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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Changes in PTHbio&#47;PTHi&#44; in relation to the iPTH values &#40;2&#46;&#170; generation&#41; &#40;pg&#47;ml&#41;&#46; &#40;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; &#40;&#42;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; &#40;&#42;&#42;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; <span class="elsevierStyleItalic">Y</span> axis bioPTH&#47;iPTH&#46; <span class="elsevierStyleItalic">X</span> axis iPTH &#40;pg&#47;ml&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The Parathyroid Hormone &#40;PTH&#41; is a 84 amino acids protein with a established role in the regulation of mineral metabolism&#59; main target organs are the bone and kidneys among others&#46; In spite of being a hormone&#44; in the case of the renal patient&#44; it is classified as a true uremic toxin because it increases progressively with the progression chronic kidney disease &#40;CKD&#41;&#44; and it responsible for multiple systemic effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> It is included as one of the uremic toxins that cause cardiovascular damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The control of PTH is important for the adequate treatment of the abnormalities of mineral metabolism in CKD&#46; Therefore much of the therapeutic efforts aimed at controlling these alterations are dedicated to an adequate control of PTH&#46; Nevertheless&#44; in hemodialysis patients PTH is a poor marker of mortality&#46; Only large studies have revealed that high PTH values that are related to higher mortality&#46; And in these studies the results are variable&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#8211;8</span></a> However&#44; other molecules such as calcium and phosphorus have shown a better prognostic significance on mortality&#44; along with vitamin D&#44; although with the later the results have been less conclusive&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Circulating PTH includes a mixture of peptides such as the whole molecule 1&#8211;84 and smaller fragments resulting from the catabolism of PTH&#44; these are called non-1&#8211;84 or carboxyterminal fragments&#46; Only PTH 1&#8211;84 &#40;whole protein&#41; exert biological activity&#46; Some of the carboxyterminal fragments have a PTH antagonistic action&#46; PTH is cleared by the kidney and the proportion of these PTH peptides varies according to the CKD stage&#46; The methods currently used to measure PTH in clinical practice are of two categories&#46; The so-called 2nd generation that measures the intact 1&#8211;84 PTH &#40;PTHi&#41; and multitude of fragments no 1&#8211;84&#46; The 3rd generation method&#44; also called PTHbio&#44; recently marketed&#44; quantify the PTH 1&#8211;84 only&#44; although its use is not generalized yet&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In an attempt to integrate the information provided bay the measurement of both molecules&#44; some authors have advocated the utility of the proportion &#40;ratio&#41; of these molecules by the ratio PTHbio&#47;PTHi as a marker of the bone remodeling<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">13&#44;14</span></a> and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In clinical practice&#44; there are currently two criteria to define the normal values of PTH&#46; The first&#44; and most classic&#44; is based on histomorphometry as defined by the Guides KDOQI<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> and the Guidelines SEN&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> At that time&#44; based on bone biopsies&#44; bone abnormalities were present if PTHi was lower than150<span class="elsevierStyleHsp" style=""></span>pg&#47;ml or above 300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46; The range of normality were established according to relationship of iPTH with the lesions observed in the bone biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> These values still exist in most of the recommendations&#46; The other criterion is mortality&#46; There are several studies that find increased mortality with high iPTH values&#59; much higher than 300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46; Thus&#44; the more recent KDIGO Guidelines<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> defined adequate iPTH as 2&#8211;9 times above the normal values&#46; However&#44; not all nephrologists were completely convinced with this recommendation&#46; The recent COSMOS study has found that in a large cohort of patients followed for 5 years&#44; the PTH values associated with less mortality are fin the range of 168&#8211;674<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> very similar to the KDIGO recommendations&#46; The authors of the COSMOS study recommend modifying the reference values of PTHi based on bone histomorphometric studies&#44; by PTH values based on survival&#46; Although there are contradictory results&#44; it seems that the mortality associated with serum PTH describes a J shape curve&#44; with higher mortality in patients with lower and higher PTH values&#46; But there is also significant variability between the different PTH 2nd generation commercial kits<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> which makes it difficult to interpret the results&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The variability in PTH measurements poses several problems when