Original article
Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients
Cumplimiento de las guías y factores predictivos de la mortalidad en la hemodiálisis. Enseñanzas de la experiencia en pacientes de Serbia
Ljubica Djukanovića,
, Nada Dimkovića, Jelena Marinkovića, Branislav Andrićb, Jasmina Bogdanovićc, Ivana Budošand, Anica Cvetičanine, Kosta Djordjevf, Verica Djordjevićg, Živka Djurićh, Branimir Haviža Lilići, Nasta Jovanovićj, Rosa Jelačićk, Violeta Kneževićl, Svetislav Kostićm, Tatjana Lazarevićn, Stanimir Ljubenovićm, Ivko Marićo, Rodoljub Markovićp, Srboljub Milenkovićq..., Olivera Milićevićr, Igor Mitićl, Vesna Mićunovićs, Milena Miškovićt, Dragana Pilipoviću, Steva Plješav, Miroslava Radakovićw, Marina Stojanović Stanojevićx, Biserka Tirmenštajn Jankovićy, Goran Vojinovićz, Kornelija ŠeferAVer más
Corresponding author
a School of Medicine, University of Belgrade, Belgrade, Serbia
b Nephrology Ward, General Hospital Krusevac, Krusevac, Serbia
c Nephrology Ward, General Hospital Valjevo, Valjevo, Serbia
d Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia
e Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia
f Nephrology Ward, Health Center Vrsac, Vrsac, Serbia
g Nephrology Ward, Health Center Smed Palanka, Smed Palanka, Serbia
h Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia
i Nephrology Ward, General Hospital Pirot, Pirot, Serbia
j Nephrology Ward, Health Centre Zagubica, Zagubica, Serbia
k Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia
l Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia
m Department of Nephrology, Clinical Center Nis, Nis, Serbia
n Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia
o Department of Nephrology, Lazarevac, Serbia
p Department of Nephrology, Clinical Centre Zemun, Belgrade, Serbia
q Nephrology Ward, General Hospital, Kos Mitrovica, Serbia
r Nephrology Ward, Health Center Kikinda, Kikinda, Serbia
s Nephrology Ward, Health Center Vrbas, Vrbas, Serbia
t Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia
u Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia
v Clinical Center Zemun, Belgrade, Serbia
w Health Center Barajevo, Barajevo, Serbia
x General Hospital, Mladenovac, Serbia
y Health Center Zaječar, Zaječar, Serbia
z Health Center Pančevo, Pančevo, Serbia
A General Hospital Subotica, Subotica, Serbia
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[ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">n</span>" "identificador" => "aff0070" ] ] ] 16 => array:3 [ "nombre" => "Stanimir" "apellidos" => "Ljubenović" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">m</span>" "identificador" => "aff0065" ] ] ] 17 => array:3 [ "nombre" => "Ivko" "apellidos" => "Marić" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">o</span>" "identificador" => "aff0075" ] ] ] 18 => array:3 [ "nombre" => "Rodoljub" "apellidos" => "Marković" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">p</span>" "identificador" => "aff0080" ] ] ] 19 => array:3 [ "nombre" => "Srboljub" "apellidos" => "Milenković" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">q</span>" "identificador" => "aff0085" ] ] ] 20 => array:3 [ "nombre" => "Olivera" "apellidos" => "Milićević" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">r</span>" "identificador" => "aff0090" ] ] ] 21 => array:3 [ "nombre" => "Igor" "apellidos" => "Mitić" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">l</span>" "identificador" => "aff0060" ] ] ] 22 => array:3 [ "nombre" => "Vesna" "apellidos" => "Mićunović" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">s</span>" "identificador" => "aff0095" ] ] ] 23 => array:3 [ "nombre" => "Milena" "apellidos" => "Mišković" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">t</span>" "identificador" => "aff0100" ] ] ] 24 => array:3 [ "nombre" => "Dragana" "apellidos" => "Pilipović" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">u</span>" "identificador" => "aff0105" ] ] ] 25 => array:3 [ "nombre" => "Steva" "apellidos" => "Plješa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">v</span>" "identificador" => "aff0110" ] ] ] 26 => array:3 [ "nombre" => "Miroslava" "apellidos" => "Radaković" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">w</span>" "identificador" => "aff0115" ] ] ] 27 => array:3 [ "nombre" => "Marina Stojanović" "apellidos" => "Stanojević" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">x</span>" "identificador" => "aff0120" ] ] ] 28 => array:3 [ "nombre" => "Biserka Tirmenštajn" "apellidos" => "Janković" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">y</span>" "identificador" => "aff0125" ] ] ] 29 => array:3 [ "nombre" => "Goran" "apellidos" => "Vojinović" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">z</span>" "identificador" => "aff0130" ] ] ] 30 => array:3 [ "nombre" => "Kornelija" "apellidos" => "Šefer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">A</span>" "identificador" => "aff0135" ] ] ] ] "afiliaciones" => array:27 [ 0 => array:3 [ "entidad" => "School of Medicine, University of Belgrade, Belgrade, Serbia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Nephrology Ward, General Hospital Krusevac, Krusevac, Serbia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Nephrology Ward, General Hospital Valjevo, Valjevo, Serbia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Nephrology Ward, Health Center Vrsac, Vrsac, Serbia" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Nephrology Ward, Health Center Smed Palanka, Smed Palanka, Serbia" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Nephrology Ward, General Hospital Pirot, Pirot, Serbia" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Nephrology Ward, Health Centre Zagubica, Zagubica, Serbia" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Department of Nephrology, Clinical Center Nis, Nis, Serbia" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia" "etiqueta" => "n" "identificador" => "aff0070" ] 14 => array:3 [ "entidad" => "Department of Nephrology, Lazarevac, Serbia" "etiqueta" => "o" "identificador" => "aff0075" ] 15 => array:3 [ "entidad" => "Department of Nephrology, Clinical Centre Zemun, Belgrade, Serbia" "etiqueta" => "p" "identificador" => "aff0080" ] 16 => array:3 [ "entidad" => "Nephrology Ward, General Hospital, Kos Mitrovica, Serbia" "etiqueta" => "q" "identificador" => "aff0085" ] 17 => array:3 [ "entidad" => "Nephrology Ward, Health Center Kikinda, Kikinda, Serbia" "etiqueta" => "r" "identificador" => "aff0090" ] 18 => array:3 [ "entidad" => "Nephrology Ward, Health Center Vrbas, Vrbas, Serbia" "etiqueta" => "s" "identificador" => "aff0095" ] 19 => array:3 [ "entidad" => "Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia" "etiqueta" => "t" "identificador" => "aff0100" ] 20 => array:3 [ "entidad" => "Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia" "etiqueta" => "u" "identificador" => "aff0105" ] 21 => array:3 [ "entidad" => "Clinical Center Zemun, Belgrade, Serbia" "etiqueta" => "v" "identificador" => "aff0110" ] 22 => array:3 [ "entidad" => "Health Center Barajevo, Barajevo, Serbia" "etiqueta" => "w" "identificador" => "aff0115" ] 23 => array:3 [ "entidad" => "General Hospital, Mladenovac, Serbia" "etiqueta" => "x" "identificador" => "aff0120" ] 24 => array:3 [ "entidad" => "Health Center Zaječar, Zaječar, Serbia" "etiqueta" => "y" "identificador" => "aff0125" ] 25 => array:3 [ "entidad" => "Health Center Pančevo, Pančevo, Serbia" "etiqueta" => "z" "identificador" => "aff0130" ] 26 => array:3 [ "entidad" => "General Hospital Subotica, Subotica, Serbia" "etiqueta" => "A" "identificador" => "aff0135" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cumplimiento de las guías y factores predictivos de la mortalidad en la hemodiálisis. Enseñanzas de la experiencia en pacientes de Serbia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1348 "Ancho" => 3054 "Tamanyo" => 208557 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to the values of five selected parameters. Hb – hemoglobin, P – serum phosphorus level, Ca – serum calcium level.