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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; is a extremely important public health problem in part because it is not always diagnosed&#44; the prevalence is high &#40;10&#37; of the adult population&#41; with significant vascular morbidity and mortality<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The prevalence is increased in diabetic &#40;men 29&#46;3&#37;&#47;women 22&#46;3&#37;&#41; and hypertensive patients &#40;men 57&#37;&#47;women 61&#46;4&#37;&#41; over the age of 60&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The care of CKD patients is a burden for the Spanish public health system&#59; the cost of care of patients with advanced CKD is aproximalety 800 million euros per year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> And the prevalence of CKD will increase due to the rise in life expectancies and a greater prevalence of obesity&#44; hypertension &#40;HTN&#41; and diabetes mellitus&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diabetic patients with kidney failure present higher morbidity and mortality rates than those with normal kidney function&#46; The estimated glomerular filtration rate &#40;eGFR&#41; has been used to stage CKD&#59; in 2013&#44; the &#8220;Kidney Disease&#58; Improving Global Outcomes&#8221; guidelines were updated to include the degree of albuminuria to better define de stage of CKD&#46; This allows stratified risk assessment of CKD progression and both cardiovascular and overall mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Studies on HTN<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> recommend motorisation of albuminuria and the eGFR&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of electronic medical records &#40;EMR&#41; in primary care &#40;PC&#41; centres in Madrid allows us to obtain valid information to conduct epidemiological studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this work is to determine the prevalence and risk of CKD progression in diabetic and&#47;or hypertensive patients over the age of 40 in Primary Care facilities&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Observational study using EMRs under conditions of regular clinical practice in 263 PC centres in the Community of Madrid&#44; which provided health care to approximately 6&#44;384&#44;000 people &#40;population database&#41;&#46; The data was collected from October first 2012 to March 31st 2013&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients over the age of 40&#44; who had been diagnosed with HTN and&#47;or diabetes&#44; were included &#40;International Classification of Primary Care&#44; ICPC codes&#58; K86&#44; K87&#44; T90&#41;&#46; Excluded patients were those in whom less than 3 or more than 15 months had elapsed between the two consecutive determinations of creatinine or albuminuria&#46; These determination were needed to match the CKD definition set out in the &#8220;Kidney Disease&#58; Improving Global Outcomes&#8221;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Creatinine and albuminuria values &#40;albumin&#47;creatinine ratio&#41; were obtained from the EMRs that incorporate all this information directly from all the laboratories in the Community of Madrid&#46; The eGFR value was estimated using the CKD-EPI equation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Data collection was performed retrospectively using &#8220;SQL&#8221; computer language on extracting information from the EMRs&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 24&#44;087 patients were included&#44; with a mean age of 68&#46;8 years &#40;SD&#58; 11&#46;5&#41;&#44; 56&#46;6&#37; were women&#59; 22&#37; &#40;5292 patients&#41; were diabetic&#59; 27&#46;5&#37; &#40;6613 patients&#41; hypertensive and 50&#46;6&#37; &#40;12&#44;182 patients&#41; had been diagnosed of both diabetes and hypertension&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the baseline clinical characteristics&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The prevalence of CKD in the population under study was 32&#46;27&#37; &#40;95&#37; CI&#58; 31&#46;67&#8211;32&#46;86&#41;&#44; with 11&#46;4&#37; &#40;95&#37; CI&#58; 11&#46;0&#8211;11&#46;8&#41; being due to the exclusive presence of albuminuria &#40;G1-G2&#47;A2-A3&#41;&#46; Among the diabetic patients&#44; the prevalence of CKD was 16&#46;95&#37; &#40;95&#37; CI&#58; 15&#46;91&#8211;17&#46;95&#41;&#46; In the hypertensive patients&#44; it was 24&#46;62&#37; &#40;95&#37; CI&#58; 23&#46;57&#8211;25&#46;66&#41;&#44; and in those with both diseases it was 31&#46;22&#37; &#40;95&#37; CI&#58; 30&#46;39&#8211;32&#46;04&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution across the different stages of CKD and the risk of progression&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The overall results of our study coincide with other publications&#44; in which a high prevalence of CKD is observed in hypertensive patients &#40;24&#37;&#41; over the age of 18&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Among diabetics&#44; there is a large variability&#44; with prevalences of 17&#46;3&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> to 34&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It is evident that a greater proportion of diabetic patients have albuminuria as compatred with hypertensive patients&#46; This is particularly relevant since some studies have shown that it is an independent risk factor of cardiovascular and all-cause mortality r in primary prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> By contrast&#44; the proportion of patients with a reduced eGFR is greater in hypertensive patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The study&#39;s limitations include the impossibility to separate different ethnic groups through the EMRs&#44; for which reason the differentiating equation cannot be applied for eGFR&#46; There may be a significant number of losses among patients with advanced CKD since they have prolonges follow up in hospital facilities&#46; Our work was performed in a population followed in PC that met the full definition of CKD&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> which means that the precision &#40;reduction of random error&#41; of this study is large in patients in early stages of CKD&#44; i&#46;e&#46; patients who are routinely monitored in our setting&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion&#44; the prevalence of CKD is greater in patients with HTN than diabetics&#44; although there was a greater proportion of diabetic patients with albuminuria&#46; These two populations are at risk of CKD progression and cardiovascular mortality&#59; controlling cardiovascular risk factors and adjusting nephrotoxic drugs according to the stage of the disease is thus extremely important to reduce disease progression&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alem&#225;n-Vega G&#44; G&#243;mez Caba&#241;as I&#44; Reques Sastre L&#44; Rosado Mart&#237;n J&#44; Polentinos-Castro E&#44; Rodr&#237;guez Barrientos R&#46; Prevalencia y riesgo de progresi&#243;n de enfermedad renal cr&#243;nica en pacientes diab&#233;ticos e hipertensos seguidos en atenci&#243;n primaria en la Comunidad de Madrid&#46; Nefrolog&#237;a&#46; 2017&#59;37&#58;343&#8211;345&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Last two values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>eGFR CKD-EPI&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The colours show the adjusted risk ratio for five events &#40;overall mortality&#44; cardiovascular mortality&#44; kidney failure treated with dialysis or transplant&#44; acute kidney failure and CKD progression&#41;&#46; The lowest risk corresponds to green &#40;&#8220;low risk&#8221; category&#59; in the event that there is no data of kidney injury&#44; it may not even be categorised as CKD&#41;&#44; followed by yellow &#40;&#8220;moderately increased&#8221; risk&#41;&#44; orange &#40;&#8220;high risk&#8221;&#41; and red &#40;&#8220;very high risk&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p>"
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                          "etal" => false
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                      "titulo" => "Enfermedad renal cr&#243;nica en atenci&#243;n primaria&#58; prevalencia y factores de riesgo asociados"
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                          "etal" => false
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                      "titulo" => "The definition&#44; classification and prognosis of chronic kidney disease&#58; a KDIGO controversies conference report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "J&#46; Coresh"
                            3 => "M&#46; El Nahas"
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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