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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">Health-related quality of life &#40;HRQoL&#41; has been defined as the evaluation made by the individual regarding his or her health and level of functioning in going about day-to-day activities&#44; including physical&#44; psychological and social function&#59; general perception of health&#59; mobility&#59; and emotional well-being&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;2</span></a> HRQoL has become an essential concept for comprehensive care of the patient with a chronic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;3</span></a> It is a useful variable for predicting potential adverse consequences in the course of the disease and for evaluating treatment efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">4</span></a> The HRQoL measurement is being used to evaluate the repercussions and impact that the disease causes in patients&#8217; day-to-day life&#46; It provides additional information of major importance to the simple diagnosis of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have evaluated HRQoL in chronic kidney disease &#40;CKD&#41; and in patients on haemodialysis &#40;HD&#41; treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;2&#44;6&#44;7</span></a> These works have shown that CKD and HD treatment interfere with the patient&#39;s life&#44; and that HRQoL decreases if this is not borne in mind and addressed&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;8</span></a> The kidney patient has a lower HRQoL than that found in the general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">9&#44;10</span></a> and this deterioration in HRQoL has been associated with clinical variables&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">11&#44;12</span></a> sociodemographic variables&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;13&#44;14</span></a> dialysis characteristics&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">14</span></a> physical symptoms&#44; social support and disease impact&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">4</span></a> In addition&#44; these studies have shown a close relationship between HRQoL indicators and morbidity&#47;mortality indices&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">7&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some previous works have focused on the importance of physical deterioration in the determination of HRQoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;4&#44;6&#44;10&#44;16</span></a> The kidney patient&#39;s physical problems modulate the assessments made by the patient of his or her adaptive capacity and condition as a sick person&#46; The most common symptoms reported by kidney patients are musculoskeletal&#44; gastrointestinal&#44; immunological&#44; cardiovascular and skin&#47;allergy-related&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a> These symptoms could be accounted for in part by the long-term effect of anaemia&#44; malnutrition&#44; cardiovascular complications typical in the kidney patient and complications or insufficient doses of dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">18</span></a> However&#44; many properly dialysed patients&#44; with good haematocrit levels and good clinical chemistry management&#44; continue to have &#8220;widespread&#8221; physical discomfort that affects their well-being&#44; for which no clear aetiology is found&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">14</span></a> and which does not respond appropriately to the treatments prescribed&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">19</span></a> One possible explanation for these symptoms and this &#8220;widespread&#8221; discomfort could lie in psychological and emotional considerations&#46; For example&#44; level of anxiety is an independent predictor of the report of somatic symptoms&#46; This accounts for the 25&#37; variance in total symptoms reported&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a> Other variables associated with the report of somatic symptoms in the kidney patient in dialysis treatment are depression&#44; degree of concern and passive strategies for coping with stress &#40;fatalism and helplessness&#47;hopelessness&#41;&#44; while level of self-efficacy&#44; social support and active coping strategies &#40;such as a fighting spirit&#41; are associated with lower reports of physical symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several works have assigned major importance to emotional disturbances in the determination of the HRQoL of the kidney patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">10&#8211;12&#44;20&#8211;23</span></a> These emotional disturbances may be caused by the numerous losses the kidney patient has to face &#40;loss of renal function&#44; loss of well-being&#44; loss of place in the family and at work&#44; loss of financial resources and loss of sexual function&#41;&#44; the continuous uncertainty that he or she experiences &#40;regarding survival&#44; dependence on medical technology&#44; etc&#46;&#41;&#44; the stress inherent to dialysis sessions&#44; serious dietary restrictions&#44; etc&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Depression is one of the factors that negatively affect HRQoL<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">20&#8211;25</span></a> in the kidney patient&#46; Some studies have found that depression is the main predictor of HRQoL<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">21</span></a>&#58; it is negatively associated with all its components and accounts for percentages of variance of around 50&#37; for physical function&#44; physical role&#44; vitality&#44; social function and mental health&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a> Less importantly&#44; degree of concern regarding the disease&#44; as well as passive strategies for coping with stress&#44; are also associated with lower HRQoL levels&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a> By contrast&#44; self-efficacy&#44; optimism&#44; social support and a fighting spirit are related to greater HRQoL levels&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a> The UK National Institute for Health and Care Excellence