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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The symptoms of chronic kidney disease &#40;CKD&#41; are non-specific and very variable&#46; Chronic musculoskeletal pain &#40;CMP&#41; is a very common symptom in CKD<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> and has a significant effect on the perception of health and quality of life of patients who suffer from it&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Previous studies have shown that&#44; despite the high prevalence of CMP&#44; it is very often undervalued and is usually attributed to different processes&#44; related or not to chronic uraemia&#44; such as bone and mineral disorders&#44; neuritis&#44; or inflammatory or degenerative osteoarthritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#8211;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The CMP in CKD is often associated with other symptoms attributable to uraemia&#44; such as insomnia and fatigue&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#8211;3</span></a> or to psychiatric disorders such as anxiety or depression&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> These patients need to take large doses of painkillers which&#44; with the altered drug metabolism associated with uraemia&#44; increases the risk of adverse reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the importance of CMP in CKD&#44; very few studies have analysed the clinical characteristics and determining factors&#46; A better understanding of the origin and characteristics of the pain could help us to design more specific and effective treatment strategies&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aims of this study were to determine the prevalence of CMP in patients with advanced CKD &#40;ACKD&#41; and to analyse associations with clinical and biochemical parameters&#44; the potential relationship with drugs and the effect on survival&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This cross-sectional&#44; observational study included incident patients referred to the ACKD clinic from January 2000 to November 2014&#46; They were all aged over 18 and had a glomerular filtration rate of less than 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; No patients were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As part of the clinical interview&#44; which was conducted by a nephrologist in all cases&#44; information on the presence of uraemia-associated symptoms was obtained by taking a specifically focused patient history&#44; as occurs with all patients in our ACKD clinic according to protocol&#46; The symptoms included were&#58; anorexia&#59; nausea or vomiting&#59; oedema&#59; dyspnoea&#59; decreased physical exercise&#59; fatigue &#40;muscle weakness&#41;&#59; pruritus&#59; ecchymosis or epistaxis&#59; cramps&#59; cold intolerance&#59; night-time insomnia&#59; daytime drowsiness&#59; restless legs&#59; myoclonus&#59; and CMP&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">CMP was defined as the presence of muscle or bone pain in any location &#40;upper or lower limbs or trunk&#41; for more than three months&#44; not attributable to trauma&#44; and requiring analgesic therapy at least three times a week&#46; The intensity of the CMP was not collected as data for the study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Cramp was defined as involuntary&#44; sustained and painful contraction of muscles or muscle groups in the lower or upper limbs&#44; which occurred spontaneously and essentially at rest&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">To characterise patients with or without pain&#44; in addition to demographic data and body mass index&#44; the following were included as variables of potential interest&#58; the Davies comorbidity index&#59; haemoglobin&#59; total leucocyte and neutrophil counts&#59; MDRD estimated glomerular filtration rate &#40;eGFR&#41;&#59; and plasma concentrations of uric acid&#44; calcium&#44; phosphorus&#44; bicarbonate&#44; PTH&#44; alkaline phosphatase&#44; serum albumin and C-reactive protein&#46; All the clinical biochemistry parameters were determined using conventional laboratory methods&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Previous history of gouty arthritis and the use of drugs of interest for their potential relationship with CMP&#44; such as statins&#44; allopurinol and erythropoiesis stimulating agents &#40;ESA&#41;&#44; were also included&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In a subgroup of 671 unselected patients&#44; serum creatine kinase &#40;CK&#41; was determined to study the association between rhabdomyolysis and CMP or cramps&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In another subgroup of 361 unselected patients&#44; serum levels of 25-hydroxy-cholecalciferol were determined for comparison between patients with and without CMP&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design and statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">In this cross-sectional study&#44; we describe the prevalence of CMP&#44; association with other symptoms&#44; clinical and biochemical characteristics of patients who suffer from CMP&#44; and the most significant differences compared to the rest of the study group&#46; In addition&#44; to establish whether CMP is predictive of patient outcome&#44; a univariate comparison was made of survival of patients with and without CMP&#44; adjusted for age and gender&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Descriptive statistics are presented as mean and standard deviation or as median and interquartile ranges &#40;IQ&#41; for continuous variables and as percentages for categorical variables&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">For comparison of continuous variables&#44; parametric tests &#40;Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41; or non-parametric tests &#40;Mann&#8211;Whitney&#41; were used&#44; depending on the type of distribution&#44; while the chi-square test was used for categorical variables&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">To establish the independent association of the study variables with CMP in the study group&#44; multivariate logistic regression was used&#46; A first analysis was performed to determine the symptoms best associated with CMP&#46; The following independent variables were included in another separate model&#58; age&#59; gender&#59; comorbidity index&#59; diabetes mellitus&#59; body mass index&#59; leucocytes&#59; neutrophils&#59; uric acid&#59; calcium&#59; phosphorus&#59; bicarbonate&#59; PTH&#58; C-reactive protein&#59; and treatment with statins&#44; allopurinol or EPO&#46; Automated stepwise regression was used for