Trace metal disturbances in end-stage renal failure patients

  • Patrick C. D′Haese

The association between metal exposure and renal failure can be approached from two points of view. On the one hand environmental/industrial exposure to heavy metals, more particularly, lead, cadmium and mercury and other inorganic substances such as silicon has been linked to a reduced renal function and/or the development of acute or chronic renal failure [1]. This issue has been dealt with in other chapters of this book. On the other hand patients with chronic renal failure, especially those treated by dialysis are at an increased risk for trace element disturbances (Figure 1). Indeed in these subjects the reduced renal function, the presence of proteinuria, metabolic alterations associated with renal insufficiency, the dialysis treatment, medication etc. all may contribute to either accumulation or deficiency of trace metals. With regard to aluminum intensive research on the element’s toxic effects has been performed in the past. Recently, new metal-containing medications have been introduced of which the potential toxic effects should be considered and put in a justified context.


Chronic Renal Failure Dialysis Patient Phosphate Binder Strontium Ranelate Continuous Ambulatory Peritoneal Dialysis 
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  1. 1.
    Nuyts GD, Van Vlem E, Thys J, De Leersnijder D, D’Haese PC, Elseviers MM, De Broe ME. Defined and undefined occupational risk factors of chronic renal failure. Lancet 1995; 346: 7-11.CrossRefPubMedGoogle Scholar
  2. 2.
    Altmann P, Butter KC, Plowman D, Chaput de Saintonge DM, Cunningham J, Marsh FP. Residual renal function in hemodialysis patients may protect against hyperaluminemia. Kidney Int 1989; 32: 710-13.CrossRefGoogle Scholar
  3. 3.
    Smythe WR, Alfrey AC, Craswell PW, Crouch CA, Ibels LS, Kubo H, Nunnelly LL, Rudolph H. Trace metal abnormalities in chronic uremia. Ann Intern Med 1982; 96: 302-310.PubMedGoogle Scholar
  4. 4.
    Blumsohn A, Morris B, Eastell R. Stable strontium absorption as a measure of intestinal calcium absorption: comparison with the double-radiotracer calcium absorption test. Clin Science 1994; 87: 363-368.Google Scholar
  5. 5.
    Barton JC, Conrad ME, Harrison L, Nuby S. Effects of calcium on the absorption and retention of lead. J Lab Clin Med 1978; 91:366-376.PubMedGoogle Scholar
  6. 6.
    Ittel TH. Determinants of gastrointestinal absorption and distribution of aluminium in health and uremia. Nephrol Dial Transplant 1993; 8 (Suppl 1): 17-24.PubMedGoogle Scholar
  7. 7.
    Canavese C, Pacitti M, Salomone M, Santoro A, Strata P, Mangiarotti G, Talarico S, Sabbioni E, Pietra R, Vercellone A. Strontium overload in uremic patients on regular dialytic treatment. Trans Am Soc Artif Inter Organs 1986: 32: 120-122.Google Scholar
  8. 8.
    Lehmann G, Hein G, Wolf G. The osteoporosis patient with renal insufficiency: what has to be taken into account in the selection and administration of antiosteoporosis medication? Z Rheumatol 2006; 65: 380-382.CrossRefGoogle Scholar
  9. 9.
    Oste L, Bervoets AR, Behets GJ, Dams G, Marijnissen RL, Geryl H, Lamberts LV, Verberckmoes SC, Van Hoof VO, De Broe ME, D’Haese PC. Time-evolution and reversibility of strontium-induced osteomalacia in chronic renal failure rats. Kidney Int 2005; 67: 920-930.CrossRefPubMedGoogle Scholar
  10. 10.
    Damment SJP, Pennick M. Systemic lanthanum is excreted in the bile of rats. Toxicol Lett. 2007; 171: 69-77.CrossRefPubMedGoogle Scholar
  11. 11.
    Singh H, Reed J, Noble S, Cangiano JL, Van Wyck DB. Effect of intravenous iron sucrose in peritoneal dialysis patients who receive erythropoiesis-stimulating agents for anemia: A randomized, controlled trial. Clin J Am Soc Nephrol 2006; 1: 475-482.Google Scholar
  12. 12.
