Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients

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] 1 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Nefrología. Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina del Aparato Digestivo, Hospital 12 de Octubre, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia de los antivirales de acción directa en la infección por el virus de la hepatitis C en pacientes en hemodiálisis" ] ] "textoCompleto" => "IntroductionChronic hepatitis C virus (HCV) infection is a serious health problem that affects more than 170 million people worldwide<a class="elsevierStyleCrossRefs" href="#bib0195">1–3</a> and may cause liver cirrhosis and hepatocellular carcinoma. The prevalence of HCV in haemodialysis patients is even greater. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) show a very wide range of prevalence among the different countries studied, which in some countries such as Spain reaches as high as 8.9%.<a class="elsevierStyleCrossRef" href="#bib0210">4</a> Moreover, the survival of infected patients decreases with respect to those without the infection.<a class="elsevierStyleCrossRefs" href="#bib0215">5–7</a>At the beginning of this century, the combination of pegylated interferon and ribavirin became the standard for treatment for HCV infection.<a class="elsevierStyleCrossRefs" href="#bib0230">8–10</a> However, the adverse effects of interferon treatment in patients with chronic kidney disease (CKD), potentiated by the ribavirin treatment together with their poor response,<a class="elsevierStyleCrossRef" href="#bib0240">10</a> have proven a major limitation for their widespread use. The recent development of antiviral agents that act directly on viral replication (direct-acting antivirals [DAA]) has completely changed the prognosis of the infection, achieving a sustained viral response (SVR) of over 90% among the general population.<a class="elsevierStyleCrossRefs" href="#bib0245">11–15</a> Experience with DAAs in HCV-positive haemodialysis patients is scant, and is related to small patient series. Nevertheless, the results are very promising, reaching an SVR in the vast majority of patients.<a class="elsevierStyleCrossRefs" href="#bib0270">16–20</a>The aim of our study is to analyse the current prevalence of HCV infection in the haemodialysis units of two hospitals and their affiliated sites, and to assess treatment response with different DAA regimens.Materials and methodsA multicentre, retrospective, observational study, in which we analysed all prevalent haemodialysis patients belonging to two hospital areas in Madrid (Spain). Patients with HCV antibodies were identified, and those treated with DAAs were separated from those who had received no specific treatment. HCV antibody detection was performed using a chemiluminescent microparticle immunoassay on an Architect i4000 sr autoanalyser (Abbott, Chicago, IL, USA).All treated patients had previously undergone impulse elastography (FibroScan), with results expressed in kilopascals (KPa) when the HCV-RNA (polymerase chain reaction (PCR) and HCV genotype were determined. The viral load, HCV-RNA (PCR), was determined using a quantitative assay (Cobas Ampliprep/Cobas Taqman HCV [Roche]) and expressed in IU/mL (quantitation range between 15 and 7×107IU/mL). The HCV genotype was determined with the HCV GT CTLS assay on the Cobas 4800 system (Roche).The following were initially recorded in all cases: personal data, history of comorbidities, time on renal replacement therapy with dialysis or transplant and laboratory tests (haemoglobin, haematocrit, platelets, INR, aspartate aminotransferase [AST], alanine aminotransferase [ALT], gamma-glutamyl transferase [GGT] and bilirubin). Post-treatment laboratory results, management of anaemia during follow-up and treatment-related adverse effects were recorded in patients treated with DAAs. Epoetin and darbepoetin doses were recorded in IU/week. A conversion factor of 1:200 was applied to compare the epoetin dose (IU) with the darbepoetin dose (mcg) as indicated in the drug's Summary of Product Characteristics, so the darbepoetin dose expressed in mcg was multiplied by 200.Treatment regimens were based on the recommendations of the American Association for the Study of Liver Diseases (AASLD) when the patient was referred to the Hepatology clinic. Data collection commenced in February 2015. The treatment regimen for patients with genotype 4 included the combination of paritaprevir (150mg)/ritonavir (100mg) and ombitasvir (25mg) in a single daily dose (COMBO 2D), together with ribavirin (200mg/day); for patients with genotype 1b, COMBO 2D was combined with dasabuvir (250mg) twice daily (COMBO 3D); patients with genotype 1a were treated with the COMBO 3D regimen combined with ribavirin; one patient was treated with a sofosbuvir (400mg) and ledipasvir (90mg) regimen (Harvoni®); another with the combination of sofosbuvir (400mg) and simeprevir (150mg); and another with the combination of simeprevir and daclatasvir (60mg). A total of 15 cases received ribavirin at a dose of 200mg/day. Treatment was maintained for 12 or 24 weeks for all regimens, according to the recommendations of the Hepatology department, based on AASLD guidelines. The patient was considered to have an SVR when the HCV-RNA (PCR) was negative 24 weeks after completion treatment.Reasons to decide non-treatment were: short life expectancy, age over 80 years, undetectable HCV-RNA (PCR), genotype 3 and clinical stability with no changes in laboratory tests or abnormalities on the FibroScan.Statistical analysisQuantitative variables are expressed as a mean and standard deviation, and compared using the Student's t-test. Qualitative variables are expressed as percentage and compared using the Chi-square test. Differences were considered to be significant when p<0.05. SPSS version 17 (Chicago, IL, USA) was used for all calculations.ResultsHCV antibodies were analysed in 465 haemodialysis patients from two hospital areas, and 54 (11.6%) were found to be positive. Among these, 29 (53.7%) were treated with different DAA regimens. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the treated and untreated patients. Only the difference in age was significant between groups. In the untreated patient group, reasons for non-treatment included high comorbidity with a short life expectancy in 5 cases, age over 80 years in 4 cases, clinical stability with no changes in laboratory tests or abnormalities on the FibroScan in 5 cases, having genotype 3 in 2 cases, and due to an undetectable viral load in 9 patients (6 spontaneously and 3 due to previous treatment with interferon and ribavirin).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Among the patients treated with DAAs, the most common aetiology was glomerular in 11 cases (37.9%), followed by diabetic nephropathy in 4 (13.8%), vascular in 3 (10.3%), interstitial nephropathy in 2 (6.9%), unknown in 2 (6.9%), 1 case of polycystic disease (3.4%) and other causes in 6 patients (20.6%). The genotypes that presented were 1b in 18 cases (62.0%), 1a in 8 cases (27.5%) and genotype 4 in 3 patients (10.4%).The viral load of patients before DAA treatment was 1,283,288±2,165,432IU/mL. After treatment, regardless of the regimen prescribed, all patients had a negative viral load and SVR at 24 weeks. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the changes in laboratory values before and after treatment, where a significant decrease in GGT levels alone can be seen.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows treatment-related adverse effects. Asthenia and muscle cramps/pain were the most common. There were no differences between the different regimens. Serum haemoglobin levels did not change significantly (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), but it should be taken into account that the doses of erythropoiesis-stimulating agents (ESA) were increased, although the changes did not reach statistical significance (4894±4689 vs. 7789±6721IU/week). Transfusion of packed red blood cells or discontinuation of treatment due to adverse effects was not necessary in any case.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In patients treated with ribavirin, serum haemoglobin levels dropped an average of 0.3±1.9g/dL, despite having increased the mean dose of ESAs (5300±6864IU/week), while in those who had not received ribavirin, the ESA dose was increased by a smaller amount (1750±3412IU/week), with a slight increase in haemoglobin levels (0.16±1.3g/dL).DiscussionOur study shows that treatment of HCV-positive haemodialysis patients with different DAA regimens is safe and effective: an SVR was obtained in all cases, with few adverse effects. Very few studies have been published to date on the treatment of haemodialysis patients, and the vast majority correspond to series with small patient numbers; our findings are consistent with the series described.<a class="elsevierStyleCrossRefs" href="#bib0275">17–21</a> Recent studies show that the response of haemodialysis patients to DAAs is better than that obtained in patients with no renal disease.<a class="elsevierStyleCrossRef" href="#bib0300">22</a> Our results confirm the need to treat all haemodialysis patients with this infection, provided there are no contraindications. This recommendation is particularly important in patients on the renal transplant waiting list, since HCV infection is accompanied by an increased risk of rejection, proteinuria, infections and the development of diabetes, HCV-associated glomerulopathy and post-transplant liver complications.<a class="elsevierStyleCrossRefs" href="#bib0305">23,24</a>In our series, the prevalence of HCV infection was 11.6%, somewhat higher than that reported in the DOPPS V study for Spain in 2015, which was 8.9%<a class="elsevierStyleCrossRef" href="#bib0210">4</a>; it may be that nosocomial transmission is decreasing as a result of isolation measures and the decrease in the number of transfusions.<a class="elsevierStyleCrossRef" href="#bib0315">25</a>The AASLD and Infectious Diseases Society of America (IDSA),<a class="elsevierStyleCrossRef" href="#bib0320">26</a> in their guidelines dated 24/02/2016, recommend daily treatment with elbasvir (50mg) and grazoprevir (100mg) for 12 weeks in patients with advanced CKD or on dialysis with genotypes 1a, 1b or 4, based on the findings of the recently published C-SURFER study.<a class="elsevierStyleCrossRef" href="#bib0270">16</a> However, none of these drugs are yet to be approved in Spain. Of the drugs available in Spain, for our haemodialysis population, in patients with genotype 1b, treatment with the paritaprevir (150mg)/ritonavir (100mg) and ombitasvir (25mg) combination is recommended in a single daily dose, together with dasabuvir (250mg) twice daily for 12 weeks; in cases of infection with genotype 1a, which is more resistant to DAAs than genotype 1b, adjusted doses of ribavirin should be added (200mg/3 times per week or even daily). Treatment should be discontinued if haemoglobin levels fall by more than 2g/dL despite the use of ESAs.<a class="elsevierStyleCrossRef" href="#bib0285">19</a> In patients infected with genotypes 2, 3, 5 or 6, pegylated interferon and adjusted doses of ribavirin (200mg/day) are recommended.<a class="elsevierStyleCrossRef" href="#bib0320">26</a>There is no agreement in regard with the best DAA regimen for treating HCV infection in haemodialysis patients. Numerous combinations have been described, which appear to be related with the antivirals approved in the different countries involved. Evidence suggests that simeprevir, ledipasvir, paritaprevir/ritonavir, ombitasvir, dasabuvir, asunaprevir and daclatasvir are safe in patients on dialysis.