the selection of variables with the best predictive models&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">To analyse the differences in survival&#44; Kaplan&#8211;Meier curves &#40;univariate analysis&#41; and a Cox multivariate proportional hazard model were used to adjust for differences in survival with age and gender only &#40;a more exhaustive adjustment was not justified&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered as statistically significant&#44; and all the <span class="elsevierStyleItalic">p</span> values shown are bilateral&#46; Statistical analyses were performed with the IBM-SPSS 21&#46;0 program &#40;IBM Corp&#46; Armonk&#44; USA&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Prevalence of chronic musculoskeletal pain and associated symptoms</span><p id="par0100" class="elsevierStylePara elsevierViewall">The demographic&#44; clinical and clinical biochemistry characteristics of the 1169 patients included in the study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Of the patients studied&#44; 441 &#40;38&#37;&#41; had CMP&#46; CMP was more common among females than males &#40;49&#37; vs 28&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The majority of the patients used paracetamol or metamizole for analgesia&#46; At the time of their first consultation&#44; over 20&#37; of the patients with CMP were also assiduously taking nonsteroidal anti-inflammatory drugs&#46; Less than 15&#37; were mixing paracetamol with tramadol or codeine&#46; Less than 5&#37; of the patients with CMP were being treated with opioids &#40;fentanyl or other similar drugs&#41; or pain-perception modifiers &#40;gabapentin or pregabalin&#41;&#59; the significant adverse effects suffered by the patients treated with these drugs are worth mentioning&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The prevalence of other symptoms is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> according to gender&#46; The majority of the symptoms were more prevalent among females than males&#46; Apart from CMP&#44; other symptoms that were notable due to their high prevalence were fatigue&#44; poor physical activity level&#44; cold intolerance and pruritus&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The prevalence of other symptoms is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> according to age quartile&#46; There was a marked increase in CMP and other symptoms like fatigue and decreased physical exercise in the top 2 age quartiles &#40;aged<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>69&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">By logistic regression&#44; the symptoms most often associated with CMP were &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; fatigue&#44; pruritus&#44; cramps&#44; ecchymosis&#44; insomnia&#44; oedema and dyspnoea&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Rhabdomyolysis and chronic musculoskeletal pain</span><p id="par0130" class="elsevierStylePara elsevierViewall">In order to investigate whether or not rhabdomyolysis could cause or contribute to CMP&#44; we included the CK plasma concentrations from analyses of 671 non-selected patients &#40;CK started to be measured in all patients from 2006 onwards&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">No significant differences were found between patients with or without CMP in mean CK concentration according to gender &#40;males with or without CMP&#58; 124<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>120 vs 140<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>169<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; females with or without CMP&#58; 91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>59 vs 94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>79<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nor was there a higher rate of CK above normal limits &#40;&#62;194<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41; in patients with CMP versus those without CMP &#40;9&#46;7 vs 14&#46;4&#37;&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">We did find a higher mean plasma concentration of CK in men who had cramp compared to those not suffering from cramp &#40;161<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>163 vs 120<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>149<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41;&#46; In women with cramp&#44; CK levels were also higher&#44; although compared to women without cramp&#44; the difference was only bordering on statistical significance &#40;101<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>72 vs&#46; 86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>67<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;058&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">CK elevation above normal was more common in all patients &#40;male and female&#41; with cramp than those who did not suffer from cramp &#40;17&#46;4&#37; vs 9&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In 391 patients treated with statins and in whom CK was determined&#44; CK levels were significantly higher than in the 280 patients not taking statins &#40;133<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>135 vs 94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>111<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Also&#44; a CK concentration above the normal limit was more common among patients on statins than among those not on statins &#40;17 vs 6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Serum levels of 25-hydroxycholecalciferol and chronic musculoskeletal pain</span><p id="par0160" class="elsevierStylePara elsevierViewall">No significant differences were found in 25-hydroxycholecalciferol levels determined in 203 patients without CMP and 158 patients with CMP&#58; 14&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4 vs 13&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Nor were significant differences found between those with or without CMP in the percentage of patients with serum 25-hydroxycholecalciferol levels below 20<span class="elsevierStyleHsp" style=""></span>ng&#47;ml &#40;82 vs 77&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;317&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Determining factors in chronic musculoskeletal pain</span><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic&#44; clinical and clinical biochemistry characteristics of the patients with or without CMP&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">CMP was most common in older women with comorbidity&#46; In addition to diabetes mellitus&#44; other conditions significantly associated with CMP were heart failure &#40;100&#37; of the patients with heart failure had CMP&#41; and COPD &#40;46&#37; had CMP&#41;&#46; In contrast&#44; other comorbidities&#44; such as coronary heart disease&#44; CVA or peripheral ischaemia&#44; or a history of gouty arthritis were not associated with higher rates of CMP&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Patients with CMP were more obese&#44; had higher C-reactive protein and total leucocyte levels than the other patients&#44; but no differences were found in clinical biochemistry parameters that characterise metabolic bone disease&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">No differences were found in the prescribing of statins&#44; allopurinol or EPO&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">By multivariate logistic regression&#44; the best predictive model for CMP &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; had the following characteristics&#58; female&#59; elderly&#59; obese&#59; comorbidity&#59; and elevated inflammatory markers &#40;C-reactive protein and non-neutrophil leucocytes&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Chronic musculoskeletal pain and survival</span><p id="par0195" class="elsevierStylePara elsevierViewall">We followed up the progress of 1078 patients&#44; collecting data on death from any cause and date with censoring for end of follow-up &#40;February 2014&#41;&#44; loss to follow-up or kidney transplantation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The median follow-up time was 1075 days &#40;IQ ranges&#58; 456&#8211;1756 days&#41;&#46; During this period&#44; 489 patients died &#40;42&#37; of the study population&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows the survival curves for the patients who had CMP as an initial symptom and those who did not&#46; Although the difference proved to be significant in the univariate comparison&#44; when just age and gender were included in a Cox proportional hazard regression model&#44; the association between CMP and mortality was no longer significant &#40;Wald 0&#46;193&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;661&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0210" class="elsevierStylePara elsevierViewall">This study shows CMP to be a highly prevalent symptom in patients with CKD&#44; which is more common in older&#44; obese women with comorbidity&#44; especially diabetes&#44; heart failure and COPD&#44; and associated with inflammatory markers&#46; Patients with CMP were also more likely to have fatigue&#44; pruritus&#44; cramps&#44; insomnia&#44; oedema and dyspnoea&#46; In contrast&#44; CMP did not appear to be associated with alterations in bone and mineral metabolism&#44; or significant differences in plasma levels of vitamin D&#44; rhabdomyolysis&#44; use of drugs &#40;statins&#44; EPO&#41; or gouty arthritis&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">It is estimated that 10&#8211;20&#37; of the general adult population suffers from some form of chronic pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#8211;13</span></a> It is reported to be more common among older women&#44; with the prevalence heavily influenced by physical factors &#40;obesity&#44; comorbidity&#41;&#44; emotional factors &#40;separation&#44; divorce&#44; widowhood&#41;&#44; psychological factors &#40;anxiety&#44; depression&#41; and social factors &#40;education&#44; employment and income&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> Around 50&#8211;70&#37; of these pain syndromes are of musculoskeletal origin &#40;CMP&#41;&#44; signifying that somewhere in the range of 5&#8211;14&#37; of the general population is affected by CMP&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#8211;14</span></a> In fact&#44; one study in Spain states that over 20&#37; of the general population suffers from CMP&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Despite the already high prevalence in the general population&#44; the figures observed in our population with CKD were much higher still&#44; making it extremely unlikely that this finding could be attributable to a variation within normal limits&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">It has been reported that CMP is very prevalent in patients on dialysis&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a> but also in CKD in predialysis stages&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;5&#44;16</span></a> and even in kidney transplant patients&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">As with the general population&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">17&#44;18</span></a> in this study&#44; we also found a higher prevalence of CMP among women than among men&#46; The reason for CMP being more likely to occur in females is not fully understood&#46; Apart from the fact that women tend to be much more explicit than men when giving their medical history &#40;subjective assessment of the authors&#41;&#44; which might also explain the higher prevalence of other symptoms in the women compared to the men in our study population&#44; there is a hypothesis that females have greater sensitivity to pain through mechanisms that may be related to both peripheral and central perception systems&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">In this study&#44; we ruled out CMP being associated with rhabdomyolysis&#44; a disease that was diagnosed from serum CK levels&#46; However&#44; we did find abnormally high CK levels in patients treated with statins and in those who reported frequent cramps&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Administration of EPO has been found to cause flu-like illness with increased sensitivity to pain&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> In this study&#44; we did not find a higher rate of treatment with ESA-EPO in patients with CMP&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">In a study conducted in Asian patients with CKD&#44; hyperuricaemia and gouty arthritis were found to be associated with an increased incidence of CMP&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> In our study&#44; we observed no significant associations between CMP and uric acid concentrations in blood&#44; treatment with xanthine-oxidase inhibitors&#44; or history of gouty arthritis&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">An association has been reported between reduced levels of blood vitamin D &#40;25-hydroxycholecalciferol&#41; and CMP in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> Low serum levels of vitamin D are very common in CKD and&#44; although the patients with CMP in our study had lower levels&#44; the difference with respect to those without CMP was not statistically significant&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The prevalence of CMP increased in