Letter to the Editor
Calcimimetics have had no impact on the indications for surgery of tertiary hyperparathyroidism
Los calcimiméticos no han tenido impacto en la cirugía del hiperparatiroidismo terciario
José Ruiza,b, Antonio Ríosa,b,c,
, José Manuel Rodrígueza,b,c, Santiago Llorented, Luisa Jimenod, Pascual Parrillaa,b,c
Corresponding author
a Departamento de Cirugía, Ginecología, Obstetricia y Pediatría, Universidad de Murcia, Murcia, Spain
b Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
c Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
d Servicio de Nefrología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Read
6643
Timeswas read the article
2385
Total PDF
4258
Total HTML
Share statistics
array:25 [ "pii" => "S2013251417301773" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.10.008" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "301" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:651-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2461 "formatos" => array:3 [ "EPUB" => 269 "HTML" => 1634 "PDF" => 558 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699516301953" "issn" => "02116995" "doi" => "10.1016/j.nefro.2016.10.021" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "301" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2017;37:651-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2922 "formatos" => array:3 [ "EPUB" => 304 "HTML" => 2026 "PDF" => 592 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Los calcimiméticos no han tenido impacto en la cirugía del hiperparatiroidismo terciario" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "651" "paginaFinal" => "653" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Calcimimetics have had no impact on the indications for surgery of tertiary hyperparathyroidism" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 1441 "Tamanyo" => 72824 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de pacientes trasplantados renales con buena función renal que son intervenidos por año de hiperparatiroidismo terciario en función de la época a estudio.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Ruiz, Antonio Ríos, José Manuel Rodríguez, Santiago Llorente, Luisa Jimeno, Pascual Parrilla" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José" "apellidos" => "Ruiz" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Ríos" ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Llorente" ] 4 => array:2 [ "nombre" => "Luisa" "apellidos" => "Jimeno" ] 5 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417301773" "doi" => "10.1016/j.nefroe.2017.10.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301773?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301953?idApp=UINPBA000064" "url" => "/02116995/0000003700000006/v2_201712010640/S0211699516301953/v2_201712010640/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417301761" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.10.007" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "286" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:653-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4231 "formatos" => array:3 [ "EPUB" => 275 "HTML" => 3118 "PDF" => 838 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Renal damage associated to intravitreal administration of ranibizumab" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "653" "paginaFinal" => "655" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Daño renal asociado a la administración intravítrea de ranibizumab" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Morales, Candela Moliz, Eduardo Gutierrez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "Morales" ] 1 => array:2 [ "nombre" => "Candela" "apellidos" => "Moliz" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Gutierrez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699516301801" "doi" => "10.1016/j.nefro.2016.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699516301801?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301761?idApp=UINPBA000064" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301761/v1_201712030528/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2013251417301633" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.09.008" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "302" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2017;37:649-51" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1726 "formatos" => array:3 [ "EPUB" => 230 "HTML" => 1087 "PDF" => 409 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Is acquired arterial-venous fistula related to Kaposi sarcoma?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "649" "paginaFinal" => "651" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Se adquiere la fístula arteriovenosa relacionada con sarcoma de Kaposi?