Administration of calcimimetics after dialysis: Same effectiveness, better gastrointestinal tolerability

array:25 ["pii" => "S2013251415000607" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.09.002" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "59" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2015;35:403-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4284 "formatos" => array:3 [ "EPUB" => 323 "HTML" => 3226 "PDF" => 735 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699515000697" "issn" => "02116995" "doi" => "10.1016/j.nefro.2015.06.013" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "59" "copyright" => "The Authors" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2015;35:403-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8379 "formatos" => array:3 [ "EPUB" => 327 "HTML" => 7340 "PDF" => 712 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original breve" "titulo" => "Administración de calcimiméticos posdiálisis: igual efectividad, mejor tolerancia gastrointestinal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "409" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Administration of calcimimetics after dialysis: same effectiveness, better gastrointestinal tolerability" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1255 "Ancho" => 1410 "Tamanyo" => 67828 ] ] "descripcion" => array:1 [ "es" => "Principal etiología de ERC. Porcentaje de pacientes en HD tratados con calcimiméticos: DM: diabetes mellitus; Glomer: glomerulares; NTIC: nefropatía tubulointersticial crónica." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vicent Esteve Simo, Fátima Moreno-Guzmán, Gemma Martínez Calvo, Miquel Fulquet Nicolas, Monica Pou Potau, Javier Macias-Toro, Verónica Duarte-Gallego, Anna Saurina Sole, Manel Ramírez-de Arellano Serna" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Vicent" "apellidos" => "Esteve Simo" ] 1 => array:2 [ "nombre" => "Fátima" "apellidos" => "Moreno-Guzmán" ] 2 => array:2 [ "nombre" => "Gemma" "apellidos" => "Martínez Calvo" ] 3 => array:2 [ "nombre" => "Miquel" "apellidos" => "Fulquet Nicolas" ] 4 => array:2 [ "nombre" => "Monica" "apellidos" => "Pou Potau" ] 5 => array:2 [ "nombre" => "Javier" "apellidos" => "Macias-Toro" ] 6 => array:2 [ "nombre" => "Verónica" "apellidos" => "Duarte-Gallego" ] 7 => array:2 [ "nombre" => "Anna" "apellidos" => "Saurina Sole" ] 8 => array:2 [ "nombre" => "Manel" "apellidos" => "Ramírez-de Arellano Serna" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251415000607" "doi" => "10.1016/j.nefroe.2015.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000607?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515000697?idApp=UINPBA000064" "url" => "/02116995/0000003500000004/v3_201511070033/S0211699515000697/v3_201511070033/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251415000590" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.09.001" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "47" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Nefrologia (English Version). 2015;35:410-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5404 "formatos" => array:3 [ "EPUB" => 326 "HTML" => 4288 "PDF" => 790 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Letters to the Editor – Brief papers about basic research or clinical experiences" "titulo" => "Struvite urolithiasis with Corynebacterium urealyticum infection: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "410" "paginaFinal" => "411" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Urolitiasis por estruvita en infección por Corynebacterium urealyticum. A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 1077 "Ancho" => 900 "Tamanyo" => 96483 ] ] "descripcion" => array:1 [ "en" => "Appearance of obstructed urinary catheter." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan A. Martín-Navarro, Vladimir Petkov-Stoyanov, M. José Gutiérrez-Sánchez, M. Esther Gordo-Flores" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juan A." "apellidos" => "Martín-Navarro" ] 1 => array:2 [ "nombre" => "Vladimir" "apellidos" => "Petkov-Stoyanov" ] 2 => array:2 [ "nombre" => "M. José" "apellidos" => "Gutiérrez-Sánchez" ] 3 => array:2 [ "nombre" => "M. Esther" "apellidos" => "Gordo-Flores" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699515000570" "doi" => "10.1016/j.nefro.2015.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515000570?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000590?idApp=UINPBA000064" "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000590/v1_201511210014/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251415000796" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2015.10.003" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "69" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2015;35:395-402" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8378 "formatos" => array:3 [ "EPUB" => 323 "HTML" => 7302 "PDF" => 753 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Repeated serum creatinine measurement in primary care: Not all patients have chronic renal failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "402" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Repetición de la medición de creatinina sérica en atención primaria: no todos tienen insuficiencia renal crónica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 2343 "Ancho" => 2502 "Tamanyo" => 236665 ] ] "descripcion" => array:1 [ "en" => "Study flowchart RF: renal failure; CRF: chronic renal failure; ORD: occult renal disease." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Delicia Gentille Lorente, Jorge Gentille Lorente, Teresa Salvadó Usach" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Delicia" "apellidos" => "Gentille Lorente" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Gentille Lorente" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Salvadó Usach" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021169951500079X" "doi" => "10.1016/j.nefro.2015.06.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951500079X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000796?idApp=UINPBA000064" "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000796/v1_201511210014/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Short Original" "titulo" => "Administration of calcimimetics after dialysis: Same effectiveness, better gastrointestinal tolerability" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "409" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vicent Esteve Simo, Fátima Moreno-Guzmán, Gemma Martínez Calvo, Miquel Fulquet Nicolas, Monica Pou Potau, Javier Macias-Toro, Verónica Duarte-Gallego, Anna Saurina Sole, Manel Ramírez-de Arellano Serna" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Vicent" "apellidos" => "Esteve Simo" "email" => array:1 [ 0 => "vesteve@cst.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fátima" "apellidos" => "Moreno-Guzmán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gemma" "apellidos" => "Martínez Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Miquel" "apellidos" => "Fulquet Nicolas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Monica" "apellidos" => "Pou Potau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "Macias-Toro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Verónica" "apellidos" => "Duarte-Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Anna" "apellidos" => "Saurina Sole" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Manel" "apellidos" => "Ramírez-de Arellano Serna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Farmacia Hospitalaria, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Administración de calcimiméticos posdiálisis: igual efectividad, mejor tolerancia gastrointestinal" ] ] "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" => 1255 "Ancho" => 1410 "Tamanyo" => 68121 ] ] "descripcion" => array:1 [ "en" => "Primary causes of CKD. Percentage of patients on HD treated with calcimimetics. CTIN, chronic tubulointerstitial nephropathy; DM, diabetes mellitus; Glomer, glomerular." ] ] ] "textoCompleto" => "IntroductionChronic kidney disease (CKD) is an important public health problem, due to its high prevalence as well as its significant cardiovascular morbidity and mortality and socioeconomic cost.<a class="elsevierStyleCrossRefs" href="#bib0155">1,2</a>The prevalence of CKD is around 10% in the general population, and it is higher in those older than 64 years. Around 1–1.5% require renal replacement therapy, in most cases with haemodialysis (HD).<a class="elsevierStyleCrossRefs" href="#bib0165">3–5</a>The aims of treatment are directed at reducing and treating the complications associated with CKD such as anaemia and secondary hyperparathyroidism. Strong association has been shown between these disturbances and an increased rate of cardiovascular events and pathological fractures.<a class="elsevierStyleCrossRefs" href="#bib0180">6–9</a>Hypocalcaemia, vitamin D (calcitriol) deficiency, and build-up of phosphorus levels in patients with CKD are some of the multiple factors that stimulate synthesis of parathyroid hormone (PTH), leading to proliferation of the parathyroid glands and various bone and systemic abnormalities. Currently, there is a broad range of drugs to control this pathological process, including phosphate binders, native vitamin D, vitamin D-receptor-selective analogues, and calcimimetics.<a class="elsevierStyleCrossRefs" href="#bib0200">10–12</a>The mechanism of action of calcimimetics is to increase the sensitivity of the calcium-sensing receptor that is located on the surface of the chief cells of the parathyroid glands, thus reducing serum concentration of PTH, calcium, and phosphorus.<a class="elsevierStyleCrossRefs" href="#bib0215">13–15</a>The use of calcimimetics is indicated in cases of uncontrolled secondary hyperparathyroidism in which optimum levels of PTH are not achieved despite administration of phosphate binders or vitamin D. Calcimimetics have a high cost, are given orally, and are dispensed from hospital, therefore patients must periodically attend to collect the drug from their reference hospital. The main adverse effects are gastrointestinal, principally in the form of nausea and vomiting associated with high doses used for control of hyperparathyroidism.<a class="elsevierStyleCrossRefs" href="#bib0230">16–18</a>Bearing in mind the characteristics of patients with CKD on HD and all the details associated with the administration of calcimimetics, it is not difficult to understand that there is poor treatment adherence and difficult control of hyperparathyroidism, with its associated consequences.There are few, very limited, previous studies available in the literature that have analysed the effectiveness of supervised, intradialytic administration of calcimimetics. Those studies obtained results of good control of secondary hyperparathyroidism without significant adverse effects, as well as better treatment adherence.<a class="elsevierStyleCrossRefs" href="#bib0245">19–21</a>This study aims to assess the effect of supervised post-dialysis administration of calcimimetics in our HD unit on control of abnormal bone mineral metabolism and gastrointestinal tolerance, our intention is the achievement of better treatment adherence with less side effects.Materials and methodsThis was a prospective single-centre observational study of 12 weeks’ duration in patients on a HD programme in our centre, carried out between November 2012 and February 2013. It was approved by the ethics committee and performed in accordance with the standards of the declaration of Helsinki.The inclusion criteria were being on a HD programme in our unit for at least 2 months prior to enrolment, receiving treatment with calcimimetics at least 2 months prior to enrolment, and giving informed consent. The exclusion criteria were sustained hypocalcaemia (<8.8mg/dL) after correcting for serum albumin, or not giving informed consent.There were two study phases, of 6 weeks’ duration each. In the first phase (phase 1), the enrolled patients received treatment with a calcimimetic prescribed according to routine clinical practice (to be taken daily as an outpatient), which was collected by the patient at the pharmacy service in our hospital. In the second phase (phase 2), the calcimimetic was given at the end of each HD session (3 times per week) under nurse supervision, with no changes to the total dose prescribed in phase 1, and no need to attend the hospital pharmacy. The calcimimetic tablets used were 30 and 60mg. All prescribed tablets were kept and stored by HD nursing staff. The daily doses for 1 one week were added to get the weekly dose (mg/week), which was then divided in 3 for administration at the end of the HD session, aiming to give the fewest tablets possible. For example, if the dose to be given was 210mg/week (30mg/day), it was divided in the following way: first day, 60mg (1 tablet); second day, 60mg (1 tablet); and third day, 90mg (1 tablet of 60mg and 1 tablet of 30mg). The highest dose was always given on the last day of HD.The main demographic and biochemical variables related to bone mineral metabolism were collected, as were variables regarding adequacy and characteristics of HD at the start and end of each phase of the study, coinciding with the routine scheduled follow-up tests for HD patients.Regarding treatment with calcimimetics, information was collected on the weekly dose (mg/week), the usual time of administration, and the length of time on treatment (months). Information was also collected on the number of tablets and types of phosphate binders (calcium binders, non-calcium binders, aluminium hydroxide), vitamin D receptor-selective analogues, and native vitamin D.In the third week of each phase, we evaluated gastrointestinal tolerance and level of satisfaction. For gastrointestinal tolerance, the Gastrointestinal Symptom Rating Scale (GSRS) was used as an assessment tool. This scale contains 15 items divided into 5 groups with different gastrointestinal symptoms. The 5 groups of symptoms are reflux, abdominal pain, diarrhoea, indigestion, and constipation. It contains a Likert-type scale of 7 marks, with 1 being the post positive option and 7 being the most negative option. For assessment of the level of satisfaction, a visual analogue scale was used, with scores and visual representation between 0 (least satisfied) and 10 (most satisfied).Treatment adherence was evaluated at the start of phase 1 using the Morinsky-Green test. This is an indirect method of evaluating treatment adherence using a self-questionnaire of 4 questions. It evaluates if the patient adopts a correct attitude regarding treatment. To be considered good adherence, the response to all questions must be adequate. At the end of phase 2, treatment adherence was evaluated by counting the number of tablets administered.Statistical analysis was performed using the programme SPSS version 180 (SPSS Inc., Chicago, IL, USA). Quantitative variables were expressed as mean and standard deviation. Qualitative variables were expressed as percentage. The comparison of quantitative data was done using Wilcoxon test for nonparametric related variables, and the comparison of qualitative data was done using McNemar test. A P value <.05 was considered statistically significant.ResultsWe analysed 62 patients on a HD programme in our HD unit, of whom 14 (22.5%) were receiving treatment with calcimimetics (cinacalcet); 10 patients were enrolled and 4 patients were excluded (1 due to a psychiatric disorder and 3 due to time on treatment being <2 months). 40% were men, and the mean age was 60.9±14.1 years. Mean time on HD was 80.9±114.9 months. The main cause of CKD in our patients was diabetes mellitus, in 40%; the other causes are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The mean Charlson comorbidity index score was 9±4.2. The mean cinacalcet dose was 201±155mg/week and the mean duration of previous cinacalcet use was 23.7±20.5 months. None of our patients had known previous gastrointestinal disease.