Statistics

 array:25 [
  "pii" => "S2013251418301354"
  "issn" => "20132514"
  "doi" => "10.1016/j.nefroe.2018.11.006"
  "estado" => "S300"
  "fechaPublicacion" => "2018-11-01"
  "aid" => "510"
  "copyright" => "Sociedad Española de Nefrología"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2018;38:622-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1496
    "formatos" => array:3 [
      "EPUB" => 170
      "HTML" => 777
      "PDF" => 549
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0211699518301073"
      "issn" => "02116995"
      "doi" => "10.1016/j.nefro.2018.05.006"
      "estado" => "S300"
      "fechaPublicacion" => "2018-11-01"
      "aid" => "510"
      "copyright" => "Sociedad Española de Nefrología"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2018;38:622-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 3252
        "formatos" => array:3 [
          "EPUB" => 218
          "HTML" => 2212
          "PDF" => 822
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "An&#225;lisis de la frecuentaci&#243;n de Urgencias en consulta ERCA &#40;enfermedad renal cr&#243;nica avanzada&#41;&#58; ense&#241;anzas para optimizar el inicio programado en tratamiento renal sustitutivo"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "622"
            "paginaFinal" => "629"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Analysis of emergency Department Frequentation among patients with advanced CKD &#40;chronic kidney disease&#41;&#58; Lessons to optimise scheduled renal replacement therapy initiation"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "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" => 1095
                "Ancho" => 1583
                "Tamanyo" => 120388
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pacientes en riesgo y destino en consulta de enfermedad renal cr&#243;nica avanzada &#40;ERCA&#41; durante 2015&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DP&#58; di&#225;lisis peritoneal&#59; HD&#58; hemodi&#225;lisis&#59; MAP&#58; m&#233;dico de Atenci&#243;n Primaria&#59; PS&#58; p&#233;rdida de seguimiento&#59; Tiempo en riesgo&#58; per&#237;odo de tiempo en d&#237;as&#44; en que los pacientes estuvieron en consulta ERCA durante 2015&#59; TRS&#58; tratamiento renal sustitutivo&#59; TxR&#58; trasplante renal&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#237;ctor Lorenzo Sellar&#233;s"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "V&#237;ctor"
                "apellidos" => "Lorenzo Sellar&#233;s"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2013251418301354"
          "doi" => "10.1016/j.nefroe.2018.11.006"
          "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/S2013251418301354?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699518301073?idApp=UINPBA000064"
      "url" => "/02116995/0000003800000006/v2_201812130605/S0211699518301073/v2_201812130605/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2013251418301470"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2018.11.011"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "532"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2018;38:630-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1309
      "formatos" => array:3 [
        "EPUB" => 173
        "HTML" => 665
        "PDF" => 471
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Rationale and design of DiPPI&#58; A randomized controlled trial to evaluate the safety and effectiveness of progressive hemodialysis in incident patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "630"
          "paginaFinal" => "638"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Justificaci&#243;n y dise&#241;o de DiPPI&#58; un ensayo controlado aleatorizado para evaluar la seguridad y la efectividad de la hemodi&#225;lisis progresiva en pacientes incidentes"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2301
              "Ancho" => 3167
              "Tamanyo" => 363559
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Timeline schedule&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Miguel A&#46; Su&#225;rez, Emilio Garc&#237;a-Cabrera, Antonio Gasc&#243;n, Francisca L&#243;pez, Eduardo Torregrosa, Giannina E&#46; Garc&#237;a, Jorge Huertas, Jos&#233; C&#46; de la Flor, Suleyka Puello, Jonathan G&#243;mez-Raja, Jes&#250;s Grande, Jos&#233; L&#46; Lerma, Carlos Corradino, Manuel Ramos, Jes&#250;s Mart&#237;n, Carlo Basile, Francesco G&#46; Casino, Javier Deira"
          "autores" => array:18 [
            0 => array:2 [
              "nombre" => "Miguel A&#46;"
              "apellidos" => "Su&#225;rez"
            ]
            1 => array:2 [
              "nombre" => "Emilio"
              "apellidos" => "Garc&#237;a-Cabrera"
            ]
            2 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Gasc&#243;n"
            ]
            3 => array:2 [
              "nombre" => "Francisca"
              "apellidos" => "L&#243;pez"
            ]
            4 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Torregrosa"
            ]
            5 => array:2 [
              "nombre" => "Giannina E&#46;"
              "apellidos" => "Garc&#237;a"
            ]
            6 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Huertas"
            ]
            7 => array:2 [
              "nombre" => "Jos&#233; C&#46;"
              "apellidos" => "de la Flor"
            ]
            8 => array:2 [
              "nombre" => "Suleyka"
              "apellidos" => "Puello"
            ]
            9 => array:2 [
              "nombre" => "Jonathan"
              "apellidos" => "G&#243;mez-Raja"
            ]
            10 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Grande"
            ]
            11 => array:2 [
              "nombre" => "Jos&#233; L&#46;"
              "apellidos" => "Lerma"
            ]
            12 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Corradino"
            ]
            13 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Ramos"
            ]
            14 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Mart&#237;n"
            ]
            15 => array:2 [
              "nombre" => "Carlo"
              "apellidos" => "Basile"
            ]
            16 => array:2 [
              "nombre" => "Francesco G&#46;"
              "apellidos" => "Casino"
            ]
