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the European Dialysis and Transplant Association &#40;EDTA&#41;&#44; at the beginning of its registry activities<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> in 1963&#44; published a list of diagnoses&#44; which was named &#8220;primary renal diagnosis &#40;PRD&#41; list&#8221;&#44; which served as a guideline when making a diagnosis of primary kidney disease &#40;PKD&#41;&#46; After several years of use&#44; and being supported since 1983 by the European Renal Association &#40;ERA&#41; and the EDTA&#44; by means of the ERA-EDTA registry&#44; this PRD list&#44; which was subsequently expanded and modified&#44; turned into a commonly used standard in renal disease registries&#44; for coding of PKD&#46; However&#44; the presence of gaps in the PRD list often caused frustration among the users&#44; because they had to adapt to a system that did not offer adequate coding options and had a limited guarantee of quality and data validation&#44; as the precision of the coding was not guaranteed&#46; After more than 40 years of use&#44; the ERA-EDTA Registry Committee identified its problems&#44; recognising<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> that the terms in the PRD list were incomplete and inflexible&#59; the list lacked definitions&#44; the term &#8220;other&#47;s&#8221; was used without a defined criteria&#44; there were no users guidelines&#44; its application was inconsistent both nationally and internationally&#44; it was not possible to indicate how accurate was the code used&#44; and there were no formal mechanisms to add or remove codes&#46; Also&#44; the list had been developed in an era before the use of computers&#44; so it was not adapted for use in that context&#46; Furthermore&#44; the codes did not have correspondence with other classification systems&#8211;such as ICD or SNOMED-CT &#40;Systematised Nomenclature of Medicine-Clinical Terms&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#8211;which made interoperability between registries very difficult&#44; and limited the possibility of such data being used for epidemiological studies or other additional uses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It was in these circumstances that the ERA-EDTA expressed the interest in developing and publishing a new PRD code list<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> that would be adjusted to international standards so the use and reliability would be increased&#44; just as been proposed by those renal patient registries that were consulted&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">For this reason&#44; as part of the European Nephrology Quality Improvement Network Initiative&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> a European Registries Coding and Definitions Working Group &#40;RCDWG&#41; was created&#44; which included nephrologists&#44; epidemiologists&#44; computer technicians&#44; and coding specialists&#46; This group began its activities between 2005 and 2006&#44; aiming &#8220;to improve and standardise the terminology of definitions and coding used in European renal registries to describe primary renal diagnoses&#8221;&#46; In 2012&#44; the new PKD<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> coding list was published in English&#44; and was distributed to the various registries affiliated to the ERA-EDTA&#46; At the same time&#44; access was given to a coding help tool &#40;&#8220;ERA-EDTA coding system for primary kidney disease &#91;PKD&#93; and the related PKD search tool&#8221;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The link between the new PKD codes of the ERA-EDTA and other classification systems&#44; such as ICD and SNOMED-CT&#44; offers some advantages&#46; One of the most obvious advantage is the validation of terms being translated into languages other than English&#46; However&#44; those translations are valid only for the terms and not for the definitions or other aspects included in the system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For this reason&#44; the various registries included in the <span class="elsevierStyleItalic">Registro Espa&#241;ol de Enfermos Renales &#40;REER&#41;</span> &#40;Spanish Register of Renal Patients&#41;&#44; considered that it was advisable to proceed to the translation and adaptation of terms and definitions and clarifications of the new PKD codes of the ERA-EDTA&#46; This would be useful for renal patient registries that use Spanish as a working language&#44; not only in Spain&#44; but in other countries&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this project is to present the results of the translation and adaptation process into Spanish of the new ERA-EDTA PKD codes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">The starting point for the translation was the list of PKD codes included in the new ERA-EDTA coding system&#44; which comprises 271 codes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The codes&#44; definitions&#44; diagnostic criteria&#44; scoring&#44; and correlation with other classification systems &#40;ICD 10th revision&#44; SNOMED-CT&#44; OMIM<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> &#91;On-line Mendelian Inheritance in Man&#93;&#41;&#44; as well as the &#8220;old&#8221; ERA-EDTA codification system&#44; were obtained from the ERA-EDTA registry in MS-Excel<span class="elsevierStyleSup">&#174;</span> spreadsheet format&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Each code has a unique sequence number &#40;&#8220;non-semantic identifier&#8221;&#41;&#46; That number&#44; which has no other significance&#44; allows users to use search tools&#44; and to re-order and select codes&#46; The definitions indicate the type of diagnostic information needed to select a code&#44; including the terms &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente probado</span>&#8221; &#40;histologically proven&#41; and &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41;&#46; There is also detailed information on the codes and their characteristics&#44; in a section called &#8220;information for users&#8221;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the adaptation to Spanish of the English-language version&#44; a professional specialised medical translator translated the list of codes and subheadings of PKD&#44; definitions&#44; diagnostic criteria&#44; and scoring&#46; Then&#44; the translation was compared with the original list by a bilingual &#40;Spanish-English&#41; physician not specialised in nephrology&#46; Next&#44; 5 bilingual &#40;Spanish-English&#41; nephrologists compared the translation results with the original list&#46; These specialists reviewed each of the codes&#44; subheadings&#44; definitions&#44; and diagnostic criteria&#46; They could ascribe 3 possible results for each code&#58; &#40;1&#41; total agreement with the translation&#44; &#40;2&#41; disagreement with one of the terms used in the translation&#44; and &#40;3&#41; disagreement with more than one of the aspects of the code translation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All terms included in category 1 were accepted as valid&#46; When more than 2 of the reviewers marked a translation in category 2 or 3&#44; the revised proposal was accepted&#46; In all cases of discrepancy among the reviewers&#44; either regarding the terms used or the reasons for discrepancy&#44; the terms were sent once again to all reviewers for verification&#44; comments&#44; and final approval&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The process took place between July 2012 and February 2013&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally&#44; the