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2292 "Ancho" => 2333 "Tamanyo" => 355614 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple discrete, (nonulcerated, erythamatous-violaceous noduler and plaques on left forearm and hand(A,B,C,D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Baris Eser, Ozlem Yayar, Ibrahim Dogan, Yilmaz Bas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Baris" "apellidos" => "Eser" ] 1 => array:2 [ "nombre" => "Ozlem" "apellidos" => "Yayar" ] 2 => array:2 [ "nombre" => "Ibrahim" "apellidos" => "Dogan" ] 3 => array:2 [ "nombre" => "Yilmaz" "apellidos" => "Bas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301633?idApp=UINPBA000064" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301633/v1_201712030528/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Calcimimetics have had no impact on the indications for surgery of tertiary hyperparathyroidism" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "651" "paginaFinal" => "652" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Ruiz, Antonio Ríos, José Manuel Rodríguez, Santiago Llorente, Luisa Jimeno, Pascual Parrilla" "autores" => array:6 [ 0 => array:3 [ "nombre" => "José" "apellidos" => "Ruiz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Antonio" "apellidos" => "Ríos" "email" => array:1 [ 0 => "arzrios@um.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Rodríguez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Santiago" "apellidos" => "Llorente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Luisa" "apellidos" => "Jimeno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "Pascual" "apellidos" => "Parrilla" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía, Ginecología, Obstetricia y Pediatría, Universidad de Murcia, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los calcimiméticos no han tenido impacto en la cirugía del hiperparatiroidismo terciario" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 852 "Ancho" => 1432 "Tamanyo" => 63607 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percent of kidney transplant patients with acceptable renal function who undergo parathyroidectomy for treatment of tertiary hyperparathyroidism as a function of the study period (pre and post cinacalcet).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tertiary hyperparathyroidism (THPT) occurs in 2–25% of renal transplant patients with normal renal function. THPT is due to the autonomous proliferation of the parathyroid glands.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> Hypercalcemia impairs renal function through vasoconstriction and causes tubulointerstitial calcifications, which limits long-term graft survival.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Therefore, early treatment of hypercalcemia is important to prevent deterioration of renal graft function.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Until year 2005, when calcimimetics became available, surgical treatment of THPT was the only effective strategy to control hypercalcemia in renal transplant patients.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> The calcimimetic, cinacalcet controls hypercalcemia without affecting renal function.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a> However, while cinacalcet reduces the need for parathyroidectomy in patients with severe secondary hyperparathyroidism,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> in the tertiary this beneficial effect has not been confirmed.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of the study is to analyze the impact that cinacalcet has had on parathyroidectomies for the treatment THPT in our center after 10 years of use.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included renal transplant patients with normal renal function who required parathyroidectomy between January 1995 and December 2014. Cases with prior thyroid and/or parathyroid surgery and those with syndrome of MEN were excluded. For the analysis of the data, two periods are differentiated separated by the introduction of cinacalcet in our center: (1) pre-cinacalcet period: 1995–2004; and (2) post-cinacalcet period: 2005–2014. In THPT surgery was performed in cases with hypercalcemia that did not respond to conservative measures. Both groups differ in the use of cinacalcet prior to surgery. Epidemiological, clinical, therapeutic and follow-up variables are analyzed. For statistical analysis, the SPSS 15.0<span class="elsevierStyleSup">®</span> software for Windows<span class="elsevierStyleSup">®</span> is used, using the chi-squared test, the Fisher exact test, the Student's <span class="elsevierStyleItalic">t</span>-test and the Mann–Whitney <span class="elsevierStyleItalic">U</span> test.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Selection criteria were fulfilled by 24 kidney transplant recipients, with a mean age of 47.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.2 years, 66.7% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16) were male. Twenty three patients (95.8%) were on hemodialysis and one (4.2%) was on peritoneal dialysis, with a mean time of 6.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.3 years prior to receiving the last transplant. 33.