            17 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Deira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699518301425"
        "doi" => "10.1016/j.nefro.2018.07.010"
        "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/S0211699518301425?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301470?idApp=UINPBA000064"
    "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418301470/v1_201812140610/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2013251418301330"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2018.11.005"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "495"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2018;38:616-21"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1799
      "formatos" => array:3 [
        "EPUB" => 173
        "HTML" => 1124
        "PDF" => 502
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Clinic of vascular access&#58; Results after implementing a multidisciplinary approach adding routine Doppler ultrasound"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "616"
          "paginaFinal" => "621"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Consulta de acceso vascular&#58; resultados antes y despu&#233;s de la instauraci&#243;n de un programa multidisciplinar con realizaci&#243;n de ecograf&#237;a doppler de rutina"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1372
              "Ancho" => 2882
              "Tamanyo" => 173542
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Other reasons for consultation in both periods&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "In&#233;s Aragoncillo Sauco, Jos&#233; Manuel Ligero Ramos, Almudena Vega Mart&#237;nez, &#193;ngel Luis Morales Mu&#241;oz, Soraya Abad Est&#233;banez, Nicol&#225;s Mac&#237;as Carmona, Diego Ruiz Chiriboga, Rosario Garc&#237;a Pajares, Teresa Cervera Bravo, Juan Manuel L&#243;pez-G&#243;mez, Soledad Manzano Grossi, Elena Men&#233;ndez S&#225;nchez, Javier R&#237;o Gomez, Ana Mar&#237;a Garc&#237;a Prieto, Tania Linares Gr&#225;valos, Fernando Garcia Boyano, Luis Manuel Reparaz Asensio, Marta Albalate Ram&#243;n, Patricia de Sequera Ortiz, Beatriz Gil Casares, Jara Ampuero Menc&#237;a, Sandra Castellano, Bel&#233;n Mart&#237;n P&#233;rez, Jos&#233; Lu&#237;s Mart&#237;n Conty, Alba Santos Garcia, Jos&#233; Lu&#241;o Fernandez"
          "autores" => array:26 [
            0 => array:2 [
              "nombre" => "In&#233;s"
              "apellidos" => "Aragoncillo Sauco"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233; Manuel"
              "apellidos" => "Ligero Ramos"
            ]
            2 => array:2 [
              "nombre" => "Almudena"
              "apellidos" => "Vega Mart&#237;nez"
            ]
            3 => array:2 [
              "nombre" => "&#193;ngel Luis"
              "apellidos" => "Morales Mu&#241;oz"
            ]
            4 => array:2 [
              "nombre" => "Soraya"
              "apellidos" => "Abad Est&#233;banez"
            ]
            5 => array:2 [
              "nombre" => "Nicol&#225;s"
              "apellidos" => "Mac&#237;as Carmona"
            ]
            6 => array:2 [
              "nombre" => "Diego"
              "apellidos" => "Ruiz Chiriboga"
            ]
            7 => array:2 [
              "nombre" => "Rosario"
              "apellidos" => "Garc&#237;a Pajares"
            ]
            8 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Cervera Bravo"
            ]
            9 => array:2 [
              "nombre" => "Juan Manuel"
              "apellidos" => "L&#243;pez-G&#243;mez"
            ]
            10 => array:2 [
              "nombre" => "Soledad"
              "apellidos" => "Manzano Grossi"
            ]
            11 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "Men&#233;ndez S&#225;nchez"
            ]
            12 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "R&#237;o Gomez"
            ]
            13 => array:2 [
              "nombre" => "Ana Mar&#237;a"
              "apellidos" => "Garc&#237;a Prieto"
            ]
            14 => array:2 [
              "nombre" => "Tania"
              "apellidos" => "Linares Gr&#225;valos"
            ]
            15 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Garcia Boyano"
            ]
            16 => array:2 [
              "nombre" => "Luis Manuel"
              "apellidos" => "Reparaz Asensio"
            ]
            17 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Albalate Ram&#243;n"
            ]
            18 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "de Sequera Ortiz"
            ]
            19 => array:2 [
              "nombre" => "Beatriz"
              "apellidos" => "Gil Casares"
            ]
            20 => array:2 [
              "nombre" => "Jara"
              "apellidos" => "Ampuero Menc&#237;a"
            ]
            21 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Castellano"
            ]
            22 => array:2 [
              "nombre" => "Bel&#233;n"
              "apellidos" => "Mart&#237;n P&#233;rez"
            ]
            23 => array:2 [
              "nombre" => "Jos&#233; Lu&#237;s"
              "apellidos" => "Mart&#237;n Conty"
            ]
            24 => array:2 [
              "nombre" => "Alba"
              "apellidos" => "Santos Garcia"
            ]
            25 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Lu&#241;o Fernandez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699518300730"
        "doi" => "10.1016/j.nefro.2018.04.003"
        "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/S0211699518300730?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301330?idApp=UINPBA000064"
    "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418301330/v1_201812140610/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Analysis of emergency Department Frequentation among patients with advanced CKD &#40;chronic kidney disease&#41;&#58; Lessons to optimize scheduled renal replacement therapy initiation"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "622"
        "paginaFinal" => "629"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "V&#237;ctor Lorenzo Sellar&#233;s"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "V&#237;ctor Lorenzo"
            "apellidos" => "Sellar&#233;s"
            "email" => array:1 [