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Bone mineral metabolismThe main biochemical data on bone mineral metabolism are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In phase 1, serum calcium increased significantly (start vs. end: Ca 8.8±0.5mg/dL vs. 9.1±0.7mg/dL, P=.045). There were no relevant changes in phosphorus values (P 5.2±0.8mg/dL vs. 4.5±1.6mg/dL, P=.270) or intact parathyroid hormone (iPTH 353±129pg/mL vs. 360±232pg/mL, P=.929). In phase 2, serum calcium decreased significantly (start vs. end: Ca 9.1±0.7mg/dL vs. 8.8±0.6mg/dL, P=.049). As with the first phase, there were no relevant changes in phosphorus values (P 4.5±1.6mg/dL vs. 4.6±1.3mg/dL, P=.766) or intact parathyroid hormone (iPTH 360.3±232.7pg/mL vs. 349±122pg/mL, P=.880). Likewise, there were no relevant changes in the values of serum albumin (39±4.9mg/dL vs. 38.4±3.85mg/dL, P=.678), serum alkaline phosphatase (ALP 151.2±148.8mg/dL vs. 155.3±162mg/dL, P=.515), magnesium (Mg 2.44±0.52mg/dL vs. 2.44±0.54mg/dL, P=.472), or native vitamin D (36.49±19.26ng/mL vs. 37.22±10.44ng/mL, P=.861) throughout the study.In both phases there were no significant changes in the mean total dose of cinacalcet (201±155mg/week vs. 207±151mg/week; P=0.816), or in the number of phosphate binders (9binders/patient/day vs. 8.2binders/patient/day, P=.678) or type of phosphate binders (85% calcium binders, 40% non-calcium binders, 15% aluminium, in both phases respectively), or in the percentage use of native vitamin D (70% vs. 60%) or selective vitamin D analogues (30% in both phases). There were no differences in the parameters of dialysis adequacy (Daugirdas second gen Kt/V: 1.69±0.26 vs. 1.71±0.27, P=.649) or in the HD characteristics (calcium bath: 2.5mEq/L, 20%; 3mEq/L, 50%; and 3.5mEq/L, 30% in both phases).Gastrointestinal tolerance and level of satisfactionSeverity of gastrointestinal symptoms improved significantly in patients treated with supervised cinacalcet at the end of the HD session (phase 1 vs. phase 2 GSRS, 7.5±5.2 vs. 4.3±1.9, P=.011). In the analysis of the different aspects of GSRS, there was a lower scoring in all aspects, fundamentally due to lack of diarrhoea and indigestion, though it was not statistically significant (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). There were no changes in consumption of antacid medications or gastric protectors throughout the study (90% in both phases). All patients completed the study.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>There was also a higher scoring for level of satisfaction, using the visual scale (4.8±2.3 vs. 6.9±2.8; P=.021), in patients who received supervised cinacalcet treatment at the end of the HD session.Treatment adherenceIn phase 1, using the Morisky–Green test, treatment adherence was 70%. In phase 2, using counting of tablets, adherence was 89% (245 tablets administered/276 prescribed).DiscussionIn our patients, supervised intermittent administration of calcimimetics after dialysis sessions was effective in control of secondary hyperparathyroidism. In the literature, there are recent studies that have assessed the effectiveness of supervised intradialytic administration of calcimimetics, with results of good control of secondary hyperparathyroidism without significant adverse effects, and better treatment adherence.Al Hilali et al.<a class="elsevierStyleCrossRef" href="#bib0245">19</a> saw a similar effect in PTH suppression after administration of calcimimetics twice per week after dialysis, compared with a daily regimen, in a group of 27 patients on a HD programme. Likewise, Haq and Chaaban<a class="elsevierStyleCrossRefs" href="#bib0250">20,21</a> observed that post-dialysis administration of cinacalcet was as effective as the standard daily home schedule in a group of 11 patients, after 16 weeks of follow-up. In contrast to the aforementioned studies, our study did not have a comparison group, there were no changes to the treatments involved in hyperparathyroidism control or in the dialysis characteristics, and also, our patients had previously received treatment with calcimimetics. Although it is true that with a higher treatment compliance there would be an expected improvement in values of bone mineral metabolism control (above all calcaemia and iPTH), in our study we saw statistically significant changes only in serum calcium values in the different phases, with no changes in the values of phosphorus and iPTH. Regarding the difference in serum Ca, this could have been due to incomplete taking of calcimimetics in phase 1, and correct treatment compliance with calcimimetics in phase 2. The absence of significant changes in iPTH values could be attributed in part to use of one isolated value and not average values of iPHT, as well as the great variability in average values in a small sample that is analysed with a nonparametric test. However, in both study phases, our patients remained within the therapeutic targets of the guidelines on bone mineral metabolism from various nephrology societies, without changes in the total doses administered. Therefore, we interpret that the 2 patterns of administration are equally effective in the control of secondary hyperparathyroidism.Many medications have adverse effects that can contribute to their irregular consumption. The gastrointestinal side effects of calcimimetics are widely known, the most common symptoms being nausea (21–43%) and vomiting (13–30%).<a class="elsevierStyleCrossRefs" href="#bib0205">11,12</a> Taking medications at night or with food are some of the strategies used to minimise those adverse effects.<a class="elsevierStyleCrossRefs" href="#bib0260">22–25</a> In our study, gastrointestinal symptoms improved after the supervised post-dialysis administration of calcimimetics. This was fundamentally due to the symptoms of diarrhoea and indigestion, which were reduced by up to 50%. These findings were attributed to the intermittent taking of the medications, which were not taken for a total of 4 days per week, thus avoiding the gastrointestinal upset associated with a daily dose. Regarding this, the low dose prescribed in our patients (most of the patients received a regular dose no more than 60mg/day) as well as the routine intradialytic ingestion of food, could have minimised gastrointestinal symptoms. In fact, under supervised administration, our patients received higher individual doses than they had routinely been prescribed, and there were no discontinuations due to gastrointestinal intolerance during the study. Furthermore, during the supervised post-dialysis administration, the level of satisfaction improved significantly. This finding could be explained firstly by the reduction in gastrointestinal symptoms, and secondly by the simple fact that patients avoided the inconvenience of collecting medications at the hospital pharmacy in our centre, which is located away from the dialysis unit and has opening hours that do not always coincide with routine HD sessions. Following the results of our study, we will consider post-dialysis administration in patients with difficulty attending the hospital pharmacy (due to either physical condition or scheduled HD time).As previously mentioned, patients on HD have a high drug load, due to their associated increased concomitant conditions, which can result in poor treatment adherence. The average rate of treatment compliance in randomised controlled studies in patients with CKD on a HD programme is around 42–78% and is getting lower over time.<a class="elsevierStyleCrossRefs" href="#bib0280">26–30</a> In our study, the adherence rate is similar to that previously published. As expected, with supervised post-dialysis administration, treatment compliance improved, despite the use of different methods of evaluating treatment compliance in the different phases of the study. The Morisky–Green test is widely used in various population studies of therapeutic inertia and compliance, particularly in the setting of the hypertensive population. It was used in phase 1 to maintain neutrality, to avoid factors of confusion and subsequent interpretation (for example, encouraging the taking of medications in supposedly noncompliant patients). In phase 2, in order to be objective, it was decided to use the final count of cinacalcet tablets to calculate the total quantity and number of tablets of medication used. However, despite supervision by a nurse, treatment nonadherence was 11%. This fact could be attributable to an oversight of the nursing staff in administering the medication in the final moments of disconnecting the patients, when there are other care tasks to be done; or possible errors in the number of tablets to administer after the HD session (for example 2 tablets instead of 3). Perhaps using a single administration schedule, or taking the medication at another point in the HD session could minimise this mild nonadherence, although the end of the HD session was chosen to ensure the same moment for taking the medication for all patients in phase 2 and to avoid errors in assessment of gastrointestinal symptoms (because of intradialytic food), as well as to not coincide with the administration of other regular medications by nursing staff during HD sessions.One point to highlight in our study is that it was carried out according to routine clinical practice. That is to say that in current practice, despite the medical indications, it is not uncommon to give low doses of calcimimetics on alternate days, thanks to recent improvements in the control of secondary hyperparathyroidism. Among the multiple limitations of our study, some of which have already been mentioned, the most notable were the low number of patients, requiring the use of a non-parametric statistical test, and the short follow-up time in our patients; though a period of 12 weeks was chosen to avoid potential changes in regular medications associated with bone mineral metabolism after routine 3-monthly tests. Regrettably, it was not possible to do a cost-economic analysis. Studies with more patients and a longer duration would be needed to confirm the effectiveness and gastrointestinal tolerance of calcimimetics given under supervision post-HD, in the control of secondary hyperparathyroidism.In conclusion, in our study, supervised post-dialysis administration of calcimimetics was effective in the control of secondary hyperparathyroidism, with fewer gastrointestinal effects and a higher level of satisfaction. Based on these results, we consider the administration of post-dialysis calcimimetics to be effective and, above all, beneficial in determined patients with poor treatment compliance.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres580887" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec597391" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres580886" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec597392" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Bone mineral metabolism" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Gastrointestinal tolerance and level of satisfaction" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Treatment adherence" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-29" "fechaAceptado" => "2014-12-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec597391" "palabras" => array:3 [ 0 => "Haemodialysis" 1 => "Calcimimetics" 2 => "Secondary hyperparathyroidism" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec597392" "palabras" => array:3 [ 0 => "Hemodiálisis" 1 => "Calcimiméticos" 2 => "Hiperparatiroidismo secundario" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionCinacalcet has proved effective to control secondary hyperparathyroidism in patients on haemodialysis (HD). Some studies have reported an appropriate secondary hyperparathyroidism control and a better compliance after intradialytic use of calcimimetics. ObjectivesTo assess the effect of post-dialysis calcimimetics use on mineral bone disorders and calcimimetics gastrointestinal tolerability in our HD unit. Material and methodsA 12-week single-centre prospective study in HD patients treated with cinacalcet (>2 months). Two study periods: usual outpatient use (Stage 1) and use after HD session (Stage 2). Endpoints: (1) biochemical MBD data; (2) Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal tolerability, and visual analogic scale (VAS) for satisfaction; (3) adherence: Morisky–Green test (MG) and final tablet count (TC). ResultsSixty-two HD patients. Fourteen received cinacalcet (22.5%). TEN patients were included, mean age was 60.9 years; patients had received HD for 80.9 months. Mean Charlson index: 9. Biochemical data: Stage 1 (initial vs. final): Ca 8.8±0.5mg/dl vs. 9.1±0.7mg/dl (P<0.05); P 5.2±0.8mg/dl vs. 4.5±1.6mg/dl, iPTH 360.3±232.7pg/ml vs. 349±122pg/ml. MG: 70%. Stage 2 (initial vs. final): Ca 9.1±0.7mg/dl vs. 8.8±0.6mg/dl; P 4.5±1.6mg/dl vs. 4.6±1.3mg/dl, iPTH 360.3±232.7pg/ml vs. 349±122pg/ml. TC: 89%. GSRS and VAS were better in Stage 2 (GSRS 7.5±5.2 vs. 4.3±1.9; VAS 4.8±2.3 vs. 6.9±2.8). No significant changes were observed in calcimimetic dose (201mg/week vs. 207mg/week), number of phosphate binders (9pts/day vs. 8.2pts/day), native vitamin D (70% vs. 60%), selective vit D receptor activators (30%), or suitable dialysis parameters. ConclusionsPost-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control, improved gastrointestinal tolerability and ameliorated patients’ satisfaction. Based on our findings, post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónCinacalcet resulta efectivo en el control del hiperparatiroidismo secundario de los pacientes en hemodiálisis (HD). Algunos estudios han reportado un buen control del hiperparatiroidismo secundario y un mejor cumplimiento terapéutico tras la administración de calcimiméticos intradiálisis. ObjetivosAnalizar el efecto de la administración de calcimiméticos posdiálisis sobre el metabolismo óseo mineral y la tolerancia gastrointestinal en nuestra unidad de HD. Material y métodosEstudio prospectivo unicéntrico de 12 semanas de duración en pacientes en HD tratados con cinacalcet (> 2 meses). Dos períodos de estudio (6 semanas): Administración habitual ambulatoria (fase 1) y posthemodiálisis (fase 2). Datos analizados: 1.- Datos bioquímicos metabolismo óseo mineral. 2.-Test síntomas gastrointestinales (Gastrointestinal Symptom Rating Scale [GSRS]) y grado de satisfacción (escala visual analógica [EVA]). 3.-Adherencia: Test de Morisky-Green (MG) y recuento final comprimidos (RC). ResultadosSesenta y dos pacientes en HD. Catorce recibían cinacalcet (22,5%). Diez pacientes incluidos, edad media 60,9 años y 80,9 meses en HD. Charlson medio: 9. Datos bioquímicos: fase 1 (inicio vs. fin): Ca 8,8±0,5 vs. 9,1±0,7 mg/dl (p<0,05); fósforo 5,2±0,8 vs. 4,5±1,6 mg/dl, PTHi 353±129 vs. 360±232 pg/ml. Adherencia (MG): 70%. Fase 2 (inicio vs. fin): Ca 9,1±0,7 vs. 8,8±0,6 mg/dl; fósforo 4,5±1,6 vs. 4,6±1,3 mg/dl; PTHi 3603±2327 vs. 349±122 pg/ml. Adherencia (RC): 89%. Con relación al GSRS y el grado de satisfacción, fueron mejores en la fase 2 (GSRS 7,5±5,2 vs. 4,3±1,9; EVA 4,8±2,3 vs. 6,9±2,8). No se objetivaron cambios significativos en la dosis de calcimiméticos (201 vs. 207 mg/sem), número captores fósforo (9 vs. 8,2 pac/día), vitamina D nativa (70 vs. 60%) o activadores selectivos receptor vitD (30%), ni en los parámetros de adecuación dialítica. ConclusionesLa administración de calcimiméticos post diálisis permitió controlar el hiperparatiroidismo secundario de forma eficaz, mejorando la sintomatología gastrointestinal y el grado de satisfacción. Se debe considerar la administración de calcimiméticos post diálisis en aquellos pacientes con escaso cumplimiento terapéutico." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Esteve Simo V, Moreno-Guzmán F, Martínez Calvo G, Fulquet Nicolas M, Pou Potau M, Macias-Toro J, et al. Administración de calcimiméticos posdiálisis: igual efectividad, mejor tolerancia gastrointestinal. Nefrologia. 2015;35:403–409." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1255 "Ancho" => 1410 "Tamanyo" => 68121 ] ] "descripcion" => array:1 [ "en" => "Primary causes of CKD. Percentage of patients on HD treated with calcimimetics. CTIN, chronic tubulointerstitial nephropathy; DM, diabetes mellitus; Glomer, glomerular." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Ca, calcium; Ca±P, calcium–phosphorus product; P, phosphorus; iPTH, intact parathyroid hormone; SS, statistical significance." "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="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Phase 1</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Phase 2</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Start \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">End \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">SS \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">Start \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">End \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">SS \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">Ca (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.045<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.049<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \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">P (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2±0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.766 \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">Ca×P (mg/dL)2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.7±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.9±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.652 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.9±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.48±7.