<a class="elsevierStyleCrossRef" href="#bib0300">22</a> In our case, the most commonly used regimen was the combination of paritaprevir/ritonavir, ombitasvir and dasabuvir, although other regimens with different combinations of DAAs, including sofosbuvir, simeprevir, ledipasvir and daclatasvir, were used to a lesser extent. In any case, an SVR was the norm in all cases, regardless of the DAA combination received.Sofosbuvir is the first pan-genotypic DAA, but is not recommended in advanced CKD (estimated glomerular filtration rate [eGFR] less than 30mL/min) due to the risk of deterioration in renal function.<a class="elsevierStyleCrossRefs" href="#bib0275">17,20,27</a> This adverse effect is irrelevant in haemodialysis patients, since patients are anuric in most cases. Nevertheless, experience with this drug in these cases is scant, and its safety is pending confirmation. Two of our patients were treated with sofosbuvir in combination with ledipasvir or simeprevir, presenting outcomes equivalent to the more commonly used regimens as well as a good tolerance. These findings corroborate those reported by other authors in short patient series,<a class="elsevierStyleCrossRefs" href="#bib0280">18,28,29</a> but larger studies are needed so that conclusions may be drawn. Other DAA combinations pending incorporation in the therapeutic arsenal, such as grazoprevir/elbasvir and daclatasvir/asunaprevir/beclavubir, could open new options for these types of patients.<a class="elsevierStyleCrossRef" href="#bib0270">16</a>Among the different HCV genotypes, subtypes 1a and 1b are the most common in the general population and in our dialysis population, followed by genotypes 3, 2 and 4. The treatment response with the different DAA regimens used was SVR in almost 100% of cases, both in patients with and without cirrhosis. In contrast, for genotypes 2, 3, 5 and 6, the recommendation continues to be the traditional treatment with interferon and ribavirin at adjusted doses.<a class="elsevierStyleCrossRef" href="#bib0320">26</a> However, given the poor tolerance to interferon in haemodialysis patients, which is even worse when combined with ribavirin,<a class="elsevierStyleCrossRefs" href="#bib0240">10,30,31</a> the few cases in our series with these genotypes still remain untreated, awaiting the approval of new DAAs.Ribavirin was used in some of our patients with a dose adjustment. It was generally well tolerated, although the decrease in haemoglobin levels was more marked than in patients who were not treated with this drug, as described in other series.<a class="elsevierStyleCrossRef" href="#bib0350">32</a> In principle, it seems reasonable to allow this agent to be combined with the other DAAs in more severe cases, those with HIV coinfection, genotype 1a and in cases of cirrhosis.<a class="elsevierStyleCrossRef" href="#bib0320">26</a> Moreover, given the frequent tendency towards anaemia,<a class="elsevierStyleCrossRefs" href="#bib0350">32,33</a> it seems reasonable to increase the ESA dose as a preventive measure, before haemoglobin levels fall, as a way to avoid potential transfusions and the need to discontinue the drug.All the patients treated presented an SVR at the end of 24 weeks. While one might think that this will be maintained over a long time, it would be advisable to determine the viral load every 3–4 months to begin with and annually thereafter until more experience with long-term outcomes is available.Due to the risk of nosocomial transmission of HCV in haemodialysis units,<a class="elsevierStyleCrossRef" href="#bib0360">34</a> many HCV-positive patients are being dialysed in separate units or with shifts or monitor isolation. The outcomes obtained with the DAAs suggest that these measures need to be reconsidered. It seems reasonable to suggest, based on our experience, that patients with anti-HCV antibodies and an SVR should continue to be dialysed in the general unit along patients who are anti-HCV antibody-negative, given that the risks of leaving them with other untreated patients and patients with other genotypes may be greater and complicate their prognosis. As more and more HCV-positive patients are treated, isolation rooms for patients with HCV may tend to disappear. In any case, the development of an effective vaccine against HCV should be the ultimate goal.<a class="elsevierStyleCrossRefs" href="#bib0365">35–37</a>One of the major limitations of DAA treatment is the cost. Data from the Spanish Ministry of Finance and Public Administration show that the net annual accrued expenditure related with these types of hospital treatments for 2015 increased by 25.8% in Spain.<a class="elsevierStyleCrossRef" href="#bib0380">38</a> However, the cost–benefit in the longer term must be evaluated, taking into account admissions, ascitic decompensations, complementary treatments and the potential effect on the development of cirrhosis and mortality. Furthermore, presumably during this time, we have experienced a peak stage with the mass treatment of patients, which is expected to be followed by a trough, due to a decrease in the number of patients. As such, costs, logically, should fall.Our study presents some limitations, such as the small number of patients included, the short follow-up and a lack of uniformity in the treatment regimens, but it has the strengths of being the first series of haemodialysis patients treated with DAAs in Spain, and allowing us to conclude that the outcome obtained within the follow-up time is excellent.In summary, we can conclude that the use of new DAAs in the treatment of HCV in haemodialysis patients provides great efficacy, with minimal side effects, and constitutes a major advance in the treatment of these patients.Conflicts of interestThe authors declare that they have no conflicts of interest regarding the content of this manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres842776" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec837984" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres842775" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec837985" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-19" "fechaAceptado" => "2016-10-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec837984" "palabras" => array:3 [ 0 => "HCV infection" 1 => "Direct-acting antivirals" 2 => "Haemodialysis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec837985" "palabras" => array:3 [ 0 => "Infección por el VHC" 1 => "Antivirales de acción directa" 2 => "Hemodiálisis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Hepatitis C virus (HCV) infection is highly prevalent among patients on haemodialysis and leads to a poorer prognosis compared to patients who do not have said infection. Treatment with interferon and ribavirin is poorly tolerated and there are limited data on the experience with new direct-acting antivirals (DAAs). The aim of this study is to retrospectively analyse the current prevalence of HCV infection and efficacy and safety results with different DAA regimens in the haemodialysis population of 2 hospital areas.This is a multicentre, retrospective and observational study in which HCV antibodies were analysed in 465 patients, with positive antibody findings in 54 of them (11.6%). Among these, 29 cases (53.7%) with genotypes 1 and 4 were treated with different DAA regimens, including combinations of paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir and ledipasvir, with/without ribavirin. Mean age was 53.3±7.9 years, 72.4% of patients were male and the most important aetiology of chronic kidney disease involved glomerular abnormalities. In 100% of cases, a sustained viral response was achieved after 24 weeks, regardless of DAA regimen received. Adverse effects were not relevant and no case required stopping treatment. In 15 cases, ribavirin was combined with the DAA. In these cases, the most significant adverse effect was anaemic tendency, which was reflected in the increase of the dose of erythropoietin stimulating agents, although none required transfusions.In summary, we conclude that new DAAs for the treatment of HCV in haemodialysis patients are highly effective with minimal adverse effects; it is a very important advance in HCV management. These patients are therefore expected to have a much better prognosis than they have had until very recently." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La infección por el virus de la hepatitis C (VHC) es muy prevalente entre los pacientes en hemodiálisis y condiciona un peor pronóstico respecto a los que no la padecen. El tratamiento con interferón y ribavirina es mal tolerado y existen pocos datos sobre la experiencia con los nuevos antivirales de acción directa (AAD). El objetivo de este trabajo es estudiar retrospectivamente la prevalencia actual de la infección por el VHC y los resultados de eficacia y seguridad con distintas pautas de AAD en la población en hemodiálisis de 2áreas hospitalarias.Estudio multicéntrico, retrospectivo y observacional en el que se analizan los anticuerpos frente al VHC en 465 pacientes, entre los que 54 de ellos eran positivos (11,6%). Entre estos, 29 casos (53,7%) con genotipos 1 y 4 fueron tratados con distintas pautas de AAD, que incluían combinaciones de paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir y ledipasvir, con/sin ribavirina. La edad media era de 53,3+7,9 años, el 72,4% eran varones y la causa más importante de la enfermedad renal crónica eran las alteraciones glomerulares. En el 100% de los casos se obtuvo una respuesta viral sostenida a las 24 semanas independientemente de la pauta de AAD recibida. Los efectos secundarios fueron poco relevantes y ningún caso precisó suspender el tratamiento. En 15 de ellos, se asoció ribavirina a los AAD. En estos casos, el efecto adverso más destacable fue la tendencia a la anemización, reflejada en el incremento de la dosis de agentes estimulantes de la eritropoyesis, aunque ninguno precisó transfusiones.En resumen, concluimos que los nuevos AAD para el tratamiento del VHC en pacientes en hemodiálisis presentan una gran eficacia, con mínimos efectos secundarios, y constituyen un avance muy importante en su manejo, con lo que cabe esperar un pronóstico mucho mejor que el que presentaban hasta muy recientemente." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Abad S, Vega A, Rincón D, Hernández E, Mérida E, Macías N, et al. Eficacia de los antivirales de acción directa en la infección por el virus de la hepatitis C en pacientes en hemodiálisis. Nefrologia. 2017;37:158–163." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; HT: hypertension; RRT: renal replacement therapy; HIV: human immunodeficiency virus infection." "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">Variable \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">Treated \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">Not treated \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">p \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">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.3±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.6±12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.3 \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">Time on RRT (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">130.5±169.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93.7±121.3 \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">Diabetes mellitus (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.7 \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">History of HT (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.3 \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">History of HIV (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \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">Viral load, PCR-RNA (IU/mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,380,236±2,055,688 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1,603,712±3,652,181 \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">AST (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.5±16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.2±10.2 \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">GGT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.7±85.