has explicitly recognised the importance of depression in kidney disease&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">26</span></a> Depression tends to be more refractory to treatment when it occurs in the context of another medical disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;28</span></a> Thus&#44; depression has a greater prevalence and is more resistant to treatment in the kidney patient in dialysis than in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Based on the previous review&#44; the 2 factors that seem to most affect the HRQoL of the kidney patient in HD treatment are somatic symptoms and mood &#40;depression and anxiety&#41;&#46; However&#44; we have not found any studies that have analysed the combined and interactive influence of these 2 factors on the HRQoL of the kidney patient&#46; In this context&#44; the objective of this study was to compare the relative predictive capacity of somatic symptoms reported by the patient and his or her mood &#40;depression and anxiety&#41; with respect to HRQoL in patients with CKD in HD treatment&#44; distinguishing between the HRQoL subcomponents of physical health and mental health&#46; The potential interaction between somatic symptoms and mood in the determination of HRQoL was also analysed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">The sample included 52 patients in chronic HD &#40;38 men and 14 women&#41;&#46; The type of dialysis received was on-line&#44; 3 sessions per week&#44; 4<span class="elsevierStyleHsp" style=""></span>h each &#40;plus one extra session to remove the overweight of patients who had gained weight relative to the previous session&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows sociodemographic and clinical characteristics of patients included&#46; The inclusion criteria were&#58; 60 years old or younger&#44; in treatment with dialysis for more than 6 months&#44; not having suffered from serious clinical situations in the last 6 months &#40;prolonged hospital stays or recent vascular access obstruction&#41; and not suffering from any psychiatric disorder or intellectual disability&#46; These criteria were used to ensure appropriate understanding of the tools for evaluation used and reduce the possibility of the patient&#39;s clinical state interfering with the results&#46; The research study was offered to 100&#37; of the patients available in the health district &#40;Haemodialysis Unit at Hospital M&#233;dico Quir&#250;rgico&#44; Centro de Hemodi&#225;lisis de Santa Catalina&#44; NefroLinares and Centro de Di&#225;lisis Playa de la Victoria&#41; who met the inclusion criteria &#40;59 patients&#41;&#46; Of these&#44; 52 &#40;88&#46;13&#37;&#41; patients ultimately agreed to participate in the research study&#46; Patient loss was due to a refusal to participate by 3 patients &#40;5&#46;1&#37;&#41; and clinical problems during the research study in 4 patients &#40;6&#46;7&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measurement tools</span><p id="par0040" class="elsevierStylePara elsevierViewall">The following instruments were administered&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SF-36 Functioning and Quality-of-Life Scale</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">30</span></a> in the Spanish version by Alonso&#44; Prieto and Ant&#243;&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a> This instrument evaluates the impact of disease on adaptive functioning and provides a state-of-health profile&#46; It contains 36 items with a 2-&#44; 3-&#44; 5- and 6-point Likert response format&#44; depending on the item&#44; with a range from 0 to 100&#58; the higher the score&#44; the better the state of health&#46; It comprises 8 dimensions&#58; <span class="elsevierStyleItalic">physical function</span>&#44; <span class="elsevierStyleItalic">physical role</span>&#44; <span class="elsevierStyleItalic">body pain</span>&#44; <span class="elsevierStyleItalic">general health</span>&#44; <span class="elsevierStyleItalic">vitality</span>&#44; <span class="elsevierStyleItalic">social function</span>&#44; <span class="elsevierStyleItalic">emotional role</span> and <span class="elsevierStyleItalic">mental health</span>&#46; By aggregating these dimensions&#44; 2 components were calculated&#58; a physical health component &#40;PHC&#41; and a mental health component &#40;MHC&#41;&#46; The internal consistency &#40;Cronbach&#39;s &#945;&#41; of the different scales ranged between 0&#46;7 and 0&#46;94&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a> For the PHC&#44; Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> was 0&#46;94&#44; and for the MHC&#44; it was 0&#46;89&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">32</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Revised Somatic Symptom Scale &#40;ESS-R&#41;</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">33</span></a> This instrument evaluates physical health based on symptoms corresponding to the most important somatic&#47;physiological systems&#46; It contains 90 items with a 5-point Likert response format with a range from 0 to 4&#58; the higher the score&#44; the greater the symptoms&#46; They are classified according to the following subscales&#58; <span class="elsevierStyleItalic">general immunological&#44; cardiovascular&#44; respiratory&#44; gastrointestinal&#44; sensorineural&#44; skin&#47;allergy-related&#44; musculoskeletal&#44; female reproductive</span> and <span class="elsevierStyleItalic">genitourinary</span>&#46; The latter 2 subscales were removed from the study&#46; The internal consistency &#40;Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span>&#41; of the different scales ranged between 0&#46;79 and 0&#46;84&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">33</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Hospital Anxiety and Depression Scale &#40;HAD&#41;</span><a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">34</span></a> in the Spanish version by Caro and Ib&#225;&#241;ez<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">35</span></a>&#46; This instrument evaluates anxiety and depression levels without taking somatic symptoms into account&#44; and so it limits the possibility that symptoms specific to the disease will contribute to scores&#46; It contains 