              0 => "vls243&#64;gmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Hospital Universitario de Canarias&#44; La Laguna &#40;Santa Cruz de Tenerife&#41;&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "An&#225;lisis de la frecuentaci&#243;n de Urgencias en consulta ERCA &#40;enfermedad renal cr&#243;nica avanzada&#41;&#58; ense&#241;anzas para optimizar el inicio programado en tratamiento renal sustitutivo"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1095
            "Ancho" => 1583
            "Tamanyo" => 118602
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients at risk and outcomes in the clinic of advanced chronic kidney disease &#40;ACKD&#41; during 2015&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">PCD&#58; primary care doctor&#46; LFU&#58; loss of follow-up&#46; RRT&#58; renal replacement therapy&#46; HD&#58; hemodialysis&#46; PD&#58; peritoneal dialysis&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">TxR&#58; kidney transplant&#46; Time at risk&#58; period of time in days&#44; when patients are in ACKD consultation during 2015&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It is well known that early programme for the initiation of renal replacement therapy &#40;RRT&#41; has a favourable impact on the patient&#39;s survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; the decision to start RRT implies a wide margin of uncertainty on these patients with a precarious health&#46; It should be kept in mind that starting early may deprive the patient from a period of a time with a good quality of dialysis free&#46; The fact is that it is being debated that early onset improves later survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#8211;5</span></a> Therefore&#44; the responsible doctor usually faces the difficult balance between starting too early&#44; or too late&#59; requiring a central venous catheter&#44; often with vital risk&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The KDIGO Guidelines<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> emphasize the initiation of RRT in symptomatic patients and&#47;or in the presence of a glomerular filtration rate &#40;GFR&#41; of 5&#8211;10<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; In general&#44; these situations result from late referral to the nephrologist&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;7&#8211;9</span></a> But this will not be our scenario&#59; now will concentrate in patients being followed in of advanced chronic kidney disease outpatient clinics &#40;ACKD&#41;&#46; Usually these patients manifest a subjective feeling of being well&#44; maintain a relatively high urinary output&#44; and are especially reticent to be dialysed&#46; However&#44; frequently an adverse event forces an emergency hemodialysis through a catheter&#46; The KDIGO Guidelines<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> present an outline for the risk of end-stage renal disease&#46; However&#44; despite these premises&#44; the proportion of patients who start precipitously and with a venous catheter is very high&#44; around 50&#37;&#44; in most series&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#8211;13</span></a> In addition&#44; the DOPPS study reports unscheduled initiation rates with venous catheter between 23 and 70&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our hypothesis is that the analysis of emergencies room visits and the causes that determine a precipitous onset of dialysis may help to optimize the plan to start RRT in a scheduled manner&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of the present study is to analyze retrospectively&#44; the frequency of emergency room visits and their relationship with the precipitated onset in RRT&#44; in patients from our ACKD clinic &#40;monocentric study&#41; during a period of 12 months&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study was performed in a ACKD outpatient clinic of a reference Hospital&#46; The centre covers the health care of approximately 400&#44;000 people&#46; Clinical Records are available from 1994 to the end of 2015 from a total of 1&#44;492 patients&#46; The modalities of RRT offered to the patients are hemodialysis &#40;HD&#41;&#44; peritoneal dialysis &#40;PD&#41; and kidney and pancreas transplantation &#40;Tx&#41; from living or cadaveric donor&#46; Inhabitants of this region are characterized for a high incidence of early onset of diabetes which has led to a high prevalence of diabetic nephropathy &#40;DN&#41; associated with high cardiovascular comorbidity&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;15&#8211;17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The ACKD clinics attend patients with GFR &#60;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; and other candidates to receive RRT&#46; Most patients come from other outpatient clinics&#44; or after a hospital discharge of cases with potentially irreversible CKD&#46; Patients&#44; who return to dialysis after the loss of the kidney graft&#44; are previously treated in the transplant clinic and they are not included in this study&#46; The patients visit the emergency room or are admitted to the same hospital where patients are being followed as outpatient&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The standard protocols recommended by the Clinical Practice Guidelines are implemented in our clinic&#46; Likewise&#44; we consider important to instruct patients on the adjustment of drugs &#40;diuretics&#44; antihypertensives&#41; both in case of hydrosaline retention and also prevent volume depletion &#40;summer season&#44; gastroenteritis&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;18</span></a> To optimize tracking and adherence to our recommendations&#44; we recommend visits on demand and routine visits which scheduled bimonthly and quarterly and &#46;a telephone number is provided to the patient&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0040" class="elsevierStylePara elsevierViewall">Retrospective&#44; observational and single centre study of the frequency of emergency room attendance and time of hospitalization of all patients of the ACKD outpatient clinic &#40;monocentric study&#41; during a period of 12 months&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the number of patients attended in consultation during 2015&#44; the period of time at risk and the outcome during this period&#46; As compared with previous years &#40;only as a reference&#41;&#44; we found that