version agreed on by the majority of reviewers was accepted&#44; and prepared in an MS-Excel<span class="elsevierStyleSup">&#174;</span> spreadsheet&#44; the same as the original version&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">For analysis&#44; the document was divided into the same sheets that completed the MS-Excel<span class="elsevierStyleSup">&#174;</span> format&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The agreements reached were separated by categories in each sheet as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In most cases&#44; there was total agreement &#40;category 1&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Most of the disagreement scores referred to minor problems&#44; for example&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Use of the term &#8220;<span class="elsevierStyleItalic">sordera nerviosa</span>&#8221; &#40;Neural deafness&#41; instead of &#8220;<span class="elsevierStyleItalic">sordera neurosensorial</span>&#8221; &#40;sensorineural deafness&#41; in Alport syndrome&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">nefropat&#237;a balc&#225;nica</span>&#8221; &#40;Balkanese nephropathy&#41; instead of &#8220;<span class="elsevierStyleItalic">nefropat&#237;a de los Balcanes</span>&#8221; &#40;Balkan nephropathy&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Use of &#8220;<span class="elsevierStyleItalic">s&#237;ndrome nefr&#243;tico infantil - sin pruebas a esteroides - sin histolog&#237;a</span>&#8221; &#40;nephrotic syndrome of childhood&#8211;no trials of steroids&#8211;no histology&#41; instead of &#8220;<span class="elsevierStyleItalic">s&#237;ndrome nefr&#243;tico infantil - sin prueba de esteroides - sin histolog&#237;a</span>&#8221; &#40;nephrotic syndrome of childhood&#8211;no trial of steroids&#8211;no histology&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">In the case of &#8220;<span class="elsevierStyleItalic">poliangitis microsc&#243;pica - histol&#243;gicamente probada</span>&#8221; &#40;Microscopic polyangiitis&#8211;histologically proven&#41; the acronym &#8220;<span class="elsevierStyleItalic">PAM</span>&#8221; was added&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Use of &#8220;<span class="elsevierStyleItalic">fibrosis retroperitoneal secundaria a malignidades</span>&#8221; &#40;retroperitoneal fibrosis secondary to malignancies&#41; instead of &#8220;<span class="elsevierStyleItalic">fibrosis retroperitoneal secundaria a neoplasias</span>&#8221; &#40;retroperitoneal fibrosis secondary to neoplasms&#41;&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">There were other discrepancies with the translation from the original version concerning more significant changes&#44; for example&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Addition of the term &#8220;<span class="elsevierStyleItalic">enfermedad por dep&#243;sito de cadenas ligeras</span>&#8221; &#40;disease due to light chain deposits&#41; in myelomatosis&#44; which was not present in the original English version&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Substitution of the term &#8220;<span class="elsevierStyleItalic">IgA secundaria a nefropat&#237;a por cirrosis hep&#225;tica - sin histolog&#237;a</span>&#8221; &#40;IgA secondary to nephropathy due to liver cirrhosis&#8211;no histology&#41; for &#8220;<span class="elsevierStyleItalic">nefropat&#237;a IgA secundaria a cirrosis hep&#225;tica - sin histolog&#237;a</span>&#8221; &#40;IgA nephropathy secondary to liver cirrhosis&#8211;no histology&#41;&#46;</p></li></ul></p><p id="par0130" class="elsevierStylePara elsevierViewall">The points of greatest discrepancy were&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Use of the terms &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41;&#44; &#8220;<span class="elsevierStyleItalic">sin control histol&#243;gico</span>&#8221; &#40;no histological control&#8221;&#44; and &#8220;<span class="elsevierStyleItalic">no histol&#243;gica</span>&#8221; &#40;non-histological&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0140" class="elsevierStylePara elsevierViewall">The use of the terms &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente confirmado</span>&#8221; &#40;histologically confirmed&#41;&#44; &#8220;<span class="elsevierStyleItalic">con diagnostic histol&#243;gico</span>&#8221; &#40;with histological diagnosis&#41;&#44; and &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente comprobado</span>&#8221; &#40;histologically proven&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">segmentaria y focal</span>&#8221; &#40;segmental focal&#41; vs &#8220;<span class="elsevierStyleItalic">focal y segmentaria</span>&#8221; &#40;focal segmental&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">The name for new code 1504&#44; which in some cases was called &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Sch&#246;nlein-Henoch</span>&#8221; &#40;Sch&#246;nlein-Henoch purpura&#41; and in others &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Henoch-Sch&#246;nlein</span>&#8221; &#40;Henoch-Sch&#246;nlein purpura&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Use of the terms &#8220;<span class="elsevierStyleItalic">&#225;cido &#250;rico</span>&#8221; &#40;uric acid&#41; vs &#8220;<span class="elsevierStyleItalic">uratos</span>&#8221; &#40;urates&#41;&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">Finally&#44; after all reviews were performed&#44; the biggest discrepancies were agreed as follows&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente probado</span>&#8221; &#40;histologically proven&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">focal y segmentaria</span>&#8221; &#40;focal segmental&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">The name of the new code 1504 was accepted as &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Sch&#246;nlein-Henoch</span>&#8221; &#40;Sch&#246;nlein-Henoch purpura&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">&#225;cido &#250;rico</span>&#8221; &#40;uric acid&#41; was accepted in place of &#8220;<span class="elsevierStyleItalic">uratos</span>&#8221; &#40;urates&#41;&#46;</p></li></ul></p><p id="par0190" class="elsevierStylePara elsevierViewall">The list of codes&#44; in their translation into Spanish&#44; can be viewed on the websites of the <span class="elsevierStyleItalic">Registro de Enfermos Renales de la Comunitat Valenciana</span> &#40;Valencian Community Register of Renal Patients&#41; and of the <span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;SEN&#41;</span> &#40;Spanish Society of Nephrology&#41;&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0090"><p id="par0195" class="elsevierStylePara elsevierViewall">h&#42;&#42;ttp&#58;&#42;&#42;&#47;&#47;ww&#42;&#42;w&#46;sp&#46;san&#46;gva&#46;es&#47;Renales&#47;</p></li><li class="elsevierStyleListItem" id="lsti0095"><p id="par0200" class="elsevierStylePara elsevierViewall">h&#42;&#42;ttp&#42;&#42;&#58;&#47;&#47;ww&#42;&#42;w&#46;senefro&#46;org&#47;modules&#46;php&#63;name&#61;webstructure&#38;idwebstructure&#61;128</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0205" class="elsevierStylePara elsevierViewall">On one hand&#44; the new ERA-EDTA codes mean abandoning a coding system and PKD registry that is already well-known and has been used for many years&#44; but on the other hand&#44; it means the offer of flexibility and precision in coding&#44; thus increasing the possibilities for use of the data collected&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The introduction of the new codes which is now required by the ERA-EDTA for all European registries&#44; will need a period of