14 items with a 4-point Likert response format with a range from 0 to 3&#58; the higher the score&#44; the greater the anxiety or depression&#46; It comprises 2 subscales&#58; one for anxiety and one for depression&#46; The instrument had good internal consistency&#44; with a Cronbach&#39;s <span class="elsevierStyleItalic">&#945;</span> coefficient of 0&#46;82 for the anxiety subscale and 0&#46;84 for the depression subscale&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">34</span></a></p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure</span><p id="par0060" class="elsevierStylePara elsevierViewall">For patient selection&#44; the dialysis centres in the Spanish province of Ja&#233;n were contacted &#40;see section&#58; Participants&#41;&#46; Once the protocol had been approved by the sites&#44; the nephrologists selected the patients who met the inclusion criteria&#46; The objectives of the study were explained to these patients&#44; and those who agreed to participate signed an informed consent form&#46; Information on sociodemographic and clinical variables was collected during HD sessions through an interview with the patient&#46; Next&#44; a booklet with the questionnaires used in the study was given according to a counterbalanced order&#46; Data was collected during the months of February to June 2014&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">To increase reliability&#44; reduce the number of statistical analyses and minimise the likelihood of a type <span class="elsevierStyleSmallCaps">I</span> error&#44; statistical analyses were performed with the total scores for each instrument&#46; The 8 dimensions of the SF-36 were reduced to the PHC&#44; the MHC and a total score for HRQoL&#44; based on the average of the 2 subcomponents&#46; A total score was obtained from the ESS-R with the sum of all the symptoms reported&#46; A general score for mood was obtained from the HAD with the sum of the scores in depression and anxiety&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The analysis of the associations between the variables considered to be predictive &#40;somatic symptoms and mood&#41; and the variables identified as dependent &#40;HRQoL in its physical component&#44; its mental component and total&#41; was performed using an exploratory correlational analysis through bivariate Pearson correlations and&#44; subsequently&#44; with a multiple regression analysis&#46; In the regression analysis&#44; as a first step&#44; the variables of age and time in dialysis were entered to control their effect on the subsequent analyses&#46; As a second step&#44; somatic symptoms and mood were entered jointly&#46; In a prior analysis&#44; the interaction factor of <span class="elsevierStyleItalic">somatic symptoms<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>mood</span> was calculated and entered in the regression analyses&#46; These analyses did not show any interaction effect and were omitted from the results report&#46; To compare the HRQoL levels of the patients with CKD in HD with those of the general Spanish population&#44; the difference in means between each patient&#39;s score and the reference values for the SF-36 in the Spanish population was calculated&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">36</span></a> The difference in means obtained was analysed using Student&#39;s <span class="elsevierStyleItalic">t</span> test for one sample&#46; The level of significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The data were analysed with the SPSS v&#46; 19&#46;0 statistics program&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Levels of health-related quality of life&#44; anxiety&#44; depression and somatic symptoms</span><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the scores for HRQoL in its physical component&#44; its mental component and total&#44; together with the reference values for the Spanish population&#46; As may be observed&#44; the HRQoL levels shown by the patients remained below those obtained by the instrument normative sample&#46; Moreover&#44; the levels shown for the PHC were significantly lower than the levels shown for the MHC &#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;4&#46;81&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the scores for anxiety&#44; depression and overall mood&#46; Definite and likely cases of anxiety comprised 36&#46;5&#37; of the sample&#44; while those of depression comprised 27&#37; of the sample evaluated&#46; The value for total somatic symptoms reported was 83&#46;17&#44; with a standard deviation of 45&#46;51&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Bivariate correlation analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the correlations between HRQoL in its physical and mental component&#44; as well as total&#44; with mood and total somatic symptoms&#46; The results showed a significant negative association between HRQoL&#44; mood and somatic symptoms &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01 in all the correlations&#41;&#46; The correlations of HRQoL in its 3 components were higher with mood than with somatic symptoms&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Multiple regression analysis to predict health-related quality of life</span><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> presents the results of the multiple regression analysis to predict HRQoL&#46; Age and time in dialysis were not significantly associated with any of the HRQoL indicators&#46; The results obtained showed that mood was the most significant predictor &#40;negative association&#41; of the 3 HRQoL indicators&#46; Total somatic symptoms also negatively predicted the PHC component of HRQoL and overall HRQoL&#44; but with a lower associative capacity than mood&#46; To illustrate these associations&#44; <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a> show the scatered plots and the regression line that correlates mood to the PHC and the MHC&#44; respectively&#46; Using a stepwise regression procedure for the 2 predictors accurately reproduced the results&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Our main objective was to compare the predictive capacity of somatic symptoms reported and mood with respect to HRQoL in patients with CKD in