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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">Patients with chronic kidney disease &#40;CKD&#41; have a high rate of cardiovascular morbidity and mortality<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; therefore in different clinical guidelines this disease is considered a powerful and common predictor of cardiovascular events and mortality&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">4</span></a> which involves stratifying these patients as being at a high or very high risk of cardiovascular disease&#44; and a tight control of different risk factors&#44; including dyslipidaemia&#46; Dyslipidaemia may contribute not only to the development of cardiovascular disease&#44; but also to the onset and progression of CKD&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">HMG-CoA reductase inhibitors&#44; or statins&#44; are the most widely used lipid-lowering drugs for the management of dyslipidaemia&#46; This is because the clear clinical evidence of their cardiovascular benefits&#44; even in patients with CKD&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#8211;9</span></a> In a recent systematic review and meta-analysis on the effects of statins in CKD patients&#44; including 31 clinical trials with 48&#46;429 patients&#44; statin therapy achieved a 23&#37; reduction in the risk of severe cardiovascular events&#44; a reduction of 18&#37; in the risk of coronary events and a 9&#37; decreased risk of cardiovascular or total mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> In addition&#44; statins may delay the progression of CKD by reducing proteinuria&#44; inflammation and fibrosis&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a> although the evidence on this beneficial effect is limited and contradictory&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;12&#44;13</span></a> However&#44; one recent cohort study points to an increased risk of renal events with the use of statins&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a> One recent consensus document by a panel of lipid experts on intolerance to statins recognises that statins may be associated with an increased risk of acute kidney failure and proteinuria&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Not all statins are cleared uniformly by kidneys&#59; some have a higher rate of renal excretion and require dose adjustments in CKD &#40;e&#46;g&#46;&#44; pravastatin or rosuvastatin&#41;&#44; while others have a significant risk of drug-related interactions<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> this is a relevant fact for renal patients&#44; who are usually polymedicated&#46; Also&#44; some evidence indicates that different statins may have different effects on urinary albumin excretion and the progression of kidney disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">17&#8211;21</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The DIANA study was recently carried out to assess the knowledge and attitudes in relation to the diabetogenicity of the different statins&#44; such as the differences that may exist amongst them&#44; with a view to a more rational use in patients with type 2 diabetes mellitus or those predisposed to developing it&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">22</span></a> To determine the opinion of prescribing doctors about the screening and management of dyslipidaemia in patients with CKD&#44; we performed a post hoc analysis of the DIANA study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">The modified Delphi method<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> was used to achieve the widest possible consensus of a broad panel of doctors experts in the management of dyslipidaemia&#46; This is a structured technique of professional consensus which is achieved remotely&#44; i&#46;e&#46;&#44; a variant of the original procedure developed by Dalkey et al&#46;&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">24&#44;25</span></a> which maintains its main advantages &#40;controlled interaction amongst panel members&#44; chance to reflect and reconsider one&#39;s opinion and statistical validation of the consensus achieved&#41; compared with other technical alternatives&#44; and which resolves some of its main drawbacks &#40;biased opinions&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The study required 2 successive rounds of a structured survey completed via an <span class="elsevierStyleItalic">on-line</span> platform&#46; The expert doctors were able to confidentially contrast their personal opinions with the panel&#39;s aggregate opinion when responding to the second round and to reconsider&#44; if deemed appropriate&#44; their initial criteria on issues that had not been agreed upon&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was carried out in 4 phases&#58; &#40;a&#41; formation of the scientific committee&#44; responsible for proposing the panel of experts and creating the survey items&#59; &#40;b&#41; formation of an expert panel of professionals from 5 medical specialties &#40;cardiology&#44; endocrinology&#44; internal medicine&#44; nephrology&#44; and family and community medicine&#41;&#44; with a special interest and experience in the field of dyslipidaemia&#44; with the exclusive task of completing the survey&#59; &#40;c&#41; <span class="elsevierStyleItalic">on-line</span> survey in 2 rounds&#59; and &#40;d&#41; compilation&#44; analysis of results and discussion of conclusions in a face-to-face session of the scientific committee&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Development of the questionnaire</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors of this study made up the project&#39;s scientific committee owing to their individual career and professional experience in this