Letter to the Editor
Prevalence of symptoms in advanced chronic kidney disease
Prevalencia de síntomas en enfermedad renal crónica avanzada
Daniel Gutiérrez Sáncheza,b, Juan P. Leiva-Santosc, María José Macías Lópezd, Antonio I. Cuesta-Vargasb,
Corresponding author
a Fundación Cudeca, Arroyo de la Miel, Málaga, Spain
b Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
c Hospital de Manacor, Mallorca, Islas Baleares, Spain
d Servicio de Nefrología, Hospital Regional Universitario de Málaga, Málaga, Spain
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"apellidos" => "Cuesta-Vargas" "email" => array:1 [ 0 => "acuesta@uma.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Fundación Cudeca, Arroyo de la Miel, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital de Manacor, Mallorca, Islas Baleares, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Regional Universitario de Málaga, Málaga, 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" => "Prevalencia de síntomas en enfermedad renal crónica avanzada" ] ] "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" => 1297 "Ancho" => 2497 "Tamanyo" => 189787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prevalence of symptoms in the pre-dialysis and dialysis subgroups.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Difference between groups: <span class="elsevierStyleSup">*</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with advanced chronic kidney disease (ACKD) present a wide range of symptoms with a high treatment cost.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> From the initial stages of ACKD, the symptoms are wide-ranging and negatively affect quality of life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Uncontrolled symptoms in this population contribute to greater suffering and symptomatic management is a priority.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The lack of studies conducted in Spain makes it impossible to compare the symptomology between the different treatment groups.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the prevalence and severity of symptoms in patients with CKD stage 4 and 5 on dialysis and pre-dialysis, and to compare the symptomology in both groups.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this cross-sectional, observational study, a descriptive analysis was conducted on the prevalence and intensity of symptoms in patients with ACKD, both on dialysis and pre-dialysis. The study data were collected between April and September 2015.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The inclusion criteria were as follows: (1) adult patients with CKD stage 4–5 in pre-dialysis or dialysis for more than 3 months; and (2) Spanish-speaking patients. Patients with cognitive impairment and those under 18 years of age were excluded.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Sociodemographic and clinical data were collected during the interviews, which took place during the ACKD consultation and in the dialysis room. Variables of interest such as symptomology, measured using the modified Spanish version of the Palliative Care Outcome Scale-Symptoms Renal (POS-S Renal), estimated glomerular filtration rate, measured using CKD-EPI, and estimated comorbidity, measured using the modified Charlson comorbidity index (mCCI), are included.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 180 patients with CKD stage 4 and 5 were included in this study, of which 124 patients were on pre-dialysis and 56 were on dialysis (44 haemodialysis and 12 peritoneal dialysis). The results are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The main comorbidities were: diabetes, ischaemic heart disease, peripheral vascular disease and malignancies.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The most common symptoms were: weakness (68.7% [CI: 22–76%]), pain (53.1% [CI: 45–61%]), depression (45% [CI: 36–51%]) and difficulty sleeping (44.4% [CI: 37–53%]). Significant differences were found in the prevalence of symptoms between pre-dialysis and dialysis for weakness (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.027), limited mobility (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018), drowsiness (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), constipation (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.015) and restless legs (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). The comparison of the prevalence of symptoms between pre-dialysis and dialysis is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The most severe symptoms were: weakness (18.8%), pain (14.6%) and pruritus (11.8%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">There are several factors such as kidney failure, associated comorbidity and renal replacement therapy (RRT) that can influence the symptomology in these patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">More than 44% of patients presented weakness, pain, depression and difficulty sleeping. These symptoms are consistent in the majority of studies and are associated with a poorer quality of life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Symptoms such as weakness, limited mobility, drowsiness, constipation and restless legs presented a significant difference in both groups, being more common in patients on dialysis (except constipation).