HD&#46; First&#44; the possibility of there being an interactive effect among the variables was analysed&#46; The results were negative&#58; both variables exerted additive rather than interactive effects&#46; Given that prior studies have shown that age and time in dialysis may affect quality of life&#44;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;37&#44;38</span></a> we performed a statistical control of the effect of both variables&#46; Neither age nor time in dialysis was found to be significantly associated with HRQoL in any of the regression analyses performed&#46; One potential explanation for that may lie in the limited range of variability for both variables in our sample&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The results of the regression analyses showed that mood was the main predictor of HRQoL&#44; both in the PHC and in the MHC&#46; Given that the association was negative&#44; a more negative mood was associated with a decrease in HRQoL indicators&#46; In addition&#44; with a lower degree of association&#44; somatic symptoms also negatively predicted the physical component of HRQoL and overall HRQoL&#46; Taken together&#44; mood and somatic symptoms accounted for 68&#37; of variance in total HRQoL&#44; 64&#37; of variance in the MHC and 62&#37; of variance in the PHC&#46; Given the magnitude of the standardised <span class="elsevierStyleItalic">&#946;</span> statistics observed &#40;between &#8722;0&#46;624 and &#8722;0&#46;709&#41;&#44; these results showed convincing evidence about the influence of mood on the determination of quality of life&#46; These results were consistent with those found in prior studies that have shown the negative influence of anxiety and depression on HRQoL&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#44;21&#8211;24</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Our results agree with findings from previous studies<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">2&#44;20&#44;36&#44;37&#44;39&#44;40</span></a> that have shown that the HRQoL levels reported by patients&#44; in both its physical component and its mental component&#44; are well below the reference values of the SF-36 questionnaire in the Spanish population&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">36</span></a> It should be noted that the PHC obtained an average significantly lower than the MHC&#46; This indicated that patients with CKD in HD perceive and are aware of the physical limitations deriving from the disease&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">16</span></a> beyond the potential repercussions in the social and emotional sphere&#46; These results were consistent with prior studies&#44; in which it has been observed that&#44; in advanced CKD in the HD phase&#44; the patient has physical limitations&#44; that cannot be attributed to other comorbid conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">41</span></a> Symptoms specific to the disease limit physical activity&#44; interfere with daily activities&#44; intensify pain and its effect on usual work&#44; and lead the patient to make a worse assessment of his or her state of health&#46; Regarding mood&#44; probable-certain cases of anxiety comprised 36&#46;5&#37; of the sample&#44; and those of depression comprised 27&#37; of the sample&#46; Therefore&#44; it should be noted that there were higher values for abnormalities linked to anxiety than to depression&#46; It is known that physiological manifestations linked to anxiety &#40;muscle tension&#44; sympathetic hyperarousal&#44; parasympathetic inhibition&#44; etc&#46;&#41;&#44; when they occur for long periods of time&#44; may promote somatic complications such as hypertension<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">42</span></a> and foster a greater report of physical symptoms in patients with CKD&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a> The percentages observed for the two disorders were greater than the reported prevalence of disorders of anxiety and depression in the general Spanish population<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">43</span></a> and agree with prior studies on the prevalence of anxiety and depression in patients in dialysis&#44; which according to other studies have been around 27&#37;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">44</span></a> for anxiety and between 20&#37; and 30&#37; for depression&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">45</span></a> Focusing on the somatic symptoms reported&#44; the levels shown by our sample of patients in HD are considered to be high as compared with the results obtained&#44; with the same evaluation tool&#44; in a group of healthy people with similar sociodemographic characteristics &#40;<span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#46;30&#59; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#46;14&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">17</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">It must be emphasised that CKD and HD treatment are highly stressful life events&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> Given the duration of the disease and its prognosis&#44; the stress is chronic&#46; This chronic stress leads to anxiety and depressive states with uncertainty about the future &#40;dialysis or transplant for survival&#41; and fear of losing control of his or her life are essential matters&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">46</span></a> Anxiety is a common problem in the kidney patient that is present since the initiation of HD treatment<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">11&#44;47</span></a> and it is associated to a lower quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">48</span></a> Similarly&#44; vital stress and the limitations imposed by a chronic disease such as CKD induce powerlessness and loss of hope that&#44; depending on how patients cope with them&#44; may lead to depression&#46; If the depressive symptoms of the patient in dialysis become chronic or recurrent&#44; they may lead the patient to experience a substantial decrease in his or her capacity to take care of day-to-day responsibilities&#44; to assess his or her current and future health more negatively&#44; to perceive more tiredness