interpreting their values&#44; and deciding the target values to be achieved when treating a renal patient&#46; What would be the normal values&#63;&#44; those based on histomorphometric studies&#63;&#44; the ones based on mortality&#63;&#44; both&#63;&#59; which method use to measure the PTH&#44; 2nd or 3rd generation&#63;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present study evaluated the differences in mortality prediction using PTH values obtained with measurement of 2nd and 3rd generation in a group of hemodialysis patients followed for 2 years&#46; In addition&#44; we have evaluated the PTHbio&#47;PTHi ratio as a possible marker of mortality&#44; in case the ratio of the circulating molecules could be a marker&#46; In addition&#44; we have analyzed the association between mortality and serum iPTH levels recommended by KDOQI &#40;150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; and the range obtained by COSMOS &#40;168&#8211;674<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41;&#46; So the values of PTH that best predict mortality were determined&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">This is a two-year prospective study performed under daily clinical practice conditions&#46; The main objective of this study was to determine the association of serum PTH with hemodialysis patient survival&#46; It included 145 hemodialysis patients from a single center&#44; who underwent a baseline analytical determination&#44; followed by a follow-up of two years&#46; We determined clinical parameters and baseline analysis in which PTH was determined by 2 different methods&#44; 2nd and 3rd generation&#44; as well as calcium&#44; phosphorus&#44; alkaline phosphatase and bone alkaline phosphatase&#44; FGF23&#44; 25 &#40;OH&#41;-vitamin D&#44; and bone remodeling markers&#46; The values of PTH-intact &#40;PTHi&#41; or PTH of 2nd generation were determined by an electrochemiluminescence method using the Elecsys autoanalyzer &#40;Roche&#41;&#59; this method uses an antibody directed against amino acids 26&#8211;32 of the molecule and another against the aminoacids 55&#8211;64&#46; Therefore it does not detect short carboxyterminal fragments&#44; but this method measures PTH 1&#8211;84 and long PTH fragments 7&#8211;84 and amino-PTH11 &#40;intra- and inter-assay coefficients of variation are &#60;2&#46;5 and &#60;3&#37; respectively and sensitivity of 1&#46;2<span class="elsevierStyleHsp" style=""></span>pg&#47;ml method&#41;&#46; The PTHi values were normalized to the Allegro PTHi using the formulas given by the Spanish Society of Nephrology &#40;SEN&#41;&#46; The values of PTH of 3rd generation or PTH-bio were determined by an electrochemiluminescence method also using the Elecsys autoanalyzer &#40;Roche&#41;&#44; which uses an antibody directed against amino acids 1&#8211;4 of the molecule and another against aminoacids 55&#8211;64&#44; thus measuring the molecule 1&#8211;84 and the amino-PTH11 &#40;coefficients of intra- and inter-assay variation are &#60;3 and &#60;6&#37; respectively and the sensitivity of the method is 5&#46;50<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41;&#46; Normal values of PTHb were defined as 50&#37; of the value of PTH&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The ratio of PTHbio&#47;PTHi molecules was also calculated in order to determine the proportion of PTH fragments 7&#8211;84&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A registry of deceased patients &#40;of any cause&#41; was recorded at year 1 and 2&#44; and general analytical parameters of mineral metabolism&#44; inflammation and nutrition were determined&#46; In both the annual and the two-year follow-up&#44; the PTH was measured using the 2nd generation method&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The ADVIA CENTAUR 2400 autoanalyzer was used for the measurements of serum albumin &#40;bromocresol green dye binding technique&#59; intra- and inter-assay coefficients of variation were &#60;1&#46;3 and &#60;2&#37; and the sensitivity of the method was 1<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&#46; Serum calcium &#40;arsenazo III technique&#44; coefficients of intra- and inter-assay variation are &#60;1&#46;2 and &#60;2&#37;&#44; and the sensitivity of the method is 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; serum creatinine &#40;alkaline picrate technique&#44; intra- and inter-assay variation are &#60;3&#46;1 and &#60;4&#37;&#44; and the sensitivity of the method is 0&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; serum phosphate &#40;UV phosphomolybdate technique&#59; intra- and interassay coefficients of variation are &#60;2&#44; 2 and &#60;3&#37;&#44; and the sensitivity of the method is 0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; total serum proteins &#40;biuret technique&#44; intra- and inter-assay coefficients of variation are &#60;1&#46;3 and &#60;2&#37;&#44; and sensitivity of the method is 2<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&#44; PCR &#40;turbidimetric technique enhanced with latex&#44; coefficients of intra- and interassay variation are &#60;4&#46;9 and &#60;6&#37;&#44; and the sensitivity of the method is 0&#46;003<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; and serum alkaline phosphatase &#40;hydrolysis p-nitrophenyl phosphate&#59; Coefficients of intra- and interassay variation are &#60;1&#46;9 and &#60;2&#46;4&#37;&#44; and the sensitivity of the method is 5<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Serum