    Hosokawa S, Yoshida O 1993 Effects of erythropoietin on trace elements in patients with chronic renal failure undergoing he- modialysis. Nephron 1993; 65: 414-417.CrossRefPubMedGoogle Scholar
  13. 13.
    Gammelgaard B, Sandberg E. Aluminium and nickel in human albumin solutions. J Trace Elem Electrolytes Health Dis 1989; 3:39-42.PubMedGoogle Scholar
  14. 14.
    D‘Haese PC, Lamberts LV, Liang L, Boone LP, Van Waeleghem, De Broe ME. Contribution of parenteral and dialysate solutions to the aluminum accumulation in dialysis patients. Blood Purif 1990; 8: 359-362.CrossRefPubMedGoogle Scholar
  15. 15.
    Reilly RF. Risk for nephrogenic systemic fibrosis with gadoteriol (ProHance) in patients who are on long-term hemodialysis. Clin J Am Soc Nephrol 2008; 3: 747-751.CrossRefPubMedGoogle Scholar
  16. 16.
    D’Haese PC, De Broe ME. Adequacy of dialysis: trace elements in dialysis fluids. Nephrol Dial Transplant 1996; 11 (Suppl 2): 92-97.PubMedGoogle Scholar
  17. 17.
    Simoes J, Barata JD, D’Haese PC, de Broe ME. Cela n’arrive qu’aux autres. Nephrol Dial Transplant 1994; 9: 67-68.PubMedGoogle Scholar
  18. 18.
    Barata JD, D’Haese PC, Pires C, Lamberts LV, Simoes J, De Broe ME. Low-dose (5mg/kg) desferrioxamine treatment in acutely aluminum-intoxicated hemodialysis patients using two drug administration schedules. Nephrol Dial Transplant 1996; 11: 125-132.PubMedGoogle Scholar
  19. 19.
    D’Haese PC, Shaheen FA, Huraib SO, Djukanovic L, Polenakovic MH, Spasovski G, Shikole A, Schurgers ML, Daneels RF, Lamberts LV, Van Landeghem GF, De Broe ME. Increased silicon levels in dialysis patients due to the high silicon content in the drinking water, inadequate water treatment procedures, and concentrate contamination: A multicentre study. Nephrol Dial Transplant 1995; 10: 1838-1844.PubMedGoogle Scholar
  20. 20.
    Schrooten I, Elseviers MM, Lamberts LV, De Broe ME, D’Haese PC. Increased serum strontium levels in dialysis patients. An epidemiological survey. Kidney Int 1999; 56: 1888-1892.CrossRefGoogle Scholar
  21. 21.
    Padovese P, Gallieni M, Brancaccio D, Pietra R, Fortaner S, Sabbioni E, Minoia C, Markakis K, Berlin A. Trace elements in dialysis fluids and assessment of the exposure of patients on regular hemodialysis, hemofiltration and continous ambulatory peritoneal dialysis. Nephron 1992; 61: 442-448.CrossRefPubMedGoogle Scholar
  22. 22.
    Mauras Y, KS Ang KS, P Simon P, B Tessier B, F Cartier F, P Allain P. Increase in blood plasma levels of boron and strontium in hemodialyzed patients. Clin Chim Acta 1986; 156: 315-320.CrossRefPubMedGoogle Scholar
  23. 23.
    Chaleil D, Simon P, Tessier B, Cartier F, Allain P. Blood plasma fluoride in haemodialysed patients. Clin Chim Acta 1986; 156: 105-108.CrossRefPubMedGoogle Scholar
  24. 24.
    Saint-Georges MD, DJ Bonnefont DJ, BA Bourely BA, M-CT Jaudon M-CT, P Cereze P, P Chau meil P, C Gard C, CL D’Auzac CL. Correction of selenium deficiency in hemodialy zed patients. Kidney Int 1989; 36 (suppl 27): 274-277.Google Scholar
  25. 25.
    Hosokawa S, Yoshida O. Serum vanadium levels in chronic hemodialysis patients. Nephron 1993; 64: 388-394.CrossRefPubMedGoogle Scholar
  26. 26.
    Wallaeys B, Cornelis R, Mees L, Lameire N. Trace elements in serum, packed cells, and dialysate of CAPD patients. Kidney Int 1986;30: 599-604.CrossRefPubMedGoogle Scholar
  27. 27.