and exhaustion&#44; to experience intensified body pain and to suffer a decline in his or her social life and mental health&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In chronic kidney diseased patients there is a high comorbidity between anxiety and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">49</span></a> Given that the origin of this anxious&#47;depressive mood normally results from the difficulty of adapting to a stressful life event&#44; which requires profound changes in the patient&#39;s life &#40;CKD itself&#41;&#44; the most common and correct psychiatric diagnosis is adjustment disorder with mixed anxiety and depressed mood&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">14</span></a> This study analysed mood as comprised of the combined influence of anxiety and depression&#46; The results showed that a worse mood predicts a decrease in the kidney patient&#39;s quality of life&#46; These results were along the lines of other studies that have shown the effect of emotional disturbances in CKD and their interference with how patients think&#44; feel and act regarding the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">11&#44;14&#44;23</span></a> Negative mood may intensify the manifestations of the disease and worsen its course and progression&#44; as well as interfere with treatment&#44; as it is associated with non-adherence behaviours&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#44;23&#44;39</span></a> When the renal patient has a negative mood &#40;anxiety and depression&#41;&#44; he or she loses perceived control over the disease and its treatment&#46; This low perceived self-efficacy may derive from engagement in counterproductive behaviours such as low adherence&#44; abusive use of medical services and improper performance of nephrology indications and required care&#46; These behaviours may cause serious consequences for the patient&#44; including malnutrition&#44; neuropathies&#44; bone diseases&#44; heart failure&#44; etc&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">50</span></a> and lead to a more pronounced deterioration in quality of life<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">12</span></a> and an increased risk of mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">11&#44;12&#44;39</span></a> These results noted the importance of early evaluation<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">51</span></a> and treatment of negative moods &#40;anxiety and depression&#41; in kidney patients&#44; as a form of promoting better clinical results and lowering the disease&#39;s interference with HRQoL&#46; Therefore&#44; for comprehensive care of the kidney patient&#44; it is very important to address negative moods&#46; This may modulate the disease&#39;s interference with the patient&#39;s adaptive functioning&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">One limitation of our study lay in the inclusion criterion of being 60 years of age or younger&#44; given that the population in dialysis is generally older&#46; This inclusion criterion reduced the sample size&#46; The objective of this criterion was to ensure optimal understanding of psychological tests and therefore achieve greater validity&#46; Consequently&#44; our results could not be directly extrapolated to other age ranges&#46; Another limitation lay in the procedure used to measure somatic symptoms&#44; using self-report scales&#46; It would be advisable to replicate the results obtained with other more direct health indicators&#46; However&#44; the scale used to measure somatic symptoms had good psychometric properties and validity consistent with external measures of state of health&#44; such as self-reports on diseases and external criteria for health such as clinical diagnoses&#44;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">33</span></a> and such scales have become indispensable for research in health&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion&#44; the kidney patient&#39;s mood &#40;anxiety and depression&#41; is a powerful predictor of HRQoL&#44; in both its physical and mental components&#44; while somatic symptoms are a predictor of PHC&#46; Bearing in mind the high prevalence of anxiety and depression in the kidney patient&#44; their negative effect on HRQoL and their importance in the determination of rates of morbidity&#47;mortality due to various diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> these results have shown the need for the kidney patient to be evaluated and addressed preventively<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">51</span></a> as early as the predialysis phase to equip him or her with coping resources to manage stress and the needs for adaptation imposed by his or her disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">26&#44;52</span></a> This may result in lower subsequent interference by the disease with HRQoL and foster an improvement in the course and progression of the disease&#44; by promoting adaptive behaviours associated with greater adherence to treatment and the patient&#39;s more active involvement in disease management&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">52</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Resumen"
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          "titulo" => "Introduction"
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              "identificador" => "sec0040"
              "titulo" => "Levels of health-related quality of life&#44; anxiety&#44; depression and somatic symptoms"
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              "titulo" => "Bivariate correlation analysis"
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              "titulo" => "Multiple regression analysis to predict health-related quality of life"
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    "fechaRecibido" => "2015-02-04"
    "fechaAceptado" => "2015-12-05"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Health-related quality of life"
            1 => "Chronic renal disease"
            2 => "Haemodialysis"
            3 => "Anxiety"
            4 => "Depression"
            5 => "Somatic symptoms"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Calidad de vida relacionada con la salud"