adaptation for all those involved in coding&#46; This is due to the change in concepts and longer time needed to select a PKD code&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In Spain&#44; part of this adaptation project has progressed already&#44; as the Spanish Society of Nephrology &#40;SEN&#41; took the initiative to create a diagnosis index for the different renal diseases and reasons for consultation&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> This diagnosis index has been standardised and validated for use in electronic patient notes and is especially focused to outpatient care&#44; where the International Classification of Diseases &#40;ICD&#41; 9th revision is used as the coding system &#40;clinical modification&#58; ICD-9-CM&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The introduction of new coding systems is always a costly process in terms of time and effort&#44; and the choice of the best system is hardly ever free from disagreement&#44; or even controversy&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10&#44;11</span></a> Furthermore&#44; coding and classification schemes and systems are always affected by the intention to achieve a balance between the having enough detail and the need to be simple and relatively straightforward&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#44; this fact certainly applies to this new coding system&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">It is important to point out that the advantages offered by the new ERA-EDTA codes outweigh the inconveniences&#46; The advantages include the addressing of previous coding gaps&#44; thus improving precision and certainty when using a code for a specific diagnosis according to international standards&#59; there is an increase in semantic interoperability&#59; and there are more potential for epidemiological analysis&#46; The inconveniences of the system are the increase in the number of codes &#40;271 in the new list vs the previous 65&#41;&#44; and the fact that the introduction of definitions and diagnostic criteria will make more laborious the process of choosing a code and&#44; the intrinsic adaptation to the whole system change&#46; Furthermore&#44; it will require modification of the computer applications currently used&#46; This last inconvenience could be overcome by new system which offers a link from the new codes to the old ones&#44; therefore the technical adaptation should be relatively fast&#44; and be further facilitated by the ERA-EDTA allowing the use of old codes for a period of time&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Although the link with SNOMED-CT&#44; and other classifications&#44; already allows access to the original version in various languages&#44; in reality&#44; this is indirect access and is of little practical use for those who must do the initial coding&#46; Therefore&#44; the translation and adaptation to Spanish represents an improvement for the introduction and use of the new system&#46; The fact that the help document is available in the working language could help reduce the time dedicated to coding and the adaptation period&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">This new coding and classification system does not reflect all possible groupings and breakdowns of diseases&#44; which could also be considered a drawback&#46; However&#44; all classification and coding systems are ultimately the product of some consensus acceptable to the majority and that cannot provide a solution to all possible issues&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The adaptation&#44; performed technically and professionally&#44; and reviewed by clinicians&#44; was carried out in a short time and is the first version of this system in a language other than English&#46; This was also made easier&#44; as planned&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> by the link with the codes previously established and available in Spanish&#44; such as ICD and SNOMED-CT&#46; Furthermore&#44; this adaptation to Spanish will allow more possibilities of collaboration with renal patient registries using Spanish as their working language&#44; which is of particular interest for Latin America&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">However&#44; using a system that has been translated from its original language to another is not without its difficulties&#44; the greatest of which is checking that the translation and review process has not changed the meaning of the codes from one language to the other&#46; In linguistic and transcultural adaptation&#8211;above all in the validation of questionnaires &#8211; this is usually a process of translation and subsequent back-translation&#46; In this case&#44; however&#44; back translation was not performed for two reasons&#59; firstly&#44; because back-translation does not always preclude subtle differences between two languages<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#59; and secondly&#44; because it was accepted that appropriate adaptation to the medical culture&#8211;in this case nephrology&#8211;would be assured by the review process carried out by the 5 participating nephrologists&#46; Nonetheless&#44; once this system is implemented in the various PKD coding environments&#44; the results obtained will need to be validated by comparison if its operating&#44; evaluating the intra- and inter-coder coherence&#46; This process has already been implemented in other settings<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> and should be done not only at a national but also international level&#46; It will allow us to determine whether the possible variations observed are due to clinical differences&#44; epidemiological differences&#44; or differences in care&#44; or due to the coding system&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">In conclusion&#44; the ERA-EDTA has made a PKD coding system that addresses the shortcomings of the previous list and is in line with international standards&#44; available to the nephrology scientific community&#46; Now&#44; this adapted system is available to Spanish-speaking nephrologists in their working language&#44; something that should result in an improvement in its use&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "C&#243;digos"
            1 => "Enfermedad renal primaria"
            2 => "Sem&#225;ntica"
            3 => "Adaptaci&#243;n"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The European Renal Association and the European Dialysis and Transplant Association &#40;ERA-EDTA&#41; have issued an English-language new coding system for primary kidney disease &#40;PKD&#41; aimed at solving the problems that were identified in the list of &#8220;Primary renal diagnoses&#8221; that has been in use for over 40 years&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Purpose</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In the context of Registro Espa&#241;ol de Enfermos Renales &#40;Spanish Registry of Renal Patients &#91;REER&#93;&#41;&#44; the need for a translation and adaptation of terms&#44; definitions and notes for the new ERA-EDTA codes was perceived in order to help those who have Spanish as their working language when using such codes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bilingual nephrologists contributed a professional translation and were involved in a terminological adaptation process&#44; which included a number of phases to contrast translation outputs&#46; Codes&#44; paragraphs&#44; definitions and diagnostic criteria were reviewed and agreements and disagreements aroused for each term were labelled&#46; Finally&#44; the version that was accepted by a majority of reviewers was agreed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A wide agreement was reached in the first review phase&#44; with only 5 points of discrepancy remaining&#44; which were agreed on in the final phase&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Translation and adaptation into Spanish represent an improvement that will help to introduce and use the new coding system for PKD&#44; as it can help reducing the time devoted to coding and also the period of adaptation of health workers to the new codes&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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            "identificador" => "abst0010"