    De Broe ME, Coburn JW (eds). Aluminum and renal failure. Dordrecht: Kluwer Acad Publ, 1989.Google Scholar
  28. 28.
    De Broe ME, Drüeke TB, Ritz E. Consensus Conference: diagnosis and treatment of aluminum overload in end-stage renal failure patients. Nephrol Dial Transplant 1993; 8 (Suppl 1): 1-4.Google Scholar
  29. 29.
    D’Haese PC, De Broe ME. Trace elements in dialysis patients. In: Hörl WE, Koch KM, Lindsay RM, Ronco C, Winchester JF (eds).Replacement of Renal Function by Dialysis. Dordrecht: Kluwer Acad Publ, 2004 pp 903-925.Google Scholar
  30. 30.
    Berend K, Knoops GJ, De Wolff FA. Prosecution after an outbreak of subacute aluminum intoxication in a hemodialysis center.Leg Med 2004; 6: 1-10.CrossRefGoogle Scholar
  31. 31.
    Lamb EJ, Hodsman A, van Schalkwyk D, Ansell D, Warwick G. Serum calcium, phosphate, parathyroid hormone, albumin, aluminium and cholesterol achievement on replacement therapy (Chapter 9). Nephrol Dial Transplant 2007; 22 (suppl 7): 105-118.Google Scholar
  32. 32.
    Bohrer D, Bertagnolli DC, de Oliveira SMR, do Nascimento PC, de Carvalho LM, Pomblum SG. Drugs as a hidden source of aluminium for chronic renal patients. Nephrol Dial Transplant 2007; 22: 605-611.CrossRefPubMedGoogle Scholar
  33. 33.
    Smans KA, D’ Haese PC, Van Landeghem GF, Andries LJ, Lamberts LV, Hendy GN, De Broe ME. Transferrin-mediated uptake of aluminium by human parathyroid cells results in reduced parathyroid hormone secretion. Nephrol Dial Transplant 2000; 15: 1328-1336.CrossRefPubMedGoogle Scholar
  34. 34.
    Van Landeghem GF, De Broe ME, D’Haese PC. Al and Si: Their speciation, distribution, and toxicity - A critical review. Clin Biochem 1998; 31: 385-397.CrossRefPubMedGoogle Scholar
  35. 35.
    Smans KA, Van Landeghem GF, D’Haese PC, Couttenye MM, De Broe ME. Is there a link between erythropietin therapy and adynamic bone disease? Nephrol Dial Transplant 1996; 11: 1248-1249.PubMedGoogle Scholar
  36. 36.
    Pennick M, Dennis K, Damment SJ. Absolute bioavailability and disposition of lanthanum in healthy human subjects administered lanthanum carbonate. J Clin Pharmacol 2006; 46: 738-746.CrossRefPubMedGoogle Scholar
  37. 37.
    D’Haese PC, Spasovski GB, Sikole A, Hutchison A, Freemont TJ, Sulkova S, Swanepoel C, Pejanovic S, Djukanovic L, Balducci A, Coen G, Sulowicz W, Ferreira A, Torres A, Curic S, Popovic M, Dimkovic N, De Broe ME. A multicenter study on the effects of lanthanum carbonate (Fosrenol) and calcium carbonate on renal bone disease in dialysis patients. Kidney Int 2003; 85 (Suppl): 73-78.CrossRefGoogle Scholar
  38. 38.
    Persy VP, Behets GJ, Bervoets AR, De Broe ME, D’Haese PC. Lanthanum: a safe phosphate binder. Semin Dial 2006; 19:195-199.CrossRefPubMedGoogle Scholar
  39. 39.
    Behets GJ, Dams G, Vercauteren SR, Damment SJ, Bouillon R, De Broe ME, D‘Haese PC. Does the phosphate binder lanthanum carbonate affect bone in rats with chronic renal failure? J Am Soc Nephrol 2004; 15: 2219-2228.CrossRefPubMedGoogle Scholar
  40. 40.
    Behets GJ, Verberckmoes SC, Oste L, Bervoets AR, Salomé M, Cox AG, Denton J, De Broe ME, D’Haese PC. Localization of lanthanum in bone of chronic renal failure rats after oral dosing with lanthanum carbonate. Kidney Int 2005; 67: 1830-1836.CrossRefPubMedGoogle Scholar
  41. 41.