the average age of patients was increasing&#44; with more male predominance&#44; and the high rate of ND was maintained as the primary cause of renal disease among incident patients<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;16</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The diagnoses of comorbidity and relevant biochemical parameters were extracted from the patients electronic records&#46; A cardiologist followed up all the patients with previous cardiovascular comorbidity&#46; The diagnoses of congestive heart failure &#40;CHF&#41; was based on clinical data and a previous echocardiography&#46; Also&#44; to assess cardiac function the cardiologist recommended stress or pharmacological tests&#44; and catheterization&#46; The coincidence of several factors was highlighted&#44; often coexisting the diagnosis of arrhythmia&#44; a variable degree systolic or diastolic dysfunction&#44; underlying coronary disease&#59; pulmonary hypertension&#44; and the aggravating effect of previous pulmonary disease &#40;history of smoking&#44; with diagnosis or suspicion of chronic obstructive pulmonary disease&#41;&#46; Likewise&#44; the accompanying gastrointestinal pathology &#40;angiodysplasia&#44; diverticula&#44; polyps&#44; etc&#46;&#41;&#44; was a clinical concern due to the frequent use of anticoagulants and anaemia due to digestive haemorrhage&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Initiation of RRT</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients were divided into 3 groups&#58; &#40;1&#41; Programmed&#58; they started with access to dialysis or received early TxR&#44; in a planned manner&#46; &#40;2&#41; Not planned&#58; those patients who due to special&#44; social&#44; health or clinical circumstances&#44; were outside the control of a nephrologist&#44; and started dialysis using venous catheter in a precipitated manner&#46; These circumstances are specified in the Results&#46; &#40;3&#41; Abrupt and&#47;or urgent initiation due to clinical events&#44; however that could have benefited from an advance programming in RRT&#46; This is the group of special interest in the analysis of the frequency of emergency room visits&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Emergency Room visits</span><p id="par0055" class="elsevierStylePara elsevierViewall">Emergency frequentation and&#47;or hospitalization was obtained from the electronic records of the hospital&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All patients had a clinical history at admission and clinical evolution&#44; with analytical data and imaging studies&#46; Information collected included the reason to attend the emergency room &#40;ER&#41;&#44; the clinical services involved in the care of the patient&#44; the evolution and the final outcome of the patient&#46; The patients were initially assessed by the emergency doctor&#44; and thereafter by the nephrologist and any other specialist&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistics</span><p id="par0065" class="elsevierStylePara elsevierViewall">Given the nature of the study&#44; does not involve a statistical analysis&#46; Only some parameters are described as mean and standard deviation&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> it is highlighted that 31 patients &#40;12&#37;&#41; initiated RRT&#59; and 11 &#40;4&#37;&#41; died&#46; Of these 11 deaths&#44; five occurred during the emergency assistance&#44; four due to cerebral vascular event and one was of cardiac origin&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Frequentation of Emergency Room and Hospitalization</span><p id="par0075" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> it is shown the basic data of patients at risk during 2015&#59; patients were grouped into those admitted to the hospital at least on one occasion&#44; and those who were not admitted during that period&#46; Sixty eight out of the 267 patients went to the Emergency Room or were hospitalized &#40;25&#37;&#41;&#46; These 68 patients visited the hospital on 97 occasions&#58; 50 once&#44; 10 twice&#44; 6 three times&#44; one four and one five times&#46; The patients who were hospitalized were adult&#44; with high proportion of DN and high cardiovascular comorbidity&#46; The values of haemoglobin and albumin were significantly lower in those admitted&#44; but within a range close to normal&#46; The control of diabetes based on HbA1c levels was not different between groups&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows that from the 97 hospital&#44; visits 85 &#40;87&#37;&#41; were to the ER&#44; and 46 &#40;47&#37;&#41; were hospitalized&#46; Twelve patients were hospitalized without going to ER&#59; none of them required RRT during hospitalization&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The visits to ER of this population was one every 4&#46;3 days&#44; which is 1&#46;6&#37; of the time at risk of the patients in medical consultation&#46; Likewise&#44; there were almost 3 hospital beds occupied daily&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The causes of ER frequentation and Hospitalization are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Almost half of the patients had and event of cardiac or cardiopulmonary origin&#44; dyspnoea was the predominant manifestation&#40;67&#37;&#41; &#40;frequently referring to &#8220;shortness of breath&#8221;&#41;&#44; orthopnoea&#44; most cases were grouped under the heading of congestive heart failure &#40;CHF&#41;&#44; pulmonary oedema or respiratory failure&#46; All had been included within the so-called cardiorenal syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> Added to 11 admissions that were due to peripheral or cerebral vascular causes&#44; the hospitalizations of cardiovascular origin reached almost 58&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Another important cause of admission was gastrointestinal &#40;GI&#41; disturbance&#44; which accounted 11&#37; of the hospitalizations&#46; It is remarkable that 8 were for some type of GI bleeding&#44; all undergoing anticoagulation or antiaggregant therapy&#46; Half of these patients had symptoms of heart failure&#46; Also&#44; there were two other hospitalizations precipitated by cerebral vascular bleeding who were also on anticoagulants&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nine patients were admitted in the Nephrology service with deterioration