prealbumin values were determined by turbidimetry in a SPA plus autoanalyzer&#44; with intra- and interassay coefficients of variation being &#60;4&#46;4 and &#60;6&#37; respectively and a sensitivity of 0&#46;006<span class="elsevierStyleHsp" style=""></span>g&#47;l&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The values of total vitamin D &#40;25 &#91;OH&#93; vitamin D2 and D3&#41; were determined by an electrochemiluminescence method performed on the Elecsys autoanalyzer &#40;Roche&#41; with coefficients of intra- and inter-assay variation respectively &#60;7&#46;5&#37; and &#60;8&#37; and sensitivity of 3<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Plasma &#40;C-terminal&#41; fibroblast growth factor 23 &#40;FGF-23&#41; was determined by an ELISA method &#40;Immutopics&#44; USA&#41; using 2 polyclonal antibodies directed to the C-terminal fraction of FGF-23 &#40;coefficients Of intra- and inter-assay variation are &#60;1&#46;7 and &#60;3&#46;5&#37; respectively and the sensitivity of the method is 1&#46;5<span class="elsevierStyleHsp" style=""></span>RU&#47;ml&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The bone isoenzyme of alkaline phosphatase was determined in serum by ELISA &#40;OSTASE BAP&#44; IDS&#44; UK&#41; &#40;coefficients of intra- and inter-assay variation are &#60;4&#46;5 and &#60;6&#46;4&#37; respectively and the sensitivity of the method is 0&#46;7<span class="elsevierStyleHsp" style=""></span>Mg&#47;l&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The determination of the C-terminal propeptide of procollagen type I &#40;PINP&#41; and the &#946;-Cross Laps &#40;&#946;-CTX&#41; in serum was performed by electrochemiluminescence in the Elecsys autoanalyzer &#40;Roche&#41; &#40;for PINP coefficients of intra- and interassay variation are &#60;2&#46;9 and &#60;3&#46;7&#37; respectively and the sensitivity of the method is 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;l&#59; for &#946;-CTX&#44; coefficients of intra- and interassay variation are &#60;4&#46;6 and &#60;4&#46;7&#37; respectively and sensitivity of the method is 0&#46;07<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A prospective study including 145 hemodialysis patients was conducted for two year period&#59; 49&#37; were women&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows baseline clinical and biochemistry data of the patients studied&#46; 85&#46;1&#37; of the patients was on some type vitamin D receptor activator&#44; and 17&#46;9&#37; received cinacalcet&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Twenty one patients died during the first year follow-up&#44; and 28 in the second year&#46; Potential Clinical and biochemical variables analytical that correlate with mortality are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The parameters related to mortality were albumin&#44; prealbumin&#44; C-reactive protein&#44; ProBNP&#44; creatinine&#44; age&#44; vascular access type&#44; and bone alkaline phosphatase&#46; However&#44; the PTH values of both the 2nd &#40;PTHi&#41; and the 3rd generation &#40;PTHbio&#41; and the ration PTHi&#47;PTHbio of the patients who died were not different than in patients that remained alive&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The main objective of this study is to define the effect on the mortality of PTH values of both 2nd and 3rd generation&#44; as the ratio between both&#46; Second generation PTH &#40;PTHi&#41; and third generation PTH &#40;PTHbio&#41; have a good correlation within each other&#46; The correlations of PTH from 2nd and the 3rd generation&#44; with other molecules of the mineral metabolism are similar &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The ratio PTHbio&#47;PTHi decreases as la PTHi values increases suggesting that non 1&#8211;84 fragments increase secondary to a degradation of the PTH 1&#8211;84 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">When patients were stratified by PTH intervals&#44; a significant increase in mortality was observed in patients with extreme PTHi values&#58; greater than 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml and less than 150<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#44; compared to the group of patients with PTH between 150 and 300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#59; although the mortality is higher among patients with PTHi between 300 and 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml than in those whose PTHi is 150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; this difference did not reach statistical significance&#46; With the PTHbio calculated as 50&#37; of the PTHi the differences are not significant in the same intervals&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Comparison of mortality in the PTH range recommended by the current SEN and KDOQI PTHi guidelines &#40;150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; and the values established by the COSMOS study &#40;164&#8211;678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; the relative risk of mortality is only significant with PTH greater than 300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml and less than 150<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46; This implies that patients with PTHi greater than 300 have higher mortality only when patients with PTHi greater than 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml are included&#46; In our study&#44; iPTH showed a better predictive value