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Weakness is a very common symptom of ACKD. Various factors, such as sleep disorders, depression, anaemia and RRT can influence the onset of this symptom.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Weakness was the most prevalent and severe symptom, and was more prevalent in dialysis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Limited mobility is associated with weakness, comorbidity and RRT. Impaired mobility after starting RRT is associated with short-term mortality in elderly patients.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In this study, limited mobility was more common in patients with RRT (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding daytime drowsiness, this is associated with other sleep disorders (sleep apnoea, insomnia, and restless leg syndrome), and with symptoms such as weakness and depression.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Various factors, such as psychological disorders, lifestyle, treatment and comorbidity can influence the onset of this problem.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The results indicate that daytime drowsiness was more common in patients on dialysis (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Constipation is a common problem in ACKD, and is associated with dietary restrictions, limited mobility and pharmacological treatment.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> This symptom was more prevalent in pre-dialysis patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Restless legs syndrome is associated with RRT and other sleep disorders, leading to a reduced quality of life.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> This problem was more common in the dialysis group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.01).</p><p id="par0075" class="elsevierStylePara elsevierViewall">This study has several limitations. It is a cross-sectional study conducted in a single centre and, therefore, the results cannot be generalised. Furthermore, the pre-dialysis and dialysis groups were not homogenous.</p><p id="par0080" class="elsevierStylePara elsevierViewall">We concluded that patients with ACKD presented a higher symptom burden. In general, there is a similar symptomatic profile in pre-dialysis and dialysis, with weakness being the most common symptom in both groups.</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: Gutiérrez Sánchez D, Leiva-Santos JP, Macías López MJ, Cuesta-Vargas AI. Prevalencia de síntomas en enfermedad renal crónica avanzada. Nefrologia. 2018;38:560–562.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1297 "Ancho" => 2497 "Tamanyo" => 189787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prevalence of symptoms in the pre-dialysis and dialysis subgroups.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Difference between groups: <span class="elsevierStyleSup">*</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \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">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-dialysis \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">Dialysis \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> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients (n)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.3 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.8 (12.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.7 (15.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">eGFR CKD-EPI ml/min/1.73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.7 (16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.6 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Haematocrit (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.6 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34.7 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Serum albumin, g/dl</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.585 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time on MRC or dialysis (months)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.8 (27.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.5<br>(17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41.3 (39.