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.983 \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">353±129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">360±232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.929 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">360±232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">350±122 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.880 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab947931.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P<.05." ] ] ] "descripcion" => array:1 [ "en" => "Main biochemical data on bone mineral metabolism. Phase 1 and phase 2 of the study." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "GSRS, Gastrointestinal Symptom Rating Scale; SS, statistical significance; VAS, visual analogue scale. Average score (1–5) of symptoms according to the different categories. Start vs. end: GSRS categories: reflux, abdominal pain, constipation, diarrhoea, and indigestion." "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Start \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">End \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">SS \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">GSRS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.3±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.011<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \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">Reflux \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.487 \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">Abdominal pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.335 \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">Constipation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.235 \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">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.085 \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">Indigestion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.074 \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">VAS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021<a class="elsevierStyleCrossRef" href="#tblfn0010">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab947932.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "P<.05." ] ] ] "descripcion" => array:1 [ "en" => "Evaluation of gastrointestinal symptoms (GSRS) and level of satisfaction (VAS)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Board of the EURECA-m Working Group of ERA-EDTA. Epidemiology, contributors to and clinical trials of mortality risk in chronic kidney failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ortiz" 1 => "A. Covic" 2 => "D. Fliser" 3 => "D. Fouque" 4 => "D. Goldsmith" 5 => "M. Kanbay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)60384-6" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "paginaInicial" => "1831" "paginaFinal" => "1843" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856028" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden of kidney disease: improving global outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Eknoyan" 1 => "N. Lameire" 2 => "R. Barsoum" 3 => "K.U. Eckardt" 4 => "A. Levin" 5 => "N. Levin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1523-1755.2004.00894.x" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2004" "volumen" => "66" "paginaInicial" => "1310" "paginaFinal" => "1314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15458424" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus document for the detection and management of chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Martínez-Castelao" 1 => "J.L. Górriz" 2 => "J. Segura-de la Morena" 3 => "J. Cebollada" 4 => "J. Escalada" 5 => "E. Esmatjes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2014.Feb.12455" "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2014" "volumen" => "34" "paginaInicial" => "243" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24658201" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the EPIRCE study group" "etal" => false "autores" => array:4 [ 0 => "A. Otero" 1 => "P. Gayoso" 2 => "F. García" 3 => "A.L.M. de Francisco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2005" "volumen" => "68" "numero" => "Suppl. 99" "paginaInicial" => "S16" "paginaFinal" => "S19" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Identifying patients with chronic kidney disease from general practice computer records" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. de Lusignan" 1 => "T. Chan" 2 => "P. Stevens" 3 => "D. O’Donoghue" 4 => "N. Hague" 5 => "B. Dzregah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/fampra/cmi026" "Revista" => array:6 [ "tituloSerie" => "Fam Pract" "fecha" => "2005" "volumen" => "22" "paginaInicial" => "234" "paginaFinal" => "241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814579" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet for hemodialyzed patients with or without a high PTH level to control serum calcium and phosphorus: ECO (evaluation of cinacalcet HCl outcome) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Yokoyama" 1 => "I. Ohkido" 2 => "M. Ishida" 3 => "H. Hashimoto" 4 => "J. Urae" 5 => "H. Sekino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2012" "volumen" => "78" "paginaInicial" => "87" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22790452" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of cinacalcet with low-dose vitamin D in incident haemodialysis subjects with secondary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ureña-Torres" 1 => "I. Bridges" 2 => "C. Christiano" 3 => "S.H. Cournoyer" 4 => "K. Cooper" 5 => "M. Farouk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfs568" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "1241" "paginaFinal" => "1254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328710" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.A. Block" 1 => "D. Zaun" 2 => "G. Smits" 3 => "M. Persky" 4 => "S. Brillhart" 5 => "K. Nieman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.2010.167" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2010" "volumen" => "78" "paginaInicial" => "578" "paginaFinal" => "589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20555319" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of cinacalcet on bone mineral density and bone markers in hemodialysis patients with secondary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Tsuruta" 1 => "K. Okano" 2 => "K. Kikuchi" 3 => "Y. Tsuruta" 4 => "T. Akiba" 5 => "K. Nitta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10157-012-0665-8" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Nephrol" "fecha" => "2013" "volumen" => "17" "paginaInicial" => "120" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22833360" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet in patients with chronic kidney disease: a cumulative meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.C. Palmer" 1 => "I. Nistor" 2 => "J.C. Craig" 3 => "F. Pellegrini" 4 => "P. Messa" 5 => "M. Tonelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pmed.1001436" "Revista" => array:5 [ "tituloSerie" => "PLoS Med" "fecha" => "2013" "volumen" => "10" "paginaInicial" => "e1001436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23637579" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet treatment for secondary hyperparathyroidism in dialysis patients: an observational study in routine clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Bover" 1 => "R. Pérez" 2 => "M. Molina" 3 => "B. Benavides" 4 => "F. Ariza" 5 => "J.L. Miguel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Nephron Clin Pract" "fecha" => "2011" "volumen" => "118" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Lindberg" 1 => "B. Culleton" 2 => "G. Wong" 3 => "M.F. Borah" 4 => "R.V. Clark" 5 => "W.B. Shapiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2004060512" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2005" "volumen" => "16" "paginaInicial" => "800" "paginaFinal" => "807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15689407" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacodynamics of the type ii calcimimetic compound cinacalcet HCL" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.F. Nemeth" 1 => "W.H. Heaton" 2 => "M. Miller" 3 => "J. Fox" 4 => "M.F. Balandrin" 5 => "B.C. Van Wagenen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1124/jpet.103.057273" "Revista" => array:6 [ "tituloSerie" => "J Pharmacol Exp Ther" "fecha" => "2004" "volumen" => "308" "paginaInicial" => "627" "paginaFinal" => "635" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14593085" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet up regulates calcium-sensing receptors of parathyroid glands in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Sumida" 1 => "M. Nakamura" 2 => "Y. Ubara" 3 => "Y. Marui" 4 => "K. Tanaka" 5 => "K. Takaichi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000350211" "Revista" => array:6 [ "tituloSerie" => "Am J Nephrol" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "405" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23594726" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet effectively reduces parathyroid hormone secretion and gland volume regardless of pretreatment gland size in patients with secondary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Komaba" 1 => "S. Nakanishi" 2 => "A. Fujimori" 3 => "M. Tanaka" 4 => "J. Shin" 5 => "K. Shibuya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.02110310" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "2305" "paginaFinal" => "2314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20798251" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilization and costs of medications associated with CKD mineral and bone disorder in dialysis patients enrolled in Medicare Part D" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.A. Yusuf" 1 => "B.L. Howell" 2 => "C.A. Powers" 3 => "W.L. St Peter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2014.04.014" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2014" "volumen" => "64" "paginaInicial" => "770" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24833203" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of side effects related to cinacalcet therapy on compliance in hemodialysis patients suffering from secondary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Zwiech" 1 => "S. Chrul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "WiadLek" "fecha" => "2012" "volumen" => "65" "paginaInicial" => "145" "paginaFinal" => "150" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluating real-world use of cinacalcet and biochemical response to therapy in US hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.D. Kilpatrick" 1 => "B.B. Newsome" 2 => "D. Zaun" 3 => "J. Liu" 4 => "C.A. Solid" 5 => "K. Nieman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000350213" "Revista" => array:6 [ "tituloSerie" => "Am J Nephrol" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "389" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23548469" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel dose regimen of cinacalcet in the treatment of severe hyperparathyroidism in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Al Hilali" 1 => "N. Hussain" 2 => "Y.A. Kay" 3 => "M. Al Azmi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Saudi J Kidney Dis Transpl" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "448" "paginaFinal" => "455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21566299" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Haq" 1 => "A. Chaaban" 2 => "N. Gebran" 3 => "I. Khan" 4 => "F. Abbachi" 5 => "M. Hassan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int Urol Nephrol" "fecha" => "2014" "volumen" => "350" "paginaInicial" => "1516" "paginaFinal" => "1525" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective randomized trial on intermittent post-dialysis of cinacalcet: a solution to non-compliance. National Kidney Foundation 2010 Spring Clinical Meetings Abstracts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Abouchacra" 1 => "A. Chaaban" 2 => "N. Haq" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Chronic Kidney Dis" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "206" "paginaFinal" => "207" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet for secondary hyperparatiroidism in patients receiving hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.A. Block" 1 => "K.J. Martin" 2 => "A.L. de Francisco" 3 => "S.A. Turner" 4 => "M.M. Avram" 5 => "M.G. Suranyi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa031633" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "1516" "paginaFinal" => "1525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15071126" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet-clinical and laboratory effectiveness, concomitant treatment patterns and treatment cost: could we do better and how?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Smržová" 1 => "T. Urbánek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000317935" "Revista" => array:6 [ "tituloSerie" => "Kidney Blood Press Res" "fecha" => "2010" "volumen" => "33" "paginaInicial" => "333" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20714162" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of the efficacy and factors influencing the response of secondary hyperparathyroidism patients on hemodialysis to cinacalcet" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Segura Torres" 1 => "F.J. Borrego Utiel" 2 => "M.C. Sánchez Perales" 3 => "M.J. García Cortés" 4 => "M.M. Biechy Baldán" 5 => "V. Pérez Bañasco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.May.10451" "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "443" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20651886" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of adherence to cinacalcet by prescription refill rates in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Gincherman" 1 => "K. Moloney" 2 => "C. McKee" 3 => "D.W. Coyne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1542-4758.2009.00397.x" "Revista" => array:6 [ "tituloSerie" => "Hemodial Int" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "68" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19732171" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical pharmacokinetic and pharmacodynamic profile of cinacalcet hydrochloride" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Padhi" 1 => "R. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/00003088-200948050-00002" "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacokinet" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "303" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19566113" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pill Burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.W. Chiu" 1 => "I. Teitelbaum" 2 => "M. Misra" 3 => "E.M. de Leon" 4 => "T. Adzize" 5 => "T. Mehrotra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin J Am SocNephrol" "fecha" => "2009" "volumen" => "4" "paginaInicial" => "1089" "paginaFinal" => "1096" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to medication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Osterberg" 1 => "T. Blaschke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "353" "paginaInicial" => "478" "paginaFinal" => "497" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of cinacalcet adherence and costs in patients on dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lee" 1 => "X. Song" 2 => "I. Khan" 3 => "V. Belozeroff" 4 => "W. Goodman" 5 => "N. Fulcher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3111/13696998.2011.627404" "Revista" => array:6 [ "tituloSerie" => "J Med Econ" "fecha" => "2011" "volumen" => "14" "paginaInicial" => "798" "paginaFinal" => "804" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21988567" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and consequences of non adherence to hemodialysis regimes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Denhaerynck" 1 => "D. Manhaeve" 2 => "F. Dobbels" 3 => "D. Garzoni" 4 => "C. Nolte" 5 => "S. De Geest" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Crit Care" "fecha" => "2007" "volumen" => "16" "paginaInicial" => "222" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17460313" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000607/v1_201511210014/en/main.assets" "Apartado" => array:4 [ "identificador" => "42660" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000004/v1_201511210014/S2013251415000607/v1_201511210014/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000607?idApp=UINPBA000064"]