            "titulo" => "Purpose"
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          2 => array:2 [
            "identificador" => "abst0015"
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            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41; ha publicado&#44; en lengua inglesa&#44; una nueva lista de c&#243;digos de enfermedad renal primaria &#40;ERP&#41;&#44; con el fin de solventar los problemas detectados en la &#171;Lista de diagn&#243;stico renal primario&#187; que se ven&#237;a utilizando desde hac&#237;a m&#225;s de 40 a&#241;os&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el seno del Registro Espa&#241;ol de Enfermos Renales &#40;REER&#41; se consider&#243; conveniente traducir y adaptar los t&#233;rminos&#44; definiciones y notas de los nuevos c&#243;digos de la ERA-EDTA para facilitar su uso por parte de quienes usan como lengua de trabajo el espa&#241;ol&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un proceso de traducci&#243;n profesional y adaptaci&#243;n terminol&#243;gica que cont&#243; con la participaci&#243;n de nefr&#243;logos biling&#252;es con varias fases de contraste del resultado de la traducci&#243;n&#44; en las que se revisaron los c&#243;digos&#44; literales&#44; definiciones y criterios diagn&#243;sticos y se marcaron los acuerdos y discrepancias surgidos para cada t&#233;rmino&#46; Finalmente se acord&#243; la versi&#243;n aceptada por la mayor&#237;a de los revisores&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El acuerdo en la primera fase de revisi&#243;n fue amplio&#44; con solo 5 puntos de discrepancia que se acordaron en la fase final&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La traducci&#243;n y adaptaci&#243;n al espa&#241;ol representa una mejora para la introducci&#243;n y uso del nuevo sistema de codificaci&#243;n de ERP&#44; ya que puede contribuir a reducir el tiempo dedicado a la codificaci&#243;n y tambi&#233;n el per&#237;odo de adaptaci&#243;n de los profesionales a los nuevos c&#243;digos&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zurriaga &#211;&#44; L&#243;pez-Briones C&#44; Mart&#237;n Escobar E&#44; Saracho-Rotaeche R&#44; Moina Eguren &#205;&#44; Pallard&#243; Mateu L&#44; et al&#46; Adaptaci&#243;n en espa&#241;ol del nuevo sistema de codificaci&#243;n de enfermedad renal primaria de la European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41;&#46; Nefrologia&#46; 2015&#59;35&#58;353&#8211;357&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Agreement categories&#58; &#40;1&#41; total agreement with the translation&#44; &#40;2&#41; disagreement with one of the terms used in the translation&#44; and &#40;3&#41; disagreement with more than one aspect of the code translation&#46;</p>"
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                  \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">Sheet&nbsp;\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">Total subheadings&nbsp;\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">Agreement &#40;category 1&#41;&nbsp;\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">Disagreement &#40;categories 2 and 3&#41;&nbsp;\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">Sheet of old ERA-EDTA codes and their equivalent with the new terms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\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">Sheet of new codes&#58; terms and subheadings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\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">Sheet of new codes&#58; other criteria and indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\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">Abbreviations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\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">Indications for users&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results of the agreement reached among nephrology specialists&#44; by agreement category&#46;</p>"
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      "titulo" => "References"
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                    ]
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                      "autores" => array:1 [
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                          "etal" => false
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                    0 => array:1 [
                      "Revista" => array:6 [
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                            "web" => "Medline"
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                      "titulo" => "New primary renal diagnosis codes for the ERA-EDTA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "G&#46; Venkat-Raman"
                            1 => "C&#46;R&#46; Tomson"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfs461"
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                        "fecha" => "2012"
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                    0 => array:1 [
                      "Libro" => array:1 [
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Special article
A Spanish version for the new ERA-EDTA coding system for primary renal disease
Adaptación en español del nuevo sistema de codificación de enfermedad renal primaria de la European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)
Óscar Zurriagaa,
Corresponding author
, Carmen López-Brionesb, Eduardo Martín Escobarc, Ramón Saracho-Rotaeched, Íñigo Moina Egurene, Luis Pallardó Mateuf, José María Abad Díezg, José Ignacio Sánchez Mireth
a Registro de Enfermos Renales de la Comunitat Valenciana, Dirección General de Salud Pública, Valencia, Spain
b Área de Desigualdades, FISABIO-Salud Pública, Valencia, Spain
c Organización Nacional de Trasplantes, Madrid, Spain
d Servicio de Nefrología, Hospital Santiago Apóstol, Vitoria-Gazteiz, Spain
e Servicio de Nefrología, Hospital de Basurto, Basurto, Spain
f Servicio de Nefrología, Hospital Doctor Peset, Valencia, Spain
g Departamento de Sanidad, Bienestar Social y Familia, Registro de Insuficiencia Renal de Aragón, Zaragoza, Spain
h Registro de Insuficiencia Renal de Aragón, Coordinación Autonómica de Trasplantes, Zaragoza, Spain