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) received more than one kidney transplant. The mean time from renal transplantation to parathyroidectomy was 37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>32.3 months (3–115 months).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fifty-four percent of patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) were parathyroidectomized during the pre-cinacalcet period and the remaining 46% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) during post-cinacalcet (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05). Regarding the total number of kidney transplant patients with acceptable renal function per year, parathyroidectomy was performed in 1.3% of patients per year during pre-cinacalcet period as compared with a 1% in the post-cinacalcet period (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Comparison of patients from the pre and post cinacalcet era shows that there were no differences in the variables analyzed, except for Two. First all patients (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13) receiving parathyroidectomy during the post-cinacalcet period were asymptomatic compared to <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7 patients (34%) in the pre-cincalcet period (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016). Most symptomatic patients had pain in bone and joints. The second difference was the serum phosphorus concentration, which was lower in the post-cinacalcet than pre-cinacalcet group (2.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2<span class="elsevierStyleHsp" style=""></span>mg/dl versus 2.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4<span class="elsevierStyleHsp" style=""></span>mg/dl; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.011). In all cases, the surgical treatment was subtotal parathyroidectomy. There was a reoccurrence of HPT in 4.2% in the pre-cinacalcet group, which is now controlled with cinacalcet t.</p><p id="par0040" class="elsevierStylePara elsevierViewall">As opposed to what is being described regarding secondary hyperparathyroidism, with approval of cinacalcet by the European Medication Agency, there has been no decrease in the number of indications for parathyroidectomy in THPT. However, we have observed that patients on cinacalcet are asymptomatic at the time of surgery. Thus both treatments improve patient's quality of life.</p><p id="par0045" class="elsevierStylePara elsevierViewall">If surgery is required, subtotal parathyroidectomy shows very acceptable results with low recurrence rates if performed in endocrine surgical units with experience.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, cinacalcet has not been able to reduce the surgical indications of THPT, although patients with surgical indication have fewer symptoms.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz J, Ríos A, Rodríguez JM, Llorente S, Jimeno L, Parrilla P. Los calcimiméticos no han tenido impacto en la cirugía del hiperparatiroidismo terciario. Nefrologia. 2017;37:651–653.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 852 "Ancho" => 1432 "Tamanyo" => 63607 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percent of kidney transplant patients with acceptable renal function who undergo parathyroidectomy for treatment of tertiary hyperparathyroidism as a function of the study period (pre and post cinacalcet).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tertiary hyperparathyroidism in kidney transplant recipients: characteristics of patients selected for different treatment strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.L. Yang" 1 => "K. Freeman" 2 => "C.E. Reinke" 3 => "D.L. Fraker" 4 => "G.C. Karakousis" 5 => "R.R. Kelz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e3182530699" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "70" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22706321" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tertiary hyperparathyroidism: histologic patterns of disease and results of parathyroidectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Kebebew" 1 => "Q. Duh" 2 => "O. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archsurg.139.9.974" "Revista" => array:5 [ "tituloSerie" => "Arch Surg" "fecha" => "2004" "volumen" => "139" "paginaInicial" => "974" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15381615" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of hypercalcemia after renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.V. Torregrosa" 1 => "X. Barros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2013.Aug.11888" "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2013" "volumen" => "33" "paginaInicial" => "751" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24241361" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of persistent hyperparathyroidism after renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Triponez" 1 => "O.H. Clark" 2 => "Y. Vanrenthergem" 3 => "P. Evenepoel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e3181728a2d" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2008" "volumen" => "248" "paginaInicial" => "18" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18580203" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet for the treatment of hyperparathyroidism in kidney transplant recipients: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.B. Cohen" 1 => "C.E. Gordon" 2 => "E.M. Balk" 3 => "J.M. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0b013e31826c3968" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "1041" "paginaFinal" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23069843" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet treatment for stable kidney transplantation patients with hypercalcemia due to persistent secondary hyperparathyroidism: a long-term follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.P. Paschoalin" 1 => "J.V. Torregrosa" 2 => "A. Sánchez-Escuredo" 3 => "X. Barros" 4 => "C.E. Durán" 5 => "J.M. Campistol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2012.09.049" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2012" "volumen" => "44" "paginaInicial" => "2588" "paginaFinal" => "2589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23146463" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cinacalcet versus standard treatment for chronic kidney disease: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Sekercioglu" 1 => "J.W. Busse" 2 => "M.F. Sekercioglu" 3 => "A. Agarwal" 4 => "S. Shaikh" 5 => "L.C. Lopes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/0886022X.2016.1172468" "Revista" => array:6 [ "tituloSerie" => "Ren Fail" "fecha" => "2016" "volumen" => "38" "paginaInicial" => "857" "paginaFinal" => "874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27137817" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.R. Zambudio" 1 => "J. Rodríguez" 2 => "J. Riquelme" 3 => "T. Soria" 4 => "M. Canteras" 5 => "P. Parrilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2004" "volumen" => "240" "paginaInicial" => "18" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15213613" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000006/v1_201712030528/S2013251417301773/v1_201712030528/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000006/v1_201712030528/S2013251417301773/v1_201712030528/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301773?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 44 | 50 | 94 |
| 2024 September | 44 | 28 | 72 |
| 2024 August | 57 | 59 | 116 |
| 2024 July | 58 | 28 | 86 |
| 2024 June | 51 | 38 | 89 |
| 2024 May | 47 | 34 | 81 |
| 2024 April | 67 | 27 | 94 |
| 2024 March | 34 | 26 | 60 |
| 2024 February | 62 | 38 | 100 |
| 2024 January | 24 | 23 | 47 |
| 2023 December | 27 | 26 | 53 |
| 2023 November | 46 | 29 | 75 |
| 2023 October | 46 | 33 | 79 |
| 2023 September | 32 | 30 | 62 |
| 2023 August | 46 | 35 | 81 |
| 2023 July | 43 | 23 | 66 |
| 2023 June | 41 | 22 | 63 |
| 2023 May | 64 | 27 | 91 |
| 2023 April | 15 | 12 | 27 |
| 2023 March | 64 | 16 | 80 |
| 2023 February | 36 | 25 | 61 |
| 2023 January | 35 | 27 | 62 |
| 2022 December | 51 | 26 | 77 |
| 2022 November | 63 | 35 | 98 |
| 2022 October | 44 | 45 | 89 |
| 2022 September | 43 | 29 | 72 |
| 2022 August | 44 | 56 | 100 |
| 2022 July | 42 | 46 | 88 |
| 2022 June | 60 | 39 | 99 |
| 2022 May | 36 | 30 | 66 |
| 2022 April | 39 | 54 | 93 |
| 2022 March | 42 | 50 | 92 |
| 2022 February | 38 | 41 | 79 |
| 2022 January | 53 | 29 | 82 |
| 2021 December | 71 | 46 | 117 |
| 2021 November | 44 | 39 | 83 |
| 2021 October | 63 | 50 | 113 |
| 2021 September | 56 | 33 | 89 |
| 2021 August | 45 | 44 | 89 |
| 2021 July | 56 | 37 | 93 |
| 2021 June | 38 | 31 | 69 |
| 2021 May | 54 | 47 | 101 |
| 2021 April | 93 | 84 | 177 |
| 2021 March | 61 | 35 | 96 |
| 2021 February | 47 | 42 | 89 |
| 2021 January | 57 | 24 | 81 |
| 2020 December | 25 | 18 | 43 |
| 2020 November | 43 | 12 | 55 |
| 2020 October | 29 | 19 | 48 |
| 2020 September | 27 | 18 | 45 |
| 2020 August | 57 | 18 | 75 |
| 2020 July | 44 | 14 | 58 |
| 2020 June | 33 | 24 | 57 |
| 2020 May | 37 | 11 | 48 |
| 2020 April | 37 | 22 | 59 |
| 2020 March | 41 | 15 | 56 |
| 2020 February | 34 | 17 | 51 |
| 2020 January | 40 | 34 | 74 |
| 2019 December | 76 | 21 | 97 |
| 2019 November | 42 | 26 | 68 |
| 2019 October | 43 | 9 | 52 |
| 2019 September | 66 | 15 | 81 |
| 2019 August | 45 | 18 | 63 |
| 2019 July | 52 | 25 | 77 |
| 2019 June | 43 | 21 | 64 |
| 2019 May | 43 | 19 | 62 |
| 2019 April | 65 | 32 | 97 |
| 2019 March | 91 | 36 | 127 |
| 2019 February | 33 | 23 | 56 |
| 2019 January | 37 | 25 | 62 |
| 2018 December | 122 | 44 | 166 |
| 2018 November | 171 | 29 | 200 |
| 2018 October | 109 | 20 | 129 |
| 2018 September | 65 | 25 | 90 |
| 2018 August | 54 | 21 | 75 |
| 2018 July | 49 | 15 | 64 |
| 2018 June | 53 | 17 | 70 |
| 2018 May | 55 | 14 | 69 |
| 2018 April | 72 | 12 | 84 |
| 2018 March | 39 | 11 | 50 |
| 2018 February | 36 | 2 | 38 |
| 2018 January | 39 | 14 | 53 |
| 2017 December | 46 | 14 | 60 |
| 2017 November | 37 | 5 | 42 |
Show all