Statistics

Short Original

Administración de calcimiméticos posdiálisis: igual efectividad, mejor tolerancia gastrointestinal

Vicent Esteve Simoa,

Corresponding author

vesteve@cst.cat

Corresponding author.

, Fátima Moreno-Guzmána, Gemma Martínez Calvob, Miquel Fulquet Nicolasa, Monica Pou Potaua, Javier Macias-Toroa, Verónica Duarte-Gallegoa, Anna Saurina Solea, Manel Ramírez-de Arellano Sernaa

a Servicio de Nefrología, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain

b Servicio de Farmacia Hospitalaria, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain

Read

8230

Times
was read the article

2475

Total PDF

5755

Total HTML

Share statistics

 array:25 [
  "pii" => "S2013251415000607"
  "issn" => "20132514"
  "doi" => "10.1016/j.nefroe.2015.09.002"
  "estado" => "S300"
  "fechaPublicacion" => "2015-07-01"
  "aid" => "59"
  "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
  "copyrightAnyo" => "2015"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2015;35:403-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4284
    "formatos" => array:3 [
      "EPUB" => 323
      "HTML" => 3226
      "PDF" => 735
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0211699515000697"
      "issn" => "02116995"
      "doi" => "10.1016/j.nefro.2015.06.013"
      "estado" => "S300"
      "fechaPublicacion" => "2015-07-01"
      "aid" => "59"
      "copyright" => "The Authors"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2015;35:403-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8379
        "formatos" => array:3 [
          "EPUB" => 327
          "HTML" => 7340
          "PDF" => 712
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>"
        "titulo" => "Administraci&#243;n de calcimim&#233;ticos posdi&#225;lisis&#58; igual efectividad&#44; mejor tolerancia gastrointestinal"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "403"
            "paginaFinal" => "409"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Administration of calcimimetics after dialysis&#58; same effectiveness&#44; better gastrointestinal tolerability"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1255
                "Ancho" => 1410
                "Tamanyo" => 67828
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Principal etiolog&#237;a de ERC&#46; Porcentaje de pacientes en HD tratados con calcimim&#233;ticos&#58; DM&#58; diabetes mellitus&#59; Glomer&#58; glomerulares&#59; NTIC&#58; nefropat&#237;a tubulointersticial cr&#243;nica&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Vicent Esteve Simo, F&#225;tima Moreno-Guzm&#225;n, Gemma Mart&#237;nez Calvo, Miquel Fulquet Nicolas, Monica Pou Potau, Javier Macias-Toro, Ver&#243;nica Duarte-Gallego, Anna Saurina Sole, Manel Ram&#237;rez-de Arellano Serna"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "Vicent"
                "apellidos" => "Esteve Simo"
              ]
              1 => array:2 [
                "nombre" => "F&#225;tima"
                "apellidos" => "Moreno-Guzm&#225;n"
              ]
              2 => array:2 [
                "nombre" => "Gemma"
                "apellidos" => "Mart&#237;nez Calvo"
              ]
              3 => array:2 [
                "nombre" => "Miquel"
                "apellidos" => "Fulquet Nicolas"
              ]
              4 => array:2 [
                "nombre" => "Monica"
                "apellidos" => "Pou Potau"
              ]
              5 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Macias-Toro"
              ]
              6 => array:2 [
                "nombre" => "Ver&#243;nica"
                "apellidos" => "Duarte-Gallego"
              ]
              7 => array:2 [
                "nombre" => "Anna"
                "apellidos" => "Saurina Sole"
              ]
              8 => array:2 [
                "nombre" => "Manel"
                "apellidos" => "Ram&#237;rez-de Arellano Serna"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2013251415000607"
          "doi" => "10.1016/j.nefroe.2015.09.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000607?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515000697?idApp=UINPBA000064"
      "url" => "/02116995/0000003500000004/v3_201511070033/S0211699515000697/v3_201511070033/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2013251415000590"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2015.09.001"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "47"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Nefrologia &#40;English Version&#41;. 2015;35:410-1"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5404
      "formatos" => array:3 [
        "EPUB" => 326
        "HTML" => 4288
        "PDF" => 790
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letters to the Editor &#8211; Brief papers about basic research or clinical experiences</span>"
      "titulo" => "Struvite urolithiasis with <span class="elsevierStyleItalic">Corynebacterium urealyticum</span> infection&#58; A case report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "410"
          "paginaFinal" => "411"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Urolitiasis por estruvita en infecci&#243;n por <span class="elsevierStyleItalic">Corynebacterium urealyticum</span>&#46; A prop&#243;sito de un caso"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1077
              "Ancho" => 900
              "Tamanyo" => 96483
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Appearance of obstructed urinary catheter&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan A&#46; Mart&#237;n-Navarro, Vladimir Petkov-Stoyanov, M&#46; Jos&#233; Guti&#233;rrez-S&#225;nchez, M&#46; Esther Gordo-Flores"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Juan A&#46;"
              "apellidos" => "Mart&#237;n-Navarro"
            ]
            1 => array:2 [
              "nombre" => "Vladimir"
              "apellidos" => "Petkov-Stoyanov"
            ]
            2 => array:2 [
              "nombre" => "M&#46; Jos&#233;"
              "apellidos" => "Guti&#233;rrez-S&#225;nchez"
            ]
            3 => array:2 [
              "nombre" => "M&#46; Esther"
              "apellidos" => "Gordo-Flores"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699515000570"
        "doi" => "10.1016/j.nefro.2015.06.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515000570?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000590?idApp=UINPBA000064"
    "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000590/v1_201511210014/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2013251415000796"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2015.10.003"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "69"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2015;35:395-402"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8378
      "formatos" => array:3 [
        "EPUB" => 323
        "HTML" => 7302
        "PDF" => 753
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Repeated serum creatinine measurement in primary care&#58; Not all patients have chronic renal failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "395"
          "paginaFinal" => "402"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Repetici&#243;n de la medici&#243;n de creatinina s&#233;rica en atenci&#243;n primaria&#58; no todos tienen insuficiencia renal cr&#243;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2343
              "Ancho" => 2502
              "Tamanyo" => 236665
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Study flowchart RF&#58; renal failure&#59; CRF&#58; chronic renal failure&#59; ORD&#58; occult renal disease&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Delicia Gentille Lorente, Jorge Gentille Lorente, Teresa Salvad&#243; Usach"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Delicia"
              "apellidos" => "Gentille Lorente"
            ]
            1 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Gentille Lorente"
            ]
            2 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Salvad&#243; Usach"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S021169951500079X"
        "doi" => "10.1016/j.nefro.2015.06.020"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951500079X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000796?idApp=UINPBA000064"
    "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000796/v1_201511210014/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Short Original</span>"
    "titulo" => "Administration of calcimimetics after dialysis&#58; Same effectiveness&#44; better gastrointestinal tolerability"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "403"
        "paginaFinal" => "409"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Vicent Esteve Simo, F&#225;tima Moreno-Guzm&#225;n, Gemma Mart&#237;nez Calvo, Miquel Fulquet Nicolas, Monica Pou Potau, Javier Macias-Toro, Ver&#243;nica Duarte-Gallego, Anna Saurina Sole, Manel Ram&#237;rez-de Arellano Serna"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "Vicent"
            "apellidos" => "Esteve Simo"
            "email" => array:1 [
              0 => "vesteve&#64;cst&#46;cat"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#225;tima"
            "apellidos" => "Moreno-Guzm&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Gemma"
            "apellidos" => "Mart&#237;nez Calvo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Miquel"
            "apellidos" => "Fulquet Nicolas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Monica"
            "apellidos" => "Pou Potau"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Macias-Toro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Ver&#243;nica"
            "apellidos" => "Duarte-Gallego"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Anna"
            "apellidos" => "Saurina Sole"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Manel"
            "apellidos" => "Ram&#237;rez-de Arellano Serna"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Hospital de Terrassa&#44; Consorci Sanitari de Terrassa&#44; Terrassa&#44; Barcelona&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Farmacia Hospitalaria&#44; Hospital de Terrassa&#44; Consorci Sanitari de Terrassa&#44; Terrassa&#44; Barcelona&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Administraci&#243;n de calcimim&#233;ticos posdi&#225;lisis&#58; igual efectividad&#44; mejor tolerancia gastrointestinal"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1255
            "Ancho" => 1410
            "Tamanyo" => 68121
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Primary causes of CKD&#46; Percentage of patients on HD treated with calcimimetics&#46; CTIN&#44; chronic tubulointerstitial nephropathy&#59; DM&#44; diabetes mellitus&#59; Glomer&#44; glomerular&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; is an important public health problem&#44; due to its high prevalence as well as its significant cardiovascular morbidity and mortality and socioeconomic cost&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of CKD is around 10&#37; in the general population&#44; and it is higher in those older than 64 years&#46; Around 1&#8211;1&#46;5&#37; require renal replacement therapy&#44; in most cases with haemodialysis &#40;HD&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aims of treatment are directed at reducing and treating the complications associated with CKD such as anaemia and secondary hyperparathyroidism&#46; Strong association has been shown between these disturbances and an increased rate of cardiovascular events and pathological fractures&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Hypocalcaemia&#44; vitamin D &#40;calcitriol&#41; deficiency&#44; and build-up of phosphorus levels in patients with CKD are some of the multiple factors that stimulate synthesis of parathyroid hormone &#40;PTH&#41;&#44; leading to proliferation of the parathyroid glands and various bone and systemic abnormalities&#46; Currently&#44; there is a broad range of drugs to control this pathological process&#44; including phosphate binders&#44; native vitamin D&#44; vitamin D-receptor-selective analogues&#44; and calcimimetics&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The mechanism of action of calcimimetics is to increase the sensitivity of the calcium-sensing receptor that is located on the surface of the chief cells of the parathyroid glands&#44; thus reducing serum concentration of PTH&#44; calcium&#44; and phosphorus&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The use of calcimimetics is indicated in cases of uncontrolled secondary hyperparathyroidism in which optimum levels of PTH are not achieved despite administration of phosphate binders or vitamin D&#46; Calcimimetics have a high cost&#44; are given orally&#44; and are dispensed from hospital&#44; therefore patients must periodically attend to collect the drug from their reference hospital&#46; The main adverse effects are gastrointestinal&#44; principally in the form of nausea and vomiting associated with high doses used for control of hyperparathyroidism&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Bearing in mind the characteristics of patients with CKD on HD and all the details associated with the administration of calcimimetics&#44; it is not difficult to understand that there is poor treatment adherence and difficult control of hyperparathyroidism&#44; with its associated consequences&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">There are few&#44; very limited&#44; previous studies available in the literature that have analysed the effectiveness of supervised&#44; intradialytic administration of calcimimetics&#46; Those studies obtained results of good control of secondary hyperparathyroidism without significant adverse effects&#44; as well as better treatment adherence&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#8211;21</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">This study aims to assess the effect of supervised post-dialysis administration of calcimimetics in our HD unit on control of abnormal bone mineral metabolism and gastrointestinal tolerance&#44; our intention is the achievement of better treatment adherence with less side effects&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">This was a prospective single-centre observational study of 12 weeks&#8217; duration in patients on a HD programme in our centre&#44; carried out between November 2012 and February 2013&#46; It was approved by the ethics committee and performed in accordance with the standards of the declaration of Helsinki&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The inclusion criteria were being on a HD programme in our unit for at least 2 months prior to enrolment&#44; receiving treatment with calcimimetics at least 2 months prior to enrolment&#44; and giving informed consent&#46; The exclusion criteria were sustained hypocalcaemia &#40;&#60;8&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; after correcting for serum albumin&#44; or not giving informed consent&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There were two study phases&#44; of 6 weeks&#8217; duration each&#46; In the first phase &#40;phase 1&#41;&#44; the enrolled patients received treatment with a calcimimetic prescribed according to routine clinical practice &#40;to be taken daily as an outpatient&#41;&#44; which was collected by the patient at the pharmacy service in our hospital&#46; In the second phase &#40;phase 2&#41;&#44; the calcimimetic was given at the end of each HD session &#40;3 times per week&#41; under nurse supervision&#44; with no changes to the total dose prescribed in phase 1&#44; and no need to attend the hospital pharmacy&#46; The calcimimetic tablets used were 30 and 60<span class="elsevierStyleHsp" style=""></span>mg&#46; All prescribed tablets were kept and stored by HD nursing staff&#46; The daily doses for 1 one week were added to get the weekly dose &#40;mg&#47;week&#41;&#44; which was then divided in 3 for administration at the end of the HD session&#44; aiming to give the fewest tablets possible&#46; For example&#44; if the dose to be given was 210<span class="elsevierStyleHsp" style=""></span>mg&#47;week &#40;30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; it was divided in the following way&#58; first day&#44; 60<span class="elsevierStyleHsp" style=""></span>mg &#40;1 tablet&#41;&#59; second day&#44; 60<span class="elsevierStyleHsp" style=""></span>mg &#40;1 tablet&#41;&#59; and third day&#44; 90<span class="elsevierStyleHsp" style=""></span>mg &#40;1 tablet of 60<span class="elsevierStyleHsp" style=""></span>mg and 1 tablet of 30<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; The highest dose was always given on the last day of HD&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The main demographic and biochemical variables related to bone mineral metabolism were collected&#44; as were variables regarding adequacy and characteristics of HD