Fibroblast growth factor is associated to left ventricular mass index, anemia and low values of transferrin saturation

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Deniz Ayli" "autores" => array:11 [ 0 => array:3 [ "nombre" => "Baris" "apellidos" => "Eser" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ozlem" "apellidos" => "Yayar" "email" => array:1 [ 0 => "ozlemderen@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Mehmet" "apellidos" => "Buyukbakkal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Bulent" "apellidos" => "Erdogan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Zafer" "apellidos" => "Ercan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Ozgur" "apellidos" => "Merhametsiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Ayhan" "apellidos" => "haspulat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Ebru Gök" "apellidos" => "Oğuz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "İbrahim" "apellidos" => "Dogan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 9 => array:3 [ "nombre" => "Basol" "apellidos" => "Canbakan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 10 => array:3 [ "nombre" => "M. Deniz" "apellidos" => "Ayli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Diskapi Yildirim Beyazid Research and Training Hospital, Nephrology Department, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hitit University Nephrology Department, Corum, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El factor de crecimiento fibroblástico está asociado con el índice de masa ventricular izquierda, anemia y niveles bajos de saturación de la transferrina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1270 "Ancho" => 1610 "Tamanyo" => 105657 ] ] "descripcion" => array:1 [ "en" => "Distribution graph of relationship between LVMI and FGF-23 (r=0.290, P=0.024)." ] ] ] "textoCompleto" => "IntroductionCardiovascular disease (CVD) is the most common cause of mortality in patients with end stage renal disease (ESRD)<a class="elsevierStyleCrossRef" href="#bib0270">1</a>. Besides the well-known traditional cardiovascular risk factors, this population has risk factors specific to chronic kidney disease which results in accelerated atherosclerosis<a class="elsevierStyleCrossRef" href="#bib0275">2</a>. LVH, commonly exists in patients with ESRD, is a major cardiovascular risk factor and independent predictor of cardiovascular mortality in this population<a class="elsevierStyleCrossRef" href="#bib0280">3</a>.Hypertension is accepted as the main underlying factor in the development of LVH. However recent studies indicated that FGF-23 may contribute to left ventricular mass enlargement<a class="elsevierStyleCrossRefs" href="#bib0285">4,5</a>. FGF-23 is phosphorus regulating hormone and significantly increased in patients with ESRD. It promotes phosphate excretion and reduces 1-25(OH)2 vitamin D production in the kidney<a class="elsevierStyleCrossRef" href="#bib0295">6</a>. Independent relation between increased FGF-23 levels and mortality was first reported by Guirez et al.<a class="elsevierStyleCrossRef" href="#bib0300">7</a> in 2008 in hemodialysis (HD) patients. Even in patients with normal renal functions higher FGF-23 was found to be independently associated with mortality and cardiovascular events<a class="elsevierStyleCrossRef" href="#bib0305">8</a>. In addition, the effect of anemia on CV disease and LVH is well known in CKD patients<a class="elsevierStyleCrossRef" href="#bib0310">9</a>. A relation between iron and FGF-23 metabolism is mentioned in a few studies. In studies, it is emphasized that iron deficiency is an important stimulator of FGF-23 transcription<a class="elsevierStyleCrossRef" href="#bib0315">10</a>. The aim of this cross-sectional study was to investigate the possible relationship between serum levels of FGF-23 with ECHO and iron parameters in PD patients.Materials and methodsSubjectsThis study was performed in peritoneal dialysis patients that are regularly followed in Ankara Diskapi Yildirim Beyazit Training and Research Hospital. Patients that suffered peritonitis or acute coronary event within last 2 months and patients with active malignancy were excluded. Sixty-one patients were included in the study. Fifty-one patients were on continuous ambulatory peritoneal dialysis program and 10 on automated peritoneal dialysis program. In all patients, the doses of dialysis were prescribed so as to generate a Kt/V of >1.7. Demographic characteristics, co-morbidities, medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded. Residual renal function was expressed as the mean value of the residual urea and creatinine clearances. Peritoneal equilibration test (PET) was applied according to the method described by Twardowski et al.<a class="elsevierStyleCrossRef" href="#bib0320">11</a>.FGF-23 measurementsIn all patients, 5ml of blood samples were obtained from peripheral vein after an overnight fasting into standard tubes biochemistry between 08.00 and 12.00AM. Within 30min of collection, samples were centrifuged at 2000rpm for 10min and stored in −80°C for maximum 1 month. Serum FGF-23 concentrations were measured using human iFGF-23 ELISA kit (Uscn Life Science Inc., Wuhan, China) which has typically a sensitivity of less than 4pg/ml.EchocardiographyAll ECHO measurements were made according to the recommendations of the American Society of Echocardiography<a class="elsevierStyleCrossRef" href="#bib0325">12</a>. Patients were evaluated in semi-supine position in a dark room by the same cardiologist who was unaware of the clinical and laboratory data of the patients. Ejection fraction (EF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (PWT), inter-ventricular wall thickness (IVWT) and left ventricular relaxation was evaluated in parasternal plane according to the guideline. The LVMI was calculated with the Devereux formula<a class="elsevierStyleCrossRef" href="#bib0330">13</a>. Body surface area was calculated with the formula of DuBois and DuBois<a class="elsevierStyleCrossRef" href="#bib0335">14</a>. Cut-off values for LVH were defined as 131g/m2 and 100g/m2 for men and women by considering the measurements in the Framingham Heart Study<a class="elsevierStyleCrossRefs" href="#bib0340">15,16</a>.EthicsThis study was approved by the local ethics committee of Ankara Diskapi Yildirim Beyazit Training and Research Hospital. The study was conducted in accordance with Declaration of Helsinki and all participants provided written informed consents.Statistical analysisData analysis was performed by using “SPSS for Windows 19” (SPSS Inc., Chicago, USA). Results of the analysis of continuous variables were expressed as mean±SD and median [min–max] while the results of analysis of discrete variables were expressed as frequency distributions and percentages. Median serum FGF-23 value was used as the cut-off point and low-and high-FGF-23 groups were formed. In FGF-23 groups, demographic, clinical and laboratory data were compared pairwise. The Kolmogorov–Smirnov test was used for testing normality of continuous variables. Normally distributed variables were analyzed by t-test while others were analyzed with the Mann–Whitney U test. Chi-square test was used for comparison of discrete variables. Linear regression analysis model was used to study the relationship between LVMI and FGF-23. P<0.05 was considered statistically significant.ResultsThere were 61 PD patients (32 men and 29 women, mean age 46.9±13.3 years) that fulfill the inclusion and exclusion criteria. Demographic characteristics, co-morbidities, medical treatments and basic laboratory results of the patients are presented in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>. The average LVMI of the patients was 140±48g/m2 and LVH was present in 69% of patients according to the criteria presented in ‘Methods’ section. This prevalence was consistent with the previous studies<a class="elsevierStyleCrossRefs" href="#bib0350">17,18</a>. Although the average EF of patients was 60.2±6%, left ventricular relaxation dysfunction (LVRD) was observed in majority of the patients (48 patients, 77%) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Mean serum FGF-23 level was determined to be 26.3±8.3pg/ml [median 23.5pg/ml (min–max; 11.53–45.63)] (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) and this value was similar to the values observed in previous studies<a class="elsevierStyleCrossRef" href="#bib0360">19</a>. Median value of FGF-23 (23.5pg/ml) was taken as a cut-off point and patients were divided into the low-and high-FGF-23 groups. Demographic, somatometric, laboratory and ECHO results of the two groups were compared (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). No statistically significant difference was observed between the two groups with regard to age, gender, duration of dialysis, BMI, waist circumference, presence of co-morbid diseases, smoking, and medical treatments. There were statistically significant differences in systolic blood pressure (SBP) and mean blood pressure (MBP) between low and high FGF-23 groups (134.8±20.5 versus 126.3±16.5mmHg; P=0.04 and 96.3±17.6 versus 103±17.6mmHg; P=0.04 respectively). However no statistically significant difference was observed for DBP (73.8±10.9 versus 83.3±11.7, P=0.157). There was also significant difference in terms of hemoglobin (12.1±2 versus 11.0±2, P=0.017), TSAT (24.9±16.8 versus 19.5±10.8, P=0.042), albumin-corrected serum calcium (9.4±0.6 versus 9.0±0.7, P=0.006), and Kt/V (2.2±0.5 versus 2.0±0.4, P=0.029) between low and high FGF-23 groups.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The parameters that were statistically significantly different between two groups were included in by multiple linear regression models to determine the effect of independent variables on FGF-23. As a result of analysis, significant negative relationship of serum calcium (r=0.057, P=0.046) and hemoglobin (r=0.199, P=0.045) was sustained (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). Distribution graphics of statistical relation between FGF-23 and hemoglobin concentration were shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>The results of ECHO parameters were compared in two groups and LVMI was found to be statistically significantly higher in high FGF-23 group (128±35 versus 150±39g/m2, P=0.023) but prevalence of LVH was not statistically different between the groups (58% versus 80%, P=0.116). There were also no differences with regard to other ECHO parameters between two groups. Linear regression analysis was applied to investigate the effect of the serum levels of FGF-23 on LVMI and the relationship was found to be statistically significant (r=0.290, P=0.024) (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>). The distribution graph of the relationship between LVMI and FGF-23 can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.<elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionIn this study, serum levels of FGF-23 were found to be positively correlated with LVMI. This correlation is likely to be caused by the effects of FGF-23 on left ventricular mass and function, independent from serum calcium, phosphorus, and parathormone levels.Increased FGF-23 level was shown to be associated with LVMI and LVH in stage II–IV CKD (4.19) and chronic HD patients<a class="elsevierStyleCrossRefs" href="#bib0365">20,21</a>. Increased FGF-23 level has also been suggested to be a mortality predictor in HD patients<a class="elsevierStyleCrossRefs" href="#bib0280">3,22</a>, and this situation was thought to be associated with LVMI<a class="elsevierStyleCrossRef" href="#bib0380">23</a>. In a study investigating the relationship between FGF-23 levels and LVH in 62 PD patients and 30 healthy controls, serum FGF-23 levels were found to be significantly higher in PD patients compared to control subjects and also in PD patients with LVH compared to PD patients without LVH. FGF-23 levels were also positively correlated with LVMI<a class="elsevierStyleCrossRef" href="#bib0385">24</a>. In our study we observed similar association between FGF-23 and LVH in PD patients. There was no difference in other ECHO parameters between patients in high and low FGF-23 groups.Although observational data supports the possible relationship between the FGF-23 and CVD and CV mortality, insufficient evidence exist about the exact cause of this association. There is not enough data about the physiological effect of FGF-23 in extra-kidney tissue. FGF-23 receptors exist in CV system and other tissues without klotho co-receptor<a class="elsevierStyleCrossRef" href="#bib0390">25</a>. This condition, has led to speculation that elevated FGF-23 level observed in progressive renal disease has no direct effect on these tissues but recent data suggests the direct effect of FGF-23 on the CV system<a class="elsevierStyleCrossRef" href="#bib0395">26</a>. In a recent experimental study, FGF-23 was shown to cause pathological hypertrophy in rat cardiomyocytes by “calcineurin-nuclear factor of activated T cells” without klotho and treatment with FGF-blockers reduced LVH in experimental models of chronic renal failure<a class="elsevierStyleCrossRef" href="#bib0400">27</a>. LVH caused by FGF-23 independent from klotho is explained by two mechanisms. First, longstanding high-FGF-23 level as in CRF, may cause the attachment of FGF to FGF-23 receptor. Although this attachment has lower affinity, exposure of the heart tissue to FGF-23, may be enough for the development of LVH. In CKD klotho expression in the kidney and parathyroid gland is reduced. This may cause the attachment of FGF-23 to FGF-23 receptors in other tissue leading to development of cardio toxicity in CRF. In the second mechanism attachment of FGF-23 to specific cardiac FGF receptors like FGF receptor-4 even in the absence of klotho may contribute to development of LVH<a class="elsevierStyleCrossRef" href="#bib0375">22</a>. In a study, besides inducing LVH, elevated FGF-23 has been shown to adversely affect the mechanics of left ventricle in HD patients<a class="elsevierStyleCrossRef" href="#bib0405">28</a>. The data of an experimental study showed that FGF23 may have additional effects on the heart, in addition to hypertrophy, specifically related to calcium handling and cardiac contractility<a class="elsevierStyleCrossRef" href="#bib0410">29</a>. In a population study, non-sudden cardiac death is found to be associated with high FGF-23<a class="elsevierStyleCrossRef" href="#bib0415">30</a>. Recently in the meta-analysis of prospective cohort studies, a relationship between FGF-23 and all-cause mortality and cardiovascular events was observed<a class="elsevierStyleCrossRef" href="#bib0420">31</a>. However, additional studies are required to determine FGF-23 receptors that mediate the cardiac effects of FGF-23.Nevertheless, the presence of cardiac hypertrophy and vascular calcification is interesting in patients with moderate CKD (stages III–IV). These patients do not have hemodynamic and inflammatory stress associated with chronic dialysis treatment and hyperphosphatemia is not obvious but FGF-23 levels are already increased<a class="elsevierStyleCrossRef" href="#bib0425">32</a>. This observation suggests that FGF-23 and phosphate might promote distinct mechanisms of cardiovascular toxicity. Indeed, animal models implicate high serum phosphate as a mechanism of vascular calcification and endothelial dysfunction, whereas high levels of FGF-23 are implicated in left ventricular hypertrophy<a class="elsevierStyleCrossRef" href="#bib0430">33</a>. FGF-23 may increase CVD by decreasing the serum 1-25(OH)2 vitamin D levels. In this regard the data obtained from HD supports the survival benefit of active vitamin D therapy<a class="elsevierStyleCrossRef" href="#bib0435">34</a>. On the other hand the idea that FGF-23 has a direct toxic effect on CV system can only be excluded by prospective trials showing the normalization of FGF-23 by active vitamin D therapy.Anemia is one of the common complications of CKD and is associated with mortality and cardiovascular events, even after accounting for CKD stage and other cardiovascular risk factors<a class="elsevierStyleCrossRef" href="#bib0440">35</a>. In addition, the effect of anemia on CV disease and LVH is well known in CKD patients<a class="elsevierStyleCrossRef" href="#bib0310">9</a>. Interestingly in this study significant negative correlation was determined between FGF-23 and hemoglobin concentration and TSAT. Furthermore in high FGF-23 group although statistically insignificant, number of patients having hemoglobin levels lower than 10g/dl and using erythropoietin was higher. Also in regression analysis the negative relation between FGF-23 and hemoglobin is persisted. A study, in HD patients no correlation was detected between hemoglobin and FGF-23<a class="elsevierStyleCrossRef" href="#bib0445">36</a>. However, in HD patients especially in patients with ischemic heart disease and heart failure, higher hemoglobin levels have been shown to increase the risk of mortality and morbidity<a class="elsevierStyleCrossRef" href="#bib0450">37</a>. For these reasons, the effect of relationship between FGF-23 and anemia on the CV system must be determined in further studies.A relation between iron and FGF-23 metabolism is mentioned in a few studies. In human and animals with autosomal dominant hypophosphatemic rickets (ADHR) a correlation between elevated FGF-23 with low serum iron was detected. However, in healthy controls, low serum iron was correlated with elevated c-terminal FGF-23 (cFGF-23), but not with iFGF-23. This may suggest that cleavage maintains homeostasis despite increased FGF-23 expression<a class="elsevierStyleCrossRefs" href="#bib0315">10,38</a>. Similar results were also obtained in patients with X-linked hypophosphatemia<a class="elsevierStyleCrossRef" href="#bib0460">39</a>. In studies in children and the elderly population also a relationship between FGF-23 and low serum iron level was detected<a class="elsevierStyleCrossRefs" href="#bib0465">40,41</a>. In studies, it is emphasized that iron deficiency is an important stimulator of FGF-23 transcription. At the same time, iron is thought to be the cofactor of enzymes taking part in the degradation of intact FGF-23 and thought to have a role in the excretion of degraded FGF-23 parts<a class="elsevierStyleCrossRefs" href="#bib0315">10,38–41</a>. In another study, the CKD patients with iron deficiency and autosomal dominant rickets showed similar molecular pathophysiology and osteocyte dysfunction is suggested to be increased by iFGF-23 level<a class="elsevierStyleCrossRef" href="#bib0475">42</a>. Despite major advances in understanding FGF23 biology, fundamental aspects of FGF23 regulation in healthy subjects and in CKD remain mostly unknown.In many human and animal studies effect of different iron preparations on FGF-23 and phosphate levels is investigated. Iron polymaltose infusions were demonstrated to raise i-FGF23 concentrations causing hypophosphatemia and osteomalacia in individuals with normal renal function<a class="elsevierStyleCrossRef" href="#bib0480">43</a>. In a study intravenous (IV) ferric carboxymaltose (FCM) and iron dextran (ID) were used. C-terminal FGF-23 was decreased after the use of both drugs. But only in FCM group iFGF-23 increased temporarily and serum phosphorous is decreased<a class="elsevierStyleCrossRef" href="#bib0485">44</a>. Besides this in HD patients PTH suppression and rise in iFGF-23 level after IV low molecular weight ID treatment was observed<a class="elsevierStyleCrossRef" href="#bib0490">45</a>. In another study in HD patients iFGF-23 level was found to be negatively associated to intravenous iron sucrose use independently from serum ferritin and iron levels. But in this study there was no data about the association of hemoglobin and iFGF-23<a class="elsevierStyleCrossRef" href="#bib0495">46</a>. Researchers think some carbohydrate components in iron preparations to inhibit FGF-23 degradation in osteocytes to cause a transient raise in iFGF-23<a class="elsevierStyleCrossRefs" href="#bib0485">44–46</a>. In another study iron isomaltose and FCM given intraperitoneally were shown to have no effect on plasma iFGF23 levels both in normal and uremic rats<a class="elsevierStyleCrossRef" href="#bib0500">47</a>. In a recent double blinded, placebo-controlled, randomized trial, rise in hemoglobin levels and decline in serum phosphate and iFGF-23 levels were detected after the use of oral ferric citrate for 12 weeks<a class="elsevierStyleCrossRef" href="#bib0505">48</a>. Also in an experimental study, FGF-23 is expressed to have negative effect on erythrocyte production and differentiation<a class="elsevierStyleCrossRef" href="#bib0510">49</a>. In our study group, none of the patients were under intravenous iron treatment. Lower than the half of the patients was using oral iron drugs and the percentage was similar in both groups. Negative correlation was detected between iFGF-23 and hemoglobin levels independent from serum ferritin, TSAT and oral iron usage in patients. The results of our studies and other studies suggest an association between disease and FGF-23 metabolism.Clinical study number in which FGF-23 concentrations are measured is increasing. But studies in which iFGF-23 (kainos; immutopics) and cFGF-23 (immutopics) measurements are compared are inadequate. In a study intra-assay variation was found to be good in all three assays but in terms of inter-assay and linearity, kainos iFGF-23 and cFGF-23 assays were found to be better<a class="elsevierStyleCrossRef" href="#bib0515">50</a>. In another study strong positive correlation was determined between iFGF assays and cFGF assay in the HD patients<a class="elsevierStyleCrossRef" href="#bib0520">51</a>. In a study an important diurnal variation is detected in iFGF-23 so the use of cFGF-23 is thought to be more useful in clinical practice<a class="elsevierStyleCrossRef" href="#bib0525">52</a>. Also both immunotrophic assays are thought to be affected from ferritin levels but this situation does not occur in kainos iFGF-23 assay<a class="elsevierStyleCrossRef" href="#bib0530">53</a>. As a result of these data we think the use of both iFGF-23 assay and cFGF-23 assay together may be suitable.There are some limitations in this cross sectional study. Due to the design of the study left ventricular function and geometry was assessed by echocardiography and changes that have occurred over time are shown. But iFGF-23 levels were measured once and possibility of change in serum iFGF-23 level during the time period could not be known. However, only iFGF-23 levels were measured. Otherwise, this is a single-centered study, the number of patients and race diversity is limited. Due to the cross-sectional design of the study we can only talk about a relationship based on the data but not a causal relationship so interpretations should be made carefully.In conclusion, data presented in this study and recent publications about the relationship between CV risk factors and anemia with FGF-23, suggests a wider role of this marker in normal biological systems. Well-designed prospective randomized trials are needed to investigate its exact role in the pathogenesis of CVD and anemia in CKD.