of mortality than bioPTH&#44; taking 150&#8211;300 &#40;75&#8211;150&#41;<span class="elsevierStyleHsp" style=""></span>pg&#47;ml as a reference&#44; but it is due to the patients with highest PTH values &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">No differences were observed in bioPTH&#47;iPTH ratio between patients who died and those who did not&#46; Likewise&#44; no differences in mortality were observed when the PTHbio&#47;PTHi ratio was analyzed by quintiles&#44; so bioPTH&#47;iPTH ratio does not appear to be a marker of mortality &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The bioPTH&#47;iPTH value higher than 0&#46;8 has a higher mortality&#44; but given the small group of patients this difference is not significant&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In renal patients&#44; abnormalities of mineral metabolism are a risk for cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> However&#44; among the parameters of mineral metabolism PTH has a relatively low weight as a marker of morbidity and mortality in the renal patient&#46; In our study we observed that PTH is not a marker of mortality when analyzed in conjunction with other factors of greater influence such as age&#44; years on dialysis&#44; albumin or vascular access&#46; However&#44; it is an important modulator of all alterations of mineral metabolism&#44; so its control should not be neglected&#46; As we observed&#44; PTHb and PTHi correlate very well with other parameters such as phosphorus&#44; FGF23&#44; bone alkaline phosphatase and years of dialysis&#46; All these parameters are associated with morbimortality&#46; In fact&#44; many research groups find a greater interest in combining several parameters of mineral metabolism as a marker of mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The main objective of this work has been to define PTH as a marker of mortality and the reference values that should used in daily practice&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The relationship between iPTH and mortality is controversial&#46; Although most studies find that PTHi is a marker of mortality some authors did not&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> The established range of 150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml were based on histomorphometric criteria&#44; but these values are also the inflection points in mortality&#46; The meta-analysis of Natoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> described PTH related mortality as a <span class="elsevierStyleItalic">J</span> curve&#46; We also a J-shaped mortality curve where values with lower mortality are within the PTHi range of 150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Like other authors&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> we found a correlation between iPTH and bioPTH&#46; Thus once adjusted&#44; the values of normality could be used interchangeably&#46; In addition&#44; both determinations correlate with the same clinical and analytical parameters&#44; so it appears that one method does not have an advantage over the other&#46; It is known that as the glomerular filtration rate decreases there is an increase in non-1&#8211;84 fragments&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> It is remarkable to see that as the 1&#8211;84 PTH increases&#44; the fragments are also increased even to a greater extent than the 1&#8211;84 PTH molecule itself&#46; As non-1&#8211;84 fragments are antagonists of 1&#8211;84 PTH it could be assumed that at a higher iPTH&#44; the systemic effects&#44; especially bone&#44; would be reduced by these molecules&#46; This aspect deserves to be investigated in order to know its relevance&#46; The changes in the proportion of these fragments are important when defining the normal values of bioPTH&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">However&#44; in our study we did not observe that patients with a low PTHb&#47;PTHI ratio had a lower mortality due to an increase in the 7&#8211;84 fragments&#44; suggesting that the PTH 1&#8211;84 molecule has a relevant role in the mortality of these patients&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The normal values of bioPTH are defined as 54&#37; of iPTHi&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> However&#44; in our study&#44; it was observed that this proportion varies according to the iPTH values&#46; That is&#44; at higher 1&#8211;84 PTH the non-1&#8211;84 PTH fragments increase to a greater extent than the 1&#8211;84 PTH itself&#46; Therefore&#44; the normal values of 1&#8211;84 PTH measured by 3rd generation methods in the hemodialysis patient are not known at present&#44; as they are not yet formally established in any guideline recommendations&#46; According to our results&#44; limits of bioPTH should be narrow&#44; since elevations of 1&#8211;84 PTH are accompanied by an even greater proportional increase non 1&#8211;84 PTH fragments&#59; this should be considered when establishing normal values for bioPTH&#46; It is not known how to interpret the values of bioPTH after eliminating the distortion factor of fragments non 1&#8211;84 PTH&#44; since there are no studies to that end&#46; The assumption of bioPTH as 50&#8211;54&#37; of the iPTH does not seem correct&#44; as it does not correspond to reality&#46; A multicenter study should be performed with a large number of patients to define these values&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The COSMOS study finds