scholarly journals Association of selenium with thyroid volume and echostructure in 35- to 60-year-old French adults

2003 ◽  
pp. 309-315 ◽  
Author(s):  
H Derumeaux ◽  
P Valeix ◽  
K Castetbon ◽  
M Bensimon ◽  
MC Boutron-Ruault ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Menopausal Status ◽  
Thyroid Tissue ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Alpha Tocopherol ◽  
Inverse Association ◽  
Selenium Status ◽  
Cross Sectional ◽  
Increased Risk

OBJECTIVE: To investigate the relationship between selenium status, thyroid Volume and gland echostructure. DESIGN: Cross-sectional. METHODS: In 792 men (45-60 Years) and 1108 women (35-60 Years) from the SU.VI.MAX study, thyroid Volume and gland echostructure were determined ultrasonographically. At baseline, thyrotropin, free thyroxine, selenium, zinc, alpha-tocopherol, beta-carotene, retinol, urinary iodine and thiocyanate concentrations were measured. Alcohol consumption, smoking, and menopausal status were assessed by a questionnaire. A stepwise linear and a logistic regression model were used, adjusting for antioxidant vitamins, trace elements status and age. RESULTS: In women, there was an inverse association between selenium status and thyroid Volume (P=0.003). A protective effect of selenium against goiter (odds ratio (OR)=0.07, 95% confidence interval (CI)=0.008-0.6) and thyroid tIssue damage (OR=0.2, 95% CI=0.06-0.7) was observed. There was no evidence of an association between menopausal status and other antioxidant elements, thyroid Volume or thyroid hypoechogenicity. Smoking, but not alcohol consumption, was associated with an increased risk of thyroid enlargement in women (OR=3.94, 95% CI=1.64-9.48). No association between thyroid Volume, thyroid structure or selenium was found in men. CONCLUSION: Our findings suggest that selenium may protect against goiter. Selenium was related to thyroid echostructure, suggesting it may also protect against autoimmune thyroid disease.

scholarly journals The role of thiocyanate in the etiology of goiter in an industrial metropolitan area

2006 ◽  
Vol 154 (2) ◽  
pp. 229-235 ◽  
Author(s):  
V F H Brauer ◽  
H Below ◽  
A Kramer ◽  
D Führer ◽  
R Paschke
Keyword(s):  
Air Pollution ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Industrial Area ◽  
Epidemiological Survey ◽  
Waste Products ◽  
Spot Urine ◽  
Increased Risk ◽  
Goiter Prevalence ◽  
High Resolution Ultrasonography

Objective: Thiocyanate (SCN−) has concentration dependent antithyroid properties and a role in the etiology of goiter has been suggested in several studies. In 1991 an epidemiological survey conducted in the region of Halle/Leipzig (Saxony), an area with significant air pollution, suggested an inverse relationship between urinary iodine (I−)/SCN− excretion and goiter prevalence. 10 years later, we reinvestigated the same industrial area to clarify if the situation has changed after the elimination of most industrial waste products and moreover, if SCN− excretion levels alone or in combination with air pollution or smoking as a SCN− source are critical for thyroid function. Design and methods: We investigated a cohort of 708 probands for I−, SCN− and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules by high resolution ultrasonography. Results: Probands with goiter (n = 79, 11%) had significantly higher urinary SCN− excretions than probands without (3.9 ± 2.8 vs 3.1 ± 3.4 mg SCN−/g creatinine) and significantly lower urinary I−/SCN− ratios than patients without thyroid disorders (41 ± 38 vs 61 ± 71 μg I−/mg SCN−/l). Mean urinary I− excretions were not different between probands with or without goiter. Smokers showed significantly elevated urinary SCN−/creatinine ratios in comparison to non-smokers (4.3 ± 4.3 vs 2.4 ± 2.1 mg SCN−/g creatinine). ANOVA revealed a prediction of thyroid volume through age (P < 0.001), gender (P < 0.001), body weight (P < 0.05) and smoking (P < 0.05). Conclusions: In our investigation, age, gender and smoking (raising SCN− levels by CN− inhalation) were predictive for thyroid volume and the urinary I−/SCN− ratios were able to detect probands with an increased risk of developing goiter in contrast to urinary I− excretion levels alone. These data suggest, that in an era and area of decreased cyanide pollution, SCN− may remain a cofactor in the multifactorial aetiology of goiter.