    Yang Z, Schryvers D, Roels F, D’Haese PC, De Broe ME. Demonstration of lanthanum in liver cells by energy-dispersive X-ray spectroscopy, electron energy loss spectroscopy and high-resolution transmission electron microscopy. J Microsc 2006; 223: 133-139.CrossRefPubMedGoogle Scholar
  42. 42.
    Bervoets ARJ, Yang Z, Schryvers D, Roels F, Behets GJ, Verberckmoes SC, Dauwe S, Blust R, De Broe ME, D’Haese PC. Transhepa-tocellular transport and increased gastro-intestinal absorption of lanthanum in chronic renal failure. Kidney Int (Submitted).Google Scholar
  43. 43.
    Altmann P, Barnett ME, Finn WF; SPD405-307 Lanthanum Carbonate Study Group. Cognitive function in Stage 5 chronic kidney disease patients on hemodialysis: no adverse effects of lanthanum carbonate compared with standard phosphate-binder therapy. Kidney Int 2007; 71: 252-259.CrossRefPubMedGoogle Scholar
  44. 44.
    Cabrera WE, Schrooten I, De Broe ME, D’Haese PC. Strontium and bone. J Bone Miner Res 1999; 14: 661-668.CrossRefPubMedGoogle Scholar
  45. 45.
    D’Haese PC, Schrooten I, Goodman WG, Cabrera WE, Lamberts LV, Elseviers MM, Couttenye M-M, De Broe ME. Increased bone strontium levels in hemodialysis patients with osteomalacia. Kidney Int 2000; 57: 1107-1114.CrossRefPubMedGoogle Scholar
  46. 46.
    Schrooten I, Cabrera W, Dauwe S, Lamberts LV, Marynisen R, Dorriné W, Goodman WG, De Broe ME, D’Haese PC. Strontium causes osteomalacia in chronic renal failure rats. Kidney Int 1998; 54: 448-456.CrossRefPubMedGoogle Scholar
  47. 47.
    Schrooten I, Behets GJ, Cabrera WE, Vercauteren SR, Lamberts LV, Verberckmoes SC, Bervoets AJ, Dams G, Goodman WG, De Broe ME, D’Haese PC. Dose-dependent effects of strontium on bone of chronic renal failure rats. Kidney Int 2003; 63: 927-935.CrossRefPubMedGoogle Scholar
  48. 48.
    Oste L, Verberckmoes SC, Behets GJ, Dams G, Bervoets AR, Van Hoof VO, Bohic S, Drakopoulos M, De Broe ME, D’Haese PC. Strontium incorporates at sites critical for bone mineralization in rats with renal failure. X-Ray Spectrometry 2007; 36: 42-44.CrossRefGoogle Scholar
  49. 49.
    Gitelman HJ, Alderman F, Perry SJ. Renal handling of silicon in normals and in patients with renal insufficiency. Kidney Int 1992;42: 957-959.CrossRefPubMedGoogle Scholar
  50. 50.
    Dobbie JW, Smith MJB Urinary and serum silicon in normal and uremic individuals. Ciba Found Symp 1986; 121: 194-213.PubMedGoogle Scholar
  51. 51.
    Gitelman HJ, Alderman FR, Perry SJ. Silicon accumulation in dialysis patients. Am J Kidney Dis 1992; 19: 140-143.PubMedGoogle Scholar
  52. 52.
    Parry R, Plowman D, Delves HT, Roberts NB, Birchall JD, Bellia JP, Davenport A, Ahmad R, Fahal I, Altmann. Silicon and aluminum interactions in haemodialysis patients. Nephrol Dial Transplant 1998; 13: 1759-1762.CrossRefPubMedGoogle Scholar
  53. 53.
    Edwardson JA, Moore PB, Ferrier IN, Lilley JS, Newton GWA, Barker J, Templar J, Day JP. Effect of silicon on gastrointestinal absorption of aluminium. Lancet 1993; 342: 211-212.CrossRefPubMedGoogle Scholar
  54. 54.
    Shainkin-Kestenbaum R, Adler AJ, Berlyne GM. Inhibition of superoxide dismutase activity by silicon. J Trace Elem Electrolytes Health Dis 1990; 4: 97-99.PubMedGoogle Scholar
  55. 55.
