Efficacy and Safety of Nefecon in Patients With Primary IgA (Immunoglobulin A) Nephropathy
- Conditions
- Primary IgA Nephropathy
- Interventions
- Drug: NefeconDrug: Placebo oral capsule
- Registration Number
- NCT03643965
- Lead Sponsor
- Calliditas Therapeutics AB
- Brief Summary
The overall aim of the study is to evaluate the efficacy, safety, and tolerability of Nefecon 16 mg per day in the treatment of patients with primary IgAN (Immunoglobulin A nephropathy) at risk of progressing to end-stage renal disease (ESRD), despite maximum tolerated treatment with renin-angiotensin system (RAS) blockade using angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II type I receptor blockers (ARBs).
- Detailed Description
This is a Phase 3, randomized, double-blind, placebo-controlled, multicenter study to evaluate the efficacy, safety, and tolerability of oral Nefecon compared to matching placebo in patients with primary IgAN on a background of optimized RAS inhibitor therapy. The study will consist of 2 parts, Part A and Part B. Part A will include a 9 month blinded Treatment Period, and a 3-month Follow up Period. Part B of the study will consist of a 12-month observational Follow up Period; no study drug will be administered during Part B. Part A and B will be blinded. Safety will be monitored by an independent Data Safety Monitoring Board.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 365
- Female or male patients ≥18 years
- Biopsy-verified IgA nephropathy
- Stable dose of RAS inhibitor therapy (ACEIs and/or ARBs) at the maximum allowed dose or Maximum Tolerated Dose (MTD) according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines
- Urine protein creatinine ratio ≥1 g/24hr
- eGFR ≥35 mL/min per 1.73 m2 and ≤90 mL/min per 1.73 m2 using the Chronic Kidney Diseae Epidemiology Collaboration (CKD-EPI) formula
- Willing and able to give informed consent
- Systemic diseases that may cause mesangial IgA deposition.
- Patients who have undergone a kidney transplant.
- Patients with acute or chronic infectious disease including hepatitis, tuberculosis, human immunodeficiency virus (HIV), and chronic urinary tract infections.
- Patients with liver cirrhosis, as assessed by the Investigator.
- Patients with a diagnosis of type 1 or type 2 diabetes mellitus which is poorly controlled.
- Patients with history of unstable angina, class III or IV congestive heart failure, and/or clinically significant arrhythmia, as judged by the Investigator;
- Patients with unacceptable blood pressure control defined as a blood pressure consistently above national guidelines for proteinuric renal disease, as assessed by the Investigator
- Patients with diagnosed malignancy within the past 5 years.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Nefecon Nefecon Nefecon 16 mg once daily by mouth for 9 months. Placebo oral capsule Placebo oral capsule Placebo oral capsule once daily by mouth for 9 months.
- Primary Outcome Measures
Name Time Method Part A: Ratio of Urine Protein to Creatinine Ratio (UPCR) at 9 Months Compared to Baseline 9 months Part A primary endpoint: The ratio of Urine Protein to Creatinine Ratio (UPCR) (based on 24-hour urine collections) at 9 months following the first dose of study drug compared to baseline.
Ratio being: UPCR at 9 months in g/gram divided with UPCR at Baseline in g/gramPart B: Time-weighted Average of Estimated Glomerular Filtration Rate (eGFR) Up to 2 years and 1 month Part B Primary endpoint: Time-weighted average of estimated glomerular filtration rate (eGFR) recordings observed at each time point over 2 years. The eGFR (CKD-EPI) at 2 years (which must have been repeated to provide a second value obtained within 14 to 35 days) was the geometric mean of the 2 assessments.
- Secondary Outcome Measures
Name Time Method Part A: Ratio of eGFR at 9 Months 9 months Part A: Ratio of eGFR at 9 months compared to baseline calculated using the CKD-EPI formula.
Part A: Ratio of eGFR at 12 Months 12 months Part A: Ratio of eGFR at 12 months compared to baseline calculated using the CKD-EPI formula.
Part A: Ratio of Urine Albumin to Creatinine Ratio (UACR) at 9 Months 9 months Part A: Ratio of urine albumin to creatinine ratio (UACR) at 9 months compared to baseline.