field&#46; Along with the collaboration of an external consultant on methodology&#44; they developed the content of the Delphi questionnaire&#46; For this&#44; a bibliographic search was carried out&#44; in which systematic meta-analyses&#47;reviews and another type of critical synthesis of the scientific literature were prioritised through the use of standard bibliographic databases<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> &#40;MEDLINE&#44; EMBASE and the Spanish Medical Index&#41;&#44; as well as a manual review of the bibliographical references obtained to identify others that may be of interest based on keywords such as dyslipidaemia&#44; diabetes mellitus or impaired glucose metabolism&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Each item of the survey evaluated by the panel was drafted by taking into account that it was an assertion&#44; affirmative or negative&#44; as a professional criterion or clinical recommendation&#44; which would respond to aspects of interest or controversy in the clinical management of patients with dyslipidaemia and impaired glucose metabolism&#46; The final version of the questionnaire included 4 blocks of questions&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Algorithm for current management of dyslipidaemia&#44; in particular in patients with impaired glucose metabolism&#58; detection&#44; therapeutic approach&#44; monitoring and follow-up &#40;57 items&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Opinion on the relative importance of the factors taken into account when prescribing and following up on statin therapy &#40;39 items&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Opinion on the profile of statins in the treatment of dyslipidaemia in patients with impaired glucose metabolism &#40;16 items&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Recommendations for selecting the hypolipidaemic treatment of choice for patients with impaired glucose metabolism &#40;24 items&#41;&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">A single type of rating scale was proposed for all questions&#58; 9-point Likert-type ordinal &#40;1&#58; no agreement&#47;never&#47;not important&#47;unnecessary&#47;inappropriate&#59; 9&#58; complete agreement&#47;always&#47;very important&#47;absolutely necessary&#47;absolutely appropriate&#41;&#44; according to the format developed in the RAND&#47;UCLA Appropriateness Method User&#39;s Manual&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> The response categories were described by linguistic qualifiers in 3 areas &#40;1&#8211;3&#58; disagreement&#44; never&#47;almost never&#44; not important&#44; unnecessary&#44; not&#47;almost never appropriate&#59; 4&#8211;6&#58; neutral&#59; 7&#8211;9&#58; agreement&#44; almost always&#47;always&#44; important&#44; necessary&#44; very&#47;absolutely appropriate&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">All questions had to be answered in order to obtain the opinion of all panellists participating in both rounds on all issues raised&#46; However&#44; the second round considered only those items in which no consensus was obtained in the previous round&#44; that is&#44; those questions that did not obtain at least 80&#37; of responses grouped in scores 1&#8211;3 &#40;consensus in disagreement&#41; or 7&#8211;9 &#40;consensus in agreement&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In this study we collected the results of the questions related to the screening and management of dyslipidaemia in patients with CKD&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Expert panel selection</span><p id="par0085" class="elsevierStylePara elsevierViewall">Panel experts were proposed by the scientific committee with the criterion of being representatives of their medical specialty with decision-making on the clinical status of the study&#44; professional recognition for their experience and scientific opinion &#40;leadership in the subject-matter&#41; and special interest in the field of dyslipidaemia&#46; For their identification&#44; a &#8220;snowball&#8221; strategy was used based on the personal contacts of the committee&#39;s members&#44; who in turn proposed new relevant candidates in their professional settings&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a> Following this process&#44; 506 professionals were invited&#46; Of those 497 experts agreed to take part from across the Spanish autonomous communities&#46; The study was carried out between February and June 2015&#44; with electronic mail as a means of distribution&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Before beginning to answer the questionnaire&#44; the experts had to answer a series of questions about their medical specialty&#44; years of professional practice&#44; and number and characteristics of patients with dyslipidaemia treated&#44; amongst others&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Analysis and interpretation of the results</span><p id="par0095" class="elsevierStylePara elsevierViewall">In order to analyse the group opinion regarding each question raised and for the interpretative purposes of the Likert-type scale questions&#44; the presentation of the answers was systematised by grouping the range of possible values between 1 and 9 into 3 levels<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a>&#58; 1&#8211;3&#44; 4&#8211;6&#44; 7&#8211;9 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A consensus was defined as one reached in disagreement or agreement when at least 80&#37; of the panellists had given scores of 1 to 3 &#40;consensus in disagreement&#41; or 7 to 9 &#40;agreement in agreement&#41;&#44; respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The data were analysed as a whole and according to the specialty of the participating doctors&#44; comparing the answers of general