scholarly journals Stature is inversely associated with self-reported diabetes in middle-aged Mexican women

2017 ◽  
Vol 41 ◽  
pp. 1
Author(s):  
Ruy Lopez-Ridaura ◽  
Karl P Puchner ◽  
Eduardo Ortiz-Panozo ◽  
Isabel Vieitez ◽  
Martín Lajous
Keyword(s):  
Menopausal Status ◽  
Urban Environments ◽  
Urban Setting ◽  
Mexican Women ◽  
Inverse Association ◽  
Middle Aged ◽  
Cross Sectional ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Sectional Analysis

Objective. To investigate whether stature is associated with two highly prevalent cardiom- etabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods. We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results. After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household’s head during participant’s childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in partici- pants living in urban environments. Conclusions. We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

Abstract P189: Associations between Lactation and Maternal Measures of Total and Regional Adiposity 15 Years Postpartum: Results from the Study of Women’s Health Across the Nation

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Candace K McClure ◽  
Christina M Shay ◽  
Ping G Tepper ◽  
Molly B Conroy ◽  
Barbara Sternfeld ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Women’S Health ◽  
Women's Health ◽  
Menopausal Status ◽  
Lower Leg ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Regional Adiposity

Objective: It has been reported that mothers who do not breastfeed are at an increased risk of T2DM, metabolic syndrome, and CVD. We hypothesize that lactation may influence cardio-metabolic risk by altering maternal body composition. We examined the extent to which lactation was associated with regional and total adiposity in a sample of US women 15 years after their last birth. Study Design : Cross-sectional analysis of data provided by 1,268 women aged 45-58 who enrolled in the Study of Women’s Health Across the Nation (1996 -1997). Adiposity was assessed using dual-energy X-ray absorptiometry. History of lactation was self-reported and categorized into three groups: mothers who breastfed for ≥3 months after every birth, those who discontinued lactation within 3 months of some births, and those who never breastfed. Results: Compared with mothers who breastfed after every birth for at least 3 months, mothers who never breastfed had 0.87 kg greater trunk fat mass (FM), 1.3% greater % trunk FM, 1.3% lower % leg FM, and 0.075 greater trunk to leg FM ratio after adjustment for age, parity, height, years since last birth, race/ethnicity, socioeconomic, lifestyle, psychological, and family history variables, maximum gestational weight gain, and menopausal status. After additional adjustment for current BMI, women who never breastfed had 0.40 kg greater trunk FM and 0.053 greater trunk to leg FM ratio than mothers who breastfed every child for ≥3 months. Similarly, mothers who discontinued lactation within 3 months of some births had 0.28 kg greater trunk FM and 0.87% lower % leg FM than mothers who consistently breastfed. Conclusion : Women who did not breastfeed for at least 3 months after every birth exhibit less favorable body fat distributions 15 years postpartum. These results provide a potential physiologic basis for prior findings that women who do not breastfeed their children face increased risk of diabetes, the metabolic syndrome, and cardiovascular disease. Given existing disparities in rates of lactation, obesity and CVD, these findings have great clinical relevance and suggest the need for targeted lactation support for women at risk of cardiovascular disease.

scholarly journals Endemic goitre and excessive iodine in urine and drinking water among Saharawi refugee children

2010 ◽  
Vol 13 (9) ◽  
pp. 1472-1477 ◽  
Author(s):  
Sigrun Henjum ◽  
Ingrid Barikmo ◽  
Anne Karine Gjerlaug ◽  
Abderraháman Mohamed-Lehabib ◽  
Arne Oshaug ◽  
...  
Keyword(s):  
Drinking Water ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
Refugee Children ◽  
Urinary Iodine Concentration ◽  
Endemic Goitre ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Excessive Iodine