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In the last few decades many guidelines for hemodialysis (HD) based on published evidence were developed by national and international associations.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">1–3</span></a> They defined standards of dialysis with the aim to improve results of HD treatment and patient outcomes. The publication of these guidelines was followed by a number of studies on the levels of guideline adherence. Most of these studies were carried out in developed countries with similar treatment options.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">4–8</span></a> Data about developing countries are insufficient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the previous decade, conditions for HD in Serbia have been considerably improved: new equipment for HD and reverse osmosis has been provided, synthetic membranes are used exclusively and agents for treatment of anemia and mineral metabolism disorders became more accessible. In the recent cross section study we showed that these more favorable dialysis treatment have brought about significant improvement in the treatment results.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">9</span></a> However, the guidelines adherence in our country and its comparison with those in developed country as well as the impact of guidelines adherence on patients’ outcome have not been studied.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the present study a cohort of 2153 patients on regular HD in Serbia were examined with the aim to determine the percent of patients failing to meet KDOQI guidelines targets in five crucial HD practice areas: dialysis dose, anemia, serum phosphorus, serum calcium and iPTH. The second aim was to find out variables significantly associated with the risk of time to death and to examine the association of guideline adherence and patient outcome.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The current study analyzed data of 2153 patients on regular HD in 24 centers in Serbia. Data were collected using a questionnaire sent to all 46 HD centers in Serbia with totally 3868 HD patients. The 24 centers responded and sent the data on all patients aged 18 years or older who were on regular HD for more than 3 months on January 1st 2010. Out of 2281 patients whose data were obtained 2153 (833 females, aged 18–90 years) with complete data were included in the study. The study was approved by The Ethics Committee of Zvezdara University Medical Center and appropriate patient consent was obtained at all study centers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The majority of patients were on conventional HD and 340 on hemodialfiltration. Usually, patients were dialyzed three times weekly for 4<span class="elsevierStyleHsp" style=""></span>h using dialyzers with polysulfone membrane mainly 1.3<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> up to 1.6<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. In all patients the bicarbonate dialysis solution was used containing 138<span class="elsevierStyleHsp" style=""></span>mmol/L sodium, 2 or 3<span class="elsevierStyleHsp" style=""></span>mmol/L potassium, 1.5–1.75<span class="elsevierStyleHsp" style=""></span>mmol/L calcium, 0.5<span class="elsevierStyleHsp" style=""></span>mmol/L magnesium, 1<span class="elsevierStyleHsp" style=""></span>g/L glucose and bicarbonate 35<span class="elsevierStyleHsp" style=""></span>mmol/L and dialysate flow was 500<span class="elsevierStyleHsp" style=""></span>ml/min. Hemodiafiltration was performed using a volume-controlled dialysis machine with optional online-HDF mode (4008H, Fresenius Medical Care, Bad Homburg, Germany).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Vascular access was arteriovenous (AV) fistula in 1940 (90.1%) patients, AV graft in 65 (3.0%) of patients, tunneled central venous catheter in 67 (3.1%) and non-tunneled catheter in 82 (3.8%) of patients.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hemoglobin, serum levels of urea, phosphorus, calcium, and albumin were measured by routine laboratory tests and iPTH by chemiluminescence essay (Diagnostic Product Corporation, USA). Measured calcium was corrected for level of serum albumin with the following formula: corrected total calcium (mmol/L)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>TCa (mmol/L)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>0.8 [40 (g/L)<span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>albumin (g/L)]. Dialysis dose (sp<span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>) was calculated from values of blood urea nitrogen pre- and post-dialysis, body weight, and dialysis duration using the second generation Daugirdas formula.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">10</span></a> Patients were followed from enrollment until their death, kidney transplantation, departure from the center or the end of the study on December 31, 2012.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data on patient demographic characteristics, medical history, HD treatment and laboratory data were obtained from medical records at the onset of the study. Based on these data the percentage of patients whose values failed to meet the targets recommended by KDOQI Clinical Practice Guidelines<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">1</span></a> was calculated in the following areas: dialysis dose (sp<span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1.2), anemia (hemoglobin >110<span class="elsevierStyleHsp" style=""></span>g/L), serum phosphorus (1.1–1.8<span class="elsevierStyleHsp" style=""></span>mmol/L), serum calcium (2.1–2.4<span class="elsevierStyleHsp" style=""></span>mmol/L) and plasma iPTH (150–300<span class="elsevierStyleHsp" style=""></span>pg/mL).