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres604418" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec618572" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres604417" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec618573" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "FGF-23 measurements" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Echocardiography" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethics" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-30" "fechaAceptado" => "2015-06-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec618572" "palabras" => array:4 [ 0 => "Fibroblast growth factor 23" 1 => "Left ventricular mass index" 2 => "Anemia" 3 => "Peritoneal dialysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec618573" "palabras" => array:4 [ 0 => "Factor de crecimiento fibroblástico 23" 1 => "Índice de masa ventricular izquierda" 2 => "Anemia" 3 => "Diálisis peritoneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundFibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone. In chronic kidney disease (CKD), circulating FGF-23 levels are markedly elevated and independently associated with mortality. Left ventricular hypertrophy (LVH) is a potent risk factor for mortality in CKD, and FGFs have been implicated in the pathogenesis of myocardial hypertrophy. In addition, the effect of anemia on CV disease and LVH is well known in CKD. A relation between iron and FGF-23 metabolism is mentioned in a few studies. The aim of this study was to test the association of FGF-23 levels with echocardiographic (ECHO) and iron parameters in peritoneal dialysis patients (PD). MethodsIn this cross-sectional study, 61 subjects with PD (29 women and 32 men, mean age: 46.9±13.3 years, mean PD vintage: 69.5±39 months) underwent echocardiograms to assess left ventricular mass index (LVMI). Medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded. Serum FGF-23 concentrations were measured using intact FGF-23 (iFGF-23) human enzyme-linked immunosorbent assay (ELİSA) kit. According to the median levels of serum FGF-23 the patients were grouped into two (FGF-23 high and low groups). ResultsSignificant positive correlation was recorded between serum FGF-23 levels and LVMI (P=0.023). There was also significant difference in terms of hemoglobin (12.1±2 versus 11.0±2, P=0.017), transferrin saturation (TSAT) (24.9±16.8 versus 19.5±10.8, P=0.042) between low and high FGF-23 group. Also in linear regression analysis the negative relation between FGF-23 and hemoglobin is persisted (r=0.199, P=0.045). ConclusionsFGF-23 is associated with LVMI, anemia and low TSAT in patients with PD. Whether increased FGF-23 is a marker or a potential mechanism of myocardial hypertrophy and anemia in patients with end-stage renal disease (ESRD) requires further study." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl factor de crecimiento fibroblástico 23 (FGF-23) es una hormona reguladora del fósforo. En la enfermedad renal crónica (ERC), los niveles de FGF-23 son especialmente elevados y se relacionan de manera independiente con mortalidad. La hipertrofia ventricular izquierda (HVI) es un importante factor de riesgo de mortalidad en la ERC y se ha implicado a los FGF en la patogenia de la hipertrofia del miocardio. Además, se conoce el efecto de la anemia en la enfermedad cardiovascular y la HVI en la ERC. En algunos estudios se menciona una relación entre el hierro y el metabolismo del FGF-23. El objetivo de este estudio fue comprobar la asociación de los niveles de FGF-23 con parámetros ecocardiográficos y de hierro en pacientes con diálisis peritoneal (DP). MetodologíaEn este estudio transversal se procedió a realizar un ecocardiograma a 61individuos con DP (29 mujeres y 32 hombres; media de edad: 46,9±13,3 años; DP clásica media: 69,5±39 meses) para evaluar el índice de masa ventricular izquierda (IMVI). Se registraron los tratamientos médicos y los valores promedio de los resultados básicos de laboratorio de los últimos 6 meses de todos los pacientes. Las concentraciones en suero del FGF-23 se midieron con el kit ELISA (enzyme-linked immunosorbent assay) de FGF-23 humano intacto (iFGF-23). Según los niveles promedio de FGF-23 en suero, los pacientes se distribuyeron en dos grupos (FGF-23 alto y bajo). ResultadosSe registró una correlación positiva significativa entre los niveles de FGF-23 en suero e IMVI (P=0,023). También hubo diferencias significativas en cuanto a la hemoglobina (12,1±2 frente a 11,0±2, P=0,017) y saturación de la transferrina (TSAT; 24,9±16,8 frente a 19,5±10,8, P=0,042) entre los grupos de FGF-23 bajo y alto. También en el análisis de regresión lineal se mantuvo la relación negativa entre el FGF-23 y la hemoglobina (r=0,199, P=0,045). ConclusionesEl FGF-23 se asocia con IMVI, anemia y TSAT baja en pacientes con DP. Saber si el aumento del FGF-23 es un marcador o un mecanismo potencial de la hipertrofia miocárdica y la anemia en pacientes con insuficiencia renal terminal exige un estudio en mayor detalle." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1366 "Ancho" => 1475 "Tamanyo" => 89044 ] ] "descripcion" => array:1 [ "en" => "Distribution graph of relation between FGF-23 and Hgb (r=0.199, P=0.045)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1270 "Ancho" => 1610 "Tamanyo" => 105657 ] ] "descripcion" => array:1 [ "en" => "Distribution graph of relationship between LVMI and FGF-23 (r=0.290, P=0.024)." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "SAPD/APD, sustained ambulatory peritoneal dialysis/instrumental peritoneal dialysis; ESRD, end stage renal disease." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">n=61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.9±13.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex women (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (%47.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Body mass index (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.4±3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dialysis vintage (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.5±39.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SAPD/APD (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84/16 \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">Systolic blood pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">129±20 \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">Diastolic blood pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81±11 \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">Mean arterial pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98±18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Causes of ESRD (n, %)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (23) \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">Chronic glomerulonephritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (18) \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">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (37.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Concomitant disease (n, %)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (60.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hyperlipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (31.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Coronary artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cerebrovascular event \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (21.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989865.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Properties of patients." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CCB, calcium channel blockers; RAS, renin angiotensin system." "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">n=61 \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 " colspan="2" align="left" valign="top">Anti-hypertensive (n, %)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CCB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (42.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RAS blocker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (27.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="char" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">β-Blocker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (26.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">α-Blocker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (14.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Antihyperlipidemics (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Statins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (16.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gemfibrozil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Active vitamin D (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (65.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">P binders (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ca-acetate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 (73.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="char" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sevelamere-HCl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (13.1) \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">No. of P binders \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Oral iron (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (68.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Erythropoietin (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (55.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Erythropoietin dosage (u/week) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8000±2500 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989868.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Treatment properties of patients." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \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">n=61 \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">Hemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5±2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemoglobin<10g/dl (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (23) \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">Transferrin saturation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22±14 \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">Ferritin (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">296±375 \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">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104±22 \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">Serum creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6±1.1 \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">Serum albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">C-reactive protein (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±2.1 \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">Alkaline phosphatase (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127±88 \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">Calcium (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">9.2±0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Phosphorus (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">5.0±1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ca×P product (mg2/dl2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47±12 \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">Intact parathormone (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">481±328 \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">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">188±45 \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">Triglyceride (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176±106 \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">LDL-Chol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112±35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HDL-Chol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40±13 \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">Kt/V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1±0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cre Cl (L/week/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.7±21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">RRF≥100ml/day (n, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (34.