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43.7±31.8 \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">Bilirubin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.48±0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.43±0.27 \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">Haemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.6±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.2±1.8 \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">Platelets (×1000/mm3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">205.8±326.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">178.7±507.8 \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">INR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.0±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.0±0.08 \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></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1423343.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of HCV-positive patients treated and not treated with direct-acting antivirals." ] ] 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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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-treatment \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-treatment \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">p \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">AST (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.5±16.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8±4.8 \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">GGT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.7±85.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4±14.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \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">Bilirubin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48±0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53±0.38 \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">Haemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.6±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets (×1000/mm3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">205.8±326.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168.2±665.2 \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">INR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1423344.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Laboratory values before and after treatment." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Anaemia is considered independently in the text as an adverse effect." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">N \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">% \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">Asthenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.0 \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">Pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.3 \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">Hypo- or hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \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">Muscle cramps/pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.7 \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">Insomnia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6 \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">Nausea/vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1423342.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Treatment-related adverse effects." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global epidemiology of hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.W. Shepard" 1 => "L. Finelli" 2 => "M.J. Alter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(05)70216-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2005" "volumen" => "5" "paginaInicial" => "558" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16122679" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0200" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.J. Alter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "2436" "paginaFinal" => "2441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17552026" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0205" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Association for the Study of Liver Diseases, Diagnosis, Management and Treatment of Hepatitis C: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.G. Ghany" 1 => "D.B. Strader" 2 => "D.L. Thomas" 3 => "L.B. Seff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.22759" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "49" "paginaInicial" => "1335" "paginaFinal" => "1374" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330875" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0210" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis C: prevalence and clinical outcomes in the dialysis outcomes and practice patterns study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Bieber" 1 => "D.A. Goodkin" 2 => "C. Nwankwo" 3 => "J.M. Arduino" 4 => "T. Akiba" 5 => "M. Jadoul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2015" "volumen" => "30" "numero" => "Suppl. 3" "paginaInicial" => "iii303" "paginaFinal" => "iii332" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0215" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis: effect of hepatitis C virus infection on mortality in dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Fabrizi" 1 => "P. Martin" 2 => "V. Dixit" 3 => "S. Bunnapradist" 4 => "G. Dulai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2004.02290.x" "Revista" => array:5 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2004" "volumen" => "20" "paginaInicial" => "1271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15606388" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0220" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher prevalence of chronic kidney disease and shorter renal survival in patients with chronic hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.K. Satapathy" 1 => "C.S. Lingisetty" 2 => "S. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12072-011-9284-9" "Revista" => array:6 [ "tituloSerie" => "Hepatol Int" "fecha" => "2012" "volumen" => "6" "paginaInicial" => "369" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21698519" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0225" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HCV in patients with end-stage renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.J. Okoh" 1 => "J.R. Bucci" 2 => "J.F. Simon" 3 => "S.A. Harrisson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2008.01981.x" "Revista" => array:7 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2008" "volumen" => "103" "paginaInicial" => "2123" "paginaFinal" => "2134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18796105" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1081120614004128" "estado" => "S300" "issn" => "10811206" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0230" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peginterferon alfa-2-a plus ribavirin for chronic hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.W. Fried" 1 => "M.L. Shiffman" 2 => "K.R. Reddy" 3 => "C. Smith" 4 => "G. Marinos" 5 => "F.L. Gonçales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "N Eng J Med" "fecha" => "2002" "volumen" => "347" "paginaInicial" => "975" "paginaFinal" => "982" "itemHostRev" => array:3 [ "pii" => "S0091674913029382" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0235" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pegylated interferon (alone or with ribavirin) for chronic hepatitis C in haemodialysis population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Espinosa" 1 => "J. Hernández" 2 => "M.D. Arenas" 3 => "F. Carnicer" 4 => "C. Caramelo" 5 => "F. Fabrizi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000368501" "Revista" => array:6 [ "tituloSerie" => "Kidney Blood Press Res" "fecha" => "2015" "volumen" => "40" "paginaInicial" => "258" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25997572" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0240" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon monotherapy for dialysis patients with chronic hepatitis C: an analysis of the literature on efficacy and safety" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.W. Russo" 1 => "C.D. Goldsweig" 2 => "I.M. Jacobson" 3 => "R.S. Brown Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2003.07526.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2003" "volumen" => "98" "paginaInicial" => "1610" "paginaFinal" => "1615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12873587" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0245" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ABT-450/r-ombitasvir and dasabuvir with or without ribavirin for HCV" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ferenci" 1 => "D. Bernstein" 2 => "J. Lalezari" 3 => "D. Cohen" 4 => "Y. Luo" 5 => "C. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1402338" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "370" "paginaInicial" => "1983" "paginaFinal" => "1992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24795200" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0250" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Poordad" 1 => "C. Hezode" 2 => "R. Trinh" 3 => "K.V. Kowdley" 4 => "S. Zeuzen" 5 => "K. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1402869" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "370" "paginaInicial" => "1973" "paginaFinal" => "1982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24725237" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0255" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retreatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Zeuzem" 1 => "I.M. Jacobson" 2 => "T. Baykal" 3 => "R.T. Marinho" 4 => "F. Poordad" 5 => "M. Bourlière" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1401561" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "370" "paginaInicial" => "1604" "paginaFinal" => "1614" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24720679" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0260" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sustained virologic response rate of 96% in HCV genotype 1a infected patients treated with ombitasvir/paritaprevir/r and dasabuvir with ribavirin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Rustgi" 1 => "H. Wedemeyer" 2 => "P. Pockros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2015" "volumen" => "110" "paginaInicial" => "S862" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0265" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "99.7% sustained virologic response rate in 369 HCV genotype 1b-infeced patients treated with label-recommended regimen of ombitasvir/paritaprevir/r and dasabuvir with or without ribavirin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I.M. Jacobson" 1 => "J.F. Dufour" 2 => "H. Wedemeyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2015" "volumen" => "110" "paginaInicial" => "S850" "paginaFinal" => "S851" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0270" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4–5 chronic kidney disease (the C-SURFER study): a combination phase 3 study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Roth" 1 => "D.R. Nelson" 2 => "A. Bruchfeld" 3 => "A.M. Liapakis" 4 => "M. Silva" 5 => "M. Howard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)00349-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2015" "volumen" => "386" "paginaInicial" => "1537" "paginaFinal" => "1545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26456905" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0275" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of sofosbuvir-containing regimens in hepatitis C infected patients with impaired renal function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Saxena" 1 => "F.M. Koraishy" 2 => "M.E. Sise" 3 => "J.K. Lim" 4 => "M. Schmidt" 5 => "R.G. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13102" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "807" "paginaFinal" => "816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26923436" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0280" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sofosbuvir and simeprevir in hepatitis C genotype 1-patients with end-stage renal disease on hemodialysis or GFR<30mL/min" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.E. Nazario" 1 => "M. Ndungu" 2 => "A.A. Modi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13025" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "798" "paginaFinal" => "801" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26583882" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0285" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of direct-acting antiviral combination for patients with HCV genotype 1 infection and severe renal impairment or end-stage renal disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Pockros" 1 => "K.R. Reddy" 2 => "P.S. Mantry" 3 => "E. Cohen" 4 => "M. Bennett" 5 => "M.S. Sulkowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2016.02.078" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2016" "volumen" => "150" "paginaInicial" => "1590" "paginaFinal" => "1598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26976799" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0290" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sofosbuvir and simeprevir combination therapy in the setting of the liver transplantation and hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Perumpail" 1 => "R. Wong" 2 => "L. Ha" 3 => "P.A. Pham" 4 => "U. Wang" 5 => "H. Luong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transpl Infec Dis" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "275" "paginaFinal" => "278" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0295" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of daclastasvir and asunaprevir combination therapy in chronic hemodialysis patients with chronic hepatitis C" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Suda" 1 => "M. Kudo" 2 => "A. Nagasaka" 3 => "K. Furuya" 4 => "Y. Yamamoto" 5 => "T. Kobayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00535-016-1162-8" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2016" "volumen" => "51" "paginaInicial" => "733" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26768604" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0300" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of dual direct-acting antiviral therapy (daclatasvir and asunaprevir) for chronic hepatitis C virus genotype 1 infection in patients on hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Toyoda" 1 => "T. Kumada" 2 => "T. Tada" 3 => "K. Takaguchi" 4 => "T. Ishikawa" 5 => "K. Tsuji" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00535-016-1174-4" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2016" "volumen" => "51" "paginaInicial" => "741" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26872889" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0305" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney transplantation in the patient with hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Morales" 1 => "R. Bloom" 2 => "D. Roth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000332385" "Revista" => array:6 [ "tituloSerie" => "Contrib Nephrol" "fecha" => "2012" "volumen" => "176" "paginaInicial" => "77" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22310783" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0310" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The kidney transplant recipient with hepatitis C infection: pre and posttransplantation treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.A. Terrault" 1 => "D.B. Adey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2007" "paginaInicial" => "563" "paginaFinal" => "575" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0315" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Espinosa" 1 => "A. Martin-Malo" 2 => "R. Ojeda" 3 => "R. Santamaria" 4 => "S. Soriano" 5 => "M. Aguera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "685" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15042545" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2215036614702494" "estado" => "S300" "issn" => "22150366" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0320" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "AASLD Practice Guidelines. [consulted 6 Feb 2016]. Available in: <a href="http://www.hvcguidelines.org/">www.hvcguidelines.org</a>." ] ] ] 26 => array:3 [ "identificador" => "bib0325" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients hepatitis C virus genotype 3 infection: ALLY-3 phase study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.R. Nelson" 1 => "J.N. Cooper" 2 => "J.P. Lalezari" 3 => "E. Lawitz" 4 => "P.J. Pockros" 5 => "N. Guitlin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.27726" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2015" "volumen" => "61" "paginaInicial" => "1127" "paginaFinal" => "1135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614962" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0330" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sofosbuvir based treatment is safe and effective in patients with chronic hepatitis C infection and end-stage renal disease: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Singh" 1 => "J. Guirguis" 2 => "S. Anthony" 3 => "J. Rivas" 4 => "I.A. Hanouneh" 5 => "N. Alkhouri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13078" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "802" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26824848" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0335" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sofosbuvir-containing regimen for HCV infection in hemodialysis patients: 400mg daily or only on the day of hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Desnoyer" 1 => "D. Pospai" 2 => "M.P. Lê" 3 => "A. Gervais" 4 => "A. Heurgué-Berlot" 5 => "A. Laradi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2016.02.044" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2016" "volumen" => "65" "paginaInicial" => "40" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26952005" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0340" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection: a systematic review of the literature and meta-analysis of treatment efficacy and harms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.E. Gordon" 1 => "K. Uhlig" 2 => "J. Lau" 3 => "C.H. Schmid" 4 => "A.S. Levey" 5 => "J.B. Wong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2007.11.003" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "263" "paginaFinal" => "277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18215704" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0091674908018538" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0345" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of pegylated interferon alfa-2b and ribavirin combination therapy versus pegylated interferon monotherapy in hemodialysis patients: a comparison of 2 sequentially treated cohorts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.L. Tseng" 1 => "T.C. Chen" 2 => "Y.S. Chien" 3 => "C.H. Hung" 4 => "Y.H. Yen" 5 => "K.C. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2013.03.037" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "789" "paginaFinal" => "795" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23746377" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0350" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pegylated interferon-α2a with or without low-dose of ribavirin for treatment-naive patients with hepatitis C virus genotype 1 receiving hemodialysis: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.H. Liu" 1 => "C.F. Huang" 2 => "C.J. Liu" 3 => "C.Y. Dai" 4 => "C.C. Liang" 5 => "J.F. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-159-11-201312030-00005" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2013" "volumen" => "159" "paginaInicial" => "729" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24297189" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0355" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ribavirin induced hemolysis: a novel mechanism of action against chronic hepatitis C virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Soota" 1 => "B. Maliakkal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3748/wjg.v20.i43.16184" "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "16184" "paginaFinal" => "16190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25473172" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0360" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Petrosillo" 1 => "P. Gilli" 2 => "D. Serraino" 3 => "P. Dentico" 4 => "A. Mele" 5 => "P. Ragni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "1004" "paginaFinal" => "1010" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11325683" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0365" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HCV E1E2-MF59 vaccine in chronic hepatitis C patients treated with PEG-IFNα2a and Ribavirin: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Colombatto" 1 => "M.R. Brunetto" 2 => "A.M. Maina" 3 => "V. Romagnoli" 4 => "P. Almasio" 5 => "M.G. Rumi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jvh.12163" "Revista" => array:6 [ "tituloSerie" => "J Viral Hepat" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "458" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24750327" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0370" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An inactivated hepatitis C virus vaccine on the horizon?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Houghton" 1 => "J.L. Law" 2 => "D.L. Tyrrell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2013.06.029" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2013" "volumen" => "145" "paginaInicial" => "285" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23806539" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0375" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A hepatitis C virus (HCV) vaccine comprising envelope glycoproteins gpE1/gpE2 derived from a single isolate elicits broad cross-genotype neutralizing antibodies in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Law" 1 => "C. Chen" 2 => "J. Wong" 3 => "D. Hockman" 4 => "D.M. Santer" 5 => "S.E. Frey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "PLoS One" "fecha" => "2013" "paginaInicial" => "e59776" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0380" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Hacienda y Administraciones Públicas. Gasto en productos farmaceúticos y sanitarios (tabla 1h. Gasto devengado neto. Tasa de variación interanual considerando el efecto de hepatitis C. Octubre 2015. [consulted 6 Feb 2016]. Available in: <a href="http://www.minhap.gob.es/es-ES/CDI/SeguimientoLeyEstabilidad/Paginas/Indicadores-sobreGasto-Farmac%26eacute;utico-y-Sanitario.aspx">http://www.minhap.gob.es/es-ES/CDI/SeguimientoLeyEstabilidad/Paginas/Indicadores-sobreGasto-Farmacéutico-y-Sanitario.aspx</a>" ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000002/v1_201705250045/S2013251417300822/v1_201705250045/en/main.assets" "Apartado" => array:4 [ "identificador" => "42660" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000002/v1_201705250045/S2013251417300822/v1_201705250045/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300822?idApp=UINPBA000064"]

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Eficacia de los antivirales de acción directa en la infección por el virus de la hepatitis C en pacientes en hemodiálisis

Soraya Abada, Almudena Vegaa, Diego Rincónb, Eduardo Hernándezc, Evangelina Méridac, Nicolás Macíasa, Raquel Muñozd, Mónica Millac, Jose Luñoa, Juan Manuel López-Gómeza,

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juanmlopez@senefro.org

Corresponding author.

a Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, Spain

b Servicio de Aparato Digestivo, Hospital Universitario Gregorio Marañón, Madrid, Spain

c Servicio de Nefrología. Hospital 12 de Octubre, Madrid, Spain

d Servicio de Medicina del Aparato Digestivo, Hospital 12 de Octubre, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic hepatitis C virus &#40;HCV&#41; infection is a serious health problem that affects more than 170 million people worldwide<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;3</span></a> and may cause liver cirrhosis and hepatocellular carcinoma&#46; The prevalence of HCV in haemodialysis patients is even greater&#46; Data from the Dialysis Outcomes and Practice Patterns Study &#40;DOPPS&#41; show a very wide range of prevalence among the different countries studied&#44; which in some countries such as Spain reaches as high as 8&#46;9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> Moreover&#44; the survival of infected patients decreases with respect to those without the infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At the beginning of this century&#44; the combination of pegylated interferon and ribavirin became the standard for treatment for HCV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8&#8211;10</span></a> However&#44; the adverse effects of interferon treatment in patients with chronic kidney disease &#40;CKD&#41;&#44; potentiated by the ribavirin treatment together with their poor response&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> have proven a major limitation for their widespread use&#46; The recent development of antiviral agents that act directly on viral replication &#40;direct-acting antivirals &#91;DAA&#93;&#41; has completely changed the prognosis of the infection&#44; achieving a sustained viral response &#40;SVR&#41; of over 90&#37; among the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#8211;15</span></a> Experience with DAAs in HCV-positive haemodialysis patients is scant&#44; and is related to small patient series&#46; Nevertheless&#44; the results are very promising&#44; reaching an SVR in the vast majority of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#8211;20</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study is to analyse the current prevalence of HCV infection in the haemodialysis units of two hospitals and their affiliated sites&#44; and to assess treatment response with different DAA regimens&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A multicentre&#44; retrospective&#44; observational study&#44; in which we analysed all prevalent haemodialysis patients belonging to two hospital areas in Madrid &#40;Spain&#41;&#46; Patients with HCV antibodies were identified&#44; and those treated with DAAs were separated from those who had received no specific treatment&#46; HCV antibody detection was performed using a chemiluminescent microparticle immunoassay on an Architect i4000 sr autoanalyser &#40;Abbott&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All treated patients had previously undergone impulse elastography &#40;FibroScan&#41;&#44; with results expressed in kilopascals &#40;KPa&#41; when the HCV-RNA &#40;polymerase chain reaction &#40;PCR&#41; and HCV genotype were determined&#46; The viral load&#44; HCV-RNA &#40;PCR&#41;&#44; was determined using a quantitative assay &#40;Cobas Ampliprep&#47;Cobas Taqman HCV &#91;Roche&#93;&#41; and expressed in IU&#47;mL &#40;quantitation range between 15 and 7<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">7</span><span class="elsevierStyleHsp" style=""></span>IU&#47;mL&#41;&#46; The HCV genotype was determined with the HCV GT CTLS assay on the Cobas 4800 system &#40;Roche&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The following were initially recorded in all cases&#58; personal data&#44; history of comorbidities&#44; time on renal replacement therapy with dialysis or transplant and laboratory tests &#40;haemoglobin&#44; haematocrit&#44; platelets&#44; INR&#44; aspartate aminotransferase &#91;AST&#93;&#44; alanine aminotransferase &#91;ALT&#93;&#44; gamma-glutamyl transferase &#91;GGT&#93; and bilirubin&#41;&#46; Post-treatment laboratory results&#44; management of anaemia during follow-up and treatment-related adverse effects were recorded in patients treated with DAAs&#46; Epoetin and darbepoetin doses were recorded in IU&#47;week&#46; A conversion factor of 1&#58;200 was applied to compare the epoetin dose &#40;IU&#41; with the darbepoetin dose &#40;mcg&#41; as indicated in the drug&#39;s Summary of Product Characteristics&#44; so the darbepoetin dose expressed in mcg was multiplied by 200&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment regimens were based on the recommendations of the American Association for the Study of Liver Diseases &#40;AASLD&#41; when the patient was referred to the Hepatology clinic&#46; Data collection commenced in February 2015&#46; The treatment regimen for patients with genotype 4 included the combination of paritaprevir &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#41;&#47;ritonavir &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#41; and ombitasvir &#40;25<span class="elsevierStyleHsp" style=""></span>mg&#41; in a single daily dose &#40;COMBO 2D&#41;&#44; together with ribavirin &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#59; for patients with genotype 1b&#44; COMBO 2D was combined with dasabuvir &#40;250<span class="elsevierStyleHsp" style=""></span>mg&#41; twice daily &#40;COMBO 3D&#41;&#59; patients with genotype 1a were treated with the COMBO 3D regimen combined with ribavirin&#59; one patient was treated with a sofosbuvir &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#41; and ledipasvir &#40;90<span class="elsevierStyleHsp" style=""></span>mg&#41; regimen &#40;Harvoni&#174;&#41;&#59; another with the combination of sofosbuvir &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#41; and simeprevir &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; and another with the combination of simeprevir and daclatasvir &#40;60<span class="elsevierStyleHsp" style=""></span>mg&#41;&#46; A total of 15 cases received ribavirin at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; Treatment was maintained for 12 or 24 weeks for all regimens&#44; according to the recommendations of the Hepatology department&#44; based on AASLD guidelines&#46; The patient was considered to have an SVR when the HCV-RNA &#40;PCR&#41; was negative 24 weeks after completion treatment&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Reasons to decide non-treatment were&#58; short life expectancy&#44; age over 80 years&#44; undetectable HCV-RNA &#40;PCR&#41;&#44; genotype 3 and clinical stability with no changes in laboratory tests or abnormalities on the FibroScan&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as a mean and standard deviation&#44; and compared using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; Qualitative variables are expressed as percentage and compared using the Chi-square test&#46; Differences were considered to be significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; SPSS version 17 &#40;Chicago&#44; IL&#44; USA&#41; was used for all calculations&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">HCV antibodies were analysed in 465 haemodialysis patients from two hospital areas&#44; and 54 &#40;11&#46;6&#37;&#41; were found to be positive&#46; Among these&#44; 29 &#40;53&#46;7&#37;&#41; were treated with different DAA regimens&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the treated and untreated patients&#46; Only the difference in age was significant between groups&#46; In the untreated patient group&#44; reasons for non-treatment included high comorbidity with a short life expectancy in 5 cases&#44; age over 80 years in 4 cases&#44; clinical stability with no changes in laboratory tests or abnormalities on the FibroScan in 5 cases&#44; having genotype 3 in 2 cases&#44; and due to an undetectable viral load in 9 patients &#40;6 spontaneously and 3 due to previous treatment with interferon and ribavirin&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Among the patients treated with DAAs&#44; the most common aetiology was glomerular in 11 cases &#40;37&#46;9&#37;&#41;&#44; followed by diabetic nephropathy in 4 &#40;13&#46;8&#37;&#41;&#44; vascular in 3 &#40;10&#46;3&#37;&#41;&#44; interstitial nephropathy in 2 &#40;6&#46;9&#37;&#41;&#44; unknown in 2 &#40;6&#46;9&#37;&#41;&#44; 1 case of polycystic disease &#40;3&#46;4&#37;&#41; and other causes in 6 patients &#40;20&#46;6&#37;&#41;&#46; The genotypes that presented were 1b in 18 cases &#40;62&#46;0&#37;&#41;&#44; 1a in 8 cases &#40;27&#46;5&#37;&#41; and genotype 4 in 3 patients &#40;10&#46;4&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The viral load of patients before DAA treatment was 1&#44;283&#44;288<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;165&#44;432<span class="elsevierStyleHsp" style=""></span>IU&#47;mL&#46; After treatment&#44; regardless of the regimen prescribed&#44; all patients had a negative viral load and SVR at 24 weeks&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the changes in laboratory values before and after treatment&#44; where a significant decrease in GGT levels alone can be seen&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows treatment-related adverse effects&#46; Asthenia and muscle cramps&#47;pain were the most common&#46; There were no differences between the different regimens&#46; Serum haemoglobin levels did not change significantly &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; but it should be taken into account that the doses of erythropoiesis-stimulating agents &#40;ESA&#41; were increased&#44; although the changes did not reach statistical significance &#40;4894<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4689 vs&#46; 7789<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6721<span class="elsevierStyleHsp" style=""></span>IU&#47;week&#41;&#46; Transfusion of packed red blood cells or discontinuation of treatment due to adverse effects was not necessary in any case&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In patients treated with ribavirin&#44; serum haemoglobin levels dropped an average of 0&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; despite having increased the mean dose of ESAs &#40;5300<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6864<span class="elsevierStyleHsp" style=""></span>IU&#47;week&#41;&#44; while in those who had not received ribavirin&#44; the ESA dose was increased by a smaller amount &#40;1750<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3412<span class="elsevierStyleHsp" style=""></span>IU&#47;week&#41;&#44; with a slight increase in haemoglobin levels &#40;0&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Our study shows that treatment of HCV-positive haemodialysis patients with different DAA regimens is safe and effective&#58; an SVR was obtained in all cases&#44; with few adverse effects&#46; Very few studies have been published to date on the treatment of haemodialysis patients&#44; and the vast majority correspond to series with small patient numbers&#59; our findings are consistent with the series described&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">17&#8211;21</span></a> Recent studies show that the response of haemodialysis patients to DAAs is better than that obtained in patients with no renal disease&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> Our results confirm the need to treat all haemodialysis patients with this infection&#44; provided there are no contraindications&#46; This recommendation is particularly important in patients on the renal transplant waiting list&#44; since HCV infection is accompanied by an increased risk of rejection&#44; proteinuria&#44; infections and the development of diabetes&#44; HCV-associated glomerulopathy and post-transplant liver complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In our series&#44; the prevalence of HCV infection was 11&#46;6&#37;&#44; somewhat higher than that reported in the DOPPS V study for Spain in 2015&#44; which was 8&#46;9&#37;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&#59; it may be that nosocomial transmission is decreasing as a result of isolation measures and the decrease in the number of transfusions&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The AASLD and Infectious Diseases Society of America &#40;IDSA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> in their guidelines dated 24&#47;02&#47;2016&#44; recommend daily treatment with elbasvir &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#41; and grazoprevir &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#41; for 12 weeks in patients with advanced CKD or on dialysis with genotypes 1a&#44; 1b or 4&#44; based on the findings of the recently published C-SURFER study&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> However&#44; none of these drugs are yet to be approved in Spain&#46; Of the drugs available in Spain&#44; for our haemodialysis population&#44; in patients with genotype 1b&#44; treatment with the paritaprevir &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#41;&#47;ritonavir &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#41; and ombitasvir &#40;25<span class="elsevierStyleHsp" style=""></span>mg&#41; combination is recommended in a single daily dose&#44; together with dasabuvir &#40;250<span class="elsevierStyleHsp" style=""></span>mg&#41; twice daily for 12 weeks&#59; in cases of infection with genotype 1a&#44; which is more resistant to DAAs than genotype 1b&#44; adjusted