Letters to the Editor – Brief papers about basic research or clinical experiences
Capturing the diagnosis of chronic kidney disease in the electronic medical record and its influence on therapeutic management
Registro del diagnóstico de insuficiencia renal crónica en la historia clínica electrónica y su influencia en el manejo terapéutico
Eugenia Espinela,f,
, Francisca Benavidesb, M. Victoria Feijóoc, Eladio Fernández-Lizd, Yolima Cossioe, Daniel Seróna,f, on behalf of the Grupo Clínico de Nefrología del Servicio de Atención Primaria SAP Muntanya y Hospital Universitari Vall d’Hebrón de Barcelona ◊
Corresponding author
a Servei de Nefrologia, Hospital Universitari Vall d¿ Hebrón, Barcelona, Spain
b Centre de Atenció Primària Rio de Janeiro, Spain
c BASIQ Unitat d’Avaluació, Sistemes d’Informació i Qualitat, Àmbit Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
d Area del Medicament,Àmbit Barcelona Ciutat, Institut Català de la Salut, Spain
e Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d¿Hebrón, Barcelona, Spain
f Instituto Carlos III, Red de Investigación en Enfermedades Renales, REDinREN, RD12/0021/0013, Spain
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The objective of the study is to determine, in patients with a GFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, whether documenting a diagnosis of CKD in the record encompasses different attitudes with respect to the prevention and treatment of CKD.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study was performed in the 16 primary care teams from the Muntanya Primary Care Service (SAP) in Barcelona, belonging to the Catalan Health Institute (ICS), where 212,321 adult patients were covered for health care in 2012. Patients with a minimum of 2 estimated glomerular filtration rates (eGFRs) using the CKD-EPI formula lower than 60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in 2012 were enrolled. We identified two groups of patient depending of whether to diagnosis of CKD had been recorded in the medical history. A between-groups comparison was performed using the chi-squared test for qualitative variables and Student's <span class="elsevierStyleItalic">t</span> test for quantitative variables. A level of statistical significance of 5% (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.05) was accepted.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2331 patients, at least 2 eGFR measurements <60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> were recorded. The diagnosis of CKD had been recorded in 1344 patients (57%), but not in 987 patients (43%). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the patients’ characteristics. The patients with a recorded diagnosis of CKD had a lower eGFR and greater albuminuria. The proportion of diabetics was similar in the two groups. Body weight, LDL cholesterol and glycated haemoglobin in patients with diabetes were lower in the group of patients with a diagnosis of CKD. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the treatment in both groups. The use of renin–angiotensin system inhibitors was similar in the both groups. By contrast, the use of non-steroidal anti-inflammatory drugs was lower in patients with the diagnosis of CKD. In diabetic patients the use of metformin and sulphonylureas was also lower in the group with a diagnosis of CKD.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The main observation of the present study is that a diagnosis of CKD is made late and that the diagnosis is not shown in the medical history of approximately 40% of patients with an eGFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>. Despite the greater severity of kidney disease, patients with a diagnosis of CKD recorded had less overweight and better control of LDL cholesterol and glycated haemoglobin (in diabetic patients). The use of non-steroidal anti-inflammatory drugs was lower in the group of patients with a diagnosis of CKD. Metformin and sulphonylureas were used less often in diabetic patients with a diagnosis of CKD. Taken together, these results suggest that a diagnosis of CKD is associated with a more proactive attitude aimed at decreasing risk factors for cardiovascular problems and for progression of kidney disease and also with greater prevention of acute renal failure. These findings raise the question of whether automatically including a diagnosis of CKD in the medical history of patients with an eGFR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> might foster a more proactive attitude in the treatment of these patients.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> However, these results should be interpreted with caution since this is a retrospective study and therefore does not allow causal relationships to be established. Conforming or refuting this hypothesis would require a prospective randomised study.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The names of participants in the study are available on <a class="elsevierStyleCrossRef" href="#sec0010">Appendix</a>.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Espinel E, Benavides F, Feijóo MV, Fernández-Liz E, Cossio Y, Serón D, et al. Registro del diagnóstico de insuficiencia renal crónica en la historia clínica electrónica y su influencia en el manejo terapéutico. Nefrología. 2016;36:315–317.