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        "titulo" => "Adaptaci&#243;n en espa&#241;ol del nuevo sistema de codificaci&#243;n de enfermedad renal primaria de la European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Disease coding for international use has a long history&#44; and its beginnings date from 1893&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> Since then&#44; various coding systems have been developed for cause of death&#44; diseases&#44; processes&#44; and clinical acts&#46; The most extensively used is the group of international classifications<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> endorsed by the World Health Organisation&#44; the most notable is the International Classification of Diseases and Related Health Problems &#40;ICD&#41;&#46; One of the main reasons of using this type of classification is to be able to compare the status of various diseases both nationally and internationally&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the field of renal disease&#44; the European Dialysis and Transplant Association &#40;EDTA&#41;&#44; at the beginning of its registry activities<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> in 1963&#44; published a list of diagnoses&#44; which was named &#8220;primary renal diagnosis &#40;PRD&#41; list&#8221;&#44; which served as a guideline when making a diagnosis of primary kidney disease &#40;PKD&#41;&#46; After several years of use&#44; and being supported since 1983 by the European Renal Association &#40;ERA&#41; and the EDTA&#44; by means of the ERA-EDTA registry&#44; this PRD list&#44; which was subsequently expanded and modified&#44; turned into a commonly used standard in renal disease registries&#44; for coding of PKD&#46; However&#44; the presence of gaps in the PRD list often caused frustration among the users&#44; because they had to adapt to a system that did not offer adequate coding options and had a limited guarantee of quality and data validation&#44; as the precision of the coding was not guaranteed&#46; After more than 40 years of use&#44; the ERA-EDTA Registry Committee identified its problems&#44; recognising<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> that the terms in the PRD list were incomplete and inflexible&#59; the list lacked definitions&#44; the term &#8220;other&#47;s&#8221; was used without a defined criteria&#44; there were no users guidelines&#44; its application was inconsistent both nationally and internationally&#44; it was not possible to indicate how accurate was the code used&#44; and there were no formal mechanisms to add or remove codes&#46; Also&#44; the list had been developed in an era before the use of computers&#44; so it was not adapted for use in that context&#46; Furthermore&#44; the codes did not have correspondence with other classification systems&#8211;such as ICD or SNOMED-CT &#40;Systematised Nomenclature of Medicine-Clinical Terms&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#8211;which made interoperability between registries very difficult&#44; and limited the possibility of such data being used for epidemiological studies or other additional uses&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It was in these circumstances that the ERA-EDTA expressed the interest in developing and publishing a new PRD code list<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> that would be adjusted to international standards so the use and reliability would be increased&#44; just as been proposed by those renal patient registries that were consulted&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">For this reason&#44; as part of the European Nephrology Quality Improvement Network Initiative&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a> a European Registries Coding and Definitions Working Group &#40;RCDWG&#41; was created&#44; which included nephrologists&#44; epidemiologists&#44; computer technicians&#44; and coding specialists&#46; This group began its activities between 2005 and 2006&#44; aiming &#8220;to improve and standardise the terminology of definitions and coding used in European renal registries to describe primary renal diagnoses&#8221;&#46; In 2012&#44; the new PKD<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> coding list was published in English&#44; and was distributed to the various registries affiliated to the ERA-EDTA&#46; At the same time&#44; access was given to a coding help tool &#40;&#8220;ERA-EDTA coding system for primary kidney disease &#91;PKD&#93; and the related PKD search tool&#8221;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The link between the new PKD codes of the ERA-EDTA and other classification systems&#44; such as ICD and SNOMED-CT&#44; offers some advantages&#46; One of the most obvious advantage is the validation of terms being translated into languages other than English&#46; However&#44; those translations are valid only for the terms and not for the definitions or other aspects included in the system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For this reason&#44; the various registries included in the <span class="elsevierStyleItalic">Registro Espa&#241;ol de Enfermos Renales &#40;REER&#41;</span> &#40;Spanish Register of Renal Patients&#41;&#44; considered that it was advisable to proceed to the translation and adaptation of terms and definitions and clarifications of the new PKD codes of the ERA-EDTA&#46; This would be useful for renal patient registries that use Spanish as a working language&#44; not only in Spain&#44; but in other countries&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this project is to present the results of the translation and adaptation process into Spanish of the new ERA-EDTA PKD codes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">The starting point for the translation was the list of PKD codes included in the new ERA-EDTA coding system&#44; which comprises 271 codes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The codes&#44; definitions&#44; diagnostic criteria&#44; scoring&#44; and correlation with other classification systems &#40;ICD 10th revision&#44; SNOMED-CT&#44; OMIM<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> &#91;On-line Mendelian Inheritance in Man&#93;&#41;&#44; as well as the &#8220;old&#8221; ERA-EDTA codification system&#44; were obtained from the ERA-EDTA registry in MS-Excel<span class="elsevierStyleSup">&#174;</span> spreadsheet format&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Each code has a unique sequence number &#40;&#8220;non-semantic identifier&#8221;&#41;&#46; That number&#44; which has no other significance&#44; allows users to use search tools&#44; and to re-order and select codes&#46; The definitions indicate the type of diagnostic information needed to select a code&#44; including the terms &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente probado</span>&#8221; &#40;histologically proven&#41; and &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41;&#46; There is also detailed information on the codes and their characteristics&#44; in a section called &#8220;information for users&#8221;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the adaptation to Spanish of the English-language version&#44; a professional specialised medical translator translated the list of codes and subheadings of PKD&#44; definitions&#44; diagnostic criteria&#44; and scoring&#46; Then&#44; the translation was compared with the original list by a bilingual &#40;Spanish-English&#41; physician not specialised in nephrology&#46; Next&#44; 5 bilingual &#40;Spanish-English&#41; nephrologists compared the translation results with the original list&#46; These specialists reviewed each of the codes&#44; subheadings&#44; definitions&#44; and diagnostic criteria&#46; They could ascribe 3 possible results for each code&#58; &#40;1&#41; total agreement with the translation&#44; &#40;2&#41; disagreement with one of the terms used in the translation&#44; and &#40;3&#41; disagreement with more than one of the aspects of the code translation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All terms included in category 1 were accepted as valid&#46; When more than 2 of the reviewers marked a translation in category 2 or 3&#44; the revised proposal was accepted&#46; In all cases of discrepancy among the reviewers&#44; either regarding the terms used or the reasons for