doses of ribavirin should be added &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#47;3 times per week or even daily&#41;&#46; Treatment should be discontinued if haemoglobin levels fall by more than 2<span class="elsevierStyleHsp" style=""></span>g&#47;dL despite the use of ESAs&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> In patients infected with genotypes 2&#44; 3&#44; 5 or 6&#44; pegylated interferon and adjusted doses of ribavirin &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; are recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">There is no agreement in regard with the best DAA regimen for treating HCV infection in haemodialysis patients&#46; Numerous combinations have been described&#44; which appear to be related with the antivirals approved in the different countries involved&#46; Evidence suggests that simeprevir&#44; ledipasvir&#44; paritaprevir&#47;ritonavir&#44; ombitasvir&#44; dasabuvir&#44; asunaprevir and daclatasvir are safe in patients on dialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> In our case&#44; the most commonly used regimen was the combination of paritaprevir&#47;ritonavir&#44; ombitasvir and dasabuvir&#44; although other regimens with different combinations of DAAs&#44; including sofosbuvir&#44; simeprevir&#44; ledipasvir and daclatasvir&#44; were used to a lesser extent&#46; In any case&#44; an SVR was the norm in all cases&#44; regardless of the DAA combination received&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Sofosbuvir is the first pan-genotypic DAA&#44; but is not recommended in advanced CKD &#40;estimated glomerular filtration rate &#91;eGFR&#93; less than 30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41; due to the risk of deterioration in renal function&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">17&#44;20&#44;27</span></a> This adverse effect is irrelevant in haemodialysis patients&#44; since patients are anuric in most cases&#46; Nevertheless&#44; experience with this drug in these cases is scant&#44; and its safety is pending confirmation&#46; Two of our patients were treated with sofosbuvir in combination with ledipasvir or simeprevir&#44; presenting outcomes equivalent to the more commonly used regimens as well as a good tolerance&#46; These findings corroborate those reported by other authors in short patient series&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">18&#44;28&#44;29</span></a> but larger studies are needed so that conclusions may be drawn&#46; Other DAA combinations pending incorporation in the therapeutic arsenal&#44; such as grazoprevir&#47;elbasvir and daclatasvir&#47;asunaprevir&#47;beclavubir&#44; could open new options for these types of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Among the different HCV genotypes&#44; subtypes 1a and 1b are the most common in the general population and in our dialysis population&#44; followed by genotypes 3&#44; 2 and 4&#46; The treatment response with the different DAA regimens used was SVR in almost 100&#37; of cases&#44; both in patients with and without cirrhosis&#46; In contrast&#44; for genotypes 2&#44; 3&#44; 5 and 6&#44; the recommendation continues to be the traditional treatment with interferon and ribavirin at adjusted doses&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> However&#44; given the poor tolerance to interferon in haemodialysis patients&#44; which is even worse when combined with ribavirin&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">10&#44;30&#44;31</span></a> the few cases in our series with these genotypes still remain untreated&#44; awaiting the approval of new DAAs&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Ribavirin was used in some of our patients with a dose adjustment&#46; It was generally well tolerated&#44; although the decrease in haemoglobin levels was more marked than in patients who were not treated with this drug&#44; as described in other series&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a> In principle&#44; it seems reasonable to allow this agent to be combined with the other DAAs in more severe cases&#44; those with HIV coinfection&#44; genotype 1a and in cases of cirrhosis&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> Moreover&#44; given the frequent tendency towards anaemia&#44;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">32&#44;33</span></a> it seems reasonable to increase the ESA dose as a preventive measure&#44; before haemoglobin levels fall&#44; as a way to avoid potential transfusions and the need to discontinue the drug&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">All the patients treated presented an SVR at the end of 24 weeks&#46; While one might think that this will be maintained over a long time&#44; it would be advisable to determine the viral load every 3&#8211;4 months to begin with and annually thereafter until more experience with long-term outcomes is available&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Due to the risk of nosocomial transmission of HCV in haemodialysis units&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> many HCV-positive patients are being dialysed in separate units or with shifts or monitor isolation&#46; The outcomes obtained with the DAAs suggest that these measures need to be reconsidered&#46; It seems reasonable <span class="elsevierStyleItalic">to suggest</span>&#44; <span class="elsevierStyleItalic">based on our experience</span>&#44; that patients with anti-HCV antibodies and an SVR should continue to be dialysed in the general unit along patients who are anti-HCV antibody-negative&#44; given that the risks of leaving them with other untreated patients and patients with other genotypes may be greater and complicate their prognosis&#46; As more and more HCV-positive patients are treated&#44; isolation rooms for patients with HCV may tend to disappear&#46; In any case&#44; the development of an effective vaccine against HCV should be the ultimate goal&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35&#8211;37</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">One of the major limitations of DAA treatment is the cost&#46; Data from the Spanish Ministry of Finance and Public Administration show that the net annual accrued expenditure related with these types of hospital treatments for 2015 increased by 25&#46;8&#37; in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> However&#44; the cost&#8211;benefit in the longer term must be evaluated&#44; taking into account admissions&#44; ascitic decompensations&#44; complementary treatments and the potential effect on the development of cirrhosis and mortality&#46; Furthermore&#44; presumably during this time&#44; we have experienced a peak stage with the mass treatment of patients&#44; which is expected to be followed by a trough&#44; due to a decrease in the number of patients&#46; As such&#44; costs&#44; logically&#44; should fall&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study presents some limitations&#44; such as the small number of patients included&#44; the short follow-up and a lack of uniformity in the treatment regimens&#44; but it has the strengths of being the first series of haemodialysis patients treated with DAAs in Spain&#44; and allowing us to conclude that the outcome obtained within the follow-up time is excellent&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In summary&#44; we can conclude that the use of new DAAs in the treatment of HCV in haemodialysis patients provides great efficacy&#44; with minimal side effects&#44; and constitutes a major advance in the treatment of these patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest regarding the content of this manuscript&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hepatitis C virus &#40;HCV&#41; infection is highly prevalent among patients on haemodialysis and leads to a poorer prognosis compared to patients who do not have said infection&#46; Treatment with interferon and ribavirin is poorly tolerated and there are limited data on the experience with new direct-acting antivirals &#40;DAAs&#41;&#46; The aim of this study is to retrospectively analyse the current prevalence of HCV infection and efficacy and safety results with different DAA regimens in the haemodialysis population of 2 hospital areas&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This is a multicentre&#44; retrospective and observational study in which HCV antibodies were analysed in 465 patients&#44; with positive antibody findings in 54 of them &#40;11&#46;6&#37;&#41;&#46; Among these&#44; 29 cases &#40;53&#46;7&#37;&#41; with genotypes 1 and 4 were treated with different DAA regimens&#44; including combinations of paritaprevir&#47;ritonavir&#44; ombitasvir&#44; dasabuvir&#44; sofosbuvir&#44; simeprevir&#44; daclatasvir and ledipasvir&#44; with&#47;without ribavirin&#46; Mean age was 53&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9 years&#44; 72&#46;4&#37; of patients were male and the most important aetiology of chronic kidney disease involved glomerular abnormalities&#46; In 100&#37; of cases&#44; a sustained viral response was achieved after 24 weeks&#44; regardless of DAA regimen received&#46; Adverse effects were not relevant and no case required stopping treatment&#46; In 15 cases&#44; ribavirin was combined with the DAA&#46; In these cases&#44; the most significant adverse effect was anaemic tendency&#44; which was reflected in the increase of the dose of erythropoietin stimulating agents&#44; although none required transfusions&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In summary&#44; we conclude that new DAAs for the treatment of HCV in haemodialysis patients are highly effective with minimal adverse effects&#59; it is a very important advance in HCV management&#46; These patients are therefore expected to have a much better prognosis than they have had until very recently&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por el virus de la hepatitis C &#40;VHC&#41; es muy prevalente entre los pacientes en hemodi&#225;lisis y condiciona un peor pron&#243;stico respecto a los que no la padecen&#46; El tratamiento con interfer&#243;n y ribavirina es mal tolerado y existen pocos datos sobre la experiencia con los nuevos antivirales de acci&#243;n directa &#40;AAD&#41;&#46; El objetivo de este trabajo es estudiar retrospectivamente la prevalencia actual de la infecci&#243;n por el VHC y los resultados de eficacia y seguridad con distintas pautas de AAD en la poblaci&#243;n en hemodi&#225;lisis de 2<span class="elsevierStyleHsp" style=""></span>&#225;reas hospitalarias&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; retrospectivo y observacional en el que se analizan los anticuerpos frente al VHC en 465 pacientes&#44; entre los que 54 de ellos eran positivos &#40;11&#44;6&#37;&#41;&#46; Entre estos&#44; 29 casos &#40;53&#44;7&#37;&#41; con genotipos 1 y 4 fueron tratados con distintas pautas de AAD&#44; que inclu&#237;an combinaciones de paritaprevir&#47;ritonavir&#44; ombitasvir&#44; dasabuvir&#44; sofosbuvir&#44; simeprevir&#44; daclatasvir y ledipasvir&#44; con&#47;sin ribavirina&#46; La edad media era de 53&#44;3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>7&#44;9 a&#241;os&#44; el 72&#44;4&#37; eran varones y la causa m&#225;s importante de la enfermedad renal cr&#243;nica eran las alteraciones glomerulares&#46; En el 100&#37; de los casos se obtuvo una respuesta viral sostenida a las 24 semanas independientemente de la pauta de AAD recibida&#46; Los efectos secundarios fueron poco relevantes y ning&#250;n caso precis&#243; suspender el tratamiento&#46; En 15 de ellos&#44; se asoci&#243; ribavirina a los AAD&#46; En estos casos&#44; el efecto adverso m&#225;s destacable fue la tendencia a la anemizaci&#243;n&#44; reflejada en el incremento de la dosis de agentes estimulantes de la eritropoyesis&#44; aunque ninguno precis&#243; transfusiones&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En resumen&#44; concluimos que los nuevos AAD para el tratamiento del VHC en pacientes en hemodi&#225;lisis presentan una gran eficacia&#44; con m&#237;nimos efectos secundarios&#44; y constituyen un avance muy importante en su manejo&#44; con lo que cabe esperar un pron&#243;stico mucho mejor que el que presentaban hasta muy recientemente&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Abad S&#44; Vega A&#44; Rinc&#243;n D&#44; Hern&#225;ndez E&#44; M&#233;rida E&#44; Mac&#237;as N&#44; et al&#46; Eficacia de los antivirales de acci&#243;n directa en la infecci&#243;n por el virus de la hepatitis C en pacientes en hemodi&#225;lisis&#46; Nefrologia&#46; 2017&#59;37&#58;158&#8211;163&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AST&#58; aspartate aminotransferase&#59; GGT&#58; gamma-glutamyl transferase&#59; HT&#58; hypertension&#59; RRT&#58; renal replacement therapy&#59; HIV&#58; human immunodeficiency virus infection&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Treated&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">Not treated&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Time on RRT &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">130&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>169&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>121&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Diabetes mellitus &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">History of HT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">History of HIV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Viral load&#44; PCR-RNA &#40;IU&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;380&#44;236<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;055&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;603&#44;712<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;652&#44;181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">AST &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Haemoglobin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Platelets &#40;&#215;1000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">205&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>326&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">178&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>507&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">INR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of HCV-positive patients treated and not treated with direct-acting antivirals&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-treatment&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">Post-treatment&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AST &#40;U&#47;L&#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&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">GGT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>85&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;01&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">Bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&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">Haemoglobin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global epidemiology of hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;W&#46; Shepard"