at the start and end of each phase of the study&#44; coinciding with the routine scheduled follow-up tests for HD patients&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding treatment with calcimimetics&#44; information was collected on the weekly dose &#40;mg&#47;week&#41;&#44; the usual time of administration&#44; and the length of time on treatment &#40;months&#41;&#46; Information was also collected on the number of tablets and types of phosphate binders &#40;calcium binders&#44; non-calcium binders&#44; aluminium hydroxide&#41;&#44; vitamin D receptor-selective analogues&#44; and native vitamin D&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In the third week of each phase&#44; we evaluated gastrointestinal tolerance and level of satisfaction&#46; For gastrointestinal tolerance&#44; the Gastrointestinal Symptom Rating Scale &#40;GSRS&#41; was used as an assessment tool&#46; This scale contains 15 items divided into 5 groups with different gastrointestinal symptoms&#46; The 5 groups of symptoms are reflux&#44; abdominal pain&#44; diarrhoea&#44; indigestion&#44; and constipation&#46; It contains a Likert-type scale of 7 marks&#44; with 1 being the post positive option and 7 being the most negative option&#46; For assessment of the level of satisfaction&#44; a visual analogue scale was used&#44; with scores and visual representation between 0 &#40;least satisfied&#41; and 10 &#40;most satisfied&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Treatment adherence was evaluated at the start of phase 1 using the Morinsky-Green test&#46; This is an indirect method of evaluating treatment adherence using a self-questionnaire of 4 questions&#46; It evaluates if the patient adopts a correct attitude regarding treatment&#46; To be considered good adherence&#44; the response to all questions must be adequate&#46; At the end of phase 2&#44; treatment adherence was evaluated by counting the number of tablets administered&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the programme SPSS version 180 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Quantitative variables were expressed as mean and standard deviation&#46; Qualitative variables were expressed as percentage&#46; The comparison of quantitative data was done using Wilcoxon test for nonparametric related variables&#44; and the comparison of qualitative data was done using McNemar test&#46; A <span class="elsevierStyleItalic">P</span> value &#60;&#46;05 was considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">We analysed 62 patients on a HD programme in our HD unit&#44; of whom 14 &#40;22&#46;5&#37;&#41; were receiving treatment with calcimimetics &#40;cinacalcet&#41;&#59; 10 patients were enrolled and 4 patients were excluded &#40;1 due to a psychiatric disorder and 3 due to time on treatment being &#60;2 months&#41;&#46; 40&#37; were men&#44; and the mean age was 60&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;1 years&#46; Mean time on HD was 80&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>114&#46;9 months&#46; The main cause of CKD in our patients was diabetes mellitus&#44; in 40&#37;&#59; the other causes are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The mean Charlson comorbidity index score was 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#46; The mean cinacalcet dose was 201<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>155<span class="elsevierStyleHsp" style=""></span>mg&#47;week and the mean duration of previous cinacalcet use was 23&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;5 months&#46; None of our patients had known previous gastrointestinal disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Bone mineral metabolism</span><p id="par0095" class="elsevierStylePara elsevierViewall">The main biochemical data on bone mineral metabolism are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In phase 1&#44; serum calcium increased significantly &#40;start vs&#46; end&#58; Ca 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;045&#41;&#46; There were no relevant changes in phosphorus values &#40;P 5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;270&#41; or intact parathyroid hormone &#40;iPTH 353<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>129<span class="elsevierStyleHsp" style=""></span>pg&#47;mL vs&#46; 360<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;929&#41;&#46; In phase 2&#44; serum calcium decreased significantly &#40;start vs&#46; end&#58; Ca 9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;049&#41;&#46; As with the first phase&#44; there were no relevant changes in phosphorus values &#40;P 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;766&#41; or intact parathyroid hormone &#40;iPTH 360&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;mL vs&#46; 349<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122<span class="elsevierStyleHsp" style=""></span>pg&#47;mL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;880&#41;&#46; Likewise&#44; there were no relevant changes in the values of serum albumin &#40;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 38&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;85<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;678&#41;&#44; serum alkaline phosphatase &#40;ALP 151&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>148&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 155&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>162<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;515&#41;&#44; magnesium &#40;Mg 2&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52<span class="elsevierStyleHsp" style=""></span>mg&#47;dL vs&#46; 2&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;54<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;472&#41;&#44; or native vitamin D &#40;36&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;26<span class="elsevierStyleHsp" style=""></span>ng&#47;mL vs&#46; 37&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;44<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;861&#41; throughout the study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In both phases there were no significant changes in the mean total dose of cinacalcet &#40;201<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>155<span class="elsevierStyleHsp" style=""></span>mg&#47;week vs&#46; 207<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>151<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;816&#41;&#44; or in the number of phosphate binders &#40;9<span class="elsevierStyleHsp" style=""></span>binders&#47;patient&#47;day vs&#46; 8&#46;2<span class="elsevierStyleHsp" style=""></span>binders&#47;patient&#47;day&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;678&#41; or type of phosphate binders &#40;85&#37; calcium binders&#44; 40&#37; non-calcium binders&#44; 15&#37; aluminium&#44; in both phases respectively&#41;&#44; or in the percentage use of native vitamin D &#40;70&#37; vs&#46; 60&#37;&#41; or selective vitamin D analogues &#40;30&#37; in both phases&#41;&#46; There were no differences in the parameters of dialysis adequacy &#40;Daugirdas second gen Kt&#47;V&#58; 1&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26 vs&#46; 1&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;649&#41; or in the HD characteristics &#40;calcium bath&#58; 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; 20&#37;&#59; 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; 50&#37;&#59; and 3&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; 30&#37; in both phases&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Gastrointestinal tolerance and level of satisfaction</span><p id="par0110" class="elsevierStylePara elsevierViewall">Severity of gastrointestinal symptoms improved significantly in patients treated with supervised cinacalcet at the end of the HD session &#40;phase 1 vs&#46; phase 2 GSRS&#44; 7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2 vs&#46; 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;011&#41;&#46; In the analysis of the different aspects of GSRS&#44; there was a lower scoring in all aspects&#44; fundamentally due to lack of diarrhoea and indigestion&#44; though it was not statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; There were no changes in consumption of antacid medications or gastric protectors throughout the study &#40;90&#37; in both phases&#41;&#46; All patients completed the study&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">There was also a higher scoring for level of satisfaction&#44; using the visual scale &#40;4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3 vs&#46; 6&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#41;&#44; in patients who received supervised cinacalcet treatment at the end of the HD session&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Treatment adherence</span><p id="par0120" class="elsevierStylePara elsevierViewall">In phase 1&#44; using the Morisky&#8211;Green test&#44; treatment adherence was 70&#37;&#46; In phase 2&#44; using counting of tablets&#44; adherence was 89&#37; &#40;245 tablets administered&#47;276 prescribed&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In our patients&#44; supervised intermittent administration of calcimimetics after dialysis sessions was effective in control of secondary hyperparathyroidism&#46; In the literature&#44; there are recent studies that have assessed the effectiveness of supervised intradialytic administration of calcimimetics&#44; with results of good control of secondary hyperparathyroidism without significant adverse effects&#44; and better treatment adherence&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Al Hilali et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> saw a similar effect in PTH suppression after administration of calcimimetics twice per week after dialysis&#44; compared with a daily regimen&#44; in a group of 27 patients on a HD programme&#46; Likewise&#44; Haq and Chaaban<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;21</span></a> observed that post-dialysis administration of cinacalcet was as effective as the standard daily home schedule in a group of 11 patients&#44; after 16 weeks of follow-up&#46; In contrast to the aforementioned studies&#44; our study did not have a comparison group&#44; there were no changes to the treatments involved in hyperparathyroidism control or in the dialysis characteristics&#44; and also&#44; our patients had previously received treatment with calcimimetics&#46; Although it is true that with a higher treatment compliance there would be an expected improvement in values of bone mineral metabolism control &#40;above all calcaemia and iPTH&#41;&#44; in our study we saw statistically significant changes only in serum calcium values in the different phases&#44; with no changes in the values of phosphorus and iPTH&#46; Regarding the difference in serum Ca&#44; this could have been due to incomplete taking of calcimimetics in phase 1&#44; and correct treatment compliance with calcimimetics in phase 2&#46; The absence of significant changes in iPTH values could be attributed in part to use of one isolated value and not average values of iPHT&#44; as well as the great variability in average values in a small sample that is analysed with a nonparametric test&#46; However&#44; in both study phases&#44; our patients remained within the therapeutic targets of the guidelines on bone mineral metabolism from various nephrology societies&#44; without changes in the total doses administered&#46; Therefore&#44; we interpret that the 2 patterns of administration are equally effective in the control of secondary hyperparathyroidism&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Many medications have adverse effects that can contribute to their irregular consumption&#46; The gastrointestinal side effects of calcimimetics are widely known&#44; the most common symptoms being nausea &#40;21&#8211;43&#37;&#41; and vomiting &#40;13&#8211;30&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;12</span></a> Taking medications at night or with food are some of the strategies used to minimise those adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#8211;25</span></a> In our study&#44; gastrointestinal symptoms improved after the supervised post-dialysis administration of calcimimetics&#46; This was fundamentally due to the symptoms of diarrhoea and indigestion&#44; which were reduced by up to 50&#37;&#46; These findings were attributed to the intermittent taking of the medications&#44; which were not taken for a total of 4 days per week&#44; thus avoiding the gastrointestinal upset associated with a daily dose&#46; Regarding this&#44; the low dose prescribed in our patients &#40;most of the patients received a regular dose no more than 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; as well as the routine intradialytic ingestion of food&#44; could have minimised gastrointestinal symptoms&#46; In fact&#44; under supervised administration&#44; our patients received higher individual doses than they had routinely been prescribed&#44; and there were no discontinuations due to gastrointestinal intolerance during the study&#46; Furthermore&#44; during the supervised post-dialysis administration&#44; the level of satisfaction improved significantly&#46; This finding could be explained firstly by the reduction in gastrointestinal symptoms&#44; and secondly by the simple fact that patients avoided the inconvenience of collecting medications at the hospital pharmacy in our centre&#44; which is located away from the dialysis unit and has opening hours that do not always coincide with routine HD sessions&#46; Following the results of our study&#44; we will consider post-dialysis administration in patients with difficulty attending the hospital pharmacy &#40;due to either physical condition or scheduled HD time&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">As previously mentioned&#44; patients on HD have a high drug load&#44; due to their associated increased concomitant conditions&#44; which can result in poor treatment adherence&#46; The average rate of treatment compliance in randomised controlled studies in patients with CKD on a HD programme is around 42&#8211;78&#37; and is getting lower over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#8211;30</span></a> In our study&#44; the adherence rate is similar to that previously published&#46; As expected&#44; with supervised post-dialysis administration&#44; treatment compliance improved&#44; despite the use of different methods of evaluating treatment compliance in the different phases of the study&#46; The Morisky&#8211;Green test is widely used in various population studies of therapeutic inertia and compliance&#44; particularly in the setting of the hypertensive population&#46; It was used in phase 1 to maintain neutrality&#44; to avoid factors of confusion and subsequent interpretation &#40;for example&#44; encouraging the taking of medications in supposedly noncompliant patients&#41;&#46; In phase 2&#44; in order to be objective&#44; it was decided to use the final count of cinacalcet tablets to calculate the total quantity and number of tablets of medication used&#46; However&#44; despite supervision by a nurse&#44; treatment nonadherence was 11&#37;&#46; This fact could be attributable to an oversight of the nursing staff in administering the medication in the final moments of disconnecting the patients&#44; when there are other care tasks to be done&#59; or possible errors in the number of tablets to administer after the HD session &#40;for example 2 tablets instead of 3&#41;&#46; Perhaps using a single administration schedule&#44; or taking the medication at another point in the HD session could minimise this mild nonadherence&#44; although the end of the HD session was chosen to ensure the same moment for taking the medication for all patients in phase 2 and to avoid errors in assessment of gastrointestinal symptoms &#40;because of intradialytic food&#41;&#44; as well as to not coincide with the administration of other regular medications by nursing staff during HD sessions&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">One point to highlight in our study is that it was carried out according to routine clinical practice&#46; That is to say that in current practice&#44; despite the medical indications&#44; it is not uncommon to give low doses of calcimimetics on alternate days&#44; thanks to recent improvements in the control of secondary hyperparathyroidism&#46; Among the multiple limitations of our study&#44; some of which have already been mentioned&#44; the most notable were the low number of patients&#44; requiring the use of a non-parametric statistical test&#44; and the short follow-up time in our patients&#59; though a period of 12 weeks was chosen to avoid potential changes in regular medications associated with bone mineral metabolism after routine 3-monthly tests&#46; Regrettably&#44; it was not possible to do a cost-economic analysis&#46; Studies with more patients and a longer duration would be needed to confirm the effectiveness and gastrointestinal tolerance of calcimimetics given under supervision post-HD&#44; in the control of secondary hyperparathyroidism&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion&#44; in our study&#44; supervised post-dialysis administration of calcimimetics was effective in the control of secondary hyperparathyroidism&#44; with fewer gastrointestinal effects and a higher level of satisfaction&#46; Based on these results&#44; we consider the administration of post-dialysis calcimimetics to be effective and&#44; above all&#44; beneficial in determined patients with poor treatment compliance&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres580887"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objectives"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Material and methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec597391"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres580886"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivos"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Material y m&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec597392"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Bone mineral metabolism"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Gastrointestinal tolerance and level of satisfaction"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Treatment adherence"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-12-29"