practitioners &#40;GPs&#41; with those of specialist doctors&#46; The comparative analysis by specialty was performed using the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> or Fisher&#39;s exact tests&#46; To perform the comparative analysis between both rounds&#44; Bowker&#39;s test<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a> was used&#44; adapting McNemar&#39;s test to compare endpoints of more than 2 categories&#46; In both cases&#44; the level of statistical significance was 0&#46;05 &#40;two-tailed&#41;&#46; The data were analysed using the statistical package SAS v&#46;9&#46;2 &#40;SAS Institute Inc&#46;&#44; Cary&#44; NC&#44; USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 497 experts participating in the study&#44; 58&#37; were GPs and 42&#37; specialist doctors &#40;14&#37; endocrinologists&#44; 14&#37; internists&#44; 7&#37; cardiologists and 7&#37; nephrologists&#41;&#46; Of the total number of experts participating&#44; 62&#37; had more than 20 years of professional practice and 80&#37; cared on average for more than 50 dyslipidaemic patients a month&#46; In addition&#44; more than 60&#37; of the participants reported that more than 50&#37; of the patients treated in their offices were over 65 years of age&#44; were polymedicated or had hypertension&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the results obtained&#46; There was a consensus &#40;agreement of &#62;80&#37; of panellists&#41; on the need for screening for dyslipidaemia in patients with CKD in the entire group &#40;89&#46;7&#37;&#41;&#44; with no statistically significant difference between GPs and specialists &#40;87&#46;9&#37; vs&#46; 92&#46;4&#37;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#44; nor any differences between nephrologists &#40;91&#46;4&#37;&#41; and non-nephrologists &#40;92&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Agreement was also reached on when to screen for dyslipidaemia in patients with CKD in clinical practice&#44; because 81&#46;3&#37; of the doctors surveyed stated that they performed this always&#47;almost always&#44; with no statistically significant differences between GPs and specialists &#40;80&#46;0&#37; vs&#46; 83&#46;1&#37;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#46; Although the differences were not significant&#44; nephrologists responded more often that they screened always&#47;almost always &#40;91&#46;4&#37;&#41; than non-nephrologist specialists &#40;81&#46;4&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding which parameters influence the choice of statin&#44; there was agreement in which&#44; amongst other aspects&#44; patient profile influences the choice of statin &#40;86&#46;9&#37;&#41;&#44; as well as possible interaction with other drugs &#40;84&#46;9&#37;&#41;&#44; with no statistically significant differences between GPs and specialists &#40;85&#46;9 vs&#46; 83&#46;6&#37;&#41;&#46; When the data were analysed by differentiating between nephrologists and non-nephrologists&#44; the former showed no consensus &#40;77&#46;1&#37;&#41;&#44; whereas the latter did show consensus &#40;89&#46;0&#37;&#41;&#44; with a similar figure for GPs &#40;86&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0635&#41;&#46; There was no difference between subgroups&#44; and there was agreement amongst all of them when considering the patients&#8217; polymedicated status on choosing a statin&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">However&#44; regarding the parameters to be considered when deciding on a statin&#44; there was no consensus in the entire sample when considering estimated glomerular filtration rate &#40;eGFR&#41; &#40;78&#46;7&#37;&#59; GPs 82&#46;4&#37; vs&#46; specialists 73&#46;4&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41;&#46; When analysing this parameter by considering a given expert&#39;s specialty&#44; as with the GPs&#44; the nephrologists deemed it necessary to consider eGFR when deciding on a statin &#40;85&#46;7&#37;&#41;&#44; but the non-nephrologists did not &#40;70&#46;9&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0458&#41;&#46; Nor was a consensus reached with regard to albuminuria in the entire sample analysed &#40;63&#46;2&#37;&#41;&#44; though the nephrologists seemed to take it into account more often &#40;74&#46;3&#37; nephrologists vs&#46; 56&#46;4&#37; non-nephrologists vs&#46; 65&#46;9&#37; GPs&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0513&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Also&#44; no agreement was reached on measuring eGFR &#40;78&#46;1&#37;&#58; GPs 78&#46;3&#37; vs&#46; specialists 77&#46;8&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41; or urinary albumin excretion &#40;65&#46;2&#37;&#58; GPs 67&#46;6&#37; vs&#46; specialists 61&#46;8&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>NS&#41; during follow-up after starting statin therapy&#46; When the specialty was subdivided between nephrologists and non-nephrologists&#44; the nephrologists considered evaluating eGFR &#40;88&#46;6&#37;&#41;&#44; whereas the non-nephrologists&#44; as well as the GPs&#44; did not reach a consensus &#40;75&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1704&#41;&#46; Something similar happened with albuminuria&#44; but in this parameter there were statistically significant differences amongst the groups of experts &#40;GPs 67&#46;6&#37;&#59; 82&#46;9&#37; vs&#46; nephrologists vs&#46; 57&#46;6&#37; non-nephrologists&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0112&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding which parameters should be considered when prescribing a statin&#44; it was considered that a patient&#39;s renal function&#47;albuminuria should be accounted for &#40;85&#46;7&#37;&#58; GPs 90&#46;0&#37; vs&#46; specialists 