Part B: Time to 30% Reduction in eGFR Over 2 years Part B: Time to 30% reduction from baseline in eGFR (CKD-EPI) confirmed by a second value.
For clarity: Please note that the number of patients with a 30% reduction is presented with statistical analysis of the time to 30% reduction.Part B: Time to Receiving Rescue Medication. Over 2 years Part B: Time from the first dose of study drug until receiving rescue medication.
For clarity: Please note that the number of patients receiving rescue medication is presented with statistical analysis of the time to receiving rescue medication.Part B: Ratio of UPCR Compared to Baseline Averaged Over Time Points Between 12 and 24 Months 12, 18 and 24 months Part B: Ratio of UPCR, UACR, and eGFR (CKD-EPI) compared to baseline averaged over time points between 12 and 24 months, inclusive, following the first dose of study drug
Part B: Ratio of UACR Compared to Baseline Averaged Over Time Points Between 12 and 24 Months 12 to 24 months Part B: Ratio of UPCR, UACR, and eGFR (CKD-EPI) compared to baseline averaged over time points between 12 and 24 months, inclusive, following the first dose of study drug.
Part B: Ratio of eGFR Compared to Baseline Averaged Over Time Points Between 12 and 24 Months 12 to 24 months Part B: Ratio of UPCR, UACR, and eGFR (CKD-EPI) compared to baseline averaged over time points between 12 and 24 months, inclusive, following the first dose of study drug;
Part B: Proportion of Patients Without Microhematuria 12 to 24 months Part B: Proportion of patients without microhematuria in at least 2 of the following time points: 12, 18, and 24 months following the first dose of study drug
Part B: Short Form 36 (SF-36) Quality of Life Assessment at 9 Months. 9 months Part B: Short Form 36 (SF-36) quality of life assessment at 9 and 24 months.
The 36-Item Short Form Health Survey (SF-36) is a set of generic, coherent, and easily administered quality-of-life measures. These measures rely upon patient self-reporting and have been widely used. It consists of eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions.
Higher scores indicate better health. Scores represent the percentage of total possible score achieved.Part B: Short Form 36 (SF-36) Quality of Life Assessment at 24 Months. 24 months Part B: Short Form 36 (SF-36) quality of life assessment at 9 and 24 months.
The 36-Item Short Form Health Survey (SF-36) is a set of generic, coherent, and easily administered quality-of-life measures. These measures rely upon patient self-reporting and have been widely used. It consists of eight health concepts: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions.
Higher scores indicate better health. Scores represent the percentage of total possible score achieved.
Trial Locations
- Locations (142)
Stanford University Medical Center, 777 Welch Rd
🇺🇸Palo Alto, California, United States
University of Kentucky Medical Center, 800 Rose St, Pavillion H 3rd floor
🇺🇸Lexington, Kentucky, United States
University of Florida-Gainesville
🇺🇸Gainesville, Florida, United States
Western Nephrology and Metabolic Bone Disease, PC-Westerminster, 8410 Decatur St.
🇺🇸Westminster, Colorado, United States
Southeastern Nephrology Associates-Wilmington, 1302 Medical Center Drive
🇺🇸Wilmington, North Carolina, United States
Box Hill Hospital, Dept of Renal Medicine, Arnold Str 5
🇦🇺Box Hill, Australia
Columbia Univ Medical Center, Div of Nephrology, 51 Audubon Av
🇺🇸New York, New York, United States
Clinico de Nefrologia, Urologia Y Enfermedades Cardiovasculares, Av. Gdor Freyre 3074
🇦🇷Santa Fe, Argentina
Chu St Etienne-Hopital Nord, Service de Nephrologie Dialyse Transplantation renale, Av. Albert Raimond
🇫🇷Saint-Priest-en-Jarez, France
Universitatsklinik Schleswig-Holstein-Campus Lubek, Medizinische Klinik I, Nephrologie, Ratzeburger Allee 160
🇩🇪Lubeck, Germany
Hallym University Sacred Heart Hospital,22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si
🇰🇷Gyeonggi-do, Korea, Republic of
Renal Disease Research Institute, 1250 Eighth Av. #135
🇺🇸Fort Worth, Texas, United States
Clinica Priv Velez Sarsfield
🇦🇷Córdoba, Argentina
Queens Hospital Centre
🇺🇸Jamaica, New York, United States
Royal Adelaide Hospital, Port Rd.