            1 => "Enfermedad renal cr&#243;nica"
            2 => "Hemodi&#225;lisis"
            3 => "Ansiedad"
            4 => "Depresi&#243;n"
            5 => "S&#237;ntomas som&#225;ticos"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare the predictive capacity of self-reported somatic symptoms and mood &#40;depression and anxiety&#41; on health-related quality of life &#40;HRQoL&#41; in patients with chronic renal disease&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Data were obtained from 52 patients undergoing haemodialysis&#46; Measures included &#40;a&#41; the SF-36 health survey&#44; &#40;b&#41; the somatic symptoms scale revised &#40;ESS-R&#41; and &#40;c&#41; the hospital anxiety and depression scale &#40;HADS&#41;&#46; Multiple regression was the main method of statistical analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients exhibited HRQoL levels below normative values&#44; with anxiety and depression prevalence at 36&#46;5&#37; and 27&#37;&#44; respectively&#46; Mood was the strongest predictor of physical &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;624&#41; and mental &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;709&#41; HRQoL&#46; Somatic symptoms were also associated with physical HRQoL&#44; but their predictive value was weaker &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;270&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">These results indicate that mood is a superior predictor of the physical and mental components of HRQoL in patients compared with the number and severity of physical symptoms&#46; The data underline the importance of assessing negative emotional states &#40;depression and anxiety&#41; in kidney patients as a basis for intervention&#44; which may facilitate reduction of the impact of chronic renal disease on HRQoL&#46;</p></span>"
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            "titulo" => "Objective"
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            "titulo" => "Method"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar la capacidad predictiva de los s&#237;ntomas som&#225;ticos informados y el estado an&#237;mico &#40;depresi&#243;n y ansiedad&#41; sobre la calidad de vida relacionada con la salud &#40;CVRS&#41; en pacientes con enfermedad renal cr&#243;nica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se evalu&#243; a 52 pacientes en tratamiento de hemodi&#225;lisis mediante&#58; a&#41; la escala de funcionamiento y calidad de vida &#40;SF-36&#41;&#44; b&#41; la escala de s&#237;ntomas som&#225;ticos-revisada &#40;ESS-R&#41; y c&#41; la escala de ansiedad y depresi&#243;n en hospital &#40;HAD&#41;&#46; Los datos fueron analizados mediante an&#225;lisis de regresi&#243;n m&#250;ltiple&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes mostraron niveles de CVRS inferiores a los valores normativos del instrumento&#44; as&#237; como un 36&#44;5&#37; de prevalencia de ansiedad y un 27&#37; de depresi&#243;n&#46; El estado an&#237;mico fue el predictor m&#225;s significativo de la CVRS&#44; tanto en su componente f&#237;sico &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;624&#41; como mental &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;709&#41;&#46; Los s&#237;ntomas som&#225;ticos predijeron&#44; con menor fuerza asociativa&#44; el componente de salud f&#237;sica &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;270&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El estado an&#237;mico es un mejor predictor de los componentes f&#237;sico y mental de la CVRS que el n&#250;mero e intensidad de los s&#237;ntomas f&#237;sicos informados por los pacientes&#46; Estos resultados se&#241;alan la importancia de evaluar e intervenir sobre los estados emocionales negativos &#40;depresi&#243;n y ansiedad&#41; en los pacientes renales&#46; Estas intervenciones pueden repercutir en una menor interferencia de la enfermedad sobre la CVRS en el paciente en hemodi&#225;lisis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Perales Montilla CM&#44; Duschek S&#44; Reyes del Paso GA&#46; Calidad de vida relacionada con la salud en la enfermedad renal cr&#243;nica&#58; relevancia predictiva del estado de &#225;nimo y la sintomatolog&#237;a som&#225;tica&#46; Nefrologia&#46; 2016&#59;36&#58;275&#8211;282&#46;</p>"
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                  \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">Variables&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>&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">&#37;&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  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>20&#8211;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&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&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>30&#8211;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&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>40&#8211;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#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  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Level of education</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No schooling&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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&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>Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#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="elsevierStyleHsp" style=""></span>Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#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="elsevierStyleHsp" style=""></span>University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#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  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Time in dialysis &#40;years&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#46;5&#8211;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#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="elsevierStyleHsp" style=""></span>11&#8211;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#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"><span class="elsevierStyleHsp" style=""></span>&#8805;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;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  