patients with comorbidity&#59; particularly marked was that associated with heart failure &#40;100&#37; of the cases&#41;&#46; This finding also helps explain the association found between CMP and both oedema and dyspnoea&#46; Diabetes mellitus and COPD are also associated with CMP&#46; This increased prevalence of pain has previously been reported in the literature in COPD patients<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">One surprising finding in this study was the lack of association between bone-mineral biochemical alterations and CMP&#46; Other studies have found a relationship between CMP and adynamic bone disease&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> and also with high-remodelling bone disease<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#44;7&#44;22</span></a>&#59; the latter of the two also being characterised by the fact that the pain tends to be more intense&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In this study&#44; CMP was associated with poorer survival compared to those who did not have CMP&#46; The association between CMP and mortality rates in CKD has also been demonstrated in another study&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> However&#44; when we adjusted the proportional hazard model simply with gender and age in our patients&#44; the statistical significance of CMP on the prediction of survival was cancelled out&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">As occurs in the general population&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a> the CMP in our patients was associated with higher levels of inflammatory markers&#44; and this finding could help us to understand the possible mechanisms underlying the development of pain in CKD&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25&#8211;27</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Chronic inflammatory states are capable of sensitising peripheral nociceptors &#40;pain receptors&#41; due to the numerous inflammatory mediator substances &#40;interleukins&#44; TNF&#44; prostaglandins&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a> The sensitisation of nociceptors can sometimes be so intense that they can end up being activated spontaneously without the mediation of any injury&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">These same inflammatory mediators&#44; and perhaps certain uraemic toxins&#44; may also play an important role in the sensitisation of pain perception in the central nervous system and the balance of endogenous pain inhibitors &#40;endorphins&#44; endocannabinoids&#44; GABA&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25&#8211;27</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">This study has certain limitations&#46; It is a cross-sectional study&#44; in which we did not estimate the pain intensity&#44; and nor did we assess or describe the severity of musculoskeletal damage and its relationship with the prevalence of CMP&#46; Moreover&#44; we did not collect information on the patients&#8217; mental health status or on their social&#47;economic&#47;cultural circumstances&#44; and that could affect the interpretation of the results&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">In conclusion&#44; CMP is highly prevalent in patients with advanced CKD and is associated with other symptoms common in chronic uraemia&#46; The main characteristics of the patient with CMP are&#58; older female&#59; obesity&#59; certain comorbidities&#59; and elevated inflammatory markers&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Further studies are needed to analyse what type of analgesics or what additional supportive measures could be more effective and less toxic in this population&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0300" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic musculoskeletal pain &#40;CMP&#41; is a very common symptom in patients with chronic kidney disease &#40;CKD&#41;&#44; and is associated with a significant deterioration in quality of life&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aims</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence and clinical characteristics associated with CMP in patients with advanced CKD not on dialysis&#44; and to analyse their relation with other uraemic symptoms and their prognosis significance&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study to analyse the uraemic symptoms of an unselected cohort of patients with CKD stage 4&#8211;5 pre-dialysis&#46; In order to characterise patients with CMP&#44; demographic and anthropometric data were collected&#44; as well as data on comorbidities and kidney function&#46; In addition&#44; inflammatory parameters&#44; uric parameters&#44; bone mineral metabolism including 25-hydroxycholecalciferol &#40;25-OHCC&#41;&#44; creatine kinase and drugs of potential interest including allopurinol&#44; statins and erythropoiesis-stimulating agents were recorded&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study group consisted of 1169 patients &#40;mean age 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 years&#44; 54&#37; male&#41;&#46; A total of 38&#37; of patients complained of CMP&#44; and this symptom was more prevalent in women than in men &#40;49 vs&#46; 28&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Muscle weakness&#44; pruritus&#44; muscle cramps&#44; ecchymosis&#44; insomnia&#44; oedema and dyspnoea were the most common symptoms associated with CMP&#46; There were no significant associations between serum levels of creatine kinase&#44; 25-OHCC&#44; treatment with allopurinol&#44; statins or erythropoiesis-stimulating agents and CMP&#46; The female gender&#44; elderly age&#44; obesity&#44; comorbidity &#40;mainly diabetes&#44; heart failure or COPD&#41;&#44; and elevated levels of inflammatory markers &#40;C-reactive protein and non-neutrophilic leukocytes&#41; were the best determinants of CMP&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">While patients with CMP showed a worse survival rate&#44; a multivariate analysis adjusted for demographic data ruled out the independent association of CMP with mortality&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CMP is highly prevalent in patients with advanced CKD and is associated with other common symptoms of chronic uraemia&#46; As with the general population&#44; elderly age&#44; the female gender&#44; obesity and some comorbid conditions are the best determinants of CMP&#46; Increased inflammatory markers commonly observed in patients with CMP may have a relevant role in its pathogenesis&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Aims"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El dolor m&#250;sculo-esquel&#233;tico cr&#243;nico &#40;DMEC&#41; es un s&#237;ntoma muy frecuente en pacientes con enfermedad renal cr&#243;nica &#40;ERC&#41;&#44; y contribuye de forma importante al deterioro de la calidad de vida&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia y caracter&#237;sticas cl&#237;nicas asociadas al DMEC en pacientes con ERC avanzada no en di&#225;lisis&#44; analizar su relaci&#243;n con otros s&#237;ntomas ur&#233;micos y su significado pron&#243;stico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal en el que se analiz&#243; la sintomatolog&#237;a ur&#233;mica de pacientes no seleccionados remitidos por ERC estadio 4 y 5 predi&#225;lisis&#46; Para caracterizar aquellos que presentaban DMEC&#44; adem&#225;s de los datos demogr&#225;ficos&#44; antropom&#233;tricos&#44; la comorbilidad y la funci&#243;n renal&#44; tambi&#233;n se recogieron par&#225;metros de inflamaci&#243;n&#44; &#225;cido &#250;rico&#44; metabolismo &#243;seo-mineral incluyendo 25-hidroxi-colecalciferol &#40;25-OHCC&#41;&#44; creatincinasa&#44; y f&#225;rmacos de potencial inter&#233;s como alopurinol&#44; estatinas y agentes estimulantes de eritropoyetina&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 1&#46;169 pacientes con edad media de 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os&#59; el 54&#37; eran hombres&#46; Un 38&#37; de los pacientes refer&#237;a DMEC&#44; y este s&#237;ntoma fue m&#225;s frecuente en mujeres que en hombres &#40;49 vs&#46; 28&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; La debilidad muscular&#44; prurito&#44; calambres&#44; equimosis&#44; insomnio&#44; edemas y disnea fueron los s&#237;ntomas m&#225;s frecuentemente asociados al DMEC&#46; No se observaron asociaciones significativas entre niveles de creatincinasa&#44; 25-OHCC&#44; tratamiento con alopurinol&#44; estatinas o agentes estimulantes de eritropoyetina con DMEC&#46; Los mejores determinantes de DMEC fueron&#58; mujer&#44; mayor&#44; obesa&#44; con comorbilidad &#40;sobre todo diabetes&#44; insuficiencia cardiaca o EPOC&#41;&#44; y marcadores de inflamaci&#243;n elevados &#40;prote&#237;na<span class="elsevierStyleHsp" style=""></span>C reactiva y leucocitos no neutr&#243;filos&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Aunque los pacientes con DMEC ten&#237;an una peor supervivencia&#44; un an&#225;lisis multivariante con ajuste simple a datos demogr&#225;ficos descart&#243; que el DMEC fuera un determinante independiente de la mortalidad&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El DMEC es muy prevalente en pacientes con ERC avanzada&#44; y se asocia con otros s&#237;ntomas comunes de la uraemia cr&#243;nica&#46; Al igual que en la poblaci&#243;n general&#44; caracter&#237;sticas como sexo femenino&#44; edad avanzada&#44; obesidad y comorbilidad est&#225;n m&#225;s frecuentemente asociados al DMEC&#46; La elevaci&#243;n de los marcadores de inflamaci&#243;n asociada al DMEC podr&#237;a ser un hallazgo relevante para explicar su patogenia&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Caravaca F&#44; Gonzales B&#44; Bayo MA&#44; Luna E&#46; Dolor m&#250;sculo-esquel&#233;tico en pacientes con enfermedad renal cr&#243;nica&#46; Nefrologia&#46; 2016&#59;36&#58;433&#8211;440&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
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        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1746
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            "Tamanyo" => 168985
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bar chart showing the prevalence of uraemic symptoms in all patients studied and according to gender&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Bar chart showing the prevalence of uraemic symptoms in patients grouped by age quartiles&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Survival curves &#40;Kaplan&#8211;Meier&#41; in patients who reported chronic musculoskeletal pain &#40;red line&#44; below&#41; and patients with no pain &#40;blue line&#44; above&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" 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">Total&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">No pain&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">Pain&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">No&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">728 &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">441 &#40;38&#37;&#41;&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">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;12&#41;&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;000&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">Gender &#40;&#37; male&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&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;000&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">Comorbidity index&#58; none&#59; mild&#47;moderate&#59; severe &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#47;52&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#47;49&#47;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#47;56&#47;20&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;000&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">Diabetes mellitus &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&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">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#46;3 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;4 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;8 &#40;6&#46;1&#41;&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;000&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">Haemoglobin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;5 &#40;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;6 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;3 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;132&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 leucocytes &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8048 &#40;2&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7925 &#40;2&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8250 &#40;2&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;041&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">Neutrophils &#40;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5411 &#40;2&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5381 &#40;2&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5459 &#40;2&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;556&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">eGFR&#44; ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;4 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;4 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;5 