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MIS* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1±1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FGF-23 (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.3±8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989867.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Laboratory findings of patients." ] ] 5 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \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">n=61 \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">Septal thickness (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PDT (cm)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1±0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVEDD (cm)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8±0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVESD (cm)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1±0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">EF (%)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.2±6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVMI (g/m2)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140±48 \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">LVH (n, %)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (69) \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">LVDD (n, %)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (77) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989869.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "LVEDD; left ventricular end-diastolic diameter, LVESD; left ventricular end-systolic diameter, EF; ejection fraction, LVMI; left ventricular mass index; LVH; left ventricular hypertrophy, LVDD; left ventricular diastolic disfunction, PDT; posterior wall thickness." ] ] ] "descripcion" => array:1 [ "en" => "Echocardiographic findings of patients." ] ] 6 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CreCl, creatinine clearance; EF, ejection fraction; HDL-C, high-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; LVDD, left ventricular diastolic disfunction; LVEDD, left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; MIS, malnutrition inflammation score; PDT, posterior wall thickness; RRF, renal residual fraction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \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">FGF-23≤23.5pg/mln=31 \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">FGF-23>23.5pg/mln=30 \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">P \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">Hemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.1±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.0±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Transferrin saturation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.9±16.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.5±10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \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">Ferritin (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">229±199 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">384±516 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.279 \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">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107.3±27.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.5±14.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.094 \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">Serum creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.608 \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">Serum albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.371 \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">C-reactive protein (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.665 \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">Alkaline phosphatase (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128±71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132±109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.583 \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">Calcium (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">9.4±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0±0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \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">Phosphorus (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">4.9±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.2±1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.374 \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 product (mg2/dl2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.900 \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">Intact parathormone (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">480±328 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">500±349 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.863 \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">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">194±49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182±42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.329 \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">Triglyceride (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176±104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">188±110 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.846 \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">LDL-C (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120±37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104±32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.072 \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">HDL-C (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.199 \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">Kt/V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.0±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \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">CreCl (L/week/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.6±22.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.1±19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.697 \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">RRF≥100cc (%)* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.655 \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">MIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.9±1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.395 \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">LVMI (g/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128±35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150±39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \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">LVH (%)* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.116 \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">EF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.0±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.9±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.661 \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">LVDD (%)* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LVESD (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.510 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989870.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Laboratory and echocardiographic findings in respect to FGF-23." ] ] 7 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \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">β \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">Standard deviation \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">P \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">Systolic blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.025 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.290 \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">Mean arterial pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.612 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.316 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.158 \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="#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">Transferrin saturation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.045 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.118 \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">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.074 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.539 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.046<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">Kt/V \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.796 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.789 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.313 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989866.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "P<0.05." ] ] ] "descripcion" => array:1 [ "en" => "Logistic regression analysis of factors associated with FGF-23." ] ] 8 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "r=0.290, F=5.397, t=2.323." "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">Left ventricular mass index</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">β \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">Standard error \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">P \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">FGF-23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.339 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.576 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989871.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Simple linear regression analysis of left ventricular mass index with FGF-23." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:53 [ 0 => array:3 [ "identificador" => "bib0270" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical epidemiology of cardiovascular disease in chronic renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.N. 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El factor de crecimiento fibroblástico está asociado con el índice de masa ventricular izquierda, anemia y niveles bajos de saturación de la transferrina

Baris Esera, Ozlem Yayara,

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ozlemderen@hotmail.com

Corresponding author.

