..
Keywords: Kidney Disease and Health, Hospital Readmissions, Hospitalization
Plantinga LC, King LM, Masud T
Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.
Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. In this retrospective cohort study, the investigators aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients. The investigators concluded that readmissions related to pulmonary edema were common in hemodialysis patients. They suggest that interventions aimed at preventing such readmissions could have a substantial impact on readmissions overall, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.
AHRQ-funded; HS025018.
Citation: Plantinga LC, King LM, Masud T . Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study. Nephrol Dial Transplant 2018 Jul;33(7):1215-23. doi: 10.1093/ndt/gfx335..
Keywords: Adverse Events, Dialysis, Heart Disease and Health, Hospital Readmissions, Hospitalization, Kidney Disease and Health

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