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Acute neonatal hyperammonemia is associated with poor neurological outcomes and high mortality. We developed, based on kinetic modeling, a user-friendly and widely applicable algorithm to tailor the treatment of acute neonatal hyperammonemia. A single compartmental model was calibrated assuming a distribution volume equal to the patient’s total body water (V), as calculated using Wells’ formula, and dialyzer clearance as derived from the measured ammonia time–concentration curves during 11 dialysis sessions in four patients (3.2 ± 0.4 kg). Based on these kinetic simulations, dialysis protocols could be derived for clinical use with different body weights, start concentrations, dialysis machines/dialyzers and dialysis settings (e.g., blood flow QB). By a single measurement of ammonia concentration at the dialyzer inlet and outlet, dialyzer clearance (K) can be calculated as K = QB∙[(Cinlet − Coutlet)/Cinlet]. The time (T) needed to decrease the ammonia concentration from a predialysis start concentration Cstart to a desired target concentration Ctarget is then equal to T = (−V/K)∙LN(Ctarget/Cstart). By implementing these formulae in a simple spreadsheet, medical staff can draw an institution-specific flowchart for patient-tailored treatment of hyperammonemia.
Sunny Eloot; Jonathan De Rudder; Patrick Verloo; Evelyn Dhont; Ann Raes; Wim Van Biesen; Evelien Snauwaert. Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia. Toxins 2021, 13, 484 .
AMA StyleSunny Eloot, Jonathan De Rudder, Patrick Verloo, Evelyn Dhont, Ann Raes, Wim Van Biesen, Evelien Snauwaert. Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia. Toxins. 2021; 13 (7):484.
Chicago/Turabian StyleSunny Eloot; Jonathan De Rudder; Patrick Verloo; Evelyn Dhont; Ann Raes; Wim Van Biesen; Evelien Snauwaert. 2021. "Towards an Algorithm-Based Tailored Treatment of Acute Neonatal Hyperammonemia." Toxins 13, no. 7: 484.
Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.
Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins 2021, 13, 225 .
AMA StyleAmina El Amouri, Evelien Snauwaert, Aurélie Foulon, Charlotte Vande Moortel, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Griet Glorieux, Wim Van Biesen, Johan Vande Walle, Ann Raes, Sunny Eloot. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins. 2021; 13 (3):225.
Chicago/Turabian StyleAmina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. 2021. "Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease." Toxins 13, no. 3: 225.
Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatric Nephrology 2021, 36, 1589 -1595.
AMA StyleAmina El Amouri, Evelien Snauwaert, Aurélie Foulon, Charlotte Vande Moortel, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Griet Glorieux, Wim Van Biesen, Johan Vande Walle, Ann Raes, Sunny Eloot. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatric Nephrology. 2021; 36 (6):1589-1595.
Chicago/Turabian StyleAmina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot. 2021. "Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain." Pediatric Nephrology 36, no. 6: 1589-1595.
Background Haemodiafiltration (HDF) is accepted to effectively lower plasma levels of middle molecules in the long term, while data are conflicting with respect to the additive effect of convection on lowering protein-bound uraemic toxins (PBUTs). Here we compared pre-dialysis β2-microglobulin (β2M) and PBUT levels and the percentage of protein binding (%PB) in children on post-dilution HDF versus conventional high- (hf) or low-flux (lf) haemodialysis (HD) over 12 months of treatment. Methods In a prospective multicentre, non-randomized parallel-arm intervention study, pre-dialysis levels of six PBUTs and β2M were measured in children (5–20 years) on post-HDF (n = 37), hf-HD (n = 42) and lf-HD (n = 18) at baseline and after 12 months. Analysis of variance was used to compare levels and %PB in post-HDF versus conventional hf-HD and lf-HD cross-sectionally at 12 