, Mehmet Buyukbakkala, Bulent Erdogana, Zafer Ercana, Ozgur Merhametsiza, Ayhan haspulata, Ebru Gök Oğuza, İbrahim Doganb, Basol Canbakana, M. Deniz Aylia

a Diskapi Yildirim Beyazid Research and Training Hospital, Nephrology Department, Turkey

b Hitit University Nephrology Department, Corum, Turkey

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        "titulo" => "El factor de crecimiento fibrobl&#225;stico est&#225; asociado con el &#237;ndice de masa ventricular izquierda&#44; anemia y niveles bajos de saturaci&#243;n de la transferrina"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution graph of relationship between LVMI and FGF-23 &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;290&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease &#40;CVD&#41; is the most common cause of mortality in patients with end stage renal disease &#40;ESRD&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">1</span></a>&#46; Besides the well-known traditional cardiovascular risk factors&#44; this population has risk factors specific to chronic kidney disease which results in accelerated atherosclerosis<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">2</span></a>&#46; LVH&#44; commonly exists in patients with ESRD&#44; is a major cardiovascular risk factor and independent predictor of cardiovascular mortality in this population<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hypertension is accepted as the main underlying factor in the development of LVH&#46; However recent studies indicated that FGF-23 may contribute to left ventricular mass enlargement<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; FGF-23 is phosphorus regulating hormone and significantly increased in patients with ESRD&#46; It promotes phosphate excretion and reduces 1-25&#40;OH&#41;<span class="elsevierStyleInf">2</span> vitamin D production in the kidney<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">6</span></a>&#46; Independent relation between increased FGF-23 levels and mortality was first reported by Guirez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">7</span></a> in 2008 in hemodialysis &#40;HD&#41; patients&#46; Even in patients with normal renal functions higher FGF-23 was found to be independently associated with mortality and cardiovascular events<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">8</span></a>&#46; In addition&#44; the effect of anemia on CV disease and LVH is well known in CKD patients<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">9</span></a>&#46; A relation between iron and FGF-23 metabolism is mentioned in a few studies&#46; In studies&#44; it is emphasized that iron deficiency is an important stimulator of FGF-23 transcription<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a>&#46; The aim of this cross-sectional study was to investigate the possible relationship between serum levels of FGF-23 with ECHO and iron parameters in PD patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">This study was performed in peritoneal dialysis patients that are regularly followed in Ankara Diskapi Yildirim Beyazit Training and Research Hospital&#46; Patients that suffered peritonitis or acute coronary event within last 2 months and patients with active malignancy were excluded&#46; Sixty-one patients were included in the study&#46; Fifty-one patients were on continuous ambulatory peritoneal dialysis program and 10 on automated peritoneal dialysis program&#46; In all patients&#44; the doses of dialysis were prescribed so as to generate a Kt&#47;V of &#62;1&#46;7&#46; Demographic characteristics&#44; co-morbidities&#44; medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded&#46; Residual renal function was expressed as the mean value of the residual urea and creatinine clearances&#46; Peritoneal equilibration test &#40;PET&#41; was applied according to the method described by Twardowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">FGF-23 measurements</span><p id="par0020" class="elsevierStylePara elsevierViewall">In all patients&#44; 5<span class="elsevierStyleHsp" style=""></span>ml of blood samples were obtained from peripheral vein after an overnight fasting into standard tubes biochemistry between 08&#46;00 and 12&#46;00<span class="elsevierStyleHsp" style=""></span>AM&#46; Within 30<span class="elsevierStyleHsp" style=""></span>min of collection&#44; samples were centrifuged at 2000<span class="elsevierStyleHsp" style=""></span>rpm for 10<span class="elsevierStyleHsp" style=""></span>min and stored in &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C for maximum 1 month&#46; Serum FGF-23 concentrations were measured using human iFGF-23 ELISA kit &#40;Uscn Life Science Inc&#46;&#44; Wuhan&#44; China&#41; which has typically a sensitivity of less than 4<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Echocardiography</span><p id="par0025" class="elsevierStylePara elsevierViewall">All ECHO measurements were made according to the recommendations of the American Society of Echocardiography<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">12</span></a>&#46; Patients were evaluated in semi-supine position in a dark room by the same cardiologist who was unaware of the clinical and laboratory data of the patients&#46; Ejection fraction &#40;EF&#41;&#44; left ventricular end-systolic diameter &#40;LVESD&#41;&#44; left ventricular end-diastolic diameter &#40;LVEDD&#41;&#44; left ventricular posterior wall thickness &#40;PWT&#41;&#44; inter-ventricular wall thickness &#40;IVWT&#41; and left ventricular relaxation was evaluated in parasternal plane according to the guideline&#46; The LVMI was calculated with the Devereux formula<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">13</span></a>&#46; Body surface area was calculated with the formula of DuBois and DuBois<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">14</span></a>&#46; Cut-off values for LVH were defined as 131<span class="elsevierStyleHsp" style=""></span>g&#47;m<span class="elsevierStyleSup">2</span> and 100<span class="elsevierStyleHsp" style=""></span>g&#47;m<span class="elsevierStyleSup">2</span> for men and women by considering the measurements in the Framingham Heart Study<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethics</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study was approved by the local ethics committee of Ankara Diskapi Yildirim Beyazit Training and Research Hospital&#46; The study was conducted in accordance with Declaration of Helsinki and all participants provided written informed consents&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data analysis was performed by using &#8220;SPSS for Windows 19&#8221; &#40;SPSS Inc&#46;&#44; Chicago&#44; USA&#41;&#46; Results of the analysis of continuous variables were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD and median &#91;min&#8211;max&#93; while the results of analysis of discrete variables were expressed as frequency distributions and percentages&#46; Median serum FGF-23 value was used as the cut-off point and low-and high-FGF-23 groups were formed&#46; In FGF-23 groups&#44; demographic&#44; clinical and laboratory data were compared pairwise&#46; The Kolmogorov&#8211;Smirnov test was used for testing normality of continuous variables&#46; Normally distributed variables were analyzed by <span class="elsevierStyleItalic">t</span>-test while others were analyzed with the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; Chi-square test was used for comparison of discrete variables&#46; Linear regression analysis model was used to study the relationship between LVMI and FGF-23&#46; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">There were 61 PD patients &#40;32 men and 29 women&#44; mean age 46&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3 years&#41; that fulfill the inclusion and exclusion criteria&#46; Demographic characteristics&#44; co-morbidities&#44; medical treatments and basic laboratory results of the patients are presented in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46; The average LVMI of the patients was 140<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>g&#47;m<span class="elsevierStyleSup">2</span> and LVH was present in 69&#37; of patients according to the criteria presented in &#8216;Methods&#8217; section&#46; This prevalence was consistent with the previous studies<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">17&#44;18</span></a>&#46; Although the average EF of patients was 60&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#37;&#44; left ventricular relaxation dysfunction &#40;LVRD&#41; was observed in majority of the patients &#40;48 patients&#44; 77&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; Mean serum FGF-23 level was determined to be 26&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#91;median 23&#46;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;min&#8211;max&#59; 11&#46;53&#8211;45&#46;63&#41;&#93; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; and this value was similar to the values observed in previous studies<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">19</span></a>&#46; Median value of FGF-23 &#40;23&#46;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; was taken as a cut-off point and patients were divided into the low-and high-FGF-23 groups&#46; Demographic&#44; somatometric&#44; laboratory and ECHO results of the two groups were compared &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; No statistically significant difference was observed between the two groups with regard to age&#44; gender&#44; duration of dialysis&#44; BMI&#44; waist circumference&#44; presence of co-morbid diseases&#44; smoking&#44; and medical treatments&#46; There were statistically significant differences in systolic blood pressure &#40;SBP&#41; and mean blood pressure &#40;MBP&#41; between low and high FGF-23 groups &#40;134&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;5 versus 126&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5<span class="elsevierStyleHsp" style=""></span>mmHg&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04 and 96&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;6 versus 103<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;6<span class="elsevierStyleHsp" style=""></span>mmHg&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04 respectively&#41;&#46; However no statistically significant difference was observed for DBP &#40;73&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;9 versus 83&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;157&#41;&#46; There was also significant difference in terms of hemoglobin &#40;12&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 versus 11&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#44; TSAT &#40;24&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;8 versus 19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#41;&#44; albumin-corrected serum calcium &#40;9&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 versus 9&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#44; and Kt&#47;V &#40;2&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 versus 2&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41; between low and high FGF-23 groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The parameters that were statistically significantly different between two groups were included in by multiple linear regression models to determine the effect of independent variables on FGF-23&#46; As a result of analysis&#44; significant negative relationship of serum calcium &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;057&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41; and hemoglobin &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;199&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41; was sustained &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; Distribution graphics of statistical relation between FGF-23 and hemoglobin concentration were shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The results of ECHO parameters were compared in two groups and LVMI was found to be statistically significantly higher in high FGF-23 group &#40;128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35 versus 150<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39<span class="elsevierStyleHsp" style=""></span>g&#47;m2&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41; but prevalence of LVH was not statistically different between the groups &#40;58&#37; versus 80&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;116&#41;&#46; There were also no differences with regard to other ECHO parameters between two groups&#46; Linear regression analysis was applied to investigate the effect of the serum levels of FGF-23 on LVMI and the relationship was found to be statistically significant &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;290&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#41;&#46; The distribution graph of the relationship between LVMI and FGF-23 can be seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">In this study&#44; serum levels of FGF-23 were found to be positively correlated with LVMI&#46; This correlation is likely to be caused by the effects of FGF-23 on left ventricular mass and function&#44; independent