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Descriptive statistics were presented as mean values and standard deviation (SD) for the continuous variables, or as frequencies for categorical variables. Pearson correlation coefficients were used to detect correlation among variables. Univariate Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. As independent variables patient age, gender, primary kidney disease, type of dialysis (HD – low-flux, high-flux, hemodiafiltration), duration of HD treatment (years), HD hours/week, <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin, serum calcium, phosphorus, iPTH, systolic blood pressure, interdialytic weight gain, iron therapy, blood transfusion, use of phosphate binders, use of calcitriol were used. Variables: number of HD weekly, erythropoietin stimulating agents (ESA) dose/week, duration of Epo treatment (years), product of calcium and phosphorus were not included in analysis due to colinearity. Significant variables in univariate analysis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.10) were tested in a multivariate Cox models using the backward stepwise method. The <span class="elsevierStyleItalic">p</span> values of less than 0.05 were considered as statistically significant. Models were adjusted for patient age, gender and duration of HD treatment (years).</p><p id="par0050" class="elsevierStylePara elsevierViewall">All analyses were performed using the SPSS statistical software package (Version 10; SPSS). IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study involved 2153 patients with mean age of 59 years, but 436 (20.3%) patients were older than 70 years. Characteristics of patients and HD treatment at the onset of the study are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Patients were on regular HD treatment for averagely 5.3 years and the most frequent cause of end-stage renal disease was hypertension. Dialyzers with polysulfone membranes were used in all patients: low-flux dialyzers in 29.8%, high-flux dialyzers in 54.4% and 15.7% of patients were on hemodiafiltration. Mean HD duration per week was 11.8<span class="elsevierStyleHsp" style=""></span>h and majority of patients had 12 and more hours dialysis weekly (84.5%), but 213 (9.9%) of patients had less than 9<span class="elsevierStyleHsp" style=""></span>h of HD weekly.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that 65.1% of patients were treated with ESA, most of them with epoetin and 378 (17.6%) with darbepoetin alpha. Intravenous iron was used in 34.7% of patients and 13.7% patients received blood transfusions when it was necessary. At the onset of the study mean (SD) hemoglobin level was 102 (17) g/L, serum ferritin level 591.4 (557.5) ng/mL and transferrin saturation 30.2 (16.1)%. Phosphate binders were used by 95% of patients and it was mainly calcium carbonate in the mean daily dose of 3.15<span class="elsevierStyleHsp" style=""></span>g<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.59<span class="elsevierStyleHsp" style=""></span>g.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Results presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> show that mean values of <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, serum phosphorus and calcium levels and calcium-phosphorus product were in guidelines target ranges. On the other hand, substantial percentage of patients was outside guidelines targets and this percentage was the lowest for calcium-phosphorus product and the highest for serum iPTH level. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows that among patients with individual values outside guidelines targets there were 14.4% of patients with <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below 1.0, 41.4% patients with hemoglobin below 100<span class="elsevierStyleHsp" style=""></span>g/L, 13.6% of patients with serum calcium above 2.6<span class="elsevierStyleHsp" style=""></span>mmol/L and 21.5% of patients with iPTH above 600<span class="elsevierStyleHsp" style=""></span>pg/mL.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">During the three-year follow-up period, 577 (26.7%) patients died, 44 (2%) were transplanted, 69 (3.2%) were lost from the follow-up and 1463 remained on regular HD. When parameters listed in methods were analyzed by univariate Cox proportional hazard model, the following variables were selected as significant predictors of time to death: age, gender, duration of HD treatment, underlying kidney disease (diabetic nephropathy, Balkan nephropathy, polycystic kidney disease), hours of HD/week, <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin, s-phosphorus, s-calcium, iPTH, use of oral iron and number of transfusions per year. Combining these variables in multivariate Cox proportional hazard model with adjustment for patient age, gender and duration of HD treatment, the significant independent predictors of time to death were selected (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">We also used a Cox proportional hazards model to investigate the association between mortality and satisfying the guidelines targets. When targets of <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin, serum phosphorus, calcium and iPTH were included in multivariate Cox model with adjustment for patient age, gender and duration of HD treatment (years), target values for <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin and iPTH were found to be the significant independent predictors of time to death (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). When Cox model was adjusted for patient age, gender, duration of HD treatment (years) and diabetic nephropathy the same targets values were selected as significant independent predictors of time to death as well as diabetic nephropathy. The values of regression coefficient (B), relative risk (RR) and confidence interval of relative risk (CI) as well as significance of coefficient (<span class="elsevierStyleItalic">p</span>) were as follows: <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> [<span class="elsevierStyleItalic">B</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.18, RR(CI)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.83 (0.68–1.01), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.042], hemoglobin [<span class="elsevierStyleItalic">B</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.22, RR(CI)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.80 (0.66–0.96), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.012], iPTH [<span class="elsevierStyleItalic">B</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.35, RR(CI)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.71 (0.51–0.98), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.042] and diabetic nephropathy [<span class="elsevierStyleItalic">B</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.68, RR(CI)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.98 (1.52–2.55), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001].