    Bergonzi G, Paties C, Vassallo G, Zangrandi A, Poisetti PG, Ballocchi S, Fontana F, Scarpioni L. Dextran deposits in tissues of patients undergoing hemodialysis. Nephrol Dial Transplant 1990; 5: 54-58.PubMedGoogle Scholar
  56. 56.
    D’Haese PC, Van Landeghem GF, De Broe ME. Increased silicon levels in dialysis patients due to the high silicon content in the drinking water, inadequate water treatment procedures, and concentrate contamination: A multicentre study. Nephrol Dial Transplant 1996; 11: 1188-1189 (Reply Letter to the Editor).Google Scholar
  57. 57.
    Saldanha LF, Gonick HC, Rodriguez HJ, Marmelzat JA, Repique EV, Marcus CL. Silicon related syndrome in dialysis patients. Nephron 1997; 77: 48-56.CrossRefPubMedGoogle Scholar
  58. 58.
    Hsieh Y-Y, Shen W-S, Lee L-Y, Wu T-L, Ning H-C, Sun C-F. Long-term changes in trace elements in patients undergoing chronic hemodialysis. Biol Trace Elem Res 2006; 109: 115-121.CrossRefPubMedGoogle Scholar
  59. 59.
    Zwołińska D, Grzeszczak W, Szczepańska M, Kiliś-Pstrusińska K, Szprynger K. Lipid peroxidation and antioxidant enzymes in children on maintenance dialysis. Pediatr Nephrol 2006; 21: 705-710.CrossRefPubMedGoogle Scholar
  60. 60.
    Bonomini M, Forster S, De Risio F, Rychly J, Nebe B, Manfrini V, Klinkmann H, Albertozzi A. Effects of selenium supplementation on immune parameters in chronic uraemic patients on haemodialysis. Neprol Dial Transplant 1995; 10: 1654-1661.Google Scholar
  61. 61.
    Rukgauer M, Schmitt Y, Schneider H, Krusejarres JD. Trace element balance in patients undergoing hemodialysis. Trace Elem & Electrolytes 1994; 11: 155-168.Google Scholar
  62. 62.
    Henderson I, Leung A, Halls D, Fell G, Dobbie J, Kennedy AC. Hyper chromiumaemia in chronic dialysis patients. Proc EDTA-ERA 1985; 22: 270-275.Google Scholar
  63. 63.
    D’Haese PC, Couttenye M-M, Lamberts LV, Elseviers MM, Goodman WG, Schrooten I, Cabrera W, De Broe ME. Al, Fe, Pb, Cd, Cu, Zn, Cr, Mg, Sr and Ca content in bone of end-stage renal failure patients. Clin Chem 1999; 45: 1548-1556.PubMedGoogle Scholar
  64. 64.
    Esfahani ST, Hamidian MR, Madani A, Ataei N, Mohseni P, Roudbari M, Marzieh Haddadi. Serum zinc and copper levels in children with chronic renal failure. Pediatr Nephrol 2006; 21: 1153-1156.CrossRefPubMedGoogle Scholar
  65. 65.
    Navarro-Alarcon M, Reyes-Pérez A, Lopez-Garcia H, Palomares-Bayo M, Olalla-Herrera M, Lopez-Martinez MC. Longitudinal study of serum zinc and copper levels in hemodialysis patients and their relation to biochemical markers. Biol Trace Elem Res; 2006; 113: 209-222.CrossRefPubMedGoogle Scholar
  66. 66.
    Mahajan SK, Bowersox EM, Rye DL, Abu-Hamdam DK, Prasad AS, McDonald FD, Biersack KL . Factors underlying abnormal zinc metabolism in uremia. Kidney Int 1989; 36 (Suppl): 269-273.Google Scholar
  67. 67.
    Richard MJ, Arnud J, Jurkovitz C, Hachache T, Meftahi H, Laporte F, Foret M, Favier A, Cordonnier D. Trace element lipid peroxidation abnormalities in patients with chronic renal failure. Nephron 1991; 57: 10-15.CrossRefPubMedGoogle Scholar
  68. 68.
    Türk S, Bozfakioglu S, Ecder ST, Kahraman T, Gürel N, Erkoç R, Aysuna N, Türkmen A, Bekiroglu N, Ark E. Effects of zinc supple-mentation on the immune system and on antibody response to multivalent influenza vaccine in hemodialysis patients. Int J Artif Organs 1998; 21: 274-278.PubMedGoogle Scholar
  69. 69.