months and longitudinal from baseline to 12 months. Results For none of the PBUTs, no difference was found in either total and free plasma levels or %PB between post-HDF versus the hf-HD and lf-HD groups. Children treated with post-HDF had lower pre-dialysis β2M levels [median 23.2 (21.5; 26.6) mg/dL] after 12 months versus children on hf-HD [P<0.01; 35.2 (29.3; 41.2) mg/dL] and children on lf-HD [P<0.001; 47.2 (34.3; 53.0) mg/dL]. While β2M levels remained steady in the hf-HD and lf-HD group, a decrease in β2M was demonstrated for children on post-HDF (P<0.01). Conclusions While post-HDF successfully decreased β2M, no additive effect on PBUT over 12 months of treatment was found. PBUT removal is complex and hampered by several factors. In children, these factors might be different from adults and should be explored in future research.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Krid Saoussen; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J Stefanidis; Rukshana Shroff; Sunny Eloot. Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population. Nephrology Dialysis Transplantation 2019, 35, 648 -656.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Griet Glorieux, Johan Vande Walle, Sanne Roels, Raymond Vanholder, Varvara Askiti, Karolis Azukaitis, Aysun Bayazit, Nur Canpolat, Michel Fischbach, Krid Saoussen, Mieczyslaw Litwin, Lukasz Obrycki, Fabio Paglialonga, Bruno Ranchin, Charlotte Samaille, Franz Schaefer, Claus Peter Schmitt, Brankica Spasojevic, Constantinos J Stefanidis, Rukshana Shroff, Sunny Eloot. Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population. Nephrology Dialysis Transplantation. 2019; 35 (4):648-656.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Krid Saoussen; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J Stefanidis; Rukshana Shroff; Sunny Eloot. 2019. "Haemodiafiltration does not lower protein-bound uraemic toxin levels compared with haemodialysis in a paediatric population." Nephrology Dialysis Transplantation 35, no. 4: 648-656.
Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4–5 (n = 24) children. In parallel β2-microglobulin (β2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (rs). We found higher levels of β2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4–5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of β2M, pCG, HA, IAA, IxS, and CMPF (rs −0.2 to −0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4–5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population.
Evelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins 2019, 11, 235 .
AMA StyleEvelien Snauwaert, Els Holvoet, Wim Van Biesen, Ann Raes, Griet Glorieux, Johan Vande Walle, Sanne Roels, Raymond Vanholder, Varvara Askiti, Karolis Azukaitis, Aysun Bayazit, Nur Canpolat, Michel Fischbach, Nathalie Godefroid, Saoussen Krid, Mieczyslaw Litwin, Lukasz Obrycki, Fabio Paglialonga, Bruno Ranchin, Charlotte Samaille, Franz Schaefer, Claus Peter Schmitt, Brankica Spasojevic, Constantinos J. Stefanidis, Maria Van Dyck, Koen Van Hoeck, Laure Collard, Sunny Eloot, Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins. 2019; 11 (4):235.
Chicago/Turabian StyleEvelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. 2019. "Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population." Toxins 11, no. 4: 235.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Raymond Vanholder; Johan Vande Walle; Sunny Eloot. A plea for more uremic toxin research in children with chronic kidney disease. Pediatric Nephrology 2018, 33, 921 -924.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Griet Glorieux, Raymond Vanholder, Johan Vande Walle, Sunny Eloot. A plea for more uremic toxin research in children with chronic kidney disease. Pediatric Nephrology. 2018; 33 (6):921-924.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Raymond Vanholder; Johan Vande Walle; Sunny Eloot. 2018. "A plea for more uremic toxin research in children with chronic kidney disease." Pediatric Nephrology 33, no. 6: 921-924.