</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study involved 2153 patients on regular HD for averagely 5.3 years, dialyzed averagely 11.8<span class="elsevierStyleHsp" style=""></span>h weekly on dialyzers with polysulfone membranes (15.7% on hemodiafiltration). The study was carried out in order to determine the percentage of patients not reaching the KDOQI guidelines targets in the five areas of HD practice and to find out whether the compliance with these targets was associated with patient outcome. Percentage of patients outside KDOQI guidelines targets was 42.4% for <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, 66.1% for hemoglobin, 50.3% for serum phosphorus, 37% for serum calcium and 79.7%, for serum iPTH levels. Cox proportional hazard model with adjustment for patient age, gender and duration of HD treatment (years) found age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy as significant independent predictors of time to death. When targets of <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin, serum phosphorus, calcium and iPTH were included in multivariate Cox model, target values for <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin and iPTH were found to be the significant predictors of time to death.</p><p id="par0085" class="elsevierStylePara elsevierViewall">During the last few decades, several guidelines have been developed recommending standards for health care of HD patients.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">1–3</span></a> Soon thereafter, it was obvious that guideline adherence is a very difficult task to manage. Numerous national and international studies were undertaken to find out the proportion of patients failing to meet guidelines targets as well as the association of guidelines compliance and patients’ outcome.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">4,6,7,11</span></a> Most of these studies were carried out in developed countries. In recent years, the number of papers presenting epidemiological data on RRT in developing countries increased, but papers on the results of HD treatment and compliance with guidelines in developing countries are scarce.<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">12–14</span></a> Recently, DOPPS 5 including several developing countries was initiated and their first results were reported at this years's ERA-EDTA Congress.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">15–17</span></a> Serbia is one of the developing countries that overpassed heavy nineties and that now has satisfactory conditions for HD treatment. In addition, at numerous scientific and educative meetings of our society recommendation of guidelines and their updating were discussed. This prompted us to check guidelines adherence and HD patient outcome in our country and compare it with those in other developing as well as developed countries. We selected KDOQI guidelines for comparative analysis since they were traditionally used by the most of the HD centers until 2012 when KDIGO guidelines started to be adopted as a daily practice.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In examined cohort of HD patients mean <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> was 1.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31 and 42.4% of patients had <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below 1.2, the minimum adequate dose proposed by KDOQI guidelines. However, 14.4% of patients had <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below 1.0. Results of DOPPS I and II showed great variation in percentage of patients with sp<span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below 1.25. Nevertheless, in all countries that participated in the study percent of patients with sp<span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below 1.2 was lower in DOPPS II (ranging between 10% and 31%) than in DOPPS I (14–42%). In our country percent of patients failing to meet <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> target decreased significantly during the last decade,<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">9</span></a> but it is still higher than those reported in DOPPS II, although DOPPS II was finished six years before our study. Mean <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> for HD population presented here was comparable to those reported in several observation national studies from developed countries,<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">6,18</span></a> but higher than in some developing countries.<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">13,14</span></a> However, mean <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> reported recently for HD patients from Russia and Turkey, two developing countries included in DOPPS 5, was 1.49<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.33 and 1.60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31, respectively.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Our study showed that <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> was a significant predictor of mortality that was reported previously and was the impetus for improvement of HD adequacy. Numerous studies indicated beneficial effect of increasing dialysis dose on patient survival,<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">19–21</span></a> although it is still not proven that increasing the <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> above the guidelines target would reduce patient mortality.<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">22,23</span></a> DOPPS study showed that not only dialysis dose but blood flow rate, duration of HD and type of dialysis had significant influence on patient survival.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">24,25</span></a> Nevertheless, for nephrologists in our country increasing of the HD adequacy and decreasing the percentage of patients failing to meet <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> target remains and important task. To achieve this it will be necessary to first carefully analyze the factors responsible for such high percentage of patients with <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> below recommended minimum of <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>. However, these factors were not objective of the present study. From the definition of <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> it is clear that it depends on dialyzer characteristics and dialysis time but increasing <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> depends primarily on the rate of blood flow through the dialyzer and a good vascular access is a key factor for achieving good blood flow and <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>. The vast majority of our patients had AV fistula but the data on blood flow as well as on many other factors influencing blood flow and <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> (comorbidities, hemodynamic stability during RRT, serum albumin, hematocrit, patient adherence to the prescribed regimen) were not available in the present study. The analysis of the factors influencing low <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> in 42.4% of our patients requires additional detailed study. Using available data from this study, we found significant correlation (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) between <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> and age, body weight, hours of dialysis weekly, type of dialysis (low and high-flux dialyzers, hemodialfiltration).