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Causes of CKD</span></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="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#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"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#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="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#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="elsevierStyleHsp" style=""></span>Polycystic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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&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>Pyelonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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&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="char" valign="top">3&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;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  " colspan="3" 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="3" align="left" valign="top"><span class="elsevierStyleItalic">Previous transplant</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&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;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="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1393549.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and clinical characteristics of the sample of patients used&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The results are presented as direct scores together with the reference values in the general Spanish population&#46; The result of the comparison of means using Student&#39;s <span class="elsevierStyleItalic">t</span> test is also presented&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Kidney patients</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Spanish population</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Comparison of means &#40;<span class="elsevierStyleItalic">t</span>-test&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean&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">SD&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">Mean&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">SD&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">Dif&#46; in means&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">t</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"><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">PHC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;31&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;9&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&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">MHC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;21&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;6&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&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 HRQoL&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;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;26&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;8&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1393545.png"
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        ]
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Means and standard deviations &#40;SDs&#41; for HRQoL in its physical component &#40;PHC&#41;&#44; its mental component &#40;MHC&#41; and total&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The number and percentage of patients who met the scale&#39;s criteria for normality&#44; probable case and definite clinical case are indicated&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anxiety</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Depression</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Overall score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Mean &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">7&#46;13 &#40;4&#46;41&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">5&#46;50 &#40;4&#46;26&#41;</th><th class="td" title="table-head  " align="center" valign="top" scope="col">12&#46;63 &#40;7&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Scale criteria&nbsp;\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">Cases&nbsp;\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">Percentage&nbsp;\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">Cases&nbsp;\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">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Normality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#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">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&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">Probable case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5&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">Definite case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5&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></tbody></table>
                  """
              ]
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                0 => "xTab1393548.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Means and standard deviations &#40;SDs&#41; for anxiety&#44; depression and overall mood&#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="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PHC&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">MHC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total QoL&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">Total symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;62<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;57<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;62<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;76<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;80<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;0&#46;81<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1393546.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Correlations between HRQoL in its physical component &#40;PHC&#41;&#44; its mental component &#40;MHC&#41; and total&#59; mood&#59; and total somatic symptoms&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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