discrepancy&#44; the terms were sent once again to all reviewers for verification&#44; comments&#44; and final approval&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The process took place between July 2012 and February 2013&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally&#44; the version agreed on by the majority of reviewers was accepted&#44; and prepared in an MS-Excel<span class="elsevierStyleSup">&#174;</span> spreadsheet&#44; the same as the original version&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">For analysis&#44; the document was divided into the same sheets that completed the MS-Excel<span class="elsevierStyleSup">&#174;</span> format&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The agreements reached were separated by categories in each sheet as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; In most cases&#44; there was total agreement &#40;category 1&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Most of the disagreement scores referred to minor problems&#44; for example&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Use of the term &#8220;<span class="elsevierStyleItalic">sordera nerviosa</span>&#8221; &#40;Neural deafness&#41; instead of &#8220;<span class="elsevierStyleItalic">sordera neurosensorial</span>&#8221; &#40;sensorineural deafness&#41; in Alport syndrome&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">nefropat&#237;a balc&#225;nica</span>&#8221; &#40;Balkanese nephropathy&#41; instead of &#8220;<span class="elsevierStyleItalic">nefropat&#237;a de los Balcanes</span>&#8221; &#40;Balkan nephropathy&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Use of &#8220;<span class="elsevierStyleItalic">s&#237;ndrome nefr&#243;tico infantil - sin pruebas a esteroides - sin histolog&#237;a</span>&#8221; &#40;nephrotic syndrome of childhood&#8211;no trials of steroids&#8211;no histology&#41; instead of &#8220;<span class="elsevierStyleItalic">s&#237;ndrome nefr&#243;tico infantil - sin prueba de esteroides - sin histolog&#237;a</span>&#8221; &#40;nephrotic syndrome of childhood&#8211;no trial of steroids&#8211;no histology&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">In the case of &#8220;<span class="elsevierStyleItalic">poliangitis microsc&#243;pica - histol&#243;gicamente probada</span>&#8221; &#40;Microscopic polyangiitis&#8211;histologically proven&#41; the acronym &#8220;<span class="elsevierStyleItalic">PAM</span>&#8221; was added&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Use of &#8220;<span class="elsevierStyleItalic">fibrosis retroperitoneal secundaria a malignidades</span>&#8221; &#40;retroperitoneal fibrosis secondary to malignancies&#41; instead of &#8220;<span class="elsevierStyleItalic">fibrosis retroperitoneal secundaria a neoplasias</span>&#8221; &#40;retroperitoneal fibrosis secondary to neoplasms&#41;&#46;</p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">There were other discrepancies with the translation from the original version concerning more significant changes&#44; for example&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Addition of the term &#8220;<span class="elsevierStyleItalic">enfermedad por dep&#243;sito de cadenas ligeras</span>&#8221; &#40;disease due to light chain deposits&#41; in myelomatosis&#44; which was not present in the original English version&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Substitution of the term &#8220;<span class="elsevierStyleItalic">IgA secundaria a nefropat&#237;a por cirrosis hep&#225;tica - sin histolog&#237;a</span>&#8221; &#40;IgA secondary to nephropathy due to liver cirrhosis&#8211;no histology&#41; for &#8220;<span class="elsevierStyleItalic">nefropat&#237;a IgA secundaria a cirrosis hep&#225;tica - sin histolog&#237;a</span>&#8221; &#40;IgA nephropathy secondary to liver cirrhosis&#8211;no histology&#41;&#46;</p></li></ul></p><p id="par0130" class="elsevierStylePara elsevierViewall">The points of greatest discrepancy were&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Use of the terms &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41;&#44; &#8220;<span class="elsevierStyleItalic">sin control histol&#243;gico</span>&#8221; &#40;no histological control&#8221;&#44; and &#8220;<span class="elsevierStyleItalic">no histol&#243;gica</span>&#8221; &#40;non-histological&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0140" class="elsevierStylePara elsevierViewall">The use of the terms &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente confirmado</span>&#8221; &#40;histologically confirmed&#41;&#44; &#8220;<span class="elsevierStyleItalic">con diagnostic histol&#243;gico</span>&#8221; &#40;with histological diagnosis&#41;&#44; and &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente comprobado</span>&#8221; &#40;histologically proven&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">segmentaria y focal</span>&#8221; &#40;segmental focal&#41; vs &#8220;<span class="elsevierStyleItalic">focal y segmentaria</span>&#8221; &#40;focal segmental&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">The name for new code 1504&#44; which in some cases was called &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Sch&#246;nlein-Henoch</span>&#8221; &#40;Sch&#246;nlein-Henoch purpura&#41; and in others &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Henoch-Sch&#246;nlein</span>&#8221; &#40;Henoch-Sch&#246;nlein purpura&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Use of the terms &#8220;<span class="elsevierStyleItalic">&#225;cido &#250;rico</span>&#8221; &#40;uric acid&#41; vs &#8220;<span class="elsevierStyleItalic">uratos</span>&#8221; &#40;urates&#41;&#46;</p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">Finally&#44; after all reviews were performed&#44; the biggest discrepancies were agreed as follows&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">sin histolog&#237;a</span>&#8221; &#40;no histology&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">histol&#243;gicamente probado</span>&#8221; &#40;histologically proven&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">focal y segmentaria</span>&#8221; &#40;focal segmental&#41; was accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">The name of the new code 1504 was accepted as &#8220;<span class="elsevierStyleItalic">p&#250;rpura de Sch&#246;nlein-Henoch</span>&#8221; &#40;Sch&#246;nlein-Henoch purpura&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">The term &#8220;<span class="elsevierStyleItalic">&#225;cido &#250;rico</span>&#8221; &#40;uric acid&#41; was accepted in place of &#8220;<span class="elsevierStyleItalic">uratos</span>&#8221; &#40;urates&#41;&#46;</p></li></ul></p><p id="par0190" class="elsevierStylePara elsevierViewall">The list of codes&#44; in their translation into Spanish&#44; can be viewed on the websites of the <span class="elsevierStyleItalic">Registro de Enfermos Renales de la Comunitat Valenciana</span> &#40;Valencian Community Register of Renal Patients&#41; and of the <span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Nefrolog&#237;a &#40;SEN&#41;</span> &#40;Spanish Society of Nephrology&#41;&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0090"><p id="par0195" class="elsevierStylePara elsevierViewall">h&#42;&#42;ttp&#58;&#42;&#42;&#47;&#47;ww&#42;&#42;w&#46;sp&#46;san&#46;gva&#46;es&#47;Renales&#47;</p></li><li class="elsevierStyleListItem" id="lsti0095"><p id="par0200" class="elsevierStylePara elsevierViewall">h&#42;&#42;ttp&#42;&#42;&#58;&#47;&#47;ww&#42;&#42;w&#46;senefro&#46;org&#47;modules&#46;php&#63;name&#61;webstructure&#38;idwebstructure&#61;128</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0205" class="elsevierStylePara