AbstractObjectiveTo assess the prevalence of enlarged thyroid volume (Tvol) in Saharawi refugee children, and their urinary iodine concentration (UIC), and to identify possible sources of excess iodine intake.DesignA cross-sectional survey was performed during January–February 2007. Tvol was measured by ultrasound and iodine concentration was analysed in casual urine samples, in household drinking water and in milk samples from household livestock.SettingThe study was undertaken in four refugee camps in the Algerian desert.SubjectsThe subjects were 421 Saharawi children, 6–14 years old.ResultsEnlarged Tvol was found in 56 % (Tvol-for-age) and 86 % (Tvol-for-body-surface-area) of the children. The median (25th percentile–75th percentile, P25–P75) UIC was 565 (357–887) μg/l. The median (P25–P75) iodine concentration in household drinking water was 108 (77–297) μg/l. None of the children had UIC below 100 μg/l, 16 % had UIC between 100 and 299 μg/l, and 84 % had UIC above 300 μg/l. There was a positive association between Tvol and whether the household possessed livestock.ConclusionsThe children are suffering from endemic goitre and high UIC caused probably by an excessive intake of iodine. The excessive iodine intakes probably originate from drinking water and milk.

scholarly journals Thyroid Functions in Bamboo-Shoots Consuming Children of Tripura, North-east India

2021 ◽  
Author(s):  
Indrajit Ray ◽  
A. K. Chandra ◽  
Saru Kumar Debbarma ◽  
Sekhar Kumar Mookerjee ◽  
Ajoy Datta ◽  
...  
Keyword(s):  
Urinary Iodine ◽  
Thyroid Volume ◽  
Thyroid Stimulating Hormone ◽  
Consumption Pattern ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
Cross Sectional ◽  
North East ◽  
Bamboo Shoots ◽  
The Village

Abstract PurposeInformation on thyroid functions in populations consuming potent antithyroidal bamboo-shoots (BS) was found scanty. Therefore, to assess thyroid function in BS consuming children was found relevant.MethodsThis cross-sectional study included 127 children from 3 villages. Thyroid volume (TV), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), thyroglobulin antibody (Tg-Ab), thyroid peroxidase antibody (TPO-Ab), urinary iodine (UI), urinary thiocyanate (USCN), salt iodine (SI), water iodine (WI), and BS consumption pattern were assessed. ResultsVariable-wise overall mean±SDs/medians/interquartile ranges (IQR) were - age: 8.69±1.69/8.77/7.22-9.74 y, TVol: 0.82±0.27/0.82/0.67-0.96 ml, FT4: 19.5+5.6/20.1/16.9-22.0 pmol/L, FT3: 4.27+1.24/4.22/3.35-4.96 pmol/L, TSH: 2.44+1.39/2.33/1.60-3.15 mIU/L, Tg-Ab: 15.2+10.0/12.5/11.1-14.5 IU/ml, TPO-Ab: 5.58+12.25/3.89/2.90-5.11 IU/ml, UI: 117.4±58.5/108/73-160.5 µg/L, USCN: 0.99+0.67/0.8/0.5-1.2 mg/dl, WI: 4 .69±4.56/3.0/1.35–7µg/L, and BS consumption: 153.8±01.4/119/71.4–214.3 g/person/day respectively. Only 80.3% salt samples had ≥15 ppm iodine. Thyroid dysfunction prevalence was 6.3%. There were positive correlations between TV and FT4 (r=0.2466, p=0.005), UI and TSH (r=0.2633, p=0.003), TSH and FT4 (r=0.2135, p=0.016), TSH and FT3 (r=0.1898, p=0.033), USCN and FT4 (r=0.2477, p=0.005), Tg-Ab and TPO-Ab (r=0.3768, p=<0.001), and negative correlations between Tg-Ab and TSH (r=-0.2024, p=0.023), Tg-Ab and FT4 (r=-0.1869, p=0.035). In boys, USCN had a positive correlation with TPO-Ab (r=0.3069, p=0.018). The village having highest levels of BS consumption (p=0.037) and median UI showed higher TSH levels (p=0.037) and higher FT3 level (p=0.001) compared to the village of lowest BS consumption.ConclusionsThe BS consuming children appear at risk of developing hypothyroidism by Tg-Ab, which may partly be diminished by reducing BS consumption.

scholarly journals A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262458
Author(s):  
Neda S. Hashemi ◽  
Jens Christoffer Skogen ◽  
Aleksandra Sevic ◽  
Mikkel Magnus Thørrisen ◽  
Silje Lill Rimstad ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Use ◽  
Sickness Absence ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Strong Relationship ◽  
Short Term ◽  
Design Data ◽  
Cross Sectional ◽  
Increased Risk