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Causes of CKD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.240 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vascular disease (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetic nephropathy (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.719 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glomerular disease (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.088 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polycystic kidney disease (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.416 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown aetiology (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.791 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other causes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1894082.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and clinical characteristics of the total group and the subgroups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://www.ncbi.nlm.nih.gov/pubmed/25923985?dopt=Abstract">https://www.ncbi.nlm.nih.gov/pubmed/25923985?dopt=Abstract</a> [accessed 12.01.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: developing a roadmap to improving quality care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.N. Davison" 1 => "A. Levin" 2 => "A.H. Moss" 3 => "V. Jha" 4 => "E.A. Brown" 5 => "F. Brennan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.2015.110" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2015" "volumen" => "88" "paginaInicial" => "447" "paginaFinal" => "459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25923985" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://www.ncbi.nlm.nih.gov/pubmed/24832095">https://www.ncbi.nlm.nih.gov/pubmed/24832095</a> [accessed 15.12.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Setting research priorities for patients on or nearing dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Manns" 1 => "B. Hemmelgarn" 2 => "E. Lillie" 3 => "S.C. Dip" 4 => "A. Cyr" 5 => "M. Gladish" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.01610214" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2014" "volumen" => "9" "paginaInicial" => "1813" "paginaFinal" => "1821" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24832095" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="https://www.ncbi.nlm.nih.gov/pubmed/27863475">https://www.ncbi.nlm.nih.gov/pubmed/27863475</a> [accessed 12.12.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish modified version of the palliative care outcome scale-symptoms renal: cross-cultural adaptation and validation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Gutiérrez-Sánchez" 1 => "J.P. Leiva-Santos" 2 => "R. Sánchez-Hernández" 3 => "D. Hernández-Marrero" 4 => "A.I. Cuesta-Vargas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12882-016-0402-8" "Revista" => array:5 [ "tituloSerie" => "BMC Nephrol" "fecha" => "2016" "volumen" => "17" "paginaInicial" => "180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27863475" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="https://www.ncbi.nlm.nih.gov/pubmed/20038962">https://www.ncbi.nlm.nih.gov/pubmed/20038962</a> [accessed 02.01.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Assessment of the new CKD-EPI equation to estimate the glomerular filtration rate]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Montañés Bermúdez" 1 => "J. Bover Sanjuán" 2 => "A. Oliver Samper" 3 => "J.A. Ballarín Castán" 4 => "S. Gràcia García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2009.Dic.5838" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2010" "volumen" => "30" "paginaInicial" => "185" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20038962" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="https://www.ncbi.nlm.nih.gov/pubmed/10856407">https://www.ncbi.nlm.nih.gov/pubmed/10856407</a> [accessed 15.11.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Beddhu" 1 => "F.J. Bruns" 2 => "M. Saul" 3 => "P. Seddon" 4 => "M.L. Zeidel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2000" "volumen" => "108" "paginaInicial" => "609" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10856407" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0035" href="https://www.ncbi.nlm.nih.gov/pubmed/23586687">https://www.ncbi.nlm.nih.gov/pubmed/23586687</a> [accessed 12.11.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ANZSN renal supportive care 2013: Opinion pieces [corrected]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Brown" 1 => "S.M. Crail" 2 => "R. Masterson" 3 => "C. Foote" 4 => "J. Robins" 5 => "I. Katz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Nephrology (Carlton)" "fecha" => "2013" "volumen" => "18" "paginaInicial" => "401" "paginaFinal" => "454" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0040" href="https://www.ncbi.nlm.nih.gov/pubmed/24397310">https://www.ncbi.nlm.nih.gov/pubmed/24397310</a> [accessed 02.02.