🇦🇺Adelaide, Australia
Western Health, Western Hospital-Sunshine Hospital, 176 Furlong Rd, Level 3, WHCRE Building
🇦🇺St Albans, Australia
Gomel Regional Clinical Hospital, 5 Brat'ev Lizukovyh str.
🇧🇾Gomel, Belarus
Study Cor Oy, Hoitajantie 4
🇫🇮Jyväskylä, Finland
Lapeyronie Hospital, Univ Hospital Montpellier, 371 Av. du Doyen Gaston Giraud
🇫🇷Montpellier, France
Prince of Wales Hospital, Nephrology Dept, Parkes 3 West
🇦🇺Randwick, Australia
Metro South Hospital and Health Service via Princess Alexandra Hospital, Dept of Nephrology, 199 Ipswich Rd.
🇦🇺Woolloongabba, Australia
Universitaetsklinikum Carl Gustav Carus Dresden, Medizinische Klinik III, Nephrologie, Fetscherstr. 74
🇩🇪Dresden, Germany
Ospedale San Carlo Borromeo, Via Pio II, 3
🇮🇹Milano, Italy
Centre Hospitalier Boulogne sur Mer, 4eme etage Batiment Administratif, Allee Jacques Monod
🇫🇷Boulogne-sur-Mer, France
Universitaetsklinikum Heidelberg-Nephrologie, Renal Clinic, Im Neuenheimer Feld 162
🇩🇪Heidelberg, Germany
Chung-Ang University Hospial, 102 Heukseok-ro, Dongiak-gu
🇰🇷Seoul, Korea, Republic of
Austin Health, Dept of Nephrology, 145 Studley Rd.
🇦🇺Heidelberg, Australia
Uniklinik RWTH Aachen, Medizinische Klinik II, Pauwelsstrasse 30
🇩🇪Aachen, Germany
ASST di Lecco, Presidio Ospedaliero Alessandro Manzoni, Via dell´Eremo 9/11
🇮🇹Lecco, Italy
Danderyds sjukhus, Njurmedicinska kliniken
🇸🇪Stockholm, Sweden
Hospital Universitari Arnau de Vilanova, Avenida Alcalde Rovire Roure 80
🇪🇸Lleida, Spain
Dong-A University Hospital, Won Suk An, 26 Daesingongwon-Ro Seogu
🇰🇷Busan, Korea, Republic of
Azienda Ospedale Policlinico di Bari
🇮🇹Bari, Italy
Istituti Clinici Scientifici Maugeri Spa-Societa Benefit, Div. di Nephrologia ed Emodialist, Via S. Maugeri 10
🇮🇹Pavia, Italy
Hospital del Mar, Passeig Maritim 25-29
🇪🇸Barcelona, Spain
Fakultni nemocnice Olomouc, I.P. Pavlova 185/6
🇨🇿Olomouc, Czechia
Kyungpook National University Hospital, 130 Dongdeok-ro Jung-gu
🇰🇷Daegu, Korea, Republic of
Hopital Bichat-Claude Bernard, Service de Nephrologie, 46 rue Henri Huchard
🇫🇷Paris, France
Hospital Clinic Barcelona, Escalera 12, Planta 5, Calle Villaroel 170
🇪🇸Barcelona, Spain
Universitaetsklinikum Erlangen, Medizinisches Klinik 4, Ulmenweg 18
🇩🇪Erlangen, Germany
Hospital Universitario Vall d´Hebron, Passeig Vall d´Hebron 119-129
🇪🇸Barcelona, Spain
Sahlgrenska University Hospital, Njurmottagningen, Vita Stråket 12
🇸🇪Göteborg, Sweden
Belfast City Hospital, 51 Lisburn Rd
🇬🇧Belfast, United Kingdom