from serum calcium&#44; phosphorus&#44; and parathormone levels&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Increased FGF-23 level was shown to be associated with LVMI and LVH in stage II&#8211;IV CKD &#40;4&#46;19&#41; and chronic HD patients<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Increased FGF-23 level has also been suggested to be a mortality predictor in HD patients<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">3&#44;22</span></a>&#44; and this situation was thought to be associated with LVMI<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">23</span></a>&#46; In a study investigating the relationship between FGF-23 levels and LVH in 62 PD patients and 30 healthy controls&#44; serum FGF-23 levels were found to be significantly higher in PD patients compared to control subjects and also in PD patients with LVH compared to PD patients without LVH&#46; FGF-23 levels were also positively correlated with LVMI<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">24</span></a>&#46; In our study we observed similar association between FGF-23 and LVH in PD patients&#46; There was no difference in other ECHO parameters between patients in high and low FGF-23 groups&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although observational data supports the possible relationship between the FGF-23 and CVD and CV mortality&#44; insufficient evidence exist about the exact cause of this association&#46; There is not enough data about the physiological effect of FGF-23 in extra-kidney tissue&#46; FGF-23 receptors exist in CV system and other tissues without klotho co-receptor<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">25</span></a>&#46; This condition&#44; has led to speculation that elevated FGF-23 level observed in progressive renal disease has no direct effect on these tissues but recent data suggests the direct effect of FGF-23 on the CV system<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">26</span></a>&#46; In a recent experimental study&#44; FGF-23 was shown to cause pathological hypertrophy in rat cardiomyocytes by &#8220;calcineurin-nuclear factor of activated T cells&#8221; without klotho and treatment with FGF-blockers reduced LVH in experimental models of chronic renal failure<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">27</span></a>&#46; LVH caused by FGF-23 independent from klotho is explained by two mechanisms&#46; First&#44; longstanding high-FGF-23 level as in CRF&#44; may cause the attachment of FGF to FGF-23 receptor&#46; Although this attachment has lower affinity&#44; exposure of the heart tissue to FGF-23&#44; may be enough for the development of LVH&#46; In CKD klotho expression in the kidney and parathyroid gland is reduced&#46; This may cause the attachment of FGF-23 to FGF-23 receptors in other tissue leading to development of cardio toxicity in CRF&#46; In the second mechanism attachment of FGF-23 to specific cardiac FGF receptors like FGF receptor-4 even in the absence of klotho may contribute to development of LVH<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">22</span></a>&#46; In a study&#44; besides inducing LVH&#44; elevated FGF-23 has been shown to adversely affect the mechanics of left ventricle in HD patients<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">28</span></a>&#46; The data of an experimental study showed that FGF23 may have additional effects on the heart&#44; in addition to hypertrophy&#44; specifically related to calcium handling and cardiac contractility<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">29</span></a>&#46; In a population study&#44; non-sudden cardiac death is found to be associated with high FGF-23<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">30</span></a>&#46; Recently in the meta-analysis of prospective cohort studies&#44; a relationship between FGF-23 and all-cause mortality and cardiovascular events was observed<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">31</span></a>&#46; However&#44; additional studies are required to determine FGF-23 receptors that mediate the cardiac effects of FGF-23&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nevertheless&#44; the presence of cardiac hypertrophy and vascular calcification is interesting in patients with moderate CKD &#40;stages III&#8211;IV&#41;&#46; These patients do not have hemodynamic and inflammatory stress associated with chronic dialysis treatment and hyperphosphatemia is not obvious but FGF-23 levels are already increased<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">32</span></a>&#46; This observation suggests that FGF-23 and phosphate might promote distinct mechanisms of cardiovascular toxicity&#46; Indeed&#44; animal models implicate high serum phosphate as a mechanism of vascular calcification and endothelial dysfunction&#44; whereas high levels of FGF-23 are implicated in left ventricular hypertrophy<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">33</span></a>&#46; FGF-23 may increase CVD by decreasing the serum 1-25&#40;OH&#41;<span class="elsevierStyleInf">2</span> vitamin D levels&#46; In this regard the data obtained from HD supports the survival benefit of active vitamin D therapy<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">34</span></a>&#46; On the other hand the idea that FGF-23 has a direct toxic effect on CV system can only be excluded by prospective trials showing the normalization of FGF-23 by active vitamin D therapy&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Anemia is one of the common complications of CKD and is associated with mortality and cardiovascular events&#44; even after accounting for CKD stage and other cardiovascular risk factors<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">35</span></a>&#46; In addition&#44; the effect of anemia on CV disease and LVH is well known in CKD patients<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">9</span></a>&#46; Interestingly in this study significant negative correlation was determined between FGF-23 and hemoglobin concentration and TSAT&#46; Furthermore in high FGF-23 group although statistically insignificant&#44; number of patients having hemoglobin levels lower than 10<span class="elsevierStyleHsp" style=""></span>g&#47;dl and using erythropoietin was higher&#46; Also in regression analysis the negative relation between FGF-23 and hemoglobin is persisted&#46; A study&#44; in HD patients no correlation was detected between hemoglobin and FGF-23<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">36</span></a>&#46; However&#44; in HD patients especially in patients with ischemic heart disease and heart failure&#44; higher hemoglobin levels have been shown to increase the risk of mortality and morbidity<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">37</span></a>&#46; For these reasons&#44; the effect of relationship between FGF-23 and anemia on the CV system must be determined in further studies&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A relation between iron and FGF-23 metabolism is mentioned in a few studies&#46; In human and animals with autosomal dominant hypophosphatemic rickets &#40;ADHR&#41; a correlation between elevated FGF-23 with low serum iron was detected&#46; However&#44; in healthy controls&#44; low serum iron was correlated with elevated c-terminal FGF-23 &#40;cFGF-23&#41;&#44; but not with iFGF-23&#46; This may suggest that cleavage maintains homeostasis despite increased FGF-23 expression<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;38</span></a>&#46; Similar results were also obtained in patients with X-linked hypophosphatemia<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">39</span></a>&#46; In studies in children and the elderly population also a relationship between FGF-23 and low serum iron level was detected<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">40&#44;41</span></a>&#46; In studies&#44; it is emphasized that iron deficiency is an important stimulator of FGF-23 transcription&#46; At the same time&#44; iron is thought to be the cofactor of enzymes taking part in the degradation of intact FGF-23 and thought to have a role in the excretion of degraded FGF-23 parts<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;38&#8211;41</span></a>&#46; In another study&#44; the CKD patients with iron deficiency and autosomal dominant rickets showed similar molecular pathophysiology and osteocyte dysfunction is suggested to be increased by iFGF-23 level<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">42</span></a>&#46; Despite major advances in understanding FGF23 biology&#44; fundamental aspects of FGF23 regulation in healthy subjects and in CKD remain mostly unknown&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In many human and animal studies effect of different iron preparations on FGF-23 and phosphate levels is investigated&#46; Iron polymaltose infusions were demonstrated to raise i-FGF23 concentrations causing hypophosphatemia and osteomalacia in individuals with normal renal function<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">43</span></a>&#46; In a study intravenous &#40;IV&#41; ferric carboxymaltose &#40;FCM&#41; and iron dextran &#40;ID&#41; were used&#46; C-terminal FGF-23 was decreased after the use of both drugs&#46; But only in FCM group iFGF-23 increased temporarily and serum phosphorous is decreased<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">44</span></a>&#46; Besides this in HD patients PTH suppression and rise in iFGF-23 level after IV low molecular weight ID treatment was observed<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">45</span></a>&#46; In another study in HD patients iFGF-23 level was found to be negatively associated to intravenous iron sucrose use independently from serum ferritin and iron levels&#46; But in this study there was no data about the association of hemoglobin and iFGF-23<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">46</span></a>&#46; Researchers think some carbohydrate components in iron preparations to inhibit FGF-23 degradation in osteocytes to cause a transient raise in iFGF-23<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">44&#8211;46</span></a>&#46; In another study iron isomaltose and FCM given intraperitoneally were shown to have no effect on plasma iFGF23 levels both in normal and uremic rats<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">47</span></a>&#46; In a recent double blinded&#44; placebo-controlled&#44; randomized trial&#44; rise in hemoglobin levels and decline in serum phosphate and iFGF-23 levels were detected after the use of oral ferric citrate for 12 weeks<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">48</span></a>&#46; Also in an experimental study&#44; FGF-23 is expressed to have negative effect on erythrocyte production and differentiation<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a>&#46; In our study group&#44; none of the patients were under intravenous iron treatment&#46; Lower than the half of the patients was using oral iron drugs and the percentage was similar in both groups&#46; Negative correlation was detected between iFGF-23 and hemoglobin levels independent from serum ferritin&#44; TSAT and oral iron usage in patients&#46; The results of our studies and other studies suggest an association between disease and FGF-23 metabolism&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Clinical study number in which FGF-23 concentrations are measured is increasing&#46; But studies in which iFGF-23 &#40;kainos&#59; immutopics&#41; and cFGF-23 &#40;immutopics&#41; measurements are compared are inadequate&#46; In a study intra-assay variation was found to be good in all three assays but in terms of inter-assay and linearity&#44; kainos iFGF-23 and cFGF-23 assays were found to be better<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">50</span></a>&#46; In another study strong positive correlation was determined between iFGF assays and cFGF assay in the HD patients<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">51</span></a>&#46; In a study an important diurnal variation is detected in iFGF-23 so the use of cFGF-23 is thought to be more useful in clinical practice<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">52</span></a>&#46; Also both immunotrophic assays are thought to be affected from ferritin levels but this situation does not occur in kainos iFGF-23 assay<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">53</span></a>&#46; As a result of these data we think the use of both iFGF-23 assay and cFGF-23 assay together may be suitable&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">There are some limitations in this cross sectional study&#46; Due to the design of the study left ventricular function and geometry was assessed by echocardiography and changes that have occurred over time are shown&#46; But iFGF-23 levels were measured once and possibility of change in serum iFGF-23 level during the time period could not be known&#46; However&#44; only iFGF-23 levels were measured&#46; Otherwise&#44; this is a single-centered study&#44; the number of patients and race diversity is limited&#46; Due to the cross-sectional design of the study we can only talk about a relationship based on the data but not a causal relationship so interpretations