Aim Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term). Method Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078. Results Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33–10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16–8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73–8.60). Conclusion This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.

scholarly journals 863Alcohol and cancer in an Australian cohort of 226,162 participants aged 45 years and over

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Peter Sarich ◽  
Karen Canfell ◽  
Sam Egger ◽  
Emily Banks ◽  
Grace Joshy ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Cancer Risk ◽  
Proportional Hazards ◽  
Absolute Risk ◽  
Cox Proportional Hazards ◽  
Inverse Association ◽  
Upper Aerodigestive Tract ◽  
Public Health Burden ◽  
Local Evidence ◽  
Increased Risk

Abstract Background Australia has a relatively high level of alcohol consumption. Although alcohol consumption is known to increase the risk of several cancer types internationally, local evidence for Australia is limited. Methods Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to weekly alcohol consumption among 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident cancer cases were ascertained by linkage to the New South Wales Cancer Registry to December 2013 by the Centre for Health Record Linkage. Results Over a median 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of any cancer (HR per seven drink increase in weekly consumption: 1.02; 95% CI: 1.00-1.04), and cancers of the upper aerodigestive tract (1.19;1.10-1.29), mouth/pharynx (1.18;1.08-1.29), oesophagus (1.22;1.04-1.43), colorectum (1.09;1.04-1.15), colon (1.13;1.06-1.20), liver (1.22;1.04-1.44), breast (1.09;1.00-1.18), and melanoma (1.05;1.00-1.10); whereas an inverse association was observed for thyroid cancer (0.80;0.64-1.00). We estimated that by age 85 years, Australian men and women who consume &gt;14 drinks/week increase their absolute risk of alcohol-attributable cancer by 4.4% and 5.4%, respectively, compared to non-drinkers. Conclusions We report relative risks of cancer incidence in relation to alcohol consumption that match the international evidence. In Australia, a nation with relatively high alcohol consumption, these risks may translate into a significant public health burden. Key messages We have generated estimates for the relationship between alcohol consumption and cancer risk in Australia.

scholarly journals Prevalence of iodine deficiency and goitre during pregnancy in east Hungary

2000 ◽  
pp. 479-483 ◽  
Author(s):  
E Mezosi ◽  
I Molnar ◽  
A Jakab ◽  
E Balogh ◽  
Z Karanyi ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Nutritional Status ◽  
Pregnant Women ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Control Group ◽  
Thyroid Function Tests ◽  
Cross Sectional ◽  
Nodular Goitre

OBJECTIVE: To assess the iodine nutritional status and the prevalence of goitre during pregnancy in a region of Hungary that appeared to be iodine sufficient in previous studies. DESIGN: A cross-sectional voluntary screening study was organized in which 313 pregnant women participated. METHODS: Urine iodine concentration and the volume of the thyroid gland were measured in every woman. In the presence of low urinary iodine concentrations, goitre, or both, thyroid function tests were performed. RESULTS: Iodine deficiency was found in 57.1% of the pregnant women, and was severe in 15.6%. The volume of the thyroid gland was enlarged in 19.2% of individuals. Nodular goitre was found in 17 women (5.4%). The frequency of goitre and the mean thyroid volume were increased in the group of iodine-deficient women. In the 89 cases of iodine deficiency or goitre, thyrotrophin concentrations were in the normal range; however, the free triiodothyronine:free throxine ratio was increased in 97% of them, indicating that the thyroid gland was in a stimulated state in these individuals. CONCLUSIONS: Iodine deficiency with high prevalence of goitre was recognized among pregnant women in an area that previously appeared to be iodine sufficient. An unexpected mild iodine deficiency was also noted in the non-pregnant control group. Reassessment and continuous monitoring of iodine nutritional status is warranted even in populations that are apparently considered to be 'at no risk' of iodine deficiency, especially in pregnant women. Regular administration of iodine, starting at preconception or in early pregnancy and continuing during the period of nursing, is recommended in these regions.

scholarly journals High prevalence of iodine deficiency in pregnant women living in adequate iodine area