Universitetssjukhuset Linköping, Njurmedicinska kliniken
🇸🇪Linköping, Sweden
Ege University Med Faculty Dept of Internal Disease, Div of Nephrology
🇹🇷İzmir, Turkey
Karolinska University Hospital-Huddinge, Njur-KBC M87
🇸🇪Stockholm, Sweden
Istanbul University Cerrahpasa, Medical Faculty-Dept of Internal Disease, Fatih-Cerrahpasa, Kocamustafapasa Caddesi No 53
🇹🇷Istanbul, Turkey
Southmead Hospital, Southmead Rd, Westbury-on-Trym
🇬🇧Bristol, United Kingdom
Gloucestershire Royal Hospital, Great Western Rd
🇬🇧Gloucester, United Kingdom
Leicester General Hospital, John Walls Renal Unit, Gwendolen Rd
🇬🇧Leicester, United Kingdom
Hospital General Universitario Gregorio Maranon, Servicio de Nefrologica, C/Dr. Esquerdo 46
🇪🇸Madrid, Spain
National Cheng Kung University Hospital, No 138 Sheng Li Rd
🇨🇳Tainan, Taiwan
Nottingham City Hospital, Hucknall Rd
🇬🇧Nottingham, United Kingdom
The Royal London Hospital, Whitechapel
🇬🇧London, United Kingdom
Los Angeles Biomedical Research Institute at HUMC, 1124 W. Carson Street
🇺🇸Torrance, California, United States
University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Thomas Jefferson University, 211 S. 9th Street
🇺🇸Philadelphia, Pennsylvania, United States
Northwestern University the Feinberg School of Medicine, 633 North St. Clair
🇺🇸Chicago, Illinois, United States
Cleveland Clinic, Glickman Urological & Kidney Institute, 9500 Euclid Av.
🇺🇸Cleveland, Ohio, United States
The Ohio State University (OSU), Wexner Medical Center, 410 West 10th Av.
🇺🇸Columbus, Ohio, United States
Hospital Maisonneuve-Rosemont, CNIB 3rd Floor, 1929 Bayview Avenue
🇨🇦Toronto, Ontario, Canada
Toronto General Hospital, University Health Network, 200 Elizabeth St, 8 N-849
🇨🇦Toronto, Ontario, Canada
Northshore University Health System, 2650 Ridge Av.
🇺🇸Evanston, Illinois, United States
Icahn School of Medicine at Mount Sinai-James J. Peters VA Medical Center, One Gustave L. Levy Place
🇺🇸New York, New York, United States
Mountain Kidney & Hypertension Assoc, 10 McDowell St
🇺🇸Asheville, North Carolina, United States
Southeastern Nephrology-Whiteville, 800 Jefferson St
🇺🇸Whiteville, North Carolina, United States
University of Vermont
🇺🇸Burlington, Vermont, United States
Hospital Universitario Austral, Unidad de Investigacion Clinica, Av. J.D. Peron 1500, piso 4
🇦🇷Pilar, Argentina
Melbourne Health, Royal Melbourne Hospital, Dept of Nephrology,Grattan Str.
🇦🇺Parkville, Australia
Westmead Hospital, Dept of Renal Medicine, Hawkesbury Rd.