should be made carefully&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion&#44; data presented in this study and recent publications about the relationship between CV risk factors and anemia with FGF-23&#44; suggests a wider role of this marker in normal biological systems&#46; Well-designed prospective randomized trials are needed to investigate its exact role in the pathogenesis of CVD and anemia in CKD&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fibroblast growth factor 23 &#40;FGF-23&#41; is a phosphorus-regulating hormone&#46; In chronic kidney disease &#40;CKD&#41;&#44; circulating FGF-23 levels are markedly elevated and independently associated with mortality&#46; Left ventricular hypertrophy &#40;LVH&#41; is a potent risk factor for mortality in CKD&#44; and FGFs have been implicated in the pathogenesis of myocardial hypertrophy&#46; In addition&#44; the effect of anemia on CV disease and LVH is well known in CKD&#46; A relation between iron and FGF-23 metabolism is mentioned in a few studies&#46; The aim of this study was to test the association of FGF-23 levels with echocardiographic &#40;ECHO&#41; and iron parameters in peritoneal dialysis patients &#40;PD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this cross-sectional study&#44; 61 subjects with PD &#40;29 women and 32 men&#44; mean age&#58; 46&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3 years&#44; mean PD vintage&#58; 69&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39 months&#41; underwent echocardiograms to assess left ventricular mass index &#40;LVMI&#41;&#46; Medical treatments and average values of the basic laboratory results of the last 6 months for all patients were recorded&#46; Serum FGF-23 concentrations were measured using intact FGF-23 &#40;iFGF-23&#41; human enzyme-linked immunosorbent assay &#40;EL&#304;SA&#41; kit&#46; According to the median levels of serum FGF-23 the patients were grouped into two &#40;FGF-23 high and low groups&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Significant positive correlation was recorded between serum FGF-23 levels and LVMI &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#46; There was also significant difference in terms of hemoglobin &#40;12&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 versus 11&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#44; transferrin saturation &#40;TSAT&#41; &#40;24&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;8 versus 19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;8&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#41; between low and high FGF-23 group&#46; Also in linear regression analysis the negative relation between FGF-23 and hemoglobin is persisted &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;199&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">FGF-23 is associated with LVMI&#44; anemia and low TSAT in patients with PD&#46; Whether increased FGF-23 is a marker or a potential mechanism of myocardial hypertrophy and anemia in patients with end-stage renal disease &#40;ESRD&#41; requires further study&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El factor de crecimiento fibrobl&#225;stico 23 &#40;FGF-23&#41; es una hormona reguladora del f&#243;sforo&#46; En la enfermedad renal cr&#243;nica &#40;ERC&#41;&#44; los niveles de FGF-23 son especialmente elevados y se relacionan de manera independiente con mortalidad&#46; La hipertrofia ventricular izquierda &#40;HVI&#41; es un importante factor de riesgo de mortalidad en la ERC y se ha implicado a los FGF en la patogenia de la hipertrofia del miocardio&#46; Adem&#225;s&#44; se conoce el efecto de la anemia en la enfermedad cardiovascular y la HVI en la ERC&#46; En algunos estudios se menciona una relaci&#243;n entre el hierro y el metabolismo del FGF-23&#46; El objetivo de este estudio fue comprobar la asociaci&#243;n de los niveles de FGF-23 con par&#225;metros ecocardiogr&#225;ficos y de hierro en pacientes con di&#225;lisis peritoneal &#40;DP&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En este estudio transversal se procedi&#243; a realizar un ecocardiograma a 61individuos con DP &#40;29 mujeres y 32 hombres&#59; media de edad&#58; 46&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;3 a&#241;os&#59; DP cl&#225;sica media&#58; 69&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39 meses&#41; para evaluar el &#237;ndice de masa ventricular izquierda &#40;IMVI&#41;&#46; Se registraron los tratamientos m&#233;dicos y los valores promedio de los resultados b&#225;sicos de laboratorio de los &#250;ltimos 6 meses de todos los pacientes&#46; Las concentraciones en suero del FGF-23 se midieron con el kit ELISA <span class="elsevierStyleItalic">&#40;enzyme-linked immunosorbent assay&#41;</span> de FGF-23 humano intacto &#40;iFGF-23&#41;&#46; Seg&#250;n los niveles promedio de FGF-23 en suero&#44; los pacientes se distribuyeron en dos grupos &#40;FGF-23 alto y bajo&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se registr&#243; una correlaci&#243;n positiva significativa entre los niveles de FGF-23 en suero e IMVI &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46; Tambi&#233;n hubo diferencias significativas en cuanto a la hemoglobina &#40;12&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 frente a 11&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41; y saturaci&#243;n de la transferrina &#40;TSAT&#59; 24&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;8 frente a 19&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8&#44; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; entre los grupos de FGF-23 bajo y alto&#46; Tambi&#233;n en el an&#225;lisis de regresi&#243;n lineal se mantuvo la relaci&#243;n negativa entre el FGF-23 y la hemoglobina &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;199&#44; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El FGF-23 se asocia con IMVI&#44; anemia y TSAT baja en pacientes con DP&#46; Saber si el aumento del FGF-23 es un marcador o un mecanismo potencial de la hipertrofia mioc&#225;rdica y la anemia en pacientes con insuficiencia renal terminal exige un estudio en mayor detalle&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution graph of relation between FGF-23 and Hgb &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;199&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SAPD&#47;APD&#44; sustained ambulatory peritoneal dialysis&#47;instrumental peritoneal dialysis&#59; ESRD&#44; end stage renal disease&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">61</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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"><span class="elsevierStyleItalic">Age &#40;year&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;3&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"><span class="elsevierStyleItalic">Sex women &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;&#37;47&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&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"><span class="elsevierStyleItalic">Dialysis vintage &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39&#46;7&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"><span class="elsevierStyleItalic">SAPD&#47;APD &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#47;16&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"><span class="elsevierStyleItalic">Systolic blood pressure &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&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"><span class="elsevierStyleItalic">Diastolic blood pressure &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&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"><span class="elsevierStyleItalic">Mean arterial pressure &#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Causes of ESRD &#40;n&#44; &#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;23&#41;&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"><span class="elsevierStyleHsp" style=""></span>Chronic glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;18&#41;&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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Others</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;11&#46;5&#41;&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"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Concomitant disease &#40;n&#44; &#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;60&#46;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;31&#46;2&#41;&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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Coronary artery disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \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
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#946;-Blocker</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#945;-Blocker</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antihyperlipidemics &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Statins&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gemfibrozil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Active vitamin D &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">P binders &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ca-acetate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45 &#40;73&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sevelamere-HCl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;13&#46;1&#41;&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"><span class="elsevierStyleHsp" style=""></span>No&#46; of P binders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;8&#46;2&#41;&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"><span class="elsevierStyleItalic">Oral iron &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;68&#46;9&#41;&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"><span class="elsevierStyleItalic">Erythropoietin &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;55&#46;7&#41;&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"><span class="elsevierStyleItalic">Erythropoietin dosage &#40;u&#47;week&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8000<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab989868.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Treatment properties of patients&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&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"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&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">Hemoglobin &#40;g&#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">11&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&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">Hemoglobin<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;23&#41;&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">Transferrin saturation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&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">Ferritin &#40;ng&#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">296<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>375&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">Glucose &#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">104<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&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">Serum creatinine &#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">9&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&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">Serum albumin &#40;g&#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">3&#46;8<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C-reactive protein &#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">1&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1&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">Alkaline phosphatase &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>88&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">Calcium &#40;Ca&#41; &#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">9&#46;2<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Phosphorus &#40;P&#41; &#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;0<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></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 product &#40;mg<span class="elsevierStyleSup">2</span>&#47;dl<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&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">Intact parathormone &#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">481<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>328&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">Total cholesterol &#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">188<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45&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">Triglyceride &#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">176<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>106&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">LDL-Chol &#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">112<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&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">HDL-Chol &#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">40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&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">Kt&#47;V&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;1<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Cre Cl &#40;L&#47;week&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&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">RRF<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>ml&#47;day &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;34&#46;4&#41;&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">MIS&#42;&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;1<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGF-23 &#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">26&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab989867.