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;630&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">Uric acid &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;7 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;4 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;035&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 calcium &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;13 &#40;0&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;11 &#40;0&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;18 &#40;0&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Phosphorus &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;73 &#40;1&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;77 &#40;1&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;67 &#40;0&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;130&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">Bicarbonate &#40;mmol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;6 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;7 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;252&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">PTH &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">260 &#40;219&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">265 &#40;222&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">252 &#40;214&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;307&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">PTH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;820&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">PTH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>500<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;369&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alkaline phosphatase &#40;IU&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;090&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Serum albumin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;87 &#40;0&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;88 &#40;0&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;86 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C-reactive protein<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;85 &#91;13&#8211;11&#46;04&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;52 &#91;1&#46;27&#8211;9&#46;35&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;45 &#91;1&#46;72&#8211;13&#46;31&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C-reactive protein &#62;5<span class="elsevierStyleHsp" style=""></span>mg&#47;l &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&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">History of gouty arthritis&#44; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;898&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">Statins &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;357&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">Allopurinol &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" 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">0&#46;281&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">ESA-EPO &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics for the whole group and the subgroups with or without chronic musculoskeletal pain&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The following did not fit into the best model&#58; anorexia&#59; nausea&#47;vomiting&#59; poor physical activity level&#59; cold intolerance&#59; myoclonus&#59; restless legs&#59; daytime drowsiness&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&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">Odds ratio&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">95&#37; CI OR&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">Fatigue &#40;muscle weakness&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;22&#8211;3&#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">&#60;0&#46;000&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">Pruritus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;34&#8211;2&#46;28&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;000&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">Cramps&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;24&#8211;2&#46;11&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;000&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">Oedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;19&#8211;2&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&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">Ecchymosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;18&#8211;2&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&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">Night-time insomnia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;04&#8211;1&#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">0&#46;027&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">Dyspnoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The following did not fit into the best prediction model&#58; uric acid&#59; bicarbonate&#59; albumin&#59; PTH&#59; alkaline phosphatase&#59; diabetes&#59; statins&#59; ESA-EPO&#59; allopurinol&#59; and glomerular filtration rate&#46;</p>"
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                  <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">Variable&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">Odds ratio&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">95&#37; CI OR&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"><span class="elsevierStyleItalic">Male gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;458&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;350&#8211;0&#46;600&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;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;&#215;10 years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;20&#8211;1&#46;42&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;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Comorbidity index</span><br><span class="elsevierStyleHsp" style=""></span>0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>none&#44;<br><span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>mild&#47;moderate&#44;<br><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;038&#8211;1&#46;584&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;021&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">1&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&#8211;1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;028&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Multivariate logistic regression&#46; Clinical and analytical characteristics best associated with the chronic musculoskeletal pain&#46;</p>"
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