Chronic kidney disease (CKD) in childhood is characterised by the accumulation of uraemic toxins resulting in a multisystem disorder that has a negative impact on quality of life. Childhood CKD is predominantly defined by a decrease in glomerular filtration rate, estimated (eGFR) by a single serum measurement of endogenous biomarkers, e.g. creatinine. The objective of this study was to evaluate how accurately eGFR predicts the concentration of uraemic toxins in a paediatric CKD cohort. In 65 children (10.8 [5.1; 14.7] years) with CKD (eGFR 44 [20; 64] mL/min/1.73 m2), serum concentrations were determined of small solutes (uric acid [UA], urea, symmetric dimethylarginine [SDMA], asymmetric dimethylarginine [ADMA]), middle molecules (β2-microglobulin [β2M], complement factor D [CfD]) and protein-bound solutes (p-cresylglucuronide [pCG], hippuric acid, indole acetic acid, indoxyl sulphate [IxS], p-cresylsulfate [pCS] and 3-carboxy-4-methyl-5-propyl-furanpropionic acid [CMPF]). Spearman’s correlation coefficients (r) were calculated to correlate uraemic toxin concentrations with three different eGFR equations, based on either serum creatinine or β2M. Updated Schwartz eGFR was correlated reasonably well with concentrations of creatinine (r = −0.98), urea (rs = −0.84), SDMA (r = −0.82) and middle molecules CfD and β2M (both rs = −0.90). In contrast, poor correlation coefficients were found for CMPF (rs = −0.32), UA (rs = −0.45), ADMA (rs = −0.47) and pCG (rs = −0.48). The other toxins, all protein-bound, had rs between −0.75 and −0.57. Comparable correlations were found between the three evaluated eGFR equations and uraemic toxin concentrations. This study demonstrates that eGFR poorly predicts concentrations of protein-bound uraemic toxins, UA and ADMA in childhood CKD. Therefore, eGFR only partially reflects the complexity of the accumulation pattern of uraemic toxins in childhood CKD.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Els Holvoet; Griet Glorieux; Koen Van Hoeck; Maria Van Dyck; Nathalie Godefroid; Raymond Vanholder; Sanne Roels; Johan Vande Walle; Sunny Eloot. Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease. Pediatric Nephrology 2017, 33, 315 -323.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Els Holvoet, Griet Glorieux, Koen Van Hoeck, Maria Van Dyck, Nathalie Godefroid, Raymond Vanholder, Sanne Roels, Johan Vande Walle, Sunny Eloot. Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease. Pediatric Nephrology. 2017; 33 (2):315-323.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Els Holvoet; Griet Glorieux; Koen Van Hoeck; Maria Van Dyck; Nathalie Godefroid; Raymond Vanholder; Sanne Roels; Johan Vande Walle; Sunny Eloot. 2017. "Accumulation of uraemic toxins is reflected only partially by estimated GFR in paediatric patients with chronic kidney disease." Pediatric Nephrology 33, no. 2: 315-323.
Chronic kidney disease (CKD) in childhood is poorly explained by routine markers (e.g. urea and creatinine) and is better depicted in adults by other uraemic toxins. This study describes concentrations of representative uraemic toxins in non-dialysis CKD versus healthy children. In 50 healthy children and 57 children with CKD Stages 1-5 [median estimated glomerular filtration rate 48 (25th-75th percentile 24-71) mL/min/1.73 m2; none on dialysis], serum concentrations of small solutes [symmetric and asymmetric dimethyl-arginine (SDMA and ADMA, respectively)], middle molecules [β2-microglobuline (β2M), complement factor D (CfD)] and protein-bound solutes [p-cresylglucuronide (pCG), hippuric acid (HA), indole-acetic acid (IAA), indoxyl sulphate (IxS), p-cresyl sulphate (pCS) and 3-carboxy-4-methyl-5-propyl-furanpropionic acid (CMPF)] were measured. Concentrations in the CKD group were expressed as z-score relative to controls and matched for age and gender. SDMA, CfD, β2M, IxS, pCS, IAA, CMPF and HA concentrations were higher in the overall CKD group compared with controls, ranging from 1.7 standard deviations (SD) for IAA and HA to 11.1 SD for SDMA. SDMA, CfD, β2M, IxS and CMPF in CKD Stages 1-2 with concentrations 4.8, 2.8, 4.5, 1.9 and 1.6 SD higher, respectively. In contrast, pCS, pCG and IAA concentrations were only higher than controls from CKD Stages 3-4 onwards, but only in CKD Stage 5 for ADMA and HA (z-score 2.6 and 20.2, respectively). This is the first study to establish reference values for a wide range of uraemic toxins in non-dialysis CKD and healthy children. We observed an accumulation of multiple uraemic toxins, each with a particular retention profile according to the different CKD stages.
Evelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Valerie Van Bogaert; Koen Van Hoeck; Marc Coppens; Sanne Roels; Johan Vande Walle; Sunny Eloot. Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population. Nephrology Dialysis Transplantation 2017, 33, 978 -986.
AMA StyleEvelien Snauwaert, Wim Van Biesen, Ann Raes, Griet Glorieux, Valerie Van Bogaert, Koen Van Hoeck, Marc Coppens, Sanne Roels, Johan Vande Walle, Sunny Eloot. Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population. Nephrology Dialysis Transplantation. 2017; 33 (6):978-986.