</p><p id="par0100" class="elsevierStylePara elsevierViewall">After 2004, ESA has become more accessible in our HD units and hemoglobin levels increased significantly.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">9</span></a> However, at the onset of the present study 66.1% of patients had hemoglobin level below KDOQI guideline target of 110<span class="elsevierStyleHsp" style=""></span>g/L and this percentage is lower than in most of developed countries<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">26–28</span></a> but similar or even higher than in developing countries.<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">29–31</span></a> Mean hemoglobin level was lower in HD patients examined here than in those treated in all countries participating in DOPPS I–III except in Japan.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">32</span></a> In Japan maximal ESA dose was limited by public reimbursement, but mean ESA dose in this country was about 50% higher than the mean dose used in our HD patients. Our Health Insurance Fund determined hemoglobin between 100 and 110<span class="elsevierStyleHsp" style=""></span>g/L as target hemoglobin. However, 41.4% of patients had hemoglobin below this target that is much more than the percentage shown in our previous cross sectional study.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">9</span></a> That could be explained not only by the limitation of our Health Insurance Fund but also by occasional ESA shortages caused by irregular supply due to prolonged tender procedures. It shows that compliance with guidelines depends not only on their knowledge but also of local circumstances. The importance of achieving target hemoglobin levels derived from its significant association with mortality showed in the present study as well as in many others.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">5,33–35</span></a> Therefore, the continuous effort to increase the percentage of patients achieving target hemoglobin value remains an important task.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Percentage of patients who fell within K/DOQI recommended range for serum phosphorus (49.7%) and iPTH (20.3%) was comparable with those in the DOPPS studies.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">5,36</span></a> It is obvious that in our HD population like in many others<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">7,30,36</span></a> patients with low iPTH level represent twice the bigger problem than those with severe hyperparathyroidism while the opposite is found in some other countries.<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">31,37</span></a> Percentage of patients who achieved targets for serum calcium was higher (63%) than in DOPPS studies and similar to results presented in some recent studies.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">7,38</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Numerous studies found a significant relationship between serum levels of phosphorus, calcium, PTH and mortality.<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">39–41</span></a> However, several meta-analyses reported conflicting data: some found significant association between increased values of all three parameters and mortality,<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">42</span></a> others found association only between high phosphorus serum level and mortality,<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">43</span></a> while some found different relationship between mortality and these three parameters depending on whether their values were above or below recommended targets.<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">44,45</span></a> Using univariate Cox proportional hazard model we found higher mortality risk in patients with higher phosphorus and iPTH and lower calcium serum levels. However, only iPTH appeared as a significant independent predictor of time to death in multivariate Cox proportional hazard model. Although majority of our patients had lower iPTH than that proposed by guideline, those with higher iPTH value are at higher risk of mortality. In addition, when targets of all five examined HD practice parameters were involved in Cox proportional hazard model, being outside target range for iPTH was also found to be associated with significantly higher risk for death.</p><p id="par0115" class="elsevierStylePara elsevierViewall">This study has several limitations. Clinical and laboratory parameters measured only in the onset of the study were included in the analysis, although multiple measurements of these parameters would be more conclusive since interventions by nephrologist were guided by initial results.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The limitation of this study is that the data on comorbid conditions were not available and adjusting for these conditions in the Cox models was not possible. Comorbidity was found as a strong predictor of mortality in incident HD patients.<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">46,47</span></a> However, the study performed in incident patients registered in European Renal Association–European Dialysis and Transplant Association Registry showed that after adjustment for age, gender, primary renal disease and treatment modality the influence of comorbidity was less important than expected.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">48</span></a> Analysis of results obtained in DOPPS study also showed that adjustment for patient demographics and comorbidities only partially reduced survival differences by location and other factors that might contribute to differing outcomes were described.<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">49</span></a> Although these data suggest that our results would insignificantly change if comorbidity was accounted for, the impact of comorbidity required to be examined. The present study was aimed to find out compliance with KDOQI guidelines targets and it has been shown that substantial proportion of patients examined failed to meet these targets. Moreover, the noncompliance with guidelines targets was associated with an increased risk of death. This study as a starting point would be significant only if the research continues to find out all potential factors associated with the failure to achieve guidelines targets which is beyond the scope of this paper.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0125" class="elsevierStylePara elsevierViewall">According to the present analysis critical points of HD practice in Serbia included low dialysis dose (in 42.4% of patients), low hemoglobin level (in 66.1%), hyperphosphatemia (in 28.6%) and low (in 40%) and high (in 21.5%) iPTH levels. Age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. The relative risk of time to death was associated with being outside the guidelines targets for <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin and iPTH. The study suggests vast opportunities for the improvement of HD patient care and possibly patient outcome.