81&#46;6&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0175&#41;&#44; with no differences between specialist types &#40;nephrologists 82&#46;9 vs&#46; 81&#46;4&#37; non-nephrologists&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">In this post hoc analysis of the DIANA study&#44; there was agreement that dyslipidaemia should be studied in patients with CKD and that it is routine practice to screen for it in this population&#46; This means that the participating doctors recognised the high cardiovascular risk associated with CKD&#44; as indicated in the guidelines and consensus documents&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;31</span></a> The <span class="elsevierStyleItalic">Kidney Disease &#124; Improving Global Outcomes</span> &#40;KDIGO&#41; guide on managing dyslipidaemia in CKD recommends measuring the lipid profile in this specific population to establish a diagnosis of dyslipidaemia&#44;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a> which amongst nephrologists is an almost-universal practice&#46; In addition&#44; the study confirmed that renal function&#47;albuminuria should be considered amongst the parameters for the choice of statin&#44; as it would classify the patient as having a high or very high cardiovascular risk&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">There was also agreement that patient profile&#44; as well as possible interaction with other drugs&#44; should be considered when choosing a statin&#46; However&#44; the nephrologists did not reach a consensus on whether patient profile influenced the choice of statin &#40;77&#46;1&#37;&#41;&#46; This may be due to the fact that&#44; in general&#44; renal patients seen by nephrologists are in more advanced stages of the disease&#44; and these patients have a very high cardiovascular risk&#46; Therefore&#44; statin therapy is almost mandatory&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a> In a word&#44; prescribing doctors are aware that&#44; in addition to considering the efficacy of a statin in meeting an LDL-C goal&#44; they should consider other aspects related to patients and polymedication&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">However&#44; there was no consensus in considering eGFR or urinary albumin excretion as factors to be taken into account in the choice of statin&#46; However&#44; according to the subgroups of doctors surveyed&#44; both GPs and nephrologists did reach a consensus in considering eGFR as an element to account for in the choice of statin&#44; but this was not achieved in non-nephrologist specialists &#40;70&#46;9&#37;&#41;&#44; with a significant difference&#46; This discrepancy may be due to different drug-prescription patterns amongst different specialists&#46; It seems then that whereas GPs integrate the different prescribed treatments and clinical conditions and perform long-term patient monitoring&#44; specialists often follow a <span class="elsevierStyleItalic">fire-and-forget</span> strategy&#44; which is advocated by the latest US guidelines&#44; which recommend starting statin therapy with fixed doses with no LDL-C goal&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a> The KDIGO guidelines<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a> also recommend the use of a statin or statin&#47;ezetimibe in patients with CKD who are older than 50 years with an eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; By contrast&#44; the 2012 European guidelines on cardiovascular disease prevention in clinical practice<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a> consider patients with stage 4&#8211;5 CKD &#40;eGFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; to have a very high cardiovascular risk&#44; and they establish the same goal for monitoring such patients &#40;LDL-C below 70<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; or at least a 50&#37; reduction compared with the baseline&#41; as for patients with a history of atherosclerotic vascular disease &#40;secondary prevention&#41;&#46; Further&#44; patients with stage 3 CKD &#40;eGFR between 30 and 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; are classified as having a high cardiovascular risk and they are assigned an LDL-C goal of &#60;100<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Alternatively&#44; it could be inferred that amongst non-nephrologist specialists there is less knowledge that some statins show greater renal clearance and therefore require dose adjustments&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">It is also surprising that there is no consensus in considering baseline albuminuria amongst any of the groups of doctors&#44; although there are studies that indicate that statins are not homogeneous in this regard&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">All of this indicates the need for a better understanding of the implications of CKD in prescribing statins amongst specialists in order to reduce cardiovascular risk and minimise the risk of renal adverse effects in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Nor was it considered necessary to monitor renal function or urinary albumin excretion during follow-up after prescribing a statin&#44; nor amongst GPs or specialists&#44; although when analysed by subgroup&#44; the nephrologists reached a consensus in evaluating eGFR and albuminuria during follow-up of their patients&#46; In this regard&#44; some observational studies have shown an increased risk of renal events &#40;acute kidney failure&#41; with the use of statins&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#44;35&#44;36</span></a> but this has not been observed in other clinical trials&#44; prospective studies or meta-analyses&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;12&#44;13&#44;37</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Although it may