elsevierViewall">On one hand&#44; the new ERA-EDTA codes mean abandoning a coding system and PKD registry that is already well-known and has been used for many years&#44; but on the other hand&#44; it means the offer of flexibility and precision in coding&#44; thus increasing the possibilities for use of the data collected&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The introduction of the new codes which is now required by the ERA-EDTA for all European registries&#44; will need a period of adaptation for all those involved in coding&#46; This is due to the change in concepts and longer time needed to select a PKD code&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In Spain&#44; part of this adaptation project has progressed already&#44; as the Spanish Society of Nephrology &#40;SEN&#41; took the initiative to create a diagnosis index for the different renal diseases and reasons for consultation&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> This diagnosis index has been standardised and validated for use in electronic patient notes and is especially focused to outpatient care&#44; where the International Classification of Diseases &#40;ICD&#41; 9th revision is used as the coding system &#40;clinical modification&#58; ICD-9-CM&#41;&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The introduction of new coding systems is always a costly process in terms of time and effort&#44; and the choice of the best system is hardly ever free from disagreement&#44; or even controversy&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10&#44;11</span></a> Furthermore&#44; coding and classification schemes and systems are always affected by the intention to achieve a balance between the having enough detail and the need to be simple and relatively straightforward&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a>&#44; this fact certainly applies to this new coding system&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">It is important to point out that the advantages offered by the new ERA-EDTA codes outweigh the inconveniences&#46; The advantages include the addressing of previous coding gaps&#44; thus improving precision and certainty when using a code for a specific diagnosis according to international standards&#59; there is an increase in semantic interoperability&#59; and there are more potential for epidemiological analysis&#46; The inconveniences of the system are the increase in the number of codes &#40;271 in the new list vs the previous 65&#41;&#44; and the fact that the introduction of definitions and diagnostic criteria will make more laborious the process of choosing a code and&#44; the intrinsic adaptation to the whole system change&#46; Furthermore&#44; it will require modification of the computer applications currently used&#46; This last inconvenience could be overcome by new system which offers a link from the new codes to the old ones&#44; therefore the technical adaptation should be relatively fast&#44; and be further facilitated by the ERA-EDTA allowing the use of old codes for a period of time&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Although the link with SNOMED-CT&#44; and other classifications&#44; already allows access to the original version in various languages&#44; in reality&#44; this is indirect access and is of little practical use for those who must do the initial coding&#46; Therefore&#44; the translation and adaptation to Spanish represents an improvement for the introduction and use of the new system&#46; The fact that the help document is available in the working language could help reduce the time dedicated to coding and the adaptation period&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">This new coding and classification system does not reflect all possible groupings and breakdowns of diseases&#44; which could also be considered a drawback&#46; However&#44; all classification and coding systems are ultimately the product of some consensus acceptable to the majority and that cannot provide a solution to all possible issues&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">The adaptation&#44; performed technically and professionally&#44; and reviewed by clinicians&#44; was carried out in a short time and is the first version of this system in a language other than English&#46; This was also made easier&#44; as planned&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> by the link with the codes previously established and available in Spanish&#44; such as ICD and SNOMED-CT&#46; Furthermore&#44; this adaptation to Spanish will allow more possibilities of collaboration with renal patient registries using Spanish as their working language&#44; which is of particular interest for Latin America&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">However&#44; using a system that has been translated from its original language to another is not without its difficulties&#44; the greatest of which is checking that the translation and review process has not changed the meaning of the codes from one language to the other&#46; In linguistic and transcultural adaptation&#8211;above all in the validation of questionnaires &#8211; this is usually a process of translation and subsequent back-translation&#46; In this case&#44; however&#44; back translation was not performed for two reasons&#59; firstly&#44; because back-translation does not always preclude subtle differences between two languages<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#59; and secondly&#44; because it was accepted that appropriate adaptation to the medical culture&#8211;in this case nephrology&#8211;would be assured by the review process carried out by the 5 participating nephrologists&#46; Nonetheless&#44; once this system is implemented in the various PKD coding environments&#44; the results obtained will need to be validated by comparison if its operating&#44; evaluating the intra- and inter-coder coherence&#46; This process has already been implemented in other settings<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> and should be done not only at a national but also international level&#46; It will allow us to determine whether the possible variations observed are due to clinical differences&#44; epidemiological differences&#44; or differences in care&#44; or due to the coding system&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">In conclusion&#44; the ERA-EDTA has made a PKD coding system that addresses the shortcomings of the previous list and is in line with international standards&#44; available to the nephrology scientific community&#46; Now&#44; this adapted system is available to Spanish-speaking nephrologists in their working language&#44; something that should result in an improvement in its use&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Antecedentes"
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          "titulo" => "Introduction"
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    "fechaRecibido" => "2014-10-07"
    "fechaAceptado" => "2015-03-22"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec597366"
          "palabras" => array:4 [
            0 => "Codes"
            1 => "Primary kidney disease"
            2 => "Semantics"
            3 => "Adaptation"
          ]
        ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec597365"
          "palabras" => array:4 [
            0 => "C&#243;digos"
            1 => "Enfermedad renal primaria"
            2 => "Sem&#225;ntica"
            3 => "Adaptaci&#243;n"