of renal function&#44; of which six started dialysis&#46; Some patients were also admitted in &#8220;others&#8221; speciality wards due to various pathologies and none of them required dialysis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There was a high percent of patients on anticoagulant&#47;antiaggregant medication&#59; among not hospitalized patients&#44; 65&#37; received anticoagulation&#47;antiaggregant therapy and among hospitalized patients a78&#37; were on anticoagulation&#47;antiaggregant therapy The proportion of those receiving acenocoumarol &#40;Sintrom&#174;&#41; was significantly increased in hospitalized patients &#40;24&#37; vs 11&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Initiation of renal replacement therapy</span><p id="par0110" class="elsevierStylePara elsevierViewall">Renal replacement therapy &#40;RRT&#41; was initiated in 31 patients &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; In Fourteen &#40;45&#37;&#41; patients the type of RRT had been planned and had arteriovenous fistula &#40;AVF&#41; or a functioning peritoneal catheter or an anticipated Kidney transplant&#46; However&#44; two of them started HD after visiting ER due to CHF&#46; Nine of the patients who had a precipitous initiation of hemodialysis with a venous catheter&#44; were on circumstances that can be consider virtually unavoidable&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The second group is the most important for our analysis&#44; since we consider that they were susceptible to earlier programming&#44; thus avoiding the implant of a catheter&#46; In these patients the initiation of dialysis was precipitated by cardiovascular causes&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Comparison of these two groups is shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; the 14 patients stating dialysis in a programmed manner with AVF&#44; peritoneal catheter in place or anticipated renal transplant&#46; There were 8 additional patients that had to start regular hemodialysis using tunnelled catheter&#59; they were seen in the ER and it is important to keep in mind that 80&#37; had a history of previous cardiac events and three patients had 2 or 3 hospitalizations due to the same cause during the last year&#46; However&#44; the GFR measured in the outpatient clinic was twice as high as high as those who initiated dialysis on scheduled basis&#59; thus&#44; such a rapid progression of the kidney damage was not expected&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">We know that the GFR and proteinuria are the best markers of kidney damage and progression of disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20&#8211;25</span></a> The GFR reflects magnitude of damage&#44; and proteinuria is associated to the rapidity of progression&#46;<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">26&#8211;28</span></a> However&#44; although its predictive value is unquestionable&#44; they do not prevent a hasty start in a considerable proportion of patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A revision of the literature reveals that despite efforts to achieve a programmed initiation of RRT&#44; more than half of the patients start RRT precipitously through a central venous catheter&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#8211;13</span></a> The objective proposed by guidelines and documents is that 80&#37; of the incidents in dialysis should start dialysis with a definitive access&#59; however this objective appears to be difficult&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> although it is a priority in the management of this population&#46; The increased age and increasing comorbidity&#44; especially cardiovascular comorbidity&#44; may not allow to achieve this objective despite the efforts by the professionals&#46; In fact&#44; heart failure is the main cause of hospitalization in patients 65 years and older&#44; with a high rate of readmissions&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> The recent study by Ronksley PE and col<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a>on renal patients confirm that 52&#37; of emergency frequentations were due to CHF episodes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There is abundant information about the importance of early referral to the nephrologist&#44; so the initiation of dialysis is organized&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;8&#8211;10</span></a> But also&#44; transcendent circumstances have been verified&#44; beyond the moment of deriving the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12&#44;32</span></a> A study similar to ours&#44; by Gomis-Couto and col&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> analyzed the causes of not programmed initiation of dialysis&#44; although they did not address the emergency room attendance&#46; These authors emphasize that unexpected incidents and the accelerated aggravation of the ERC as the most non-preventable variable&#46; But very important&#44; the authors note that the greatest area for improvement lies in the delay in performing vascular access&#46; In another study&#44; Mendelssohn DC and col<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> highlighted that 37&#37; of patients started dialysis while hospitalized&#44; and 54&#37; with a temporary catheter&#59; and that this is independent of early or late referral&#46; In this regard&#44; Bhan V and col<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> emphasize that the delay in performing vascular access in fast progressors is an important preventable obstacle for a programmed initiation of dialysis&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The period of preparation to start RRT is variable among the centres&#44; but not less than the two months required for maturation of AVF or for peritoneal catheter ready to use or even more time in the anticipated TxR&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The analysis of the frequency of ER visits and the reasons for precipitated initiation of dialysis may provide useful information&#46; By reviewing the literature&#44; we found that the issue of early initiation of dialysis was not approached from this perspective&#46; The present study has provided information about the use of Hospital Emergency Services by patients with ACKD&#46; Out of a population at risk of 267 