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres577015" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec593643" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres577014" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec593642" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-08-26" "fechaAceptado" => "2015-02-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec593643" "palabras" => array:3 [ 0 => "Hemodialysis results" 1 => "KDOQI guidelines targets" 2 => "Serbia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec593642" "palabras" => array:3 [ 0 => "Resultados de hemodiálisis" 1 => "Objetivos de guía KDOQI" 2 => "Serbia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (<span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>1.2), hemoglobin (>110<span class="elsevierStyleHsp" style=""></span>g/L), serum phosphorus (1.1–1.8<span class="elsevierStyleHsp" style=""></span>mmol/L), calcium (2.1–2.4<span class="elsevierStyleHsp" style=""></span>mmol/L) and iPTH (150–300<span class="elsevierStyleHsp" style=""></span>pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patients were on regular HD for 5.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.3 years, dialyzed 11.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.9<span class="elsevierStyleHsp" style=""></span>h/week. <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1.2 had 42.4% of patients, hemoglobin <110<span class="elsevierStyleHsp" style=""></span>g/L had 66.1%, s-phosphorus <1.1<span class="elsevierStyleHsp" style=""></span>mmol/L had 21.7% and >1.8<span class="elsevierStyleHsp" style=""></span>mmol/L 28.6%, s-calcium <2.1<span class="elsevierStyleHsp" style=""></span>mmol/L had 11.7% and >2.4<span class="elsevierStyleHsp" style=""></span>mmol/L 25.3%, iPTH <150<span class="elsevierStyleHsp" style=""></span>pg/mL had 40% and >300<span class="elsevierStyleHsp" style=""></span>pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for <span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span>, hemoglobin and iPTH.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los objetivos del estudio fueron determinar el porcentaje de pacientes en tratamiento de hemodiálisis (HD) regular de Serbia en los que no se alcanzaron los objetivos de la guía KDOQI y determinar los factores asociados al riesgo de tiempo hasta la muerte, así como la asociación entre el cumplimiento de la guía y los resultados clínicos.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un seguimiento de una cohorte de 2153 pacientes en HD regular de 24 centros de Serbia (un 55,7% de la población total en HD) entre enero de 2010 y diciembre de 2012. Se determinó el porcentaje de pacientes que no alcanzaron los objetivos establecidos en la guía KDOQI respecto a dosis de diálisis (Kt/V>1,2), hemoglobina (>110 g/L), fósforo en suero (1,1-1,8 mmol/L), calcio (2,1-2,4 mmol/L) e iPTH (150-300 pg/mL). Se utilizó un modelo de riesgos proporcionales de Cox para identificar las variables con una asociación significativa con el riesgo de tiempo hasta la muerte.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes habían estado en HD regular durante un periodo de 5,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,3 años, con un tiempo de diálisis de 11,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1,9 horas/semana. Se observaron valores de Kt/V <1,2 en el 42,4% de los pacientes, hemoglobina <110 g/L en el 66,1%, fósforo en suero <1,1 mmol/L en el 21,7% y >1,8 mmol/L en el 28,6%, calcio en suero <2,1 mmol/l en el 11,7% y >2,4 mmol/L en el 25,3%, iPTH <150 pg/mL en el 40% y >300 pg/mL en el 39,7%. Con el empleo de un modelo de Cox (con ajuste respecto a edad del paciente, sexo y duración del tratamiento de HD) se seleccionaron las variables de edad, duración del tratamiento de HD, hemoglobina, iPTH y nefropatía diabética como factores predictivos independientes significativos del tiempo hasta la muerte. Al introducir los objetivos de los cinco parámetros examinados en un modelo de Cox, se observó que los objetivos de KtV, hemoglobina e iPTH eran factores predictivos independientes para el tiempo hasta la muerte.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una parte sustancial de los pacientes examinados no alcanzaron los objetivos establecidos en la guía KDOQI. El riesgo relativo del tiempo hasta la muerte se asoció al hecho de no estar en el objetivo de Kt/V, hemoglobina e iPTH.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1348 "Ancho" => 3054 "Tamanyo" => 208557 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to the values of five selected parameters. Hb – hemoglobin, P – serum phosphorus level, Ca – serum calcium level.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ID – interdialytic.</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Mean values (SD) are presented for continuous variables.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">Number</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2153 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Gender</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Males</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1320 (61.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Females</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">833 (38.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Age, years</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Range</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18–90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">>70 years</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">436 (20.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Diagnosis</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Glomerulonephritis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">370 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TIN (without Balkan nephropathy)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">117 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Balkan nephropathy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hypertensive nephropathy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">540 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetic nephropathy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">276 (13.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Polycystic kidney disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">168 (8.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">253 (12.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unknown</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">195 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Blood pressure, mmHg</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Systolic</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">136<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diastolic</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Vintage, years</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Range</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5–35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Dialysis treatment</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Low-flux dialyzers</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">642 (29.