Letter to the Editor
Educating your patient is cost-effective: It reduces serum phosphate and saves €200 per patient per month
Las estrategias de educación a pacientes son coste efectivas: reduzca el fósforo ahorrando 200€ al mes por paciente
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(A) Chest X ray – Interstitial reticular fibrotic infiltration with honey comb appearance over both lungs. (B) Non-contrast computed tomography of the chest shows pulmonary fibrosis with cystic change in bilateral lung fields, with lower lung zones predominance. Infiltrates and ground-glass opacity in bilateral peri-hilar regions were also noted. (C) Renal biopsy (400×) – Glomeruli showed mesoangiocapillary proliferation and segmental sclerosis. 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Rodriguez-Palomares, Maria Carmen Japaz Cancino, Luis Blazquez Collado, Ruth Fiallos Criollo, Paola Milena Villabon Ochoa, Marta Sanchez Heras, Maria Angeles Basterrechea, Gabriel de Arriba de la Fuente" "autores" => array:8 [ 0 => array:4 [ "nombre" => "José R." "apellidos" => "Rodriguez-Palomares" "email" => array:1 [ 0 => "athelas36@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maria Carmen" "apellidos" => "Japaz Cancino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Luis" "apellidos" => "Blazquez Collado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Ruth" "apellidos" => "Fiallos Criollo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Paola Milena" "apellidos" => "Villabon Ochoa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Marta" "apellidos" => "Sanchez Heras" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Maria Angeles" "apellidos" => "Basterrechea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Gabriel" "apellidos" => "de Arriba de la Fuente" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Nefrología, Hospital Universitario Guadalajara, Guadalajara, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Nefrología y Hemodiálisis, Clínica Fuensanta, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las estrategias de educación a pacientes son coste efectivas: reduzca el fósforo ahorrando 200<span class="elsevierStyleHsp" style=""></span>€ al mes por paciente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In dialysis patients, there are only 3 mechanisms of phosphate control: (1) elimination of phosphate by dialysis, (2) chelating therapy, and (3) dietary restrictions. Phosphate elimination by dialysis has been shown to be useful but insufficient, while the other two mechanisms require patients to follow the prescribed treatment.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Failure to follow treatment in chronic patients is very common, multifactorial and involves factors related to the patient, the disease, the health system and the medication itself.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Non-compliance with medication is even more striking with chelators, and is possibly the leading cause of lack of phosphate control.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Various studies show that phosphate control improves with educational strategies, improving adherence to dietary and medication recommendations.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> Despite the high prices of new, more effective chelators, very few studies have addressed the economic aspects deriving from potencial saving associated with improved compliance.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We want to determine whether educational activities improved compliance with medication and phosphate control and evaluate whether this is associated with a lower need for binders and savings in pharmaceutical expenditure.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a population of haemodialysis and peritoneal dialysis patients, we measured the degree of phosphate control, the level of adherence to medication on 2 different scales (8-item Morisky and SMAQ),<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> knowledge about diet and treatment through a 6-item survey, the need for binders in each patient measured as the number of binders and dose prescribed of each binder (calcium carbonate/acetate, aluminium hydroxide, sevelamer hydrochloride/carbonate and lanthanum carbonate). The adherence using scales previously validated in chronic and dialysis patients. The scales classify patients as compliant and non-compliant, and also provide values that allows to be used as a continuous variable, assigning a score for each of the items including questions asked in the form of the Likert scale. The Morisky scale assigns a higher score a better adherence, while the SMAQ scale assigns a lower score to a better the compliance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted an educational activity as workshop in which we addressed the clinical consequences of uncontrolled phosphate, identification of chelating medication, appropriate methods of administration, identification of foods with a high phosphate content and how to reduced their intake.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Three months after, we re-measured all of the parameters mentioned. We collected data from 35 patients with a mean age of 59.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.9, 18 on haemodialysis (HD) and 17 on peritoneal dialysis (PD), 43% female, 47% diabetic, with a time on dialysis of 54.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>82.9 months. The results of the study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Phosphate levels were significantly reduced (5.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.5 vs. 4.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4). The percentage of patients with phosphate controlled rose from 40 to 71%. We observed no change in any other biochemical parameters except a negligible reduction in protein and albumin levels. The compliance with pharmacological treatment improved as measured by Morisky, as did the compliance of chelators measured by SMAQ. The number of errors in the knowledge test also improved significantly.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">This improved control of phosphate led to a reduction in the number of binders and in the dose prescribed. The change in chelator dose and monthly expenditure is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The number of binders an the dose prescribed per patient was reduced especially in calcium and sevelamer binders. The monthly savings in the treatment of 35 patients was over 6000 euros, and with a better control of serum phosphate.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Patient education and therapeutic alliance in the prescription process are not only effective, but also cost-effective. To be effective educational strategies need to be uninterrupted. It is evident that educational activities directed to patients are needed; these activities should have a multidisciplinary approach including doctors, dietitians and nutritionists capable of planning and carrying out these training activities on an ongoing basis, is daily more evident. If educating just 35 patients produces a monthly saving of 6000 euros, how much could be saved by improving the education of all patients on chelation, diet, potassium, interdialytic weight gain, etc.?</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodriguez-Palomares JR, Japaz Cancino MC, Blazquez Collado L, Fiallos Criollo R, Villabon Ochoa PM, Sanchez Heras M, et al. Las estrategias de educación a pacientes son coste efectivas: reduzca el fósforo ahorrando 200<span class="elsevierStyleHsp" style=""></span>€ al mes por paciente. Nefrología. 