    Chevalier CA, Liepa G, Murphy MD, Suneson J, Vanbeber AD, Gorman MA, Cochran C. The effects of zinc supplementation on serum zinc and cholesterol concentrations in hemodialysis patients. J Ren Nutr 2002; 12: 183-189.CrossRefPubMedGoogle Scholar
  70. 70.
    Thomson NP, Stevens BJ, Humphery TJ, Atkins RC. Comparison of trace elements in peritoneal dialysis, hemodialysis and uremia. Kidney Int 1983; 23: 9-14.CrossRefPubMedGoogle Scholar
  71. 71.
    Van Landeghem GF, D’Haese PC, Lamberts LV, Djukanovic L, Pejanovic S, Goodman WG, De Broe ME. Low serum aluminum values in dialysis patients with increased bone aluminum levels. Clin Nephrol 1998; 50: 69-76.PubMedGoogle Scholar
  72. 72.
    Evans C (ed). Biochemistry of lanthanides. Plenum Press New York 1990.Google Scholar
  73. 73.
    Rosenkranz AR, Grobner T, Mayer GJ. Conventional or gadolinium containing contrast media: the choice between acute renal failure or nephrogenic systemic fibrosis. Wien klin Wochenschr 2007, 119: 271-275.CrossRefPubMedGoogle Scholar
  74. 74.
    Evenepoel P, Zeegers M, Segaert S, Claes K, Kuypers D, Maes B, Flamen P, Fransis S, Vanrenterghem Y. Nephrogenic fibrosing dermopathy: a novel, disabling disorder in patients with renal failure. Nephrol Dial Transplant 2004, 19: 469-473.CrossRefPubMedGoogle Scholar
  75. 75.
    Grobner T, Prischl. Gadolinium and nephrogenic systemic fibrosis. Kidney Int 2007; 72: 260-264.CrossRefPubMedGoogle Scholar
  76. 76.
    Boyd AS, Zic JA, Abraham JL. Gadolinium deposition in nephrogenic fibrosing dermopathy. J Am Acad Dermatol 2007; 56: 27-30.CrossRefPubMedGoogle Scholar
  77. 77.
    Marckmann P, Skov L, Rossen K, Dupont A, Brimnes Damholt M, Goya Heaf J, Thomsen HS. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 2006; 17: 2359 - 2362.CrossRefPubMedGoogle Scholar
  78. 78.
    Andréjak M, Thuillier D, Lok C, Gras-Champel V. Fibrose systémique néphrogénique et produits à base de gadolinium: données disponibles début 2007 Nephrogenic Systemic Fibrosis and Gadolinium-based Contrast Media. Thérapie 2007; 62: 169-172.CrossRefPubMedGoogle Scholar
  79. 79.
    Thomsen HS, (ed) Contrast Media. Safety Issues and ESUR Guidelines. Springer: Berlin, Heidelberg, New York, 2006.Google Scholar
  80. 80.
    Liu J, liu Y, Habeebu SM, Waalkes MP, Klaassen CD. Chronic combined exposure to cadmium and arsenic exacerbates nephro- toxicity, particularly in metallothionein-I/II null mice. Toxicology 2000, 147:157-166.CrossRefPubMedGoogle Scholar
  81. 81.
    El-Sharaky AS, Newairy AA, Badreldeen MM, Eweda SM, Sheweita SA. Protective role of selenium against renal toxicity induced by cadmium in rats. Toxicology 2007; 235: 185-93.CrossRefPubMedGoogle Scholar
  82. 82.
    Van Landeghem GF, D’ Haese PC, Lamberts LV, De Broe ME. Competition of iron and aluminium for transferrin: the molecular basis for aluminium deposition in iron-overloaded dialysis patients? Exp Nephrol 1997; 5: 239-245.PubMedGoogle Scholar
  83. 83.
    Ahamed M, Singh S, Behari JR, Kumar A, Siddiqui MKJ. Interaction of lead with some essential trace metals in the blood of anemic children from Lucknow, India. Clin Chim Acta 2007; 377: 92-97.CrossRefGoogle Scholar

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  • Patrick C. D′Haese

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