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        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The European Renal Association and the European Dialysis and Transplant Association &#40;ERA-EDTA&#41; have issued an English-language new coding system for primary kidney disease &#40;PKD&#41; aimed at solving the problems that were identified in the list of &#8220;Primary renal diagnoses&#8221; that has been in use for over 40 years&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Purpose</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In the context of Registro Espa&#241;ol de Enfermos Renales &#40;Spanish Registry of Renal Patients &#91;REER&#93;&#41;&#44; the need for a translation and adaptation of terms&#44; definitions and notes for the new ERA-EDTA codes was perceived in order to help those who have Spanish as their working language when using such codes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bilingual nephrologists contributed a professional translation and were involved in a terminological adaptation process&#44; which included a number of phases to contrast translation outputs&#46; Codes&#44; paragraphs&#44; definitions and diagnostic criteria were reviewed and agreements and disagreements aroused for each term were labelled&#46; Finally&#44; the version that was accepted by a majority of reviewers was agreed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A wide agreement was reached in the first review phase&#44; with only 5 points of discrepancy remaining&#44; which were agreed on in the final phase&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Translation and adaptation into Spanish represent an improvement that will help to introduce and use the new coding system for PKD&#44; as it can help reducing the time devoted to coding and also the period of adaptation of health workers to the new codes&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Background"
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            "titulo" => "Purpose"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41; ha publicado&#44; en lengua inglesa&#44; una nueva lista de c&#243;digos de enfermedad renal primaria &#40;ERP&#41;&#44; con el fin de solventar los problemas detectados en la &#171;Lista de diagn&#243;stico renal primario&#187; que se ven&#237;a utilizando desde hac&#237;a m&#225;s de 40 a&#241;os&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el seno del Registro Espa&#241;ol de Enfermos Renales &#40;REER&#41; se consider&#243; conveniente traducir y adaptar los t&#233;rminos&#44; definiciones y notas de los nuevos c&#243;digos de la ERA-EDTA para facilitar su uso por parte de quienes usan como lengua de trabajo el espa&#241;ol&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un proceso de traducci&#243;n profesional y adaptaci&#243;n terminol&#243;gica que cont&#243; con la participaci&#243;n de nefr&#243;logos biling&#252;es con varias fases de contraste del resultado de la traducci&#243;n&#44; en las que se revisaron los c&#243;digos&#44; literales&#44; definiciones y criterios diagn&#243;sticos y se marcaron los acuerdos y discrepancias surgidos para cada t&#233;rmino&#46; Finalmente se acord&#243; la versi&#243;n aceptada por la mayor&#237;a de los revisores&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El acuerdo en la primera fase de revisi&#243;n fue amplio&#44; con solo 5 puntos de discrepancia que se acordaron en la fase final&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La traducci&#243;n y adaptaci&#243;n al espa&#241;ol representa una mejora para la introducci&#243;n y uso del nuevo sistema de codificaci&#243;n de ERP&#44; ya que puede contribuir a reducir el tiempo dedicado a la codificaci&#243;n y tambi&#233;n el per&#237;odo de adaptaci&#243;n de los profesionales a los nuevos c&#243;digos&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zurriaga &#211;&#44; L&#243;pez-Briones C&#44; Mart&#237;n Escobar E&#44; Saracho-Rotaeche R&#44; Moina Eguren &#205;&#44; Pallard&#243; Mateu L&#44; et al&#46; Adaptaci&#243;n en espa&#241;ol del nuevo sistema de codificaci&#243;n de enfermedad renal primaria de la European Renal Association-European Dialysis and Transplant Association &#40;ERA-EDTA&#41;&#46; Nefrologia&#46; 2015&#59;35&#58;353&#8211;357&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Agreement categories&#58; &#40;1&#41; total agreement with the translation&#44; &#40;2&#41; disagreement with one of the terms used in the translation&#44; and &#40;3&#41; disagreement with more than one aspect of the code translation&#46;</p>"
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                  \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">Sheet&nbsp;\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">Total subheadings&nbsp;\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">Agreement &#40;category 1&#41;&nbsp;\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">Disagreement &#40;categories 2 and 3&#41;&nbsp;\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">Sheet of old ERA-EDTA codes and their equivalent with the new terms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\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">Sheet of new codes&#58; terms and subheadings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&nbsp;\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">Sheet of new codes&#58; other criteria and indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\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">Abbreviations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\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">Indications for users&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results of the agreement reached among nephrology specialists&#44; by agreement category&#46;</p>"
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      "titulo" => "References"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Apreciaciones sobre la Clasificaci&#243;n Internacional de Enfermedades"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Rodr&#237;guez J&#250;stiz"
                            1 => "A&#46; Fern&#225;ndez N&#250;&#241;ez"
                            2 => "A&#46; Baly Gil"
                          ]
                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "fecha" => "2000"
                        "volumen" => "38"
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              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Madden"
                            1 => "C&#46; Sykes"
                            2 => "T&#46;B&#46; Ustun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2007"
                        "editorial" => "World Health Organization"
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              "identificador" => "bib0090"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ERA-EDTA Registry returns to Amsterdam"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;D&#46; Briggs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2000"
                        "volumen" => "15"
                        "paginaInicial" => "1326"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10978386"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0095"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New primary renal diagnosis codes for the ERA-EDTA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Venkat-Raman"
                            1 => "C&#46;R&#46; Tomson"
                            2 => "Y&#46; Gao"
                            3 => "R&#46; Cornet"
                            4 => "B&#46; Stengel"
                            5 => "C&#46; Gronhagen-Riska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfs461"
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
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