2018 ◽  
Vol 7 (5) ◽  
pp. 762-767 ◽  
Author(s):  
Verônica Carneiro Borges Mioto ◽  
Ana Carolina de Castro Nassif Gomes Monteiro ◽  
Rosalinda Yossie Asato de Camargo ◽  
Andréia Rodrigues Borel ◽  
Regina Maria Catarino ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Adverse Outcomes ◽  
Urinary Iodine Concentration ◽  
Serum Thyroglobulin ◽  
Cross Sectional ◽  
Iodine Status

Objectives Iodine deficiency during pregnancy is associated with obstetric and neonatal adverse outcomes. Serum thyroglobulin (sTg) and thyroid volume (TV) are optional tools to urinary iodine concentration (UIC) for defining iodine status. This cross-sectional study aims to evaluate the iodine status of pregnant women living in iodine-adequate area by spot UIC and correlation with sTg, TV and thyroid function. Methods Two hundred and seventy-three pregnant women were evaluated at three trimesters. All had no previous thyroid disease, no iodine supplementation and negative thyroperoxidase and thyroglobulin antibodies. Thyroid function and sTg were measured using electrochemiluminescence immunoassays. TV was determined by ultrasonography; UIC was determined using a modified Sandell–Kolthoff method. Results Median UIC was 146 µg/L, being 52% iodine deficient and only 4% excessive. TSH values were 1.50 ± 0.92, 1.50 ± 0.92 and 1.91 ± 0.96 mIU/L, respectively, in each trimester (P = 0.001). sTg did not change significantly during trimesters with median 11.2 ng/mL and only 3.3% had above 40 ng/mL. Mean TV was 9.3 ± 3.4 mL, which positively correlated with body mass index, but not with sTg. Only 4.5% presented with goitre. When pregnant women were categorized as iodine deficient (UIC < 150 µg/L), adequate (≥150 and <250 µg/L) and excessive (≥250 µg/L), sTg, thyroid hormones and TV at each trimester showed no statistical differences. Conclusions Iodine deficiency was detected frequently in pregnant women living in iodine-adequate area. sTg concentration and TV did not correlate to UIC. Our observation also demonstrated that the Brazilian salt-iodization programme prevents deficiency, but does not maintain iodine status within adequate and recommended ranges for pregnant women.

scholarly journals Sonographic assessment of thyroid gland in patients with chronic kidney disease undergoing hemodialysis

2017 ◽  
Vol 5 (1) ◽  
pp. 4 ◽  
Author(s):  
Maisa Elzakil ◽  
Awadia Gareeballah ◽  
Moawia Gameraddin ◽  
Mowada Burai ◽  
Fathelrehman Alagab
Keyword(s):  
Chronic Kidney Disease ◽  
Thyroid Gland ◽  
Kidney Disease ◽  
Thyroid Nodules ◽  
Kidney Diseases ◽  
Morphological Changes ◽  
Thyroid Tissue ◽  
Thyroid Volume ◽  
Cross Sectional Study ◽  
Cross Sectional

Background: Thyroid gland morphology and disorders were affected with chronic kidney diseases (CKD). The study aims to assess thyroid gland disorders and morphology in patients with CKD on regular hemodialysis.Materials and methods: A cross-sectional study included 71 participants divided into two groups. The study group included 51 patients with known chronic kidney disease on hemodialysis and healthy group included 20 participants. The exclusion criteria were thyroid disorders. The thyroid gland was scanned with ultrasound using a 7 MHz probe.Results: The thyroid is enlarged in 21.57% of patients and heterogeneous echotexture in 31.4%. The prevalence of thyroid nodules and cysts were 9.8% and 7.8% respectively. A positive linear correlation existed between duration of hemodialysis and thyroid volume. Thyroid volume and echotexture were significantly increased with duration of hemodialysis (p = .001 and .00 respectively). Thyroid nodules and cysts were not significantly correlated with duration of hemodialysis (p = .06 and .28 respectively).Conclusions: In conclusion, enlargement of thyroid gland and heterogeneity of thyroid tissue were the most common morphological changes in patients with chronic renal failure undergoing hemodialysis. The prevalence increased with longer duration of hemodialysis. Periodic ultrasound assessment of thyroid volume and texture are recommended in hemodialyzed patients to avoid complications.

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