Chicago/Turabian StyleEvelien Snauwaert; Wim Van Biesen; Ann Raes; Griet Glorieux; Valerie Van Bogaert; Koen Van Hoeck; Marc Coppens; Sanne Roels; Johan Vande Walle; Sunny Eloot. 2017. "Concentrations of representative uraemic toxins in a healthy versus non-dialysis chronic kidney disease paediatric population." Nephrology Dialysis Transplantation 33, no. 6: 978-986.
Evidence-based medicine (EBM) is gaining importance in the current paediatric healthcare landscape. Improvement of paediatric health status is its major aim. However, for EBM to be successful, all stakeholders involved should understand what EBM really is, why and how EBM should or should not be practiced, and have the necessary skills to distinguish methodologically sound papers from biased opinion papers, and understand how and why guidelines are different from systematic reviews. Improving patient outcome requires attention to high-quality evidence and understanding of the processes of medical decision-making. Rigorous methodology is the cornerstone of guideline production, but in cases where quality evidence cannot be produced, as is often the case in paediatric nephrology because of low patient numbers, consensus-based guidance may be suitable to assist the practitioner at the bedside, as long as the underlying process is transparent. Most importantly, EBM should support patient involvement in a shared decision-making process. The more consistent and accurately predictable the effect of certain interventions is, clinically relevant to patients rather than affecting surrogate outcomes, and a priority for patients and other stakeholders, the more likely it is that adherence to the guidance provided will improve the outcome of patients.
Evelien Snauwaert; Johan Vandewalle; Evi V. Nagler; Wim Van Biesen. Building on evidence to improve patient care. Pediatric Nephrology 2016, 32, 2193 -2202.
AMA StyleEvelien Snauwaert, Johan Vandewalle, Evi V. Nagler, Wim Van Biesen. Building on evidence to improve patient care. Pediatric Nephrology. 2016; 32 (12):2193-2202.
Chicago/Turabian StyleEvelien Snauwaert; Johan Vandewalle; Evi V. Nagler; Wim Van Biesen. 2016. "Building on evidence to improve patient care." Pediatric Nephrology 32, no. 12: 2193-2202.
PurposeSince 1997, strong incentives have been introduced worldwide to improve access to safe and effective medicines addressing the therapeutic needs of children. ACE inhibitors, the most prescribed antihypertensive drugs in the paediatric population, are one of the prototype drugs targeted by the legislation initiatives. Our purpose in assembling this review is to evaluate and describe the current evidence for the efficacy and safety profile of ACE inhibitors in the paediatric population.MethodsThe authors made a descriptive review of the literature from 1980 to 2015 using the following search terms: hypertension, child, paediatric, ACE (inhibitors), renin–angiotensin aldosterone system, captopril, lisinopril, enalapril, ramipril and fosinopril.ResultsA total of 16 studies evaluating efficacy and safety of ACE inhibitors were included in this review. The included studies demonstrate that ACE inhibitors have the potency to decrease the systolic and/or diastolic blood pressure with an overall favourable safety profile in a short-term period. More importantly, the incentives resulted in an improvement of the overall availability of paediatric labelling, dosing and safety information for ACE inhibitors. However, they failed to fulfil several of paediatric needs: absence of long-term safety data on growth and maturation, absence of commercially available child-friendly formulations and incomplete evaluation of the entire paediatric hypertension population.ConclusionAdditional efforts are needed to close the gap between the availability of drugs that are labelled and indicated for paediatric use and the actual drug usage in children, especially in young children, neonates and children with severe hypertension, renal transplantation or severe renal impairment.
Evelien Snauwaert; Johan Vande Walle; Pauline De Bruyne. Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review. Archives of Disease in Childhood 2016, 102, 63 -71.
AMA StyleEvelien Snauwaert, Johan Vande Walle, Pauline De Bruyne. Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review. Archives of Disease in Childhood. 2016; 102 (1):63-71.
Chicago/Turabian StyleEvelien Snauwaert; Johan Vande Walle; Pauline De Bruyne. 2016. "Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review." Archives of Disease in Childhood 102, no. 1: 63-71.