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Decreased mobility after starting dialysis is an independent risk factor for short-term mortality after initiation of dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Arai" 1 => "E. Kanda" 2 => "H. Kikuchi" 3 => "C. Yamamura" 4 => "S. Hirasawa" 5 => "S. Aki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nephrology (Carlton)" "fecha" => "2014" "volumen" => "19" "paginaInicial" => "227" "paginaFinal" => "233" "itemHostRev" => array:3 [ "pii" => "S0886335008006299" "estado" => "S300" "issn" => "08863350" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0045" href="https://www.ncbi.nlm.nih.gov/pubmed/27152260">https://www.ncbi.nlm.nih.gov/pubmed/27152260</a> [accessed 10.01.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleep disorders and chronic kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.C. Maung" 1 => "A. El Sara" 2 => "C. Chapman" 3 => "D. Cohen" 4 => "D. Cukor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5527/wjn.v5.i3.224" "Revista" => array:6 [ "tituloSerie" => "World J Nephrol" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "224" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27152260" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0050" href="https://www.ncbi.nlm.nih.gov/pubmed/27113374">https://www.ncbi.nlm.nih.gov/pubmed/27113374</a> [accessed 22.01.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of constipation in patients with advanced kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Lee" 1 => "K. Lambert" 2 => "P. Byrne" 3 => "M. Lonergan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jorc.12157" "Revista" => array:6 [ "tituloSerie" => "J Ren Care" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "144" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27113374" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0055" href="https://ncbi.nlm.nih.gov/pubmed/18061749/">https://ncbi.nlm.nih.gov/pubmed/18061749/</a> [accessed 25.07.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Restless legs syndrome, insomnia, and quality of life after renal transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.Z. Molnar" 1 => "M. Novak" 2 => "L. Szeifert" 3 => "C. Ambrus" 4 => "A. Keszei" 5 => "A. Koczy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpsychores.2007.06.007" "Revista" => array:6 [ "tituloSerie" => "J Psychosom Res" "fecha" => "2007" "volumen" => "63" "paginaInicial" => "591" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18061749" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003800000005/v1_201811140611/S2013251418301020/v1_201811140611/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/20132514/0000003800000005/v1_201811140611/S2013251418301020/v1_201811140611/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301020?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 12 | 23 |
| 2024 October | 58 | 44 | 102 |
| 2024 September | 57 | 30 | 87 |
| 2024 August | 78 | 61 | 139 |
| 2024 July | 44 | 32 | 76 |
| 2024 June | 64 | 37 | 101 |
| 2024 May | 54 | 35 | 89 |
| 2024 April | 42 | 31 | 73 |
| 2024 March | 52 | 41 | 93 |
| 2024 February | 44 | 47 | 91 |
| 2024 January | 46 | 45 | 91 |
| 2023 December | 47 | 30 | 77 |
| 2023 November | 49 | 40 | 89 |
| 2023 October | 60 | 31 | 91 |
| 2023 September | 75 | 28 | 103 |
| 2023 August | 51 | 25 | 76 |
| 2023 July | 59 | 42 | 101 |
| 2023 June | 89 | 34 | 123 |
| 2023 May | 91 | 35 | 126 |
| 2023 April | 73 | 28 | 101 |
| 2023 March | 84 | 36 | 120 |
| 2023 February | 46 | 22 | 68 |
| 2023 January | 61 | 45 | 106 |
| 2022 December | 77 | 39 | 116 |
| 2022 November | 116 | 26 | 142 |
| 2022 October | 68 | 53 | 121 |
| 2022 September | 49 | 37 | 86 |
| 2022 August | 59 | 55 | 114 |
| 2022 July | 37 | 47 | 84 |
| 2022 June | 36 | 42 | 78 |
| 2022 May | 59 | 33 | 92 |
| 2022 April | 72 | 57 | 129 |
| 2022 March | 66 | 50 | 116 |
| 2022 February | 68 | 40 | 108 |
| 2022 January | 49 | 35 | 84 |
| 2021 December | 79 | 44 | 123 |
| 2021 November | 64 | 34 | 98 |
| 2021 October | 143 | 50 | 193 |
| 2021 September | 79 | 37 | 116 |
| 2021 August | 46 | 42 | 88 |
| 2021 July | 45 | 45 | 90 |
| 2021 June | 62 | 34 | 96 |
| 2021 May | 84 | 52 | 136 |
| 2021 April | 93 | 73 | 166 |
| 2021 March | 46 | 45 | 91 |
| 2021 February | 51 | 34 | 85 |
| 2021 January | 36 | 27 | 63 |
| 2020 December | 31 | 20 | 51 |
| 2020 November | 24 | 14 | 38 |
| 2020 October | 45 | 23 | 68 |
| 2020 September | 35 | 18 | 53 |
| 2020 August | 36 | 18 | 54 |
| 2020 July | 29 | 20 | 49 |
| 2020 June | 39 | 24 | 63 |
| 2020 May | 52 | 24 | 76 |
| 2020 April | 48 | 31 | 79 |
| 2020 March | 33 | 13 | 46 |
| 2020 February | 53 | 18 | 71 |
| 2020 January | 61 | 30 | 91 |
| 2019 December | 58 | 32 | 90 |
| 2019 November | 79 | 26 | 105 |
| 2019 October | 39 | 13 | 52 |
| 2019 September | 44 | 33 | 77 |
| 2019 August | 54 | 26 | 80 |
| 2019 July | 40 | 33 | 73 |
| 2019 June | 43 | 33 | 76 |
| 2019 May | 52 | 30 | 82 |
| 2019 April | 57 | 45 | 102 |
| 2019 March | 34 | 21 | 55 |
| 2019 February | 46 | 22 | 68 |
| 2019 January | 47 | 32 | 79 |
| 2018 December | 81 | 41 | 122 |
| 2018 November | 111 | 22 | 133 |
| 2018 October | 47 | 10 | 57 |
| 2018 September | 56 | 13 | 69 |
| 2018 August | 41 | 11 | 52 |
| 2018 July | 136 | 2 | 138 |
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