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">High-flux dialyzers</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1171 (54.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemodiafiltration</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">340 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dialysis hours/week</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dialysis time</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><9<span class="elsevierStyleHsp" style=""></span>h/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">213 (9.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>9–12<span class="elsevierStyleHsp" style=""></span>h/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">119 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>h/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1585 (73.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>>12<span class="elsevierStyleHsp" style=""></span>h/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">236 (10.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">ID weight gain, kg</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Range</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0–9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942043.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients and hemodialysis treatment at the onset of the study.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Iron, number (%) of treated patients</span></td><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Phosphate binders, number (%)of treated patients</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">247 (11.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CaCO<span class="elsevierStyleInf">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1602 (74.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>i.v. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">747 (34.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 (20.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ESA use, number (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1402<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> (65.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not treated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">443 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ESA dosage, U/week (mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3574<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2601 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Vitamin D3, number (%)of treated patients</span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Transfusion</span></td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>One-alphaD3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">603 (28.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Number of patients receiving \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">296 (13.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1,25 D3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">349 (16.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Units/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.72<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Not treated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1201 (55.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942044.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">378 (17.6%) of patients were treated with darbepoetin alpha and the others used epoetin.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Treatment of anemia and mineral metabolism disorders.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Single pool Kt/V</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.64–2.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><1.2, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">912 (42.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Hemoglobin, g/l</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55–142 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">102<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><110<span class="elsevierStyleHsp" style=""></span>g/L, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1423 (66.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">S-phosphorus, mmol/L</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.42–4.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><1.1<span class="elsevierStyleHsp" style=""></span>mmol/L, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">467 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>1.8<span class="elsevierStyleHsp" style=""></span>mmol/L, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">616 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">s-clacium, mmol/L</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.90–3.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.31<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><2.1<span class="elsevierStyleHsp" style=""></span>mmol/L, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">252 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>2.4<span class="elsevierStyleHsp" style=""></span>mmol/L, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">545 (25.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">s-calcium</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">×</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">phsophorus, mmol</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">/L</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.91–13.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>4.4<span class="elsevierStyleHsp" style=""></span>mmol<span class="elsevierStyleSup">2</span>/L<span class="elsevierStyleSup">2</span>, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">626 (29.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">s-iPTH, pg/mL</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Range \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.2–4480.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">407.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>512.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><150<span class="elsevierStyleHsp" style=""></span>pg/mL, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">861 (40.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>>300<span class="elsevierStyleHsp" style=""></span>pg/mL, no. (%) of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">855 (39.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942046.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mean values (±SD) and ranges of variables examined and proportion of patients outside guidelines targets at the onset of the study.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">RR – relative risk, Exp(B), CI – 95% confidence interval of Exp(<span class="elsevierStyleItalic">B</span>), <span class="elsevierStyleItalic">p</span> – significance of coefficient.