🇦🇺Westmead, Australia
Kingston General Hospital
🇨🇦Kingston, Ontario, Canada
Fakultni nemocnice Brno, Interni gastroenterologicka klinika, Jihlavska 20
🇨🇿Brno, Czechia
Fakultni nemocnice Hradec Kralove, Sokolska 581
🇨🇿Hradec Králové, Czechia
Helsinki University Central Hospital (HUCH), Nephrology Clinic, Meilahti Triangle Hospital
🇫🇮Helsinki, Finland
Vseobecna fakultni nemocnice v Praze, Klinik nefrologie, U Nemocnice 499/2
🇨🇿Praha 2, Czechia
General Hospital of Athens-Laiko, Nephrology Clinic, 17 Agiou Thoma Street
🇬🇷Athens, Greece
Universitaetsklinikum Regensburg, Abteilung für Nephrologie, Franz-Josef-Strauss Allee 11
🇩🇪Regensburg, Germany
Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu
🇰🇷Seoul, Korea, Republic of
Hospital 12 de Octubre, Residencia General (Sotano 1)-Area de Ensayos Clinicos, Avda. Cordoba s/n
🇪🇸Madrid, Spain
Cukurova University Medical Faculty, Dept of Internal Disease, Div of Nephrology, Balcali
🇹🇷Adana, Turkey
Kocaeli University Medical School-Internal Medicine, Nephrology, Umuttepe Yerleskesi
🇹🇷Kocaeli, Turkey
Queen Elizabeth University Hosp-Glasgow, Glasgow Clin Research Facility 5th floor, Institute of Neurosciences
🇬🇧Glasgow, United Kingdom
University of Minnesota, 717 Delaware St. SE
🇺🇸Minneapolis, Minnesota, United States
Tampere University Hospital, P O Box 2000, Munuaiskeskus, Erakennus, 1. kerros
🇫🇮Tampere, Finland
Centre Hospiitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord
🇨🇦Sherbrooke, Quebec, Canada
Hospital Britanico de Buenos Aires, Pedriel 74
🇦🇷Capital federal, Argentina
Sanatorio Allende, Hipolito Yrigoyen 384, 2 Piso
🇦🇷Córdoba, Argentina
Brest Regional Hospital, 7 Meditsinskaya str.
🇧🇾Brest, Belarus
Grodno Regional Clinical Hospital, 52 Bulvar Leninskogo Komsomola
🇧🇾Grodno, Belarus
4-th N.E. Savchenko City Clinical Hospital, 110, R. Luxemburg str.
🇧🇾Minsk, Belarus
CISSS de la Monteregie-Centre-Hopital Charles LeMoyne, Room E-304, 3120 Taschereau Blvd
🇨🇦Greenfield Park, Quebec, Canada
Sonomed Sp. z.o.o. ul. Bandurskiego 98/U12
🇵🇱Szczecin, Poland
Hospital Privado-Centro Medico de Cordoba, Naciones Unidas 346, Nefrologia piso 1
🇦🇷Córdoba, Argentina
Vancouver Coastal Health Authority, Gordon and Leslie Diamond Health Care Centre, 5 th floor, Diamond Building
🇨🇦Vancouver, British Columbia, Canada
Cliniques Universitaires Saint-Luc, Nephrology Dept, Av. Hippocrate 10
🇧🇪Brussel, Belgium
University Hospital Gent, Dept of Medical Nephrology, Corneel Heymanslaan 10
🇧🇪Gent, Belgium
AZ Delta, Wilgenstraat 2
🇧🇪Roeselare, Belgium
University Hospital of Heraklion, Nephrology Clinic, Diastaurosi Staurakion-Vouton
🇬🇷Heraklion, Greece
Washington Nephrology Associates-Washington DC, 730 24th Street NW
🇺🇸Washington, District of Columbia, United States
Queen Elizabeth II Health Sciences Centre, 1276 South Park St
🇨🇦Halifax, Nova Scotia, Canada
CHUQ-L'Hotel Dieu de Quebec, 11 côte du Palais
🇨🇦Québec City, Quebec, Canada
Univ of Arizona, 1501 N Campbell Ave
🇺🇸Tucson, Arizona, United States
University General Hospital of Ioannina, Nephrology Clinic, Leof. Stavros Niarchou
🇬🇷Ioánnina, Greece
Monash Medical Centre
🇦🇺Clayton, Victoria, Australia
University Hospital Erasmus (Brussels), Recherche Clinique Nephrologie Transplantation, Route de Lennik 808
🇧🇪Brussels, Belgium
Centre Hospitalier Universitaire de Liege, Nephrology Dept. Domaine Universitaire de Sart-Tilman
🇧🇪Liège, Belgium
University Hospital of Larissa Medical School, Nefrology Clinic, Mezourlo
🇬🇷Larissa, Greece
Kaohsiung Medical Univ Chung-Ho Memorial Hospital
🇨🇳Kaohsiung, Taiwan
China Medical University Hospital, No 2 Yude Rd
🇨🇳Taichung, Taiwan
Royal Inland Hospital, Kidney Clinic, 7 South, 311 Columbia Street
🇨🇦Kamloops, British Columbia, Canada
Interior Health-Kelowna General Hosp (IH KGH), 2268 Pandosy Str.