                            1 => "L&#46; Finelli"
                            2 => "M&#46;J&#46; Alter"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/S1473-3099(05)70216-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2005"
                        "volumen" => "5"
                        "paginaInicial" => "558"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16122679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;J&#46; Alter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "2436"
                        "paginaFinal" => "2441"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17552026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Association for the Study of Liver Diseases&#44; Diagnosis&#44; Management and Treatment of Hepatitis C&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;G&#46; Ghany"
                            1 => "D&#46;B&#46; Strader"
                            2 => "D&#46;L&#46; Thomas"
                            3 => "L&#46;B&#46; Seff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.22759"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2009"
                        "volumen" => "49"
                        "paginaInicial" => "1335"
                        "paginaFinal" => "1374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330875"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis C&#58; prevalence and clinical outcomes in the dialysis outcomes and practice patterns study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Bieber"
                            1 => "D&#46;A&#46; Goodkin"
                            2 => "C&#46; Nwankwo"
                            3 => "J&#46;M&#46; Arduino"
                            4 => "T&#46; Akiba"
                            5 => "M&#46; Jadoul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "numero" => "Suppl&#46; 3"
                        "paginaInicial" => "iii303"
                        "paginaFinal" => "iii332"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; effect of hepatitis C virus infection on mortality in dialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Fabrizi"
                            1 => "P&#46; Martin"
                            2 => "V&#46; Dixit"
                            3 => "S&#46; Bunnapradist"
                            4 => "G&#46; Dulai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2036.2004.02290.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2004"
                        "volumen" => "20"
                        "paginaInicial" => "1271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15606388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher prevalence of chronic kidney disease and shorter renal survival in patients with chronic hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;K&#46; Satapathy"
                            1 => "C&#46;S&#46; Lingisetty"
                            2 => "S&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12072-011-9284-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatol Int"
                        "fecha" => "2012"
                        "volumen" => "6"
                        "paginaInicial" => "369"
                        "paginaFinal" => "378"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21698519"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HCV in patients with end-stage renal disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;J&#46; Okoh"
                            1 => "J&#46;R&#46; Bucci"
                            2 => "J&#46;F&#46; Simon"
                            3 => "S&#46;A&#46; Harrisson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2008.01981.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2008"
                        "volumen" => "103"
                        "paginaInicial" => "2123"
                        "paginaFinal" => "2134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18796105"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1081120614004128"
                          "estado" => "S300"
                          "issn" => "10811206"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Peginterferon alfa-2-a plus ribavirin for chronic hepatitis C virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;W&#46; Fried"
                            1 => "M&#46;L&#46; Shiffman"
                            2 => "K&#46;R&#46; Reddy"
                            3 => "C&#46; Smith"
                            4 => "G&#46; Marinos"
                            5 => "F&#46;L&#46; Gon&#231;ales"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2002"
                        "volumen" => "347"
                        "paginaInicial" => "975"
                        "paginaFinal" => "982"
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674913029382"
                          "estado" => "S300"
                          "issn" => "00916749"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pegylated interferon &#40;alone or with ribavirin&#41; for chronic hepatitis C in haemodialysis population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Espinosa"
                            1 => "J&#46; Hern&#225;ndez"
                            2 => "M&#46;D&#46; Arenas"
                            3 => "F&#46; Carnicer"
                            4 => "C&#46; Caramelo"
                            5 => "F&#46; Fabrizi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000368501"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Blood Press Res"
                        "fecha" => "2015"
                        "volumen" => "40"
                        "paginaInicial" => "258"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25997572"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interferon monotherapy for dialysis patients with chronic hepatitis C&#58; an analysis of the literature on efficacy and safety"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;W&#46; Russo"
                            1 => "C&#46;D&#46; Goldsweig"
                            2 => "I&#46;M&#46; Jacobson"
                            3 => "R&#46;S&#46; Brown Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1572-0241.2003.07526.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2003"
                        "volumen" => "98"
                        "paginaInicial" => "1610"
                        "paginaFinal" => "1615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12873587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0245"
              "etiqueta" => "11"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ABT-450&#47;r-ombitasvir and dasabuvir with or without ribavirin for HCV"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Ferenci"
                            1 => "D&#46; Bernstein"
                            2 => "J&#46; Lalezari"
                            3 => "D&#46; Cohen"
                            4 => "Y&#46; Luo"
                            5 => "C&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1402338"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2014"
                        "volumen" => "370"
                        "paginaInicial" => "1983"
                        "paginaFinal" => "1992"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24795200"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0250"
              "etiqueta" => "12"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "ABT-450&#47;r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "R&#46; Trinh"
                            3 => "K&#46;V&#46; Kowdley"
                            4 => "S&#46; Zeuzen"
                            5 => "K&#46; Agarwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1402869"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2014"
                        "volumen" => "370"
                        "paginaInicial" => "1973"
                        "paginaFinal" => "1982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24725237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Retreatment of HCV with ABT-450&#47;r-ombitasvir and dasabuvir with ribavirin"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Zeuzem"
                            1 => "I&#46;M&#46; Jacobson"
                            2 => "T&#46; Baykal"
                            3 => "R&#46;T&#46; Marinho"
                            4 => "F&#46; Poordad"
                            5 => "M&#46; Bourli&#232;re"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2014"
                        "volumen" => "370"
                        "paginaInicial" => "1604"
                        "paginaFinal" => "1614"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24720679"
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                    0 => array:2 [
                      "titulo" => "Sustained virologic response rate of 96&#37; in HCV genotype 1a infected patients treated with ombitasvir&#47;paritaprevir&#47;r and dasabuvir with ribavirin"
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                            2 => "P&#46; Pockros"
                          ]
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                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Gastroenterol"
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                        "paginaInicial" => "S862"
                      ]
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                  ]
                ]
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                      "titulo" => "99&#46;7&#37; sustained virologic response rate in 369 HCV genotype 1b-infeced patients treated with label-recommended regimen of ombitasvir&#47;paritaprevir&#47;r and dasabuvir with or without ribavirin"
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                        "tituloSerie" => "Am J Gastroenterol"
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                        "volumen" => "110"
                        "paginaInicial" => "S850"
                        "paginaFinal" => "S851"
                      ]
                    ]
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                      "titulo" => "Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4&#8211;5 chronic kidney disease &#40;the C-SURFER study&#41;&#58; a combination phase 3 study"
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                          "autores" => array:6 [
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                            1 => "D&#46;R&#46; Nelson"
                            2 => "A&#46; Bruchfeld"
                            3 => "A&#46;M&#46; Liapakis"
                            4 => "M&#46; Silva"
                            5 => "M&#46; Howard"
                          ]
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                        "tituloSerie" => "Lancet"
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                        "volumen" => "386"
                        "paginaInicial" => "1537"
                        "paginaFinal" => "1545"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26456905"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Safety and efficacy of sofosbuvir-containing regimens in hepatitis C infected patients with impaired renal function"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Saxena"
                            1 => "F&#46;M&#46; Koraishy"
                            2 => "M&#46;E&#46; Sise"
                            3 => "J&#46;K&#46; Lim"
                            4 => "M&#46; Schmidt"
                            5 => "R&#46;G&#46; Chung"
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                        "tituloSerie" => "Liver Int"
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                        "volumen" => "36"
                        "paginaInicial" => "807"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26923436"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Sofosbuvir and simeprevir in hepatitis C genotype 1-patients with end-stage renal disease on hemodialysis or GFR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mL&#47;min"