seem that the effects of statins on renal function are minor&#44; many of the positive studies stem from the analysis of clinical trials designed to evaluate cardiovascular events in which the measure of renal function was limited to the eGFR&#46; With respect to specific statins&#44; some evidence indicates a beneficial effect on renal function in some&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">17&#44;19</span></a> and a neutral effect in others&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> In comparative clinical trials of statins&#44; differences have been observed amongst them in terms of progression of CKD<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> or of reduction of albuminuria&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">20</span></a> This seems to be known in particular amongst nephrologists&#44; and to a lesser extent amongst GPs and non-nephrologists&#46; Finally&#44; a recent meta-analysis indicates that high-efficacy statins might have a beneficial effect on decreased renal function &#40;but not those of medium-low efficacy&#41; in patients with CKD&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">As mentioned above&#44; patients with CKD have a higher risk of developing adverse effects when treated with statins<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a>&#59; therefore it is important to choose a statin with sufficient hypocholesterolaemic efficacy&#44; with no risk of accumulation in the presence of CKD&#44; and with a low risk of drug interactions that&#44; if possible&#44; have shown a beneficial effect on the progression of CKD&#46; In this regard the European guidelines for the treatment of dyslipidaemia recommend the use of statins that show a lower renal excretion&#44; such as fluvastatin&#44; atorvastatin and pitavastatin&#44; in patients with CKD&#44;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a> although they do not refer to dose adjustments in the presence of CKD&#46; The Spanish consensus document on CKD is similar in this sense&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">31</span></a> Also in this vein&#44; the KDIGO guidelines include dose adjustments for each statin in patients with CKD&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">32</span></a> It should also be noted that statins metabolised by cytochrome P450 3A4 &#40;lovastatin&#44; simvastatin and atorvastatin&#41; may cause adverse reactions due to their interaction with other drugs commonly used for these patients&#46; The lack of consensus in the recommendations on the type and maximum dose of statin in CKD&#44; especially in advanced CKD&#44; and on the relationship between statins and proteinuria&#47;albuminuria is therefore evident&#46; Therefore a consensus document&#47;guide to advise specialists in the choice of statin in CKD would be useful&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">This study&#39;s main limitation is that the questionnaire was not specifically designed to show whether the presence of CKD had any effect on screening for dyslipidaemia or on selecting a hypolipidaemic treatment&#46; Nor did it specifically ask whether there are differences between statins regarding renal function or albuminuria&#44; or regarding possible differences between high- and low-medium-efficacy statins&#59; this should be addressed in a future study&#46; However&#44; the answers contained in this analysis are novel&#44; based on clinical practice&#44; and allow us to detect training-related deficiencies of prescribing doctors in terms of the appropriate choice of a statin in patients with CKD&#46; By contrast&#44; the number of nephrologists included is small&#44; and therefore the results of the study may not be extrapolated to all nephrologists&#46; The statistical power of the study is limited when analysing the data by nephrologist and non-nephrologist&#58; a &#8220;false negative&#8221; may be obtained&#44; i&#46;e&#46;&#44; maintaining that there are no differences amongst groups&#44; when in fact differences exist&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In summary&#44; the data from this study show that there is a consensus on the need to detect dyslipidaemia in CKD&#44; thus indicating that doctors recognise that the condition involves stratifying patients as being at a high or very high cardiovascular risk&#44; and therefore&#44; the need to prescribe statins in this population&#46; However&#44; there does not appear to be adequate knowledge about the clinically relevant differences that exist amongst different statins in relation to CKD&#46; Improving this situation&#44; by developing a guide&#47;consensus document and conducting training on the subject for different specialties&#44; might allow doctors to choose the most suitable statin for each patient and to minimise the risk of adverse effects in this population&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs1">Laboratorios Esteve</span>&#44; which did not&#44; however&#44; participate in the preparation of the survey&#44; statistical analysis&#44; discussion of results or the writing of the article&#44; which were the responsibility of the committee of experts who signed as authors of the article&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Authorship&#47;collaborations</span><p id="par0195" class="elsevierStylePara elsevierViewall">All the authors actively contributed to developing the study and drafting the manuscript&#44; approving the final version and its submission for publication in <span class="elsevierStyleSmallCaps">Nefrolog&#237;a</span>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">All authors state that there are no conflicts of interest in the writing of the manuscript&#44; and any type of financial or personal relationship that might interfere with the study has been specified&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Antecedentes y objetivos"