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Laboratory findings of patients&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&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"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&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">Septal thickness &#40;cm&#41;&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;2&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">PDT &#40;cm&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">1&#46;1<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVEDD &#40;cm&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">4&#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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LVESD &#40;cm&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">3&#46;1<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></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">EF &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">60&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&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">LVMI &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">140<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&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">LVH &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">42 &#40;69&#41;&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">LVDD &#40;<span class="elsevierStyleItalic">n</span>&#44; &#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">48 &#40;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">LVEDD&#59; left ventricular end-diastolic diameter&#44; LVESD&#59; left ventricular end-systolic diameter&#44; EF&#59; ejection fraction&#44; LVMI&#59; left ventricular mass index&#59; LVH&#59; left ventricular hypertrophy&#44; LVDD&#59; left ventricular diastolic disfunction&#44; PDT&#59; posterior wall thickness&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Echocardiographic findings of patients&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CreCl&#44; creatinine clearance&#59; EF&#44; ejection fraction&#59; HDL-C&#44; high-density lipoprotein&#59; LDL-C&#44; low-density lipoprotein cholesterol&#59; LVDD&#44; left ventricular diastolic disfunction&#59; LVEDD&#44; left ventricular end-diastolic diameter&#59; LVESD&#44; left ventricular end-systolic diameter&#59; LVH&#44; left ventricular hypertrophy&#59; LVMI&#44; left ventricular mass index&#59; MIS&#44; malnutrition inflammation score&#59; PDT&#44; posterior wall thickness&#59; RRF&#44; renal residual fraction&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&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">FGF-23&#8804;23&#46;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&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">FGF-23<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>23&#46;5<span class="elsevierStyleHsp" style=""></span>pg&#47;ml<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&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"><span class="elsevierStyleItalic">P</span>&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">Hemoglobin &#40;g&#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">12&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>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;017&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">Transferrin saturation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#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">19&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#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;042&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">Ferritin &#40;ng&#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">229<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">384<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>516&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;279&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">Glucose &#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">107&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#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">99&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#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;094&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">Serum creatinine &#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">9&#46;5<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">9&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>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;608&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">Serum albumin &#40;g&#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">3&#46;8<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">3&#46;7<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">0&#46;371&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">C-reactive protein &#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">1&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#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;5<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;665&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">Alkaline phosphatase &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>109&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;583&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">Calcium &#40;Ca&#41; &#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">9&#46;4<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">9&#46;0<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;006&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">Phosphorus &#40;P&#41; &#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">4&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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">5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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">0&#46;374&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 product &#40;mg<span class="elsevierStyleSup">2</span>&#47;dl<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&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;900&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">Intact parathormone &#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">480<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>328&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">500<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>349&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;863&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">Total cholesterol &#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">194<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&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;329&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">Triglyceride &#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">176<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">188<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>110&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;846&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">LDL-C &#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">120<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&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;072&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">HDL-C &#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">37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&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;199&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">Kt&#47;V&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;5&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;0<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;029&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">CreCl &#40;L&#47;week&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#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">65&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#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;697&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">RRF<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>cc &#40;&#37;&#41;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#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">30&#46;0&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;655&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">MIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>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;395&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">LVMI &#40;g&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>39&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;023&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">LVH &#40;&#37;&#41;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&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;116&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">EF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#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">58&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>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;661&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">LVDD &#40;&#37;&#41;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#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">80&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;0&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">LVESD &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0<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">3&#46;2<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;510&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab989870.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Laboratory and echocardiographic findings in respect to FGF-23&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&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"><span class="elsevierStyleItalic">&#946;</span>&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">Standard deviation&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2015.10.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	5	11
2024 October	43	41	84
2024 September	37	30	67
2024 August	58	45	103
2024 July	35	19	54
2024 June	54	32	86
2024 May	31	11	42
2024 April	43	26	69
2024 March	61	25	86
2024 February	45	36	81
2024 January	36	20	56
2023 December	35	24	59
2023 November	43	22	65
2023 October	46	24	70
2023 September	26	19	45
2023 August	37	18	55
2023 July	31	15	46
2023 June	41	19	60
2023 May	41	25	66
2023 April	32	14	46
2023 March	40	20	60
2023 February	43	23	66
2023 January	29	37	66
2022 December	53	31	84
2022 November	51	32	83
2022 October	44	49	93
2022 September	34	31	65
2022 August	48	40	88
2022 July	22	42	64
2022 June	38	37	75
2022 May	19	32	51
2022 April	38	34	72
2022 March	45	35	80
2022 February	52	33	85
2022 January	46	31	77
2021 December	43	39	82
2021 November	33	32	65
2021 October	43	39	82
2021 September	31	32	63
2021 August	29	30	59
2021 July	33	32	65
2021 June	20	21	41
2021 May	29	25	54
2021 April	70	35	105
2021 March	31	30	61
2021 February	27	19	46
2021 January	43	21	64
2020 December	30	15	45
2020 November	47	18	65
2020 October	24	14	38
2020 September	24	15	39
2020 August	42	14	56
2020 July	28	15	43
2020 June	19	23	42
2020 May	38	13	51
2020 April	29	17	46
2020 March	28	19	47
2020 February	48	20	68
2020 January	55	18	73
2019 December	54	23	77
2019 November	44	23	67
2019 October	23	10	33
2019 September	27	22	49
2019 August	39	19	58
2019 July	31	20	51
2019 June	36	21	57
2019 May	28	20	48
2019 April	92	34	126
2019 March	39	20	59
2019 February	30	19	49
2019 January	34	21	55
2018 December	221	40	261
2018 November	457	23	480
2018 October	457	21	478
2018 September	183	18	201
2018 August	192	21	213
2018 July	51	14	65
2018 June	41	12	53
2018 May	35	16	51
2018 April	25	2	27
2018 March	29	8	37
2018 February	34	5	39
2018 January	29	6	35
2017 December	31	9	40
2017 November	35	11	46
2017 October	32	4	36
2017 September	37	10	47
2017 August	22	11	33
2017 July	27	9	36
2017 June	25	8	33
2017 May	34	10	44
2017 April	34	13	47
2017 March	26	27	53
2017 February	20	8	28
2017 January	18	1	19
2016 December	60	6	66
2016 November	75	20	95
2016 October	101	12	113
2016 September	130	7	137
2016 August	139	4	143
2016 July	177	11	188
2016 June	132	0	132
2016 May	189	0	189
2016 April	162	0	162
2016 March	149	0	149
2016 February	152	0	152
2016 January	105	0	105
2015 December	51	0	51

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