that a iPTH of 674<span class="elsevierStyleHsp" style=""></span>ng&#47;ml may be established as the upper limit of the reference interval in terms of mortality&#46; Like other authors<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> we did not find&#44; that a higher mortality in patients with iPTH between 300 and 674 than in those with iPTH between 150 and 300<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46; These results should make us cautious before establishing the value of 678<span class="elsevierStyleHsp" style=""></span>ng&#47;ml as the upper reference value&#46; Mortality is significant above 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#44; but we should never consider that figure as a safe value&#46; Statistical significance should not make us think that an increase in iPTHi up to 9 times normal values is safe&#46; Such a high iPTH value may cause alterations of the mineral metabolism that may have negative repercussion in the renal patient&#46; There is a confidence zone between 300 and 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml in which mortality is low but we think that being near 300 is safer than 678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The bioPTH &#40;1&#8211;84&#41;&#47;PTHi &#40;1&#8211;84 PTH<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>non 1&#8211;84 PTH&#41; ratio has been evaluated as a marker of bone histomorphometric changes and as a predictor of mortality&#46; However the evidence is still sparse&#46; Like in the study by Melamed et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> our results show that the ratio is not associated with mortality&#46; Other authors have found that ratio bioPTH&#47;iPTH is a good marker of mortality in men on hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> Those patients with higher values of ratio bioPTH&#47;iPTH ratio would have a higher mortality&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; The sample of patients studied is small&#44; since a larger group of extreme PTH values is necessary&#46; Another limitation of our study is to have performed bio PTH at baseline only and not being repeated in successive time points&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">According to our results the values of PTHi defined by histomorphometric criteria are well-established limits of mortality in hemodialysis patients&#44; the 300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml value defines better the cutoff point of mortality than the 674 value defined in the COSMOS study&#44; although the mortality between 150&#8211;300 and 300&#8211;678<span class="elsevierStyleHsp" style=""></span>pg&#47;ml is the same&#46; The 3rd generation of PTH measurement method that define the bioPTH do not add more precision to define defining mortality&#46; The normal values of iPTH are not well defined&#44; so the iPTH and bioPTH may not be compared with the values currently stablished&#46; The ratio bioPTH&#47;iPTH ratio is not a good marker of mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">Roche Spain has sponsored the measurements of bioPTH&#44; and has had no role in the design or the preparation of this publication&#46;</p></span></span>"
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          "titulo" => "Abstract"
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          "titulo" => "Introduction"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2016-01-13"
    "fechaAceptado" => "2016-11-17"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Haemodialysis"
            1 => "Parathormone"
            2 => "PTH bio"
            3 => "Intact PTH"
            4 => "Mortality"
            5 => "Cardiovascular"
          ]
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      ]
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Hemodi&#225;lisis"
            1 => "Parathormona"
            2 => "PTH bio"
            3 => "PTH intacta"
            4 => "Mortalidad"
            5 => "Cardiovascular"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Parathormone plays a key role in controlling mineral metabolism&#46; PTH is considered a uremic toxin causing cardiovascular damage and cardiovascular mortality in dialysis patients&#46; There are two different assays to measure PTH called 2nd generation or intact PTH &#40;iPTH&#41; and 3rd generation or bioPTH &#40;PTHbio&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate the differences in mortality of dialysis patients between both assays to measure PTH&#44; as well as the possible prognostic role of the PTHbio&#47;iPTH ratio&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">145 haemodialysis patients were included with 2-year monitoring including baseline laboratory test and annually thereafter&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">21 patients died in the first year and 28 in the second&#46; No correlation was found between PTH&#44; PTHbio and PTHbio&#47;iPTH ratio with mortality&#46; Both PTH have a perfect correlation between them and correlate similarly with other molecules of the mineral metabolism&#46; The extreme baseline values of PTH are those of higher mortality&#46; In survival by iPTH intervals &#40;according to guidelines and COSMOS study&#41;&#44; a <span class="elsevierStyleItalic">J</span> curve is observed&#46; When iPTH increases&#44; the ratio decreases&#44; possibly when increasing fragments no&#46; 1&#8211;84&#46; There is no greater prognostic approximation on mortality with PTHbio than