    "fechaAceptado" => "2014-12-29"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec597391"
          "palabras" => array:3 [
            0 => "Haemodialysis"
            1 => "Calcimimetics"
            2 => "Secondary hyperparathyroidism"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec597392"
          "palabras" => array:3 [
            0 => "Hemodi&#225;lisis"
            1 => "Calcimim&#233;ticos"
            2 => "Hiperparatiroidismo secundario"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cinacalcet has proved effective to control secondary hyperparathyroidism in patients on haemodialysis &#40;HD&#41;&#46; Some studies have reported an appropriate secondary hyperparathyroidism control and a better compliance after intradialytic use of calcimimetics&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the effect of post-dialysis calcimimetics use on mineral bone disorders and calcimimetics gastrointestinal tolerability in our HD unit&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 12-week single-centre prospective study in HD patients treated with cinacalcet &#40;&#62;2 months&#41;&#46; Two study periods&#58; usual outpatient use &#40;Stage 1&#41; and use after HD session &#40;Stage 2&#41;&#46; Endpoints&#58; &#40;1&#41; biochemical MBD data&#59; &#40;2&#41; Gastrointestinal Symptom Rating Scale &#40;GSRS&#41; for gastrointestinal tolerability&#44; and visual analogic scale &#40;VAS&#41; for satisfaction&#59; &#40;3&#41; adherence&#58; Morisky&#8211;Green test &#40;MG&#41; and final tablet count &#40;TC&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sixty-two HD patients&#46; Fourteen received cinacalcet &#40;22&#46;5&#37;&#41;&#46; TEN patients were included&#44; mean age was 60&#46;9 years&#59; patients had received HD for 80&#46;9 months&#46; Mean Charlson index&#58; 9&#46; Biochemical data&#58; Stage 1 &#40;initial vs&#46; final&#41;&#58; Ca 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; 9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#59; P 5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; iPTH 360&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;ml vs&#46; 349<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46; MG&#58; 70&#37;&#46; Stage 2 &#40;initial vs&#46; final&#41;&#58; Ca 9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; P 4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6<span class="elsevierStyleHsp" style=""></span>mg&#47;dl vs&#46; 4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; iPTH 360&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232&#46;7<span class="elsevierStyleHsp" style=""></span>pg&#47;ml vs&#46; 349<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46; TC&#58; 89&#37;&#46; GSRS and VAS were better in Stage 2 &#40;GSRS 7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2 vs&#46; 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&#59; VAS 4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3 vs&#46; 6&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&#41;&#46; No significant changes were observed in calcimimetic dose &#40;201<span class="elsevierStyleHsp" style=""></span>mg&#47;week vs&#46; 207<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#41;&#44; number of phosphate binders &#40;9<span class="elsevierStyleHsp" style=""></span>pts&#47;day vs&#46; 8&#46;2<span class="elsevierStyleHsp" style=""></span>pts&#47;day&#41;&#44; native vitamin D &#40;70&#37; vs&#46; 60&#37;&#41;&#44; selective vit D receptor activators &#40;30&#37;&#41;&#44; or suitable dialysis parameters&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Post-dialysis use of calcimimetic was effective in secondary hyperparathyroidism control&#44; improved gastrointestinal tolerability and ameliorated patients&#8217; satisfaction&#46; Based on our findings&#44; post-dialysis use of calcimimetics should be considered in selected patients with low therapeutic compliance&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cinacalcet resulta efectivo en el control del hiperparatiroidismo secundario de los pacientes en hemodi&#225;lisis &#40;HD&#41;&#46; Algunos estudios han reportado un buen control del hiperparatiroidismo secundario y un mejor cumplimiento terap&#233;utico tras la administraci&#243;n de calcimim&#233;ticos intradi&#225;lisis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar el efecto de la administraci&#243;n de calcimim&#233;ticos posdi&#225;lisis sobre el metabolismo &#243;seo mineral y la tolerancia gastrointestinal en nuestra unidad de HD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo unic&#233;ntrico de 12 semanas de duraci&#243;n en pacientes en HD tratados con cinacalcet &#40;&#62; 2 meses&#41;&#46; Dos per&#237;odos de estudio &#40;6 semanas&#41;&#58; Administraci&#243;n habitual ambulatoria &#40;fase 1&#41; y posthemodi&#225;lisis &#40;fase 2&#41;&#46; Datos analizados&#58; 1&#46;- Datos bioqu&#237;micos metabolismo &#243;seo mineral&#46; 2&#46;-Test s&#237;ntomas gastrointestinales &#40;Gastrointestinal Symptom Rating Scale &#91;GSRS&#93;&#41; y grado de satisfacci&#243;n &#40;escala visual anal&#243;gica &#91;EVA&#93;&#41;&#46; 3&#46;-Adherencia&#58; Test de Morisky-Green &#40;MG&#41; y recuento final comprimidos &#40;RC&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sesenta y dos pacientes en HD&#46; Catorce recib&#237;an cinacalcet &#40;22&#44;5&#37;&#41;&#46; Diez pacientes incluidos&#44; edad media 60&#44;9 a&#241;os y 80&#44;9 meses en HD&#46; Charlson medio&#58; 9&#46; Datos bioqu&#237;micos&#58; fase 1 &#40;inicio vs&#46; fin&#41;&#58; Ca 8&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5 vs&#46; 9&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7 mg&#47;dl &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#59; f&#243;sforo 5&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8 vs&#46; 4&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6 mg&#47;dl&#44; PTHi 353<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>129 vs&#46; 360<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232 pg&#47;ml&#46; Adherencia &#40;MG&#41;&#58; 70&#37;&#46; Fase 2 &#40;inicio vs&#46; fin&#41;&#58; Ca 9&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7 vs&#46; 8&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 mg&#47;dl&#59; f&#243;sforo 4&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6 vs&#46; 4&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;3 mg&#47;dl&#59; PTHi 3603<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2327 vs&#46; 349<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122 pg&#47;ml&#46; Adherencia &#40;RC&#41;&#58; 89&#37;&#46; Con relaci&#243;n al GSRS y el grado de satisfacci&#243;n&#44; fueron mejores en la fase 2 &#40;GSRS 7&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;2 vs&#46; 4&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#59; EVA 4&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3 vs&#46; 6&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&#41;&#46; No se objetivaron cambios significativos en la dosis de calcimim&#233;ticos &#40;201 vs&#46; 207 mg&#47;sem&#41;&#44; n&#250;mero captores f&#243;sforo &#40;9 vs&#46; 8&#44;2 pac&#47;d&#237;a&#41;&#44; vitamina D nativa &#40;70 vs&#46; 60&#37;&#41; o activadores selectivos receptor vitD &#40;30&#37;&#41;&#44; ni en los par&#225;metros de adecuaci&#243;n dial&#237;tica&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La administraci&#243;n de calcimim&#233;ticos post di&#225;lisis permiti&#243; controlar el hiperparatiroidismo secundario de forma eficaz&#44; mejorando la sintomatolog&#237;a gastrointestinal y el grado de satisfacci&#243;n&#46; Se debe considerar la administraci&#243;n de calcimim&#233;ticos post di&#225;lisis en aquellos pacientes con escaso cumplimiento terap&#233;utico&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Esteve Simo V&#44; Moreno-Guzm&#225;n F&#44; Mart&#237;nez Calvo G&#44; Fulquet Nicolas M&#44; Pou Potau M&#44; Macias-Toro J&#44; et al&#46; Administraci&#243;n de calcimim&#233;ticos posdi&#225;lisis&#58; igual efectividad&#44; mejor tolerancia gastrointestinal&#46; Nefrologia&#46; 2015&#59;35&#58;403&#8211;409&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1255
            "Ancho" => 1410
            "Tamanyo" => 68121
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Primary causes of CKD&#46; Percentage of patients on HD treated with calcimimetics&#46; CTIN&#44; chronic tubulointerstitial nephropathy&#59; DM&#44; diabetes mellitus&#59; Glomer&#44; glomerular&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ca&#44; calcium&#59; Ca<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>P&#44; calcium&#8211;phosphorus product&#59; P&#44; phosphorus&#59; iPTH&#44; intact parathyroid hormone&#59; SS&#44; statistical significance&#46;</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="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Phase 1</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Phase 2</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Start&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">End&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">SS&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">Start&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">End&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">SS&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">Ca &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;045<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;049<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&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">P &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;766&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">Ca<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>P &#40;mg&#47;dL&#41;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;652&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;983&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">iPTH &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">353<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">360<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;929&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">360<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;880&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab947931.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Main biochemical data on bone mineral metabolism&#46; Phase 1 and phase 2 of the study&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">GSRS&#44; Gastrointestinal Symptom Rating Scale&#59; SS&#44; statistical significance&#59; VAS&#44; visual analogue scale&#46; Average score &#40;1&#8211;5&#41; of symptoms according to the different categories&#46; Start vs&#46; end&#58; GSRS categories&#58; reflux&#44; abdominal pain&#44; constipation&#44; diarrhoea&#44; and indigestion&#46;</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="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Start&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">End&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">SS&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">GSRS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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">Reflux&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;487&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">Abdominal pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;335&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">Constipation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;235&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">Diarrhoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;085&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">Indigestion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;074&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">VAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab947932.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Evaluation of gastrointestinal symptoms &#40;GSRS&#41; and level of satisfaction &#40;VAS&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Board of the EURECA-m Working Group of ERA-EDTA&#46; Epidemiology&#44; contributors to and clinical trials of mortality risk in chronic kidney failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Ortiz"
                            1 => "A&#46; Covic"
                            2 => "D&#46; Fliser"
                            3 => "D&#46; Fouque"
                            4 => "D&#46; Goldsmith"
                            5 => "M&#46; Kanbay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)60384-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "383"
                        "paginaInicial" => "1831"
                        "paginaFinal" => "1843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24856028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The burden of kidney disease&#58; improving global outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Eknoyan"
                            1 => "N&#46; Lameire"
                            2 => "R&#46; Barsoum"
                            3 => "K&#46;U&#46; Eckardt"
                            4 => "A&#46; Levin"
                            5 => "N&#46; Levin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1523-1755.2004.00894.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2004"
                        "volumen" => "66"
                        "paginaInicial" => "1310"
                        "paginaFinal" => "1314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15458424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus document for the detection and management of chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mart&#237;nez-Castelao"
                            1 => "J&#46;L&#46; G&#243;rriz"
                            2 => "J&#46; Segura-de la Morena"
                            3 => "J&#46; Cebollada"
                            4 => "J&#46; Escalada"
                            5 => "E&#46; Esmatjes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2014.Feb.12455"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrolog&#237;a"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "paginaInicial" => "243"
                        "paginaFinal" => "262"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24658201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of chronic renal disease in the Galician population&#58; results of the pilot Spanish EPIRCE study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "on behalf of the EPIRCE study group"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Otero"
                            1 => "P&#46; Gayoso"
                            2 => "F&#46; Garc&#237;a"
                            3 => "A&#46;L&#46;M&#46; de Francisco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2005"
                        "volumen" => "68"
                        "numero" => "Suppl&#46; 99"
                        "paginaInicial" => "S16"
                        "paginaFinal" => "S19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying patients with chronic kidney disease from general practice computer records"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; de Lusignan"
                            1 => "T&#46; Chan"
                            2 => "P&#46; Stevens"
                            3 => "D&#46; O&#8217;Donoghue"
                            4 => "N&#46; Hague"