patients&#44; the frequency of ER visits was one every 4 days approximately&#44; and the occupation of hospital beds was almost 3 beds&#47;day&#46; We did not find similar information from other sources&#44; but the annual analysis should allow to analyze annual changes&#44; and evaluate the results after improving strategies&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study also shows that despite the high age and comorbidity&#44; the proportion of patients who died or who started RRT appear to be low &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; however we have no other data to compare&#46; This observation may s be similar &#8211; or better &#8211; in other health areas&#44; but in any case&#44; what indicates is that progress in health care entail a greater survival&#44; a greater use of resources&#44; and very importantly&#44; generates an extraordinary health care expense that must adapt to these growing demand&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">34&#44;35</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The next step was to analyze the circumstances that precipitated the unscheduled initiation of dialysis and make an attempt to advance in the preparation of these patients&#46; As also observed by Gomis-Couto A and col&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> there are situations as frequent as unavoidable described in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> that precipitates the need for dialysis&#46; The most characteristic cases are those patients that state &#8220;I will not be dialyzed&#8221; an idea that changes a soon as they find themselves in the ER symptomatic and at risk of losing their life&#44; sudden renal deterioration due to an unpredictable intercurrent process&#59; and failure or delay in preparation for access for dialysis&#46; Other potential causes described in the study by Gomis-Couto A&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> such as acute renal failure that di not recover renal function or late referral to the nephrologist&#44; have not occurred&#44; since our practice receives patients that have already passed that filter&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The most interesting part of our study was the search of those cases that could have benefited from an early planning for dialysis&#46; There is a sum of &#8220;extrarenal&#8221; factors which have been decisive for the hasty and not programmed beginning of dialysis&#59; cardiovascular events accounted for six out of ten visits to the ER with precipitated start of hemodialysis with catheter &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; This should warn the nephrologist of the need to speed up the preparation of patients with this clinical profile&#59; despite the frequent subjective sensation of well-being between events&#44; and with levels of renal function &#8220;acceptable&#8221;&#46; In these cases&#44; the most characteristic were the repeated episodes of CHF&#44; the result of a frequent combination of underlying coronary disease&#44; valvular disease and heart rhythm disorders&#59; that frequently coexisting with chronic lung disease and gastrointestinal pathology&#46; The last one is very important&#44; since the frequent prescription of anticoagulants or antiaggregants&#44; increases the risk of gastrointestinal bleeding&#44; anaemia and heart failure&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The blood parameters &#40;haemoglobin and serum albumin&#41; were slightly lower in those patients that frequently visited the ER&#44; but within a range close to normal&#44; hence being helpful in warning about these events&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows a diagram of the most frequent comorbidity profile that leads the ACKD patient to go to the Emergency Service symptomatic and initiate dialysis in a precipitated and unscheduled manner&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Coming back to our hypothesis&#44; this analysis of the frequency of ER visits provides additional information to the glomerular filtration and proteinuria as the main variables of renal risk&#46; As a corollary<span class="elsevierStyleUnderline">&#44;</span> we suggest that in circumstances illustrated in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#44; especially if they have led the patient to attend the emergency department repeatedly in the last year&#44; preparation for RRT should begin even with glomerular filtration rates of 20&#8211;25<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; Very especially for those patients with resistant proteinuria of medium-high range &#40;more than 1&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h and very especially if it is persistently greater than 2&#46;5<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; The early preparation of these cases does not imply initiating dialysis immediately&#44; but giving priority to the preparation of the chosen modality&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Despite the retrospective nature of the study&#44; and given the practical difficulty of preparing and obtaining results from prospective studies&#44; we propose this opinion as a complement to the current recommendations for a scheduled initiation in technique&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres1127245"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Hypothesis"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Method"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1060964"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1127246"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:1 [
              "identificador" => "abst0030"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Hip&#243;tesis"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "M&#233;todo"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1060963"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Method"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Initiation of RRT"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Emergency Room visits"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistics"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Frequentation of Emergency Room and Hospitalization"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Initiation of renal replacement therapy"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-03"