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">B</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RR (CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87 (0.66−1.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.326 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.054 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (1.04−1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of HD treatment, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.660 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 (0.47−0.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hours of HD/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91 (0.82−1.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.062 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemoglobin, g/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 (0.98−1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">iPTH, pg/mL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 (1.00−1.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetic nephropathy, yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.672 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.96 (1.39−2.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942042.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Relative risk of mortality: multivariate Cox proportional hazard model.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">RR – relative risk, Exp(B), CI – 95% confidence interval of Exp(<span class="elsevierStyleItalic">B</span>), <span class="elsevierStyleItalic">p</span> – significance of coefficient.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">B</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">RR (CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 (0.63–0.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04 (1.03–1.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Duration of HD treatment, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 (0.51–0.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hours of HD/week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.96 (0.91–1.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.216 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Kt</span>/<span class="elsevierStyleItalic">V</span> >1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81 (0.66–0.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.037 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemoglobin >110<span class="elsevierStyleHsp" style=""></span>g/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 (0.36–0.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">s-phosphorus 1.1–1.8<span class="elsevierStyleHsp" style=""></span>mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93 (0.77–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.442 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">s-calcium 2.1–2.4<span class="elsevierStyleHsp" style=""></span>mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 (0.78–1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.531 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">iPTH 150–300, pg/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71 (0.50–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab942045.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Relative risk of mortality: multivariate Cox proportional hazard model included guidelines target values as independent variables.</p>" ] ] ] "bibliografia" => array:2 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 49 | 50 | 99 |
| 2024 September | 37 | 21 | 58 |
| 2024 August | 54 | 87 | 141 |
| 2024 July | 94 | 25 | 119 |
| 2024 June | 41 | 34 | 75 |
| 2024 May | 42 | 39 | 81 |
| 2024 April | 39 | 31 | 70 |
| 2024 March | 34 | 30 | 64 |
| 2024 February | 32 | 34 | 66 |
| 2024 January | 28 | 20 | 48 |
| 2023 December | 28 | 22 | 50 |
| 2023 November | 38 | 37 | 75 |
| 2023 October | 32 | 27 | 59 |
| 2023 September | 25 | 26 | 51 |
| 2023 August | 35 | 30 | 65 |
| 2023 July | 34 | 19 | 53 |
| 2023 June | 20 | 24 | 44 |
| 2023 May | 52 | 34 | 86 |
| 2023 April | 26 | 17 | 43 |
| 2023 March | 69 | 16 | 85 |
| 2023 February | 69 | 18 | 87 |
| 2023 January | 30 | 31 | 61 |
| 2022 December | 88 | 36 | 124 |
| 2022 November | 47 | 32 | 79 |
| 2022 October | 54 | 35 | 89 |
| 2022 September | 44 | 47 | 91 |
| 2022 August | 39 | 45 | 84 |
| 2022 July | 28 | 41 | 69 |
| 2022 June | 27 | 34 | 61 |
| 2022 May | 30 | 33 | 63 |
| 2022 April | 22 | 38 | 60 |
| 2022 March | 33 | 38 | 71 |
| 2022 February | 26 | 31 | 57 |
| 2022 January | 25 | 31 | 56 |
| 2021 December | 35 | 41 | 76 |
| 2021 November | 21 | 38 | 59 |
| 2021 October | 19 | 40 | 59 |
| 2021 September | 29 | 34 | 63 |
| 2021 August | 32 | 45 | 77 |
| 2021 July | 37 | 46 | 83 |
| 2021 June | 8 | 28 | 36 |
| 2021 May | 33 | 35 | 68 |
| 2021 April | 39 | 39 | 78 |
| 2021 March | 39 | 41 | 80 |
| 2021 February | 40 | 31 | 71 |
| 2021 January | 35 | 25 | 60 |
| 2020 December | 43 | 29 | 72 |
| 2020 November | 37 | 30 | 67 |
| 2020 October | 19 | 14 | 33 |
| 2020 September | 28 | 16 | 44 |
| 2020 August | 37 | 19 | 56 |
| 2020 July | 27 | 8 | 35 |
| 2020 June | 39 | 20 | 59 |
| 2020 May | 51 | 35 | 86 |
| 2020 April | 85 | 38 | 123 |
| 2020 March | 39 | 25 | 64 |
| 2020 February | 43 | 28 | 71 |
| 2020 January | 39 | 22 | 61 |
| 2019 December | 52 | 41 | 93 |
| 2019 November | 48 | 38 | 86 |
| 2019 October | 39 | 52 | 91 |
| 2019 September | 47 | 29 | 76 |
| 2019 August | 37 | 38 | 75 |
| 2019 July | 31 | 39 | 70 |
| 2019 June | 34 | 25 | 59 |
| 2019 May | 16 | 23 | 39 |
| 2019 April | 56 | 50 | 106 |
| 2019 March | 28 | 14 | 42 |
| 2019 February | 20 | 14 | 34 |
| 2019 January | 25 | 20 | 45 |
| 2018 December | 202 | 36 | 238 |
| 2018 November | 440 | 36 | 476 |
| 2018 October | 360 | 32 | 392 |
| 2018 September | 187 | 7 | 194 |
| 2018 August | 31 | 14 | 45 |
| 2018 July | 33 | 12 | 45 |
| 2018 June | 16 | 7 | 23 |
| 2018 May | 34 | 14 | 48 |
| 2018 April | 33 | 5 | 38 |
| 2018 March | 29 | 7 | 36 |
| 2018 February | 28 | 4 | 32 |
| 2018 January | 16 | 9 | 25 |
| 2017 December | 36 | 8 | 44 |
| 2017 November | 26 | 13 | 39 |
| 2017 October | 31 | 8 | 39 |
| 2017 September | 43 | 10 | 53 |
| 2017 August | 18 | 8 | 26 |
| 2017 July | 30 | 8 | 38 |
| 2017 June | 38 | 11 | 49 |
| 2017 May | 24 | 15 | 39 |
| 2017 April | 28 | 16 | 44 |
| 2017 March | 15 | 2 | 17 |
| 2017 February | 14 | 6 | 20 |
| 2017 January | 18 | 7 | 25 |
| 2016 December | 64 | 3 | 67 |
| 2016 November | 86 | 14 | 100 |
| 2016 October | 100 | 6 | 106 |
| 2016 September | 161 | 9 | 170 |
| 2016 August | 187 | 4 | 191 |
| 2016 July | 207 | 7 | 214 |
| 2016 June | 138 | 0 | 138 |
| 2016 May | 175 | 0 | 175 |
| 2016 April | 122 | 0 | 122 |
| 2016 March | 108 | 0 | 108 |
| 2016 February | 96 | 0 | 96 |
| 2016 January | 100 | 0 | 100 |
| 2015 December | 100 | 0 | 100 |
| 2015 November | 122 | 0 | 122 |
| 2015 October | 104 | 0 | 104 |
| 2015 September | 108 | 0 | 108 |
| 2015 August | 84 | 0 | 84 |
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