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          "titulo" => "Introduction"
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              "titulo" => "Development of the questionnaire"
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              "titulo" => "Expert panel selection"
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          "titulo" => "Acknowledgements"
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          "titulo" => "References"
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    "fechaRecibido" => "2016-04-28"
    "fechaAceptado" => "2016-07-23"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec802020"
          "palabras" => array:4 [
            0 => "Dyslipidaemia"
            1 => "Chronic kidney disease"
            2 => "Statins"
            3 => "Cardiovascular risk"
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      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "Dislipidemia"
            1 => "Enfermedad renal cr&#243;nica"
            2 => "Estatinas"
            3 => "Riesgo cardiovascular"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This post hoc study analysed the perception of the relevance of chronic kidney disease &#40;CKD&#41; in dyslipidaemia screening and the choice of statin among primary care physicians &#40;PCPs&#41; and other specialists through a Delphi questionnaire&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The questionnaire included 4 blocks of questions concerning dyslipidaemic patients with impaired carbohydrate metabolism&#46; This study presents the results of the impact of CKD on screening and the choice of statin&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 497 experts included&#44; 58&#37; were PCPs and 42&#37; were specialists &#40;35&#44; 7&#37; were nephrologists&#41;&#46; There was consensus by both PCPs and specialists&#44; with no difference between PCPs and specialists&#44; that CKD patients should undergo a dyslipidaemia screening and that the screening should be part of routine clinical practice&#46; However&#44; there was no consensus in considering the estimated glomerular filtration rate &#40;eGFR&#41; &#40;although there was consensus among PCPs and nephrologists&#41;&#44; or considering albuminuria when selecting a statin&#44; or in determining albuminuria during follow-up after having initiated treatment with statins &#40;although there was consensus among the nephrologists&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The consensus to analyse the lipid profile in CKD patients suggests acknowledgement of the high cardiovascular risk of this condition&#46; However&#44; the lack of consensus in considering renal function or albuminuria&#44; both when selecting a statin and during follow-up&#44; suggests a limited knowledge of the differences between statins in relation to CKD&#46; Thus&#44; it would be advisable to develop a guideline&#47;consensus document on the use of statins in CKD&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
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          1 => array:2 [
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            "titulo" => "Methods"
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            "titulo" => "Results"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este estudio <span class="elsevierStyleItalic">post hoc</span> analiz&#243; la percepci&#243;n de la importancia de la enfermedad renal cr&#243;nica &#40;ERC&#41; en el cribado de la dislipidemia y en la elecci&#243;n del tratamiento con estatinas entre m&#233;dicos de Atenci&#243;n Primaria &#40;MAP&#41; y otras especialidades mediante cuestionario Delphi&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El cuestionario incluy&#243; 4<span class="elsevierStyleHsp" style=""></span>bloques de preguntas alrededor del paciente dislip&#233;mico con alteraci&#243;n del metabolismo hidrocarbonado&#46; Aqu&#237; se presentan los resultados relacionados con la consideraci&#243;n de la ERC en el cribado y la elecci&#243;n de la estatina&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 497 expertos incluidos&#44; el 58&#37; eran MAP y el 42&#37;&#44; especialistas &#40;35&#44; el 7&#37;&#44; nefr&#243;logos&#41;&#46; Hubo consenso en realizar un cribado de la dislipidemia en los pacientes con ERC&#44; sin diferencias entre MAP y especialistas&#59; y tambi&#233;n en realizar el cribado en la pr&#225;ctica cl&#237;nica habitual&#46; Sin embargo&#44; no se alcanz&#243; el consenso en considerar el filtrado glomerular estimado &#40;aunque s&#237; entre MAP y nefr&#243;logos&#41; o la albuminuria en la elecci&#243;n de la estatina&#44; ni en su determinaci&#243;n durante el seguimiento despu&#233;s de instaurar un tratamiento con estatinas &#40;aunque hubo consenso entre nefr&#243;logos&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El consenso en analizar el perfil lip&#237;dico en los pacientes con ERC indica el reconocimiento del alto riesgo cardiovascular de esta enfermedad&#46; La ausencia de acuerdo en considerar la funci&#243;n renal o la albuminuria&#44; tanto en la elecci&#243;n de la estatina como durante el seguimiento&#44; indica un conocimiento limitado de las diferencias entre estatinas en relaci&#243;n con la ERC&#44; por lo que ser&#237;a deseable disponer de una gu&#237;a&#47;documento de consenso sobre uso de estatinas en la ERC&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Cases Amen&#243;s A&#44; Pedro-Botet Montoya J&#44; Pascual Fuster V&#44; Barrios Alonso V&#44; Pint&#243; Sala X&#44; Ascaso Gimilio JF&#44; et al&#46; Consenso Delphi sobre el diagn&#243;stico y manejo de la dislipidemia en pacientes con enfermedad renal cr&#243;nica&#58; an&#225;lisis <span class="elsevierStyleItalic">post-hoc</span> del estudio DIANA&#46; Nefrologia&#46; 2016&#59;36&#58;679&#8211;686&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CKD&#58; chronic kidney disease&#59; GPs&#58; general practitioners&#46;</p>"