    "fechaAceptado" => "2018-05-09"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1060964"
          "palabras" => array:4 [
            0 => "Advanced chronic kidney disease"
            1 => "Renal replacement therapy initiation"
            2 => "Emergency Department frequentation"
            3 => "Non-scheduled renal replacement therapy initiation"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1060963"
          "palabras" => array:4 [
            0 => "Enfermedad renal cr&#243;nica avanzada"
            1 => "Inicio de tratamiento renal sustitutivo"
            2 => "Frecuentaci&#243;n de Urgencias"
            3 => "Inicio no programado en tratamiento renal sustitutivo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The decision to initiate renal replacement therapy &#40;RRT&#41; implies a wide margin of uncertainty&#46; Glomerular filtration rate &#40;GFR&#41; tells us the magnitude of renal damage&#46; Proteinuria indicates the speed of progression&#46; However&#44; nowadays more than 50&#37; of patients are still initiating RRT hastily&#44; and it is life threatening&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Hypothesis</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">By analysing Emergency Department &#40;ED&#41; frequentation and causes of a hurried initiation&#44; we can better schedule the timing of the start of RRT&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Retrospective and observational study of all CKD patients in our outpatient clinic&#46; ED frequentation and hospitalization &#40;Hos&#41; time were reviewed during a 12-month period&#46; We analyzed&#58; &#40;1&#41; time at risk&#44; purpose &#40;modality of RRT&#41;&#44; previous comorbidity&#59; &#40;2&#41; causes of ED frequentation and Hos&#59; &#40;3&#41; type of initiation&#58; &#8220;scheduled&#8221; vs&#46; &#8220;non-scheduled&#8221;&#44; and within these &#8220;non-planned&#8221; vs&#46; &#8220;potentially planned&#8221;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Of a total of 267 patients &#40;time at risk 63&#46;987 days&#44; 70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years&#44; 67&#37; males&#44; 38&#37; diabetics&#41;&#44; 68 &#40;25&#37;&#41; patients came to hospital on 97 occasions&#58; 39 only ED&#44; 46 ED<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Hos and 12 only Hos&#46; ED frequentation was one patient every 4&#46;3 days&#44; and bed occupation was almost 3 per day&#46; Main causes&#58; 47&#37; cardiopulmonary &#40;1&#47;3 heart failure&#41;&#44; 11&#37; vascular peripheral<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cerebral&#44; 11&#37; gastrointestinal&#58; 8&#47;11 due to bleeding &#40;all with anticoagulants&#47;antiplatelet agents&#41;&#46; Thirty-one &#40;12&#37;&#41; patients initiated RRT&#58; of these&#44; 14 &#40;45&#37;&#41; were scheduled &#40;6 PD&#44; 6 HD&#44; and 2 living donor RTx&#41;&#44; and 17 &#40;55&#37;&#41; were not scheduled or were rushed&#44; all with venous central catheter&#46; Following the objectives of this study&#44; the non-scheduled group were itemized into 2 groups&#58; 9 non-planned &#40;initial indication of conservative management or patient&#39;s refusal to undergo dialysis&#44; and diverse social circumstances not controllable by the nephrologist&#41; and 8 were considered potentially planned &#40;6 heart failure&#44; one gastrointestinal bleeding and one peripheral vascular complication&#41;&#46; This last group &#40;potentially planned&#41;&#44; when compared with the 14 patients who started treatment in a scheduled manner&#44; had significant differences in that they were older&#44; with more previous cardiac events&#44; and GFR almost double that of the other group&#46; All of them started treatment in the ED&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This analysis provides us with knowledge on those patients who may benefit from an earlier preparation in RRT&#46; We suggest that patients with previous cardiac events&#44; especially with a risk of gastrointestinal bleeding&#44; should start the preparation for RRT even with GFR rates of 20&#8211;25<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; In spite of the retrospective nature of this study&#44; and taking into account the difficulties of carrying out clinical trials in this population&#44; we propose this suggestion as complementary to the current recommendations for a scheduled start using this technique&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:1 [
            "identificador" => "abst0005"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Hypothesis"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Method"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La decisi&#243;n de empezar tratamiento renal sustitutivo &#40;TRS&#41; conlleva un amplio margen de incertidumbre&#46; El filtrado glomerular &#40;FG&#41; nos dice la magnitud del da&#241;o&#46; La proteinuria&#44; la velocidad de progresi&#243;n&#46; A pesar de estas premisas&#44; m&#225;s del 50&#37; de los pacientes contin&#250;an iniciando TRS de forma precipitada y con riesgo vital&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Hip&#243;tesis</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizando la frecuentaci&#243;n de Urgencias &#40;Urg&#41; y las causas determinantes de un inicio precipitado&#44; podremos programar mejor el momento de iniciar un TRS&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo&#44; observacional&#44; de la frecuentaci&#243;n de Urg y del tiempo de hospitalizaci&#243;n &#40;Hos&#41; de todos los pacientes de la consulta ERCA&#44; durante un per&#237;odo de 12 meses&#46; Se analiz&#243;&#58; 1&#41; tiempo en riesgo&#44; destino &#40;modalidad de TRS&#41;&#44; comorbilidad previa&#46; 2&#41; Causas de frecuentaci&#243;n de Urg y Hos&#46; 3&#41; Tipo de inicio&#58; &#171;programado&#187; vs&#46; &#171;no programado&#187; y&#44; dentro de estos&#44; &#171;no planificables&#187; vs&#46; &#171;potencialmente planificables&#187;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">De 267 pacientes &#40;con un tiempo en riesgo de 63&#46;987 d&#237;as&#59; 70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 a&#241;os&#59; 67&#37; varones&#59; 38&#37; diab&#233;ticos&#41;&#44; 68 &#40;25&#37;&#41; pacientes acudieron al hospital en 97 ocasiones&#58; 39 solo Urg&#44; 46 Urg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Hos