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0030" class="elsevierStylePara elsevierViewall">Carme Nebot. Servei d’atenció primària Muntanya Dreta.</p> <p id="par0035" class="elsevierStylePara elsevierViewall">Pilar Algueró. Centre d’atenció primària Turó.</p> <p id="par0040" class="elsevierStylePara elsevierViewall">Maribel Colas. Centre d’atenció primària Turó.</p> <p id="par0045" class="elsevierStylePara elsevierViewall">Joan Atmetlla Andreu. Centre d’atenció primària Xafarinas.</p> <p id="par0050" class="elsevierStylePara elsevierViewall">Dolors Llauradó. Centre d’atenció primària Turó.</p> <p id="par0055" class="elsevierStylePara elsevierViewall">Araceli Martín. Centre d’atenció primària Ciutat Meridiana.</p> <p id="par0060" class="elsevierStylePara elsevierViewall">Andrea Sánchez Callejas. BASIQ. Unitat d’Avaluació, Sistemes d’Informació i Qualitat.</p> <p id="par0065" class="elsevierStylePara elsevierViewall">Francisca Benavides. Centre d’atenció primària Rio de Janeiro.</p> <p id="par0070" class="elsevierStylePara elsevierViewall">Eladio Fernández-Liz. Area del Medicament Àmbit Barcelona Ciutat.</p> <p id="par0075" class="elsevierStylePara elsevierViewall">Daniel Serón. Servei de Nefrologia. Hospital Universitari Vall d’Hebrón. Barcelona.</p> <p id="par0080" class="elsevierStylePara elsevierViewall">Eugenia Espinel. Servei de Nefrologia. Hospital Universitari Vall d’Hebrón. Barcelona.</p>" "etiqueta" => "Appendix" "titulo" => "Grupo clínico de Nefrología del Servei d’Atenció Primària SAP Muntanya y Hospital Universitari Vall d’Hebrón. Institut Català de la Salut (ICS) Barcelona." "identificador" => "sec0010" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DM, diabetes mellitus; GFR, glomerular filtration rate; HbA1c, glycated haemoglobin; BMI, body mass index; LDL-C, LDL cholesterol; Malb, microalbuminuria; NS, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05; DBP, diastolic blood pressure; SBP, systolic blood pressure.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Any visit to the site for any reason has been counted.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> Referrals to the Nephrology Department of the referral hospital.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without a diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With a diagnosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1344 \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.09 (8.74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.27 (8.74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women (<span class="elsevierStyleItalic">n</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">647 (65.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">770 (57.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP (mmHg) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132.58 (19.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">133.62 (19.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP (mmHg) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.58 (12.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.33 (10.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malb (mg/g) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.68 (58.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.02 (10.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.21 (0.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.62 (3.50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GFR, ml/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.90 (7.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.02 (10.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemoglobin (g/dl) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.48 (1.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.44 (3.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes (<span class="elsevierStyleItalic">n</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">496 (50.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">641 (47.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HbA1c (%) (in DM) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6 (3.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.3 (1.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.16 (5.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.46 (4.91) \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><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL-C (mg/dl) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (34.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (34.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. of visits<span class="elsevierStyleSup">a</span> (2012) (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.07 (17.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.72 (17.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Referrals<span class="elsevierStyleSup">b</span> (<span class="elsevierStyleItalic">n</span>, %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">123 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393588.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic data and mean baseline values.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NSAIDs, non-steroidal anti-inflammatory drugs; AIIRAs, angiotensin II receptor antagonists; Diab, diabetic; ACE inhibitors, angiotensin converting enzyme inhibitors; NS, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Bold values represent the number of patients.