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                  \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">Endpoint&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">Response&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 sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>497&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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">GPs &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>290&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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">Specialty &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>207&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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">Nephrology specialty &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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">Specialty other than nephrology &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172&#41;<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&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  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">Algorithm for current management of dyslipidaemia&#44; in particular in patients with impaired glucose metabolism &#40;prediabetes and diabetes mellitus&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Need for detecting dyslipidaemia in patients with CKD</td><td class="td" title="table-entry  " align="left" valign="top">Disagreement &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#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">3 &#40;1&#46;4&#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 &#40;2&#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">2 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;3053</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">45 &#40;9&#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">32 &#40;11&#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">13 &#40;6&#46;3&#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 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Agreement &#40;7&#8211;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">446 &#40;89&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">255 &#40;87&#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">191 &#40;92&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;91&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;92&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Screening for dyslipidaemia in patients with CKD in clinical practice</td><td class="td" title="table-entry  " align="left" valign="top">Never&#47;almost never &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;4&#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 &#40;0&#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">3 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;6029</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">86 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;18&#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">32 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;8&#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">29 &#40;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Almost always&#47;always &#40;7&#8211;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">404 &#40;81&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">232 &#40;80&#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">172 &#40;83&#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">32 &#40;91&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Patient profile as a parameter influencing choice of statin</td><td class="td" title="table-entry  " align="left" valign="top">Disagreement &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#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="char" valign="top">3 &#40;8&#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">5 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;0635</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">53 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Agreement &#40;7&#8211;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">432 &#40;86&#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">252 &#40;86&#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">180 &#40;87&#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">27 &#40;77&#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">153 &#40;89&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Possible interaction with other drugs as a parameter influencing choice of statin</td><td class="td" title="table-entry  " align="left" valign="top">Disagreement &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#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">8 &#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="char" valign="top">3 &#40;8&#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">5 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;0882</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">64 &#40;12&#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">38 &#40;13&#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">26 &#40;12&#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">3 &#40;8&#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">23 &#40;13&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Agreement &#40;7&#8211;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">422 &#40;84&#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">249 &#40;85&#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">173 &#40;83&#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">29 &#40;82&#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">144 &#40;83&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" 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="8" align="left" valign="top"><span class="elsevierStyleItalic">Opinion on the relative importance of the factors taken into account when prescribing and following up on treatment with statins</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Parameter to consider when prescribing the statin&#58; glomerular filtration</td><td class="td" title="table-entry  " align="left" valign="top">Unnecessary &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#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="char" valign="top">9 &#40;3&#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">11 &#40;5&#46;3&#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 &#40;2&#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">10 &#40;5&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;0458<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">86 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Necessary &#40;7&#8211;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">391 &#40;78&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">239 &#40;82&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;73&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">122 &#40;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Parameter to consider when prescribing the statin&#58; urinary albumin excretion</td><td class="td" title="table-entry  " align="left" valign="top">Unnecessary &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;9&#46;2&#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 &#40;0&#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">19 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;0513</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">146 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;27&#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">65 &#40;31&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Necessary &#40;7&#8211;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">314 &#40;63&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">191 &#40;65&#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">123 &#40;59&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;74&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;56&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Follow-up after starting treatment with statins&#58; glomerular filtration</td><td class="td" title="table-entry  " align="left" valign="top">Unnecessary &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;3&#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">12 &#40;4&#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">3 &#40;1&#46;4&#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 &#40;0&#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">3 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;1704</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">94 &#40;18&#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">51 &#40;17&#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">43 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;22&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Necessary &#40;7&#8211;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">388 &#40;78&#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">227 &#40;78&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">161 &#40;77&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;88&#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">130 &#40;75&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Follow-up after starting treatment with statins&#58; urinary albumin excretion</td><td class="td" title="table-entry  " align="left" valign="top">Unnecessary &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;6&#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">15 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;8&#46;7&#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 &#40;0&#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">18 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="char" valign="top">0&#46;0112<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutral &#40;4&#8211;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">140 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">324 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">196 &#40;67&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;57&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" 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="8" align="left" valign="top"><span class="elsevierStyleItalic">Recommendations for selecting the hypolipidaemic treatment of choice for patients with impaired glucose metabolism &#40;prediabetes or diabetes mellitus&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Required parameters for evaluating when deciding&#58; Take into account the patient&#39;s renal function&#47;albuminuria</td><td class="td" title="table-entry  " align="left" valign="top">Not&#47;almost never appropriate &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;15&#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">4 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">430 &#40;86&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">261 &#40;90&#46;0&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">169 &#40;81&#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">29 &#40;82&#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">140 &#40;81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Level of agreement reached after 2 rounds by the participating experts&#46;</p>"
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      "titulo" => "References"
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