PTHi&#46; There was also no difference in mortality when progression ratio PTHbio&#47;PTHi was analysed&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We didn&#8217;t find any advantages to using bioPTH vs&#46; PTHi as a marker of mortality&#46; BioPTH limits of normality must be reevaluated because its relationship with iPTH is not consistent&#46; Not knowing these limits affects its prognostic value&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La paratohormona tiene un papel fundamental en el control del metabolismo mineral&#46; Adem&#225;s es considerada como una toxina ur&#233;mica al originar da&#241;o cardiovascular e influir en la mortalidad cardiovascular del paciente en di&#225;lisis&#46; Existen dos m&#233;todos de medici&#243;n denominados de 2&#46;&#170; generaci&#243;n o PTH intacta &#40;PTHi&#41; y de 3&#46;&#170; generaci&#243;n o bioPTH &#40;PTHbio&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar las diferencias en la mortalidad del paciente en di&#225;lisis entre ambas formas de medici&#243;n de PTH&#44; as&#237; como el posible papel pron&#243;stico de su cociente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 145 pacientes en hemodi&#225;lisis con un seguimiento de 2 a&#241;os con determinaci&#243;n anal&#237;tica basal y posteriormente de forma anual&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Veinti&#250;n pacientes fallecieron el primer a&#241;o y 28 el segundo&#46; No se encontr&#243; correlaci&#243;n entre PTHi&#44; PTHbio y cociente PTHbio&#47;PTHi con la mortalidad&#46; Ambas PTH tienen una buena correlaci&#243;n entre ellas y correlacionan de manera similar con otras mol&#233;culas del metabolismo mineral&#46; Los valores basales de PTH extremos son los de mayor mortalidad&#46; En la supervivencia por tramos de PTHi &#40;seg&#250;n gu&#237;as y estudio COSMOS&#41; se observa una curva en J&#46; A mayor aumento de PTHi el cociente desciende&#44; posiblemente al aumentar los fragmentos no 1-84&#46; No existe una mayor aproximaci&#243;n pron&#243;stica sobre mortalidad con PTHbio que con PTHi&#46; No se observan diferencias en el valor predictivo del cociente sobre la mortalidad&#46; Tampoco hubo diferencias en mortalidad cuando se analiza la progresi&#243;n del cociente PTHbio&#47;PTHi&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">No encontramos ventajas en la utilizaci&#243;n de PTHbio sobre la PTHi como marcador de mortalidad&#46; Se deben reevaluar los l&#237;mites de la PTHbio pues su relaci&#243;n con la PTHi no es constante&#46; El no conocer esos l&#237;mites condiciona su utilidad pron&#243;stica&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rodr&#237;guez-Osorio L&#44; de la Piedra C&#44; Rubert M&#44; Mart&#237;n-Fern&#225;ndez M&#44; Gonz&#225;lez Casaus ML&#44; Gracia-Iguacel C&#44; et al&#46; Diferencias entre los m&#233;todos de determinaci&#243;n de 2&#46;&#170; y 3&#46;&#170; generaci&#243;n de la parathormona s&#233;rica sobre la mortalidad en el paciente en hemodi&#225;lisis&#46; Nefrolog&#237;a&#46; 2017&#59;37&#58;389&#8211;396&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Changes in PTHbio&#47;PTHi&#44; in relation to the iPTH values &#40;2&#46;&#170; generation&#41; &#40;pg&#47;ml&#41;&#46; &#40;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#59; &#40;&#42;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#59; &#40;&#42;&#42;&#42;&#41;&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; <span class="elsevierStyleItalic">Y</span> axis bioPTH&#47;iPTH&#46; <span class="elsevierStyleItalic">X</span> axis iPTH &#40;pg&#47;ml&#41;&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mortality according to the PTH reference values established by SEN guidelines&#44; KDOQI guidelines and the COSMOS study&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mortality in relation to the bioPTH&#47;iPTH ratio&#46; <span class="elsevierStyleItalic">Y</span> axis&#58; mortality &#40;&#37;&#41;&#59; <span class="elsevierStyleItalic">X</span> axis &#40;0&#46;4&#8211;0&#46;5&#41;&#40;0&#46;5&#8211;0&#46;6&#41;&#40;0&#46;6&#8211;0&#46;7&#41;&#40;0&#46;7&#8211;0&#46;8&#41;&#40;0&#46;8&#8211;0&#46;9&#41;&#59; ratio&#40;bioPTH&#47;iPTH&#41;&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dry weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mean 3 &#40;P25-2&#59; P75-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Males &#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">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Vascular access &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AVF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PTFE &#40;politetrafluoroetileno&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Permanent catheter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Hemodilalysis technique &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Conventional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>On-line&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipemia &#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">35&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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"><span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hemoglobin &#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;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hematocrit &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Urea &#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">117&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Proteins &#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">6&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Albumin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Iron &#40;&#956;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">65&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fe saturation index &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Calcium &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Phosphate &#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">4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total cholesterol &#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">158<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Prealbumin &#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">33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ferritin &#40;ng&#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">406<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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">Mean &#40;P25&#59;P75&#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  " align="left" valign="top">Bone alkaline phosphatase &#40;&#956;g&#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">29&#46;6 &#40;20&#46;7&#59;41&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PINP &#40;&#956;g&#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">255&#46;3 &#40;161&#46;2&#59;486&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">&#946;-CTX &#40;ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8 &#40;1&#46;3&#59;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PTH 2&#46;&#170; gen &#40;iPTH&#41; &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">205 &#40;116&#46;5&#59;386&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PTH 3&#46;&#170; gen &#40;bioPTH&#41; &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119&#46;5 &#40;76&#46;2&#59; 240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Ratio bioPTH&#47;iPTH&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;61 &#40;0&#46;56&#59;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">25OH- D &#40;ng&#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">22&#46;9 &#40;12&#46;7&#59;34&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Creatinine &#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">7&#46;6 &#40;5&#46;6&#59;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alkaline phosphatase &#40;UI&#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">111 &#40;89&#59;145&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Triglycerides &#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">146 &#40;102&#59;193&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">C reactive protein &#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;6 &#40;0&#46;25&#59;1&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ProBNP &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8325 &#40;3422&#59;17450&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FGF-23 &#40;RU&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">788 &#40;384&#59;3258&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics&#59; and&#44; baseline biochemistry of the study population&#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">No exitus&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">Exitus&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> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age &#40;years&#41; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#59;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Vintage Me &#40;P25&#44;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#59;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;3&#59;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Permanent catheter &#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">9&#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">36&#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"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Albumin &#40;g&#47;dl&#41; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Prealbmin &#40;mg&#47;dl&#41; <span class="elsevierStyleItalic">M</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Bone alkaline phosphatase &#40;&#956;g&#47;l&#41; Me &#40;P25&#44;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;8 &#40;19&#46;7&#59;31&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;4 &#40;22&#46;4&#59;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Creatinine &#40;mg&#47;dl&#41; Me &#40;P25&#44;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;5&#46;8&#59;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;6 &#40;5&#46;5&#59;8&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRP &#40;mg&#47;dl&#41; Me &#40;P25&#44;P75&#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;25 &#40;0&#46;25&#59;1&#46;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">1&#46;3 &#40;0&#46;25&#59;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ProBNP &#40;pg&#47;ml&#41; Me &#40;P25&#44;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6590 &#40;2778&#59;14450&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;100 &#40;6580&#59;34000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Variables significantly related with mortality&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">iPTH</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">bioPTH</th></tr><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"><span class="elsevierStyleItalic">r</span>&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><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">25OH-D &#40;ng&#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">&#8722;0&#46;034&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><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;033&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" title="table-entry  " align="left" valign="top">FGF-23 &#40;RU&#47;ml&#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;296&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;0003&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;228&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;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alkaline phosphatase &#40;UI&#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">0&#46;268&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;0012&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;254&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;0022&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;342&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;0000&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;338&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;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Calcium &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;001&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><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;050&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" title="table-entry  " align="left" valign="top">Phosphate &#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;326&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;0001&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;295&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;0003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Correlation of PTH 2&#46;&#170; y 3&#46;&#170; generation with other molecules of mineral metabolism&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Guides<br>iPTH&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">Exitus<br>No&#47;yes&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">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Guides<br>bioPTH&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">Exitus<br>No&#47;yes&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">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">150&#8211;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#8211;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;99 &#40;1&#46;14&#8211;7&#46;88&#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;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;62 &#40;0&#46;90&#8211;7&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#62;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;15 &#40;1&#46;20&#8211;8&#46;25&#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;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#47;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;63 &#40;0&#46;93&#8211;7&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">Cosmos<br>iPTH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cosmos<br>BioPTH&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;IC95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#47;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#8211;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#47;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;19 &#40;0&#46;56&#8211;2&#46;50&#41;&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><td class="td" title="table-entry  " align="char" valign="top">&#60;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;24 &#40;0&#46;57&#8211;2&#46;74&#41;&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" title="table-entry  " align="char" valign="top">&#62;674&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;56 &#40;0&#46;71&#8211;9&#46;32&#41;&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><td class="td" title="table-entry  " align="char" valign="top">&#62;337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;07 &#40;0&#46;66&#8211;6&#46;51&#41;&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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                0 => "xTab1502143.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Mortality in patients with PTH within reference values established by Guides SEN and KDOQI &#40;150&#8211;300<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; and COSMOS &#40;168&#8211;674<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#41; using iPTH and bio PTH methods&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of abnormal serum vitamin D&#44; PTH&#44; calcium&#44; and phosphorus in patients with chronic kidney disease&#58; results of the study to evaluate early kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Levin"
                            1 => "G&#46;L&#46; Bakris"
                            2 => "M&#46; Molitch"
                            3 => "M&#46; Smulders"
                            4 => "J&#46; Tian"
                            5 => "L&#46;A&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2007"
                        "volumen" => "71"
                        "paginaInicial" => "31"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17091124"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Secondary hyperparathyroidism is associated with higher mortality in men with moderate to severe chronic kidney disease"
                      "autores" => array:1 [
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