                            5 => "B&#46; Dzregah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/fampra/cmi026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Fam Pract"
                        "fecha" => "2005"
                        "volumen" => "22"
                        "paginaInicial" => "234"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet for hemodialyzed patients with or without a high PTH level to control serum calcium and phosphorus&#58; ECO &#40;evaluation of cinacalcet HCl outcome&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Yokoyama"
                            1 => "I&#46; Ohkido"
                            2 => "M&#46; Ishida"
                            3 => "H&#46; Hashimoto"
                            4 => "J&#46; Urae"
                            5 => "H&#46; Sekino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nephrol"
                        "fecha" => "2012"
                        "volumen" => "78"
                        "paginaInicial" => "87"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22790452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of cinacalcet with low-dose vitamin D in incident haemodialysis subjects with secondary hyperparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Ure&#241;a-Torres"
                            1 => "I&#46; Bridges"
                            2 => "C&#46; Christiano"
                            3 => "S&#46;H&#46; Cournoyer"
                            4 => "K&#46; Cooper"
                            5 => "M&#46; Farouk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfs568"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "1241"
                        "paginaFinal" => "1254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328710"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet hydrochloride treatment significantly improves all-cause and cardiovascular survival in a large cohort of hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;A&#46; Block"
                            1 => "D&#46; Zaun"
                            2 => "G&#46; Smits"
                            3 => "M&#46; Persky"
                            4 => "S&#46; Brillhart"
                            5 => "K&#46; Nieman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2010.167"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2010"
                        "volumen" => "78"
                        "paginaInicial" => "578"
                        "paginaFinal" => "589"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20555319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of cinacalcet on bone mineral density and bone markers in hemodialysis patients with secondary hyperparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46; Tsuruta"
                            1 => "K&#46; Okano"
                            2 => "K&#46; Kikuchi"
                            3 => "Y&#46; Tsuruta"
                            4 => "T&#46; Akiba"
                            5 => "K&#46; Nitta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10157-012-0665-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Nephrol"
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "120"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22833360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet in patients with chronic kidney disease&#58; a cumulative meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;C&#46; Palmer"
                            1 => "I&#46; Nistor"
                            2 => "J&#46;C&#46; Craig"
                            3 => "F&#46; Pellegrini"
                            4 => "P&#46; Messa"
                            5 => "M&#46; Tonelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pmed.1001436"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS Med"
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "e1001436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23637579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet treatment for secondary hyperparathyroidism in dialysis patients&#58; an observational study in routine clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Bover"
                            1 => "R&#46; P&#233;rez"
                            2 => "M&#46; Molina"
                            3 => "B&#46; Benavides"
                            4 => "F&#46; Ariza"
                            5 => "J&#46;L&#46; Miguel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Nephron Clin Pract"
                        "fecha" => "2011"
                        "volumen" => "118"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet HCl&#44; an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis&#58; a randomized&#44; double-blind&#44; multicenter study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Lindberg"
                            1 => "B&#46; Culleton"
                            2 => "G&#46; Wong"
                            3 => "M&#46;F&#46; Borah"
                            4 => "R&#46;V&#46; Clark"
                            5 => "W&#46;B&#46; Shapiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2004060512"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2005"
                        "volumen" => "16"
                        "paginaInicial" => "800"
                        "paginaFinal" => "807"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15689407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pharmacodynamics of the type <span class="elsevierStyleSmallCaps">ii</span> calcimimetic compound cinacalcet HCL"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;F&#46; Nemeth"
                            1 => "W&#46;H&#46; Heaton"
                            2 => "M&#46; Miller"
                            3 => "J&#46; Fox"
                            4 => "M&#46;F&#46; Balandrin"
                            5 => "B&#46;C&#46; Van Wagenen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1124/jpet.103.057273"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pharmacol Exp Ther"
                        "fecha" => "2004"
                        "volumen" => "308"
                        "paginaInicial" => "627"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14593085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet up regulates calcium-sensing receptors of parathyroid glands in hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Sumida"
                            1 => "M&#46; Nakamura"
                            2 => "Y&#46; Ubara"
                            3 => "Y&#46; Marui"
                            4 => "K&#46; Tanaka"
                            5 => "K&#46; Takaichi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000350211"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "405"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23594726"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet effectively reduces parathyroid hormone secretion and gland volume regardless of pretreatment gland size in patients with secondary hyperparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Komaba"
                            1 => "S&#46; Nakanishi"
                            2 => "A&#46; Fujimori"
                            3 => "M&#46; Tanaka"
                            4 => "J&#46; Shin"
                            5 => "K&#46; Shibuya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.02110310"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "2305"
                        "paginaFinal" => "2314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20798251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization and costs of medications associated with CKD mineral and bone disorder in dialysis patients enrolled in Medicare Part D"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;A&#46; Yusuf"
                            1 => "B&#46;L&#46; Howell"
                            2 => "C&#46;A&#46; Powers"
                            3 => "W&#46;L&#46; St Peter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.ajkd.2014.04.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2014"
                        "volumen" => "64"
                        "paginaInicial" => "770"
                        "paginaFinal" => "780"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24833203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of side effects related to cinacalcet therapy on compliance in hemodialysis patients suffering from secondary hyperparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Zwiech"
                            1 => "S&#46; Chrul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "WiadLek"
                        "fecha" => "2012"
                        "volumen" => "65"
                        "paginaInicial" => "145"
                        "paginaFinal" => "150"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluating real-world use of cinacalcet and biochemical response to therapy in US hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;D&#46; Kilpatrick"
                            1 => "B&#46;B&#46; Newsome"
                            2 => "D&#46; Zaun"
                            3 => "J&#46; Liu"
                            4 => "C&#46;A&#46; Solid"
                            5 => "K&#46; Nieman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000350213"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "389"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23548469"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A novel dose regimen of cinacalcet in the treatment of severe hyperparathyroidism in hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Al Hilali"
                            1 => "N&#46; Hussain"
                            2 => "Y&#46;A&#46; Kay"
                            3 => "M&#46; Al Azmi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Saudi J Kidney Dis Transpl"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "448"
                        "paginaFinal" => "455"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21566299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Haq"
                            1 => "A&#46; Chaaban"
                            2 => "N&#46; Gebran"
                            3 => "I&#46; Khan"
                            4 => "F&#46; Abbachi"
                            5 => "M&#46; Hassan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int Urol Nephrol"
                        "fecha" => "2014"
                        "volumen" => "350"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1525"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective randomized trial on intermittent post-dialysis of cinacalcet&#58; a solution to non-compliance&#46; National Kidney Foundation 2010 Spring Clinical Meetings Abstracts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Abouchacra"
                            1 => "A&#46; Chaaban"
                            2 => "N&#46; Haq"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Chronic Kidney Dis"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "206"
                        "paginaFinal" => "207"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet for secondary hyperparatiroidism in patients receiving hemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;A&#46; Block"
                            1 => "K&#46;J&#46; Martin"
                            2 => "A&#46;L&#46; de Francisco"
                            3 => "S&#46;A&#46; Turner"
                            4 => "M&#46;M&#46; Avram"
                            5 => "M&#46;G&#46; Suranyi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa031633"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15071126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cinacalcet-clinical and laboratory effectiveness&#44; concomitant treatment patterns and treatment cost&#58; could we do better and how&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Smr&#382;ov&#225;"
                            1 => "T&#46; Urb&#225;nek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000317935"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Blood Press Res"
                        "fecha" => "2010"
                        "volumen" => "33"
                        "paginaInicial" => "333"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20714162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of the efficacy and factors influencing the response of secondary hyperparathyroidism patients on hemodialysis to cinacalcet"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Segura Torres"
                            1 => "F&#46;J&#46; Borrego Utiel"
                            2 => "M&#46;C&#46; S&#225;nchez Perales"
                            3 => "M&#46;J&#46; Garc&#237;a Cort&#233;s"
                            4 => "M&#46;M&#46; Biechy Bald&#225;n"
                            5 => "V&#46; P&#233;rez Ba&#241;asco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2010.May.10451"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrolog&#237;a"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20651886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of adherence to cinacalcet by prescription refill rates in hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Gincherman"
                            1 => "K&#46; Moloney"
                            2 => "C&#46; McKee"
                            3 => "D&#46;W&#46; Coyne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1542-4758.2009.00397.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hemodial Int"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "68"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19732171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical pharmacokinetic and pharmacodynamic profile of cinacalcet hydrochloride"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Padhi"
                            1 => "R&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/00003088-200948050-00002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Pharmacokinet"
                        "fecha" => "2009"
                        "volumen" => "48"
                        "paginaInicial" => "303"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19566113"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pill Burden&#44; adherence&#44; hyperphosphatemia&#44; and quality of life in maintenance dialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;W&#46; Chiu"
                            1 => "I&#46; Teitelbaum"
                            2 => "M&#46; Misra"
                            3 => "E&#46;M&#46; de Leon"
                            4 => "T&#46; Adzize"
                            5 => "T&#46; Mehrotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin J Am SocNephrol"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "1089"
                        "paginaFinal" => "1096"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to medication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Osterberg"
                            1 => "T&#46; Blaschke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "353"
                        "paginaInicial" => "478"
                        "paginaFinal" => "497"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of cinacalcet adherence and costs in patients on dialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Lee"
                            1 => "X&#46; Song"
                            2 => "I&#46; Khan"
                            3 => "V&#46; Belozeroff"
                            4 => "W&#46; Goodman"
                            5 => "N&#46; Fulcher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3111/13696998.2011.627404"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Econ"
                        "fecha" => "2011"
                        "volumen" => "14"
                        "paginaInicial" => "798"
                        "paginaFinal" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21988567"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and consequences of non adherence to hemodialysis regimes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46; Denhaerynck"
                            1 => "D&#46; Manhaeve"
                            2 => "F&#46; Dobbels"
                            3 => "D&#46; Garzoni"
                            4 => "C&#46; Nolte"
                            5 => "S&#46; De Geest"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Crit Care"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "paginaInicial" => "222"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17460313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003500000004/v1_201511210014/S2013251415000607/v1_201511210014/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "42660"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003500000004/v1_201511210014/S2013251415000607/v1_201511210014/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251415000607?idApp=UINPBA000064"
]

Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2015.09.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	12	22
2024 October	76	38	114
2024 September	66	23	89
2024 August	86	71	157
2024 July	49	26	75
2024 June	68	44	112
2024 May	67	48	115
2024 April	52	37	89
2024 March	46	38	84
2024 February	34	42	76
2024 January	29	26	55
2023 December	29	26	55
2023 November	49	31	80
2023 October	46	37	83
2023 September	44	35	79
2023 August	50	40	90
2023 July	55	33	88
2023 June	64	29	93
2023 May	63	48	111
2023 April	35	21	56
2023 March	55	31	86
2023 February	39	23	62
2023 January	38	21	59
2022 December	50	41	91
2022 November	70	28	98
2022 October	50	45	95
2022 September	53	29	82
2022 August	61	38	99
2022 July	29	40	69
2022 June	32	31	63
2022 May	65	38	103
2022 April	50	40	90
2022 March	55	37	92
2022 February	54	38	92
2022 January	34	30	64
2021 December	39	43	82
2021 November	48	42	90
2021 October	41	39	80
2021 September	33	31	64
2021 August	30	34	64
2021 July	27	29	56
2021 June	20	19	39
2021 May	27	28	55
2021 April	46	37	83
2021 March	32	25	57
2021 February	50	18	68
2021 January	29	16	45
2020 December	32	8	40
2020 November	29	15	44
2020 October	25	22	47
2020 September	18	11	29
2020 August	41	13	54
2020 July	39	11	50
2020 June	25	18	43
2020 May	49	10	59
2020 April	31	20	51
2020 March	46	24	70
2020 February	38	26	64
2020 January	42	24	66
2019 December	55	29	84
2019 November	49	20	69
2019 October	32	20	52
2019 September	35	10	45
2019 August	20	20	40
2019 July	39	32	71
2019 June	16	21	37
2019 May	24	28	52
2019 April	56	68	124
2019 March	33	25	58
2019 February	21	18	39
2019 January	43	29	72
2018 December	102	51	153
2018 November	156	17	173
2018 October	137	20	157
2018 September	90	13	103
2018 August	54	17	71
2018 July	43	13	56
2018 June	27	13	40
2018 May	36	14	50
2018 April	38	7	45
2018 March	35	8	43
2018 February	34	13	47
2018 January	30	8	38
2017 December	28	6	34
2017 November	37	15	52
2017 October	40	8	48
2017 September	41	15	56
2017 August	46	17	63
2017 July	29	8	37
2017 June	57	8	65
2017 May	34	5	39
2017 April	32	12	44
2017 March	23	7	30
2017 February	31	14	45
2017 January	18	13	31
2016 December	50	4	54
2016 November	72	23	95
2016 October	89	12	101
2016 September	108	3	111
2016 August	107	3	110
2016 July	153	10	163
2016 June	120	0	120
2016 May	134	0	134
2016 April	124	0	124
2016 March	111	0	111
2016 February	120	0	120
2016 January	83	0	83
2015 December	92	0	92
2015 November	81	0	81
2015 October	100	0	100

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter