Patrick Hank Pun | Scholars@Duke

Patrick Hank Pun
Associate Professor of Medicine

My current research interest is in understanding the mechanisms of cardiovascular disease among patients with chronic kidney disease, with a particular focus on the epidemic of sudden cardiac death. The ultimate goal is to reduce the impact of sudden death through improved risk stratification and novel risk mitigation therapies. Current investigations are focused on identifying novel genetic and biomarker risk factors among CKD patients, understanding the interplay of hemodialysis-specific exposures in the development of arrhythmias, and examining the risks and benefits of implantable cardioverter defibrillators among CKD patients using clinical trial and registry data.

Current Appointments & Affiliations

Associate Professor of Medicine, Medicine, Nephrology, Medicine 2020
Member of the Duke Clinical Research Institute, Duke Clinical Research Institute, Institutes and Centers 2015

Contact Information

Duke Box 17969, Durham, NC 27705
PO Box 17969, 2400 Pratt St Rm 0311 Terrace Level, Durham, NC 27705
(919) 668-8529

Background
Education, Training, & Certifications
- Fellow in Nephrology, Medicine, Duke University 2004 - 2007
- Medical Resident, Medicine, Duke University 2001 - 2004
- M.D., Vanderbilt University 2001
Duke Appointment History
- Associate Professor of Medicine, Medicine, Nephrology, Medicine 2017 - 2020
- Assistant Professor of Medicine, Medicine, Nephrology, Medicine 2010 - 2017
- Medical Instructor in the Department of Medicine, Medicine, Nephrology, Medicine 2007 - 2010
- Instructor, Temporary in the Department of Medicine, Medicine, Nephrology, Medicine 2007
Research
Selected Grants
- A Phase 3, Intravenous Sodium Thiosulfate for Acute Calciphylaxis Treatment: A Multicenter, Randomized, Double-blind, Placebo-controlled, Clinical Trial awarded by Hope Pharmaceuticals Inc. 2019 - 2022
- Association Between ECG data obtained via the Medtronic Reveal LINQ device and Real-Time Blood Chemistry Values: RADAR Ancillary Study Proposal awarded by New York University School of Medicine 2018 - 2022
- QT prolonging medications and sudden cardiac death among individuals on hemodialysis awarded by University of North Carolina - Chapel Hill 2020 - 2022
- Reducing Arrhythmia in Dialysis by ADjusting the Rx Electrolytes- RADAR awarded by New York University School of Medicine 2019 - 2021
- Evaluating and Improving Cardiac Arrest Resuscitation Efforts in Hemodialysis Clinics awarded by National Institutes of Health 2017 - 2020
- Randomized trials using point of care guided manipulation of dialysate potassium, dialysate bicarbonate, and ultrafiltration rate to prevent hemodialysis-associated arrhythmia awarded by Brigham and Women's Hospital 2018 - 2019
- Wearable Cardioverter Defibrillator ( Zoll Study) awarded by DaVita Clinical Research 2016 - 2017
- ACO Model and Comprehensive ESRD Care Initiative awarded by Deloitte Consulting LLP 2016 - 2017
- Risk Factors for Sudden Cardiac Death in Patients with Chronic Kidney Disease awarded by National Institutes of Health 2014 - 2017
- EPC_TO#3_WA#7_Anemia Management in Renal Disease Populations - Part 2 awarded by Agency for Healthcare Research and Quality 2010
- EPC _TO #1_WA #3_Anemia Management in Renal Disease Populations - (Part 1) awarded by Agency for Healthcare Research and Quality 2010
External Relationships
- Fresenius Medical North America
- ardelyx
Publications & Artistic Works
Selected Publications
- Academic Articles
  - Hein, Aaron M., Julia J. Scialla, Jie-Lena Sun, Stephen J. Greene, Linda K. Shaw, Karen Chiswell, Patrick H. Pun, and Robert J. Mentz. “Estimated Glomerular Filtration Rate Variability in Patients With Heart Failure and Chronic Kidney Disease.” J Card Fail, May 10, 2021. https://doi.org/10.1016/j.cardfail.2021.04.016.
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  - Lunyera, Joseph, Robert M. Clare, Karen Chiswell, Julia J. Scialla, Patrick H. Pun, Kevin L. Thomas, Monique A. Starks, and Clarissa J. Diamantidis. “Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention.” J Am Soc Nephrol 32, no. 3 (March 2021): 654–62. https://doi.org/10.1681/ASN.2020040502.
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  - Pun, Patrick H., Sean D. Pokorney, and Christopher B. Granger. “Warfarin for Atrial Fibrillation Stroke Prophylaxis in Advanced Kidney Disease: If You Are Not Confused, You Are Not Thinking Clearly.” Jacc Clin Electrophysiol 6, no. 13 (December 14, 2020): 1669–71. https://doi.org/10.1016/j.jacep.2020.07.020.
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  - Pun, Patrick H., Craig S. Parzynski, Daniel J. Friedman, Gillian Sanders, Jeptha P. Curtis, and Sana M. Al-Khatib. “Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Patients Undergoing Long-Term Dialysis.” Clin J Am Soc Nephrol 15, no. 11 (November 6, 2020): 1622–30. https://doi.org/10.2215/CJN.07920520.
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  - Hofacker, Samuel A., Matthew E. Dupre, Kimberly Vellano, Bryan McNally, Monique Anderson Starks, Myles Wolf, Laura P. Svetkey, and Patrick H. Pun. “Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group.” Resuscitation 156 (November 2020): 42–50. https://doi.org/10.1016/j.resuscitation.2020.07.036.
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  - Hofacker, Samuel A., Laura J. Fish, Audrey L. Blewer, and Patrick H. Pun. “Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study.” Nephrol Nurs J 47, no. 5 (September 2020): 401–11.
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  - Assimon, Magdalene M., Lily Wang, Patrick H. Pun, Wolfgang C. Winkelmayer, and Jennifer E. Flythe. “Use of QT Prolonging Medications by Hemodialysis Patients and Individuals Without End-Stage Kidney Disease.” J Am Heart Assoc 9, no. 13 (July 7, 2020): e015969. https://doi.org/10.1161/JAHA.120.015969.
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  - Edmonston, Daniel L., and Patrick H. Pun. “Coronary artery disease in chronic kidney disease: highlights from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.” Kidney Int 97, no. 4 (April 2020): 642–44. https://doi.org/10.1016/j.kint.2019.12.010.
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  - Starks, Monique Anderson, Jingjing Wu, Eric D. Peterson, Judith A. Stafford, Roland A. Matsouaka, L Ebony Boulware, Laura P. Svetkey, Paul S. Chan, Patrick H. Pun, and Patrick H. for American Heart Association’s Get With the Guidelines-Resuscitation Investigators. “In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients.” Clin J Am Soc Nephrol 15, no. 2 (February 7, 2020): 219–27. https://doi.org/10.2215/CJN.05070419.
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  - Pun, Patrick H., and Sana M. Al-Khatib. “Implantable Defibrillators for Primary Prevention of Sudden Death in Patients on Dialysis.” Am J Kidney Dis 74, no. 6 (December 2019): 857–60. https://doi.org/10.1053/j.ajkd.2019.05.002.
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  - Pun, Patrick H., Matthew E. Dupre, Clark Tyson, Sana M. Al-Khatib, and Christopher B. Granger. “Authors' Reply.” J Am Soc Nephrol 30, no. 6 (June 2019): 1137–38. https://doi.org/10.1681/ASN.2019040353.
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  - Pun, Patrick H., Matthew E. Dupre, Monique A. Starks, Clark Tyson, Kimberly Vellano, Laura P. Svetkey, Steen Hansen, et al. “Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics.” J Am Soc Nephrol, February 7, 2019. https://doi.org/10.1681/ASN.2018090911.
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  - Massicotte-Azarniouch, David, John Paul Kuwornu, Megan K. McCallum, Nisha Bansal, Ngan Lam, Amber O. Molnar, Patrick Pun, Deborah Zimmerman, Amit X. Garg, and Manish M. Sood. “The Association of Kidney Function and Albuminuria With the Risk and Outcomes of Syncope: A Population-Based Cohort Study.” Can J Cardiol 34, no. 12 (December 2018): 1631–40. https://doi.org/10.1016/j.cjca.2018.08.033.
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  - Pun, Patrick H. “Dialysate potassium concentration: Should mass balance trump electrophysiology?” Semin Dial 31, no. 6 (November 2018): 569–75. https://doi.org/10.1111/sdi.12738.
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  - Pun, Patrick H., and Christina M. Wyatt. “Utility of implantable cardioverter defibrillators in chronic kidney disease.” Kidney Int 93, no. 5 (May 2018): 1028–30. https://doi.org/10.1016/j.kint.2018.03.001.
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  - Pun, Patrick H., and John P. Middleton. “Dialysate Potassium, Dialysate Magnesium, and Hemodialysis Risk.” J Am Soc Nephrol 28, no. 12 (December 2017): 3441–51. https://doi.org/10.1681/ASN.2017060640.
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  - Pun, Patrick H., Benjamin A. Goldstein, John A. Gallis, John P. Middleton, and Laura P. Svetkey. “Serum Potassium Levels and Risk of Sudden Cardiac Death Among Patients With Chronic Kidney Disease and Significant Coronary Artery Disease.” Kidney Int Rep 2, no. 6 (November 2017): 1122–31. https://doi.org/10.1016/j.ekir.2017.07.001.
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  - Al-Khatib, S. M., D. J. Friedman, P. L. Hess, P. H. Pun, and G. D. Sanders. “Do Implantable Cardioverter-Defibrillators Lower the Risk of Sudden Death and Total Mortality in Patients with End-Stage Renal Disease?” Current Cardiovascular Risk Reports 11, no. 9 (September 1, 2017). https://doi.org/10.1007/s12170-017-0551-8.
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  - Makar, Melissa S., and Patrick H. Pun. “Sudden Cardiac Death Among Hemodialysis Patients.” Am J Kidney Dis 69, no. 5 (May 2017): 684–95. https://doi.org/10.1053/j.ajkd.2016.12.006.
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  - Pun, Patrick H., Shubin Sheng, Gillian Sanders, Adam D. DeVore, Daniel Friedman, Gregg C. Fonarow, Paul A. Heidenreich, Clyde W. Yancy, Adrian F. Hernandez, and Sana M. Al-Khatib. “Prescription of Guideline-Recommended Implantable Cardioverter Defibrillator and Cardiac Resynchronization Therapy Among Patients Hospitalized With Heart Failure and Varying Degrees of Renal Function.” Am J Cardiol 119, no. 6 (March 15, 2017): 886–92. https://doi.org/10.1016/j.amjcard.2016.11.043.
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  - Wang, Hanghang, Patrick H. Pun, Lydia Kwee, Damian Craig, Carol Haynes, Megan Chryst-Ladd, Laura P. Svetkey, et al. “Apolipoprotein L1 Genetic Variants Are Associated with Chronic Kidney Disease but Not with Cardiovascular Disease in a Population Referred for Cardiac Catheterization.” Cardiorenal Med 7, no. 2 (February 2017): 96–103. https://doi.org/10.1159/000453458.
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  - Pun, Patrick H., Safa Abdalla, Geoffrey A. Block, Glenn M. Chertow, Ricardo Correa-Rotter, Bastian Dehmel, Tilman B. Drüeke, et al. “Cinacalcet, dialysate calcium concentration, and cardiovascular events in the EVOLVE trial.” Hemodial Int 20, no. 3 (July 2016): 421–31. https://doi.org/10.1111/hdi.12382.
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  - Pun, Patrick H., Anne S. Hellkamp, Gillian D. Sanders, John P. Middleton, Stephen C. Hammill, Hussein R. Al-Khalidi, Lesley H. Curtis, Gregg C. Fonarow, and Sana M. Al-Khatib. “Primary prevention implantable cardioverter defibrillators in end-stage kidney disease patients on dialysis: a matched cohort study.” Nephrol Dial Transplant 30, no. 5 (May 2015): 829–35. https://doi.org/10.1093/ndt/gfu274.
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  - Pun, Patrick H. “The interplay between CKD, sudden cardiac death, and ventricular arrhythmias.” Adv Chronic Kidney Dis 21, no. 6 (November 2014): 480–88. https://doi.org/10.1053/j.ackd.2014.06.007.
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  - Hess, Paul L., Anne S. Hellkamp, Eric D. Peterson, Gillian D. Sanders, Hussein R. Al-Khalidi, Lesley H. Curtis, Bradley G. Hammill, et al. “Survival after primary prevention implantable cardioverter-defibrillator placement among patients with chronic kidney disease.” Circ Arrhythm Electrophysiol 7, no. 5 (October 2014): 793–99. https://doi.org/10.1161/CIRCEP.114.001455.
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  - Pun, Patrick H., Sana M. Al-Khatib, Joo Yoon Han, Rex Edwards, Gust H. Bardy, J Thomas Bigger, Alfred E. Buxton, et al. “Implantable cardioverter-defibrillators for primary prevention of sudden cardiac death in CKD: a meta-analysis of patient-level data from 3 randomized trials.” Am J Kidney Dis 64, no. 1 (July 2014): 32–39. https://doi.org/10.1053/j.ajkd.2013.12.009.
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  - Surana, Sikander P., Patrick H. Pun, Sai Ram Keithi-Reddy, Steven M. Spiegel, John P. Middleton, and Ajay K. Singh. “Sudden cardiac arrest in ESRD patients.” Clin Nephrol 81, no. 2 (February 2014): 121–31. https://doi.org/10.5414/CN107667.
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  - Tyson, Crystal C., Maragatha Kuchibhatla, Uptal D. Patel, Patrick H. Pun, Alex Chang, Chinazo Nwankwo, Michael A. Joseph, and Laura P. Svetkey. “Impact of Kidney Function on Effects of the Dietary Approaches to Stop Hypertension (Dash) Diet.” J Hypertens (Los Angel) 3 (2014). https://doi.org/10.4172/2167-1095.1000168.
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  - Pun, Patrick H., John R. Horton, and John P. Middleton. “Dialysate calcium concentration and the risk of sudden cardiac arrest in hemodialysis patients.” Clin J Am Soc Nephrol 8, no. 5 (May 2013): 797–803. https://doi.org/10.2215/CJN.10000912.
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  - Pun, Patrick H., Debra Schumm, Gillian D. Sanders, Deborah Hickey, John P. Middleton, Nancy Clapp-Channing, and Sana M. Al-Khatib. “A pilot study using an implantable device to characterize cardiac arrhythmias in hemodialysis patients: implications for future research.” Ann Noninvasive Electrocardiol 17, no. 2 (April 2012): 159. https://doi.org/10.1111/j.1542-474X.2012.00491.x.
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  - Pun, Patrick H., Charles A. Herzog, and John P. Middleton. “Improving ascertainment of sudden cardiac death in patients with end stage renal disease.” Clin J Am Soc Nephrol 7, no. 1 (January 2012): 116–22. https://doi.org/10.2215/CJN.02820311.
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  - Pun, Patrick H., and John P. Middleton. “Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.” Blood Purif 33, no. 1–3 (2012): 183–89. https://doi.org/10.1159/000334154.
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  - Herzog, Charles A., Richard W. Asinger, Alan K. Berger, David M. Charytan, Javier Díez, Robert G. Hart, Kai-Uwe Eckardt, et al. “Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).” Kidney Int 80, no. 6 (September 2011): 572–86. https://doi.org/10.1038/ki.2011.223.
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  - Pun, P. H., and J. P. Middleton. “The authors reply:.” Kidney International 79, no. 11 (June 1, 2011): 1259. https://doi.org/10.1038/ki.2011.71.
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  - Pun, Patrick H., Ruediger W. Lehrich, Emily F. Honeycutt, Charles A. Herzog, and John P. Middleton. “Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics.” Kidney Int 79, no. 2 (January 2011): 218–27. https://doi.org/10.1038/ki.2010.315.
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  - Middleton, John P., and Patrick H. Pun. “Hypertension, chronic kidney disease, and the development of cardiovascular risk: a joint primacy.” Kidney Int 77, no. 9 (May 2010): 753–55. https://doi.org/10.1038/ki.2010.19.