y 12 solo Hos&#46; La frecuentaci&#243;n de Urg fue de un paciente cada 4&#44;3 d&#237;as y la ocupaci&#243;n de camas fue de casi 3 diarias&#46; Causas predominantes&#58; 47&#37; cardiopulmonar &#40;1&#47;3 insuficiencia card&#237;aca&#41;&#44; 11&#37; vascular perif&#233;rico<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>cerebral&#44; 11&#37; digestivo&#58; 8&#47;11 por sangrado &#40;todos con anticoagulantes&#47;antiagregantes&#41;&#46; Iniciaron TRS&#58; 31 &#40;12&#37;&#41;&#58; de estos&#44; 14 &#40;45&#37;&#41; de forma programada &#40;6&#160;DP&#44; 6&#160;HD y 2&#160;TxR de donante vivo&#41;&#59; 17 &#40;55&#37;&#41; no programados o precipitados&#44; todos con cat&#233;ter venoso&#46; Siguiendo los objetivos del estudio&#44; estos &#250;ltimos se desglosaron en 2 grupos&#58; 9 no planificables &#40;indicaci&#243;n inicial de manejo conservador o negativa del paciente a dializarse&#44; y circunstancias sociales diversas no controlables por el nefr&#243;logo&#41; y 8 que consideramos potencialmente planificables &#40;6 con fallo card&#237;aco&#44; uno con hemorragia digestiva y uno vascular perif&#233;rico&#41;&#46; Estos &#250;ltimos &#40;potencialmente planificables&#41;&#44; comparados con los 14 que iniciaron de forma programada&#44; ten&#237;an significativamente mayor edad&#44; m&#225;s eventos card&#237;acos previos y el FG casi duplicaba al del otro grupo&#59; todos entraron por Urg&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Este an&#225;lisis nos aporta conocimiento sobre aquellos pacientes que pueden beneficiarse de una preparaci&#243;n m&#225;s precoz en TRS&#58; proponemos que en los enfermos con eventos card&#237;acos previos&#44; especialmente con riesgo de sangrado digestivo&#44; se inicie la preparaci&#243;n para TRS aun con tasas de FG de 20-25<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; A pesar de la naturaleza retrospectiva del estudio y ante la dificultad pr&#225;ctica de ensayos cl&#237;nicos en esta poblaci&#243;n&#44; proponemos esta medida como complemento a las recomendaciones actuales para un inicio programado en esta t&#233;cnica&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:1 [
            "identificador" => "abst0030"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Hip&#243;tesis"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todo"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Lorenzo Sellar&#233;s V&#46; An&#225;lisis de la frecuentaci&#243;n de Urgencias en consulta ERCA &#40;enfermedad renal cr&#243;nica avanzada&#41;&#58; ense&#241;anzas para optimizar el inicio programado en tratamiento renal sustitutivo&#46; Nefrologia&#46; 2018&#59;38&#58;622&#8211;629&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1095
            "Ancho" => 1583
            "Tamanyo" => 118602
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients at risk and outcomes in the clinic of advanced chronic kidney disease &#40;ACKD&#41; during 2015&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">PCD&#58; primary care doctor&#46; LFU&#58; loss of follow-up&#46; RRT&#58; renal replacement therapy&#46; HD&#58; hemodialysis&#46; PD&#58; peritoneal dialysis&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">TxR&#58; kidney transplant&#46; Time at risk&#58; period of time in days&#44; when patients are in ACKD consultation during 2015&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1286
            "Ancho" => 1571
            "Tamanyo" => 133795
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Frequency of visits to the emergency room and hospitalizations&#58; number of patients and time of bed occupation&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1562
            "Ancho" => 2167
            "Tamanyo" => 228226
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Proportion of patients who started RRT&#44; scheduled vs&#46; unscheduled or precipitated initiation&#46; Within this later group&#44; patients were grouped in &#8220;unable to programme RRT&#8221; and &#8220;programmable RRT&#8221;&#46; PC&#58; peritoneal catheter&#46; CHF&#58; congestive heart failure&#46; TC&#58; tunnelled catheter</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ER&#58; start from the Emergency Room&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1295
            "Ancho" => 1583
            "Tamanyo" => 96548
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Diagram of the most frequent comorbidity profile that leads the patient to the emergency room symptomatic and requiring initiation of RRT in an hasty way&#46; ACS&#58; Acute Coronary Syndrome&#46; Dysf&#58; dysfunction &#40;S&#58; systolic&#59; D&#58; diastolic&#41;&#46; CHF&#58; congestive Heart Failure&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CHF&#58; congestive heart failure&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&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">All&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">Not-admitted&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">Admitted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</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">267&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">199 &#40;75&#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">68 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&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;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender &#40;&#37;male&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#46; diabetics &#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">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&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;045&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular comorbidity &#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><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coronary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&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><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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valvulopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&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-with-role" title="table-entry ; entry_with_role_rowhead " 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="left" valign="top">4&#46;2<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><td class="td" title