🇨🇦Kelowna, British Columbia, Canada
General Hospital of Nikaia Ag. Panteleimon, Nephrology Clinic, Mantouvalou 3 Str.
🇬🇷Níkaia, Greece
Uniwersyteckie Centrum Kliniczne-Szpital Gdanskiego Uniwersytetu Medycznego
🇵🇱Gdańsk, Poland
University General Hospital of Patras, Rio
🇬🇷Patras, Greece
Hippokration General Hosp of Thessaloniki, Nephrology Clinic, 49 Konstantinoupoleos Str
🇬🇷Thessaloníki, Greece
Wojewodzki Szpital Specjalistyczny w Olsztynie, Oddzial Kliniczny Nefrologiczny, Hipertensjologii i Chorob Wewnetrznych, ul. Zolnierska 18
🇵🇱Olsztyn, Poland
Taichung Veterans General Hospital
🇨🇳Taichung, Taiwan
Samodzielny Publiczny Zaklad Opieki Zdrowotnej Centralny Szpital Kliniczny, Uniwersytetu Medycznego w Lodzi, ul Pomorska 251
🇵🇱Łódź, Poland
Uppsala University Hospital, Dept of Nephrology, ing 30, plan 5
🇸🇪Uppsala, Sweden
CHU Grenoble-Hopital Michallon, Service Nephrologie-Hemodialyse-Aphereses-Transplantation Renale, Boulevard de la Chantourne CS 10217
🇫🇷Grenoble, France
Centre Hospitalier de Valenciennes, Service de Nephrologie-Medecine Interne, Av. Desandrouin BP 379
🇫🇷Valenciennes, France
Erciyes University Faculty of Medicine,Semiha Kibar Organ Nakli ve Dyaliz Hastanesi, Kosk Mah. prof dr Turhan Feyziogly Cad. no 42
🇹🇷Kayseri, Turkey
St James´s University Hospital, Beckett St.
🇬🇧Leeds, United Kingdom
University of Manchester, Manchester Royal Infirmary, Oxford Rd
🇬🇧Manchester, United Kingdom
Northern General Hospital, Herries Rd.
🇬🇧Sheffield, United Kingdom
Hospital Universitario Fundacion Alcorcon, C/Budapest 1
🇪🇸Alcorcón, Spain
Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu
🇰🇷Daejeon, Korea, Republic of
Seoul St. Mary´s Hospital, 222 Banpo-Daero, Seocho-gu
🇰🇷Seoul, Korea, Republic of
University Clinic Munich, LMU-Inner City Medical Polyclinic, Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV
🇩🇪Munich, Germany
Fakultni nemocnice Kralovske Vinohrady, Linterni klinika, Srobarova 1150/50
🇨🇿Praha 10, Czechia
Kidney Care and Transplant Services of New England, PC, 354 Birnie Av.
🇺🇸Springfield, Massachusetts, United States
Allegheny General Hospital, 4800 Friendship Av.
🇺🇸Pittsburgh, Pennsylvania, United States
University of Alabama at Birmingham, 1720 2nd Ave South
🇺🇸Birmingham, Alabama, United States
University of Colorado Health Science Center, 1200 East 19th Av.
🇺🇸Aurora, Colorado, United States
Yale University School of Medicine, 330 Cedar Street
🇺🇸New Haven, Connecticut, United States
University of Louisville-Nephrology
🇺🇸Louisville, Kentucky, United States
Omega Research Maitland, 7912 Forest City Rd.
🇺🇸Orlando, Florida, United States
Omega Research Maitland
🇺🇸Orlando, Florida, United States
Clinical Research Consultants, LLC, 3930 Washington St
🇺🇸Kansas City, Missouri, United States
University of North Carolina at Chapel Hill, Clinical & Translational Research Centre
🇺🇸Chapel Hill, North Carolina, United States
Oregon Health & Science University, 3181 SW Sam Jackson Park Rd
🇺🇸Portland, Oregon, United States
Nephrology Associates, P.C., 28 White Bridge Rd
🇺🇸Nashville, Tennessee, United States