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  - Pun, P. H., E. F. Honeycutt, S. M. Al-Khatib, and J. P. Middleton. “The authors reply.” Kidney International 77, no. 7 (January 1, 2010): 648–49. https://doi.org/10.1038/ki.2009.536.
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  - Pun, Patrick H., Thomas R. Smarz, Emily F. Honeycutt, Linda K. Shaw, Sana M. Al-Khatib, and John P. Middleton. “Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery disease.” Kidney Int 76, no. 6 (September 2009): 652–58. https://doi.org/10.1038/ki.2009.219.
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  - Pun, P. H., and E. C. Kovalik. “Methods of hemodialysis anticoagulation,” December 1, 2008, 224–38. https://doi.org/10.1016/B978-1-4160-4197-9.50018-1.
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  - Pun, Patrick H., Ruediger W. Lehrich, Stephen R. Smith, and John P. Middleton. “Predictors of survival after cardiac arrest in outpatient hemodialysis clinics.” Clin J Am Soc Nephrol 2, no. 3 (May 2007): 491–500. https://doi.org/10.2215/CJN.02360706.
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  - Lehrich, Ruediger W., Patrick H. Pun, Nadine D. Tanenbaum, Stephen R. Smith, and John P. Middleton. “Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic.” J Am Soc Nephrol 18, no. 1 (January 2007): 312–20. https://doi.org/10.1681/ASN.2006040392.
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- Book Sections
  - Adam, M. O. A., P. H. Pun, and J. A. Olson. “Secondary hyperparathyroidism.” In The Handbook of Endocrine Surgery, 179–202, 2011. https://doi.org/10.1142/9789814293204_0016.
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- Conference Papers
  - Hein, Aaron M., Julia J. Scialla, Linda K. Shaw, Karen Chiswell, Patrick H. Pun, and Robert J. Mentz. “Increased eGFR Variability is Observed in Patients with HFrEF Compared to no HF or HFpEF in the Setting of Chronic Kidney Disease.” In Journal of Cardiac Failure, 25:S92–S92. Elsevier BV, 2019. https://doi.org/10.1016/j.cardfail.2019.07.263.
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  - Pun, Patrick Hank, Matthew Dupre, Monique Anderson, Steen M. Hansen, Clark Tyson, Brian Frizzelle, Kimberly Vellano, James Jollis, Bryan McNally, and Christopher Granger. “CHARACTERISTICS OF CARDIAC ARREST AND BYSTANDER RESUSCITATION WITHIN OUTPATIENT DIALYSIS CLINICS IN NORTH CAROLINA.” In Journal of the American College of Cardiology, 71:A303–A303. Elsevier BV, 2018. https://doi.org/10.1016/s0735-1097(18)30844-1.
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  - Pun, Patrick Hank, Sana M. Al-Khatib, Rex Edwards, Gust Bardy, J Thomas Bigger, Alfred Buxton, Arthur Moss, et al. “INFLUENCE OF CHRONIC KIDNEY DISEASE ON THE EFFICACY OF PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER DEFIBRILLATORS: A META-ANALYSIS OF THREE RANDOMIZED TRIALS.” In Journal of the American College of Cardiology, 61:E393–E393. Elsevier BV, 2013. https://doi.org/10.1016/s0735-1097(13)60393-9.
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  - Raasch, E., P. Pun, A. Starr, I. Klem, and J. P. Middleton. “CHRONIC KIDNEY DISEASE, RISK OF CARDIAC ARREST, AND MYOCARDIAL FIBROSIS.” In Journal of Investigative Medicine, 58:431–431. LIPPINCOTT WILLIAMS & WILKINS, 2010.
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  - Pun, P. H., R. W. Lehrich, S. R. Smith, and J. P. Middleton. “Predictors of survival following sudden cardiac arrest in outpatient hemodialysis clinics.” In Journal of Investigative Medicine, 54:S298–S298. B C DECKER INC, 2006.
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Education, Training, & Certifications

Duke Appointment History

Selected Grants

External Relationships

Selected Publications

Academic Articles

Book Sections

Conference Papers