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                        "volumen" => "36"
                        "paginaInicial" => "798"
                        "paginaFinal" => "801"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26583882"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Efficacy of direct-acting antiviral combination for patients with HCV genotype 1 infection and severe renal impairment or end-stage renal disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "K&#46;R&#46; Reddy"
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                            4 => "M&#46; Bennett"
                            5 => "M&#46;S&#46; Sulkowski"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26976799"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Sofosbuvir and simeprevir combination therapy in the setting of the liver transplantation and hemodialysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "L&#46; Ha"
                            3 => "P&#46;A&#46; Pham"
                            4 => "U&#46; Wang"
                            5 => "H&#46; Luong"
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                  "host" => array:1 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "Transpl Infec Dis"
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                        "volumen" => "17"
                        "paginaInicial" => "275"
                        "paginaFinal" => "278"
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                    ]
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                    0 => array:2 [
                      "titulo" => "Efficacy and safety of daclastasvir and asunaprevir combination therapy in chronic hemodialysis patients with chronic hepatitis C"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Kudo"
                            2 => "A&#46; Nagasaka"
                            3 => "K&#46; Furuya"
                            4 => "Y&#46; Yamamoto"
                            5 => "T&#46; Kobayashi"
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                        "volumen" => "51"
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                        "paginaFinal" => "740"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Safety and efficacy of dual direct-acting antiviral therapy &#40;daclatasvir and asunaprevir&#41; for chronic hepatitis C virus genotype 1 infection in patients on hemodialysis"
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                        0 => array:2 [
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                            1 => "T&#46; Kumada"
                            2 => "T&#46; Tada"
                            3 => "K&#46; Takaguchi"
                            4 => "T&#46; Ishikawa"
                            5 => "K&#46; Tsuji"
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                        "paginaFinal" => "747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26872889"
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                    0 => array:2 [
                      "titulo" => "Kidney transplantation in the patient with hepatitis C virus infection"
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                          "etal" => false
                          "autores" => array:3 [
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                            2 => "D&#46; Roth"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000332385"
                      "Revista" => array:6 [
                        "tituloSerie" => "Contrib Nephrol"
                        "fecha" => "2012"
                        "volumen" => "176"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22310783"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0310"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The kidney transplant recipient with hepatitis C infection&#58; pre and posttransplantation treatment"
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                            1 => "D&#46;B&#46; Adey"
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                        "paginaFinal" => "575"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients&#58; causes and consequences"
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                            5 => "M&#46; Aguera"
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                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Kidney Dis"
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                        "paginaInicial" => "685"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
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              "identificador" => "bib0320"
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                0 => array:1 [
                  "referenciaCompleta" => "AASLD Practice Guidelines&#46; &#91;consulted 6 Feb 2016&#93;&#46; Available in&#58; <a href="http://www.hvcguidelines.org/">www&#46;hvcguidelines&#46;org</a>&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients hepatitis C virus genotype 3 infection&#58; ALLY-3 phase study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                    0 => array:2 [
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                        "paginaFinal" => "1135"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25614962"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sofosbuvir based treatment is safe and effective in patients with chronic hepatitis C infection and end-stage renal disease&#58; a case series"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "S&#46; Anthony"
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                            4 => "I&#46;A&#46; Hanouneh"
                            5 => "N&#46; Alkhouri"
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                        "tituloSerie" => "Liver Int"
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                        "volumen" => "36"
                        "paginaInicial" => "802"
                        "paginaFinal" => "806"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26824848"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Sofosbuvir-containing regimen for HCV infection in hemodialysis patients&#58; 400<span class="elsevierStyleHsp" style=""></span>mg daily or only on the day of hemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
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                        "paginaInicial" => "40"
                        "paginaFinal" => "47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26952005"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection&#58; a systematic review of the literature and meta-analysis of treatment efficacy and harms"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            2 => "J&#46; Lau"
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                            4 => "A&#46;S&#46; Levey"
                            5 => "J&#46;B&#46; Wong"
                          ]
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Kidney Dis"
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                        "paginaInicial" => "263"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
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                          ]
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                          "issn" => "00916749"
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                ]
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              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and safety of pegylated interferon alfa-2b and ribavirin combination therapy versus pegylated interferon monotherapy in hemodialysis patients&#58; a comparison of 2 sequentially treated cohorts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            1 => "T&#46;C&#46; Chen"
                            2 => "Y&#46;S&#46; Chien"
                            3 => "C&#46;H&#46; Hung"
                            4 => "Y&#46;H&#46; Yen"
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                            3 => "C&#46;Y&#46; Dai"
                            4 => "C&#46;C&#46; Liang"
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                        ]
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                    ]
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                        "tituloSerie" => "Ann Intern Med"
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                        "paginaFinal" => "738"
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                          0 => array:2 [
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                          "etal" => false
                          "autores" => array:2 [
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                            1 => "B&#46; Maliakkal"
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                      ]
                    ]
                  ]
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                      "doi" => "10.3748/wjg.v20.i43.16184"
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                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "16184"
                        "paginaFinal" => "16190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25473172"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Petrosillo"
                            1 => "P&#46; Gilli"
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                            3 => "P&#46; Dentico"
                            4 => "A&#46; Mele"
                            5 => "P&#46; Ragni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "1004"
                        "paginaFinal" => "1010"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11325683"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "HCV E1E2-MF59 vaccine in chronic hepatitis C patients treated with PEG-IFN&#945;2a and Ribavirin&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
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                            4 => "P&#46; Almasio"
                            5 => "M&#46;G&#46; Rumi"
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                        "tituloSerie" => "J Viral Hepat"
                        "fecha" => "2014"
                        "volumen" => "21"
                        "paginaInicial" => "458"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24750327"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
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                    0 => array:2 [
                      "titulo" => "An inactivated hepatitis C virus vaccine on the horizon&#63;"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "M&#46; Houghton"
                            1 => "J&#46;L&#46; Law"
                            2 => "D&#46;L&#46; Tyrrell"
                          ]
                        ]
                      ]
                    ]
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                ]
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                            2 => "J&#46; Wong"
                            3 => "D&#46; Hockman"
                            4 => "D&#46;M&#46; Santer"
                            5 => "S&#46;E&#46; Frey"
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                    ]
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                  "host" => array:1 [
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2017.04.010

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Year/Month	Html	Pdf	Total

2024 November	11	5	16
2024 October	52	31	83
2024 September	53	31	84
2024 August	69	61	130
2024 July	43	19	62
2024 June	63	33	96
2024 May	53	32	85
2024 April	47	28	75
2024 March	41	26	67
2024 February	36	27	63
2024 January	35	23	58
2023 December	36	25	61
2023 November	76	34	110
2023 October	54	31	85
2023 September	25	31	56
2023 August	32	29	61
2023 July	29	21	50
2023 June	28	15	43
2023 May	42	27	69
2023 April	26	10	36
2023 March	47	20	67
2023 February	30	17	47
2023 January	21	22	43
2022 December	64	33	97
2022 November	50	29	79
2022 October	60	39	99
2022 September	39	38	77
2022 August	45	48	93
2022 July	33	50	83
2022 June	36	40	76
2022 May	56	31	87
2022 April	61	43	104
2022 March	75	47	122
2022 February	73	58	131
2022 January	66	54	120
2021 December	55	41	96
2021 November	44	37	81
2021 October	96	47	143
2021 September	55	46	101
2021 August	69	41	110
2021 July	70	49	119
2021 June	51	28	79
2021 May	49	52	101
2021 April	193	71	264
2021 March	136	37	173
2021 February	131	41	172
2021 January	83	32	115
2020 December	114	21	135
2020 November	146	31	177
2020 October	42	23	65
2020 September	55	20	75
2020 August	71	31	102
2020 July	75	14	89
2020 June	58	27	85
2020 May	87	31	118
2020 April	78	28	106
2020 March	84	39	123
2020 February	67	31	98
2020 January	72	45	117
2019 December	91	41	132
2019 November	112	43	155
2019 October	86	16	102
2019 September	124	18	142
2019 August	135	21	156
2019 July	70	25	95
2019 June	58	35	93
2019 May	72	37	109
2019 April	117	54	171
2019 March	80	26	106
2019 February	48	20	68
2019 January	43	28	71
2018 December	176	55	231
2018 November	301	18	319
2018 October	241	13	254
2018 September	104	18	122
2018 August	81	19	100
2018 July	50	17	67
2018 June	74	16	90
2018 May	72	15	87
2018 April	122	10	132
2018 March	82	19	101
2018 February	42	13	55
2018 January	60	14	74
2017 December	53	7	60
2017 November	60	14	74
2017 October	58	12	70
2017 September	39	8	47
2017 August	74	11	85
2017 July	62	11	73
2017 June	67	10	77
2017 May	82	14	96

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