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without a diagnosis (<span class="elsevierStyleItalic">n</span>, %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With a diagnosis (<span class="elsevierStyleItalic">n</span>, %) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total number of cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">987</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">1344</span> \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACE inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">393 (39.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">505 (37.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIIRAs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">373 (37.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">550 (40.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ACE inhibitors<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>AIIRAs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aliskiren \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (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 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NSAIDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">312 (31.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">345 (25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total diabetic patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">497</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">642</span> \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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diab:metformin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186 (37.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">167 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diab:sulphonylureas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1393589.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Treatment differences according to group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolving importance of kidney disease: from subspecialty to global health burden" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 50 | 49 | 99 |
| 2024 September | 55 | 30 | 85 |
| 2024 August | 67 | 50 | 117 |
| 2024 July | 46 | 27 | 73 |
| 2024 June | 48 | 33 | 81 |
| 2024 May | 53 | 39 | 92 |
| 2024 April | 40 | 22 | 62 |
| 2024 March | 34 | 25 | 59 |
| 2024 February | 51 | 89 | 140 |
| 2024 January | 27 | 22 | 49 |
| 2023 December | 28 | 27 | 55 |
| 2023 November | 38 | 30 | 68 |
| 2023 October | 69 | 39 | 108 |
| 2023 September | 60 | 24 | 84 |
| 2023 August | 40 | 29 | 69 |
| 2023 July | 34 | 35 | 69 |
| 2023 June | 59 | 16 | 75 |
| 2023 May | 53 | 28 | 81 |
| 2023 April | 38 | 12 | 50 |
| 2023 March | 88 | 19 | 107 |
| 2023 February | 41 | 16 | 57 |
| 2023 January | 41 | 17 | 58 |
| 2022 December | 62 | 22 | 84 |
| 2022 November | 37 | 38 | 75 |
| 2022 October | 62 | 32 | 94 |
| 2022 September | 44 | 29 | 73 |
| 2022 August | 50 | 37 | 87 |
| 2022 July | 32 | 41 | 73 |
| 2022 June | 31 | 29 | 60 |
| 2022 May | 37 | 31 | 68 |
| 2022 April | 35 | 37 | 72 |
| 2022 March | 50 | 42 | 92 |
| 2022 February | 66 | 32 | 98 |
| 2022 January | 41 | 33 | 74 |
| 2021 December | 36 | 40 | 76 |
| 2021 November | 39 | 27 | 66 |
| 2021 October | 39 | 36 | 75 |
| 2021 September | 38 | 37 | 75 |
| 2021 August | 34 | 41 | 75 |
| 2021 July | 43 | 38 | 81 |
| 2021 June | 40 | 23 | 63 |
| 2021 May | 42 | 56 | 98 |
| 2021 April | 101 | 91 | 192 |
| 2021 March | 62 | 43 | 105 |
| 2021 February | 62 | 30 | 92 |
| 2021 January | 46 | 26 | 72 |
| 2020 December | 48 | 28 | 76 |
| 2020 November | 49 | 15 | 64 |
| 2020 October | 29 | 20 | 49 |
| 2020 September | 30 | 20 | 50 |
| 2020 August | 46 | 31 | 77 |
| 2020 July | 38 | 18 | 56 |
| 2020 June | 28 | 27 | 55 |
| 2020 May | 53 | 14 | 67 |
| 2020 April | 39 | 19 | 58 |
| 2020 March | 47 | 15 | 62 |
| 2020 February | 38 | 19 | 57 |
| 2020 January | 52 | 19 | 71 |
| 2019 December | 51 | 19 | 70 |
| 2019 November | 43 | 20 | 63 |
| 2019 October | 27 | 12 | 39 |
| 2019 September | 32 | 16 | 48 |
| 2019 August | 26 | 14 | 40 |
| 2019 July | 48 | 22 | 70 |
| 2019 June | 37 | 12 | 49 |
| 2019 May | 39 | 13 | 52 |
| 2019 April | 84 | 28 | 112 |
| 2019 March | 55 | 19 | 74 |
| 2019 February | 44 | 19 | 63 |
| 2019 January | 33 | 18 | 51 |
| 2018 December | 120 | 36 | 156 |
| 2018 November | 200 | 12 | 212 |
| 2018 October | 162 | 16 | 178 |
| 2018 September | 92 | 24 | 116 |
| 2018 August | 73 | 16 | 89 |
| 2018 July | 44 | 9 | 53 |
| 2018 June | 64 | 17 | 81 |
| 2018 May | 67 | 12 | 79 |
| 2018 April | 80 | 11 | 91 |
| 2018 March | 72 | 10 | 82 |
| 2018 February | 54 | 6 | 60 |
| 2018 January | 76 | 6 | 82 |
| 2017 December | 87 | 7 | 94 |
| 2017 November | 72 | 9 | 81 |
| 2017 October | 46 | 4 | 50 |
| 2017 September | 47 | 8 | 55 |
| 2017 August | 44 | 6 | 50 |
| 2017 July | 58 | 10 | 68 |
| 2017 June | 41 | 14 | 55 |
| 2017 May | 53 | 7 | 60 |
| 2017 April | 62 | 8 | 70 |
| 2017 March | 27 | 17 | 44 |
| 2017 February | 38 | 9 | 47 |
| 2017 January | 30 | 9 | 39 |
| 2016 December | 34 | 4 | 38 |
| 2016 November | 46 | 13 | 59 |
| 2016 October | 57 | 10 | 67 |
| 2016 September | 113 | 1 | 114 |
| 2016 August | 72 | 2 | 74 |
| 2016 July | 120 | 2 | 122 |
| 2016 June | 101 | 0 | 101 |
| 2016 May | 30 | 0 | 30 |
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