2017;37:103–105.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \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">Pre-activity \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">Post-activity \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">Statistical significance \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="left" valign="top">35</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proteins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.53<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \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">Albumin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.73<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \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">Calcium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Phosphate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percentage of controlled patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">395.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>272.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">398.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>34.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>31.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CRP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>26.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">KTV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Morisky \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \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">SMAQ-Q \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.95<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \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">Known dietary errors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.94<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.42<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1375922.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Change in parameters after educational activity.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-activity</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Post-activity</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Statistical significance \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Binders</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">1.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.0</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">1.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.2</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Calcium: % pat. and g/wk</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Euros/month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">182.92<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">160.52<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aluminium: % pat. and g/wk</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Euros/month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">36.72<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">71.12<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sevelamer: % pat. and g/wk</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>26.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Euros/month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">21,482<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">15,169.6<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lanthanum: % pat. and g/wk</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Euros/month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">3918.6<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">4053.0<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Chelator cost</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">25,619.64<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">19,454.24<span class="elsevierStyleHsp" style=""></span>€</td><td class="td" title="table-entry " align="left" valign="top">6165.4<span class="elsevierStyleHsp" style=""></span>€ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1375923.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Changes in binders treatment after educational activity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consequences of the implementation of K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease in a population of patients on chronic hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Arenas" 1 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 2 | 4 |
| 2024 October | 39 | 47 | 86 |
| 2024 September | 49 | 20 | 69 |
| 2024 August | 50 | 65 | 115 |
| 2024 July | 40 | 30 | 70 |
| 2024 June | 49 | 37 | 86 |
| 2024 May | 47 | 29 | 76 |
| 2024 April | 51 | 34 | 85 |
| 2024 March | 45 | 29 | 74 |
| 2024 February | 37 | 35 | 72 |
| 2024 January | 28 | 26 | 54 |
| 2023 December | 25 | 26 | 51 |
| 2023 November | 37 | 36 | 73 |
| 2023 October | 54 | 18 | 72 |
| 2023 September | 41 | 26 | 67 |
| 2023 August | 34 | 20 | 54 |
| 2023 July | 45 | 25 | 70 |
| 2023 June | 41 | 21 | 62 |
| 2023 May | 40 | 31 | 71 |
| 2023 April | 25 | 15 | 40 |
| 2023 March | 41 | 24 | 65 |
| 2023 February | 46 | 19 | 65 |
| 2023 January | 48 | 29 | 77 |
| 2022 December | 51 | 41 | 92 |
| 2022 November | 45 | 37 | 82 |
| 2022 October | 37 | 38 | 75 |
| 2022 September | 51 | 38 | 89 |
| 2022 August | 47 | 49 | 96 |
| 2022 July | 33 | 48 | 81 |
| 2022 June | 37 | 32 | 69 |
| 2022 May | 60 | 42 | 102 |
| 2022 April | 62 | 40 | 102 |
| 2022 March | 47 | 55 | 102 |
| 2022 February | 62 | 41 | 103 |
| 2022 January | 69 | 34 | 103 |
| 2021 December | 88 | 43 | 131 |
| 2021 November | 62 | 35 | 97 |
| 2021 October | 52 | 50 | 102 |
| 2021 September | 41 | 37 | 78 |
| 2021 August | 38 | 49 | 87 |
| 2021 July | 39 | 34 | 73 |
| 2021 June | 29 | 19 | 48 |
| 2021 May | 51 | 32 | 83 |
| 2021 April | 78 | 40 | 118 |
| 2021 March | 48 | 32 | 80 |
| 2021 February | 52 | 32 | 84 |
| 2021 January | 28 | 18 | 46 |
| 2020 December | 25 | 12 | 37 |
| 2020 November | 35 | 20 | 55 |
| 2020 October | 19 | 18 | 37 |
| 2020 September | 23 | 13 | 36 |
| 2020 August | 39 | 18 | 57 |
| 2020 July | 41 | 13 | 54 |
| 2020 June | 20 | 28 | 48 |
| 2020 May | 29 | 13 | 42 |
| 2020 April | 38 | 16 | 54 |
| 2020 March | 41 | 14 | 55 |
| 2020 February | 40 | 30 | 70 |
| 2020 January | 47 | 17 | 64 |
| 2019 December | 28 | 32 | 60 |
| 2019 November | 36 | 22 | 58 |
| 2019 October | 28 | 15 | 43 |
| 2019 September | 21 | 14 | 35 |
| 2019 August | 25 | 11 | 36 |
| 2019 July | 19 | 24 | 43 |
| 2019 June | 34 | 30 | 64 |
| 2019 May | 20 | 26 | 46 |
| 2019 April | 42 | 38 | 80 |
| 2019 March | 41 | 27 | 68 |
| 2019 February | 26 | 19 | 45 |
| 2019 January | 36 | 27 | 63 |
| 2018 December | 131 | 46 | 177 |
| 2018 November | 238 | 35 | 273 |
| 2018 October | 191 | 21 | 212 |
| 2018 September | 95 | 27 | 122 |
| 2018 August | 52 | 21 | 73 |
| 2018 July | 44 | 20 | 64 |
| 2018 June | 61 | 14 | 75 |
| 2018 May | 68 | 15 | 83 |
| 2018 April | 144 | 9 | 153 |
| 2018 March | 64 | 5 | 69 |
| 2018 February | 113 | 9 | 122 |
| 2018 January | 59 | 5 | 64 |
| 2017 December | 93 | 4 | 97 |
| 2017 November | 57 | 17 | 74 |
| 2017 October | 31 | 5 | 36 |
| 2017 September | 51 | 10 | 61 |
| 2017 August | 69 | 9 | 78 |
| 2017 July | 56 | 4 | 60 |
| 2017 June | 53 | 6 | 59 |
| 2017 May | 52 | 12 | 64 |
| 2017 April | 48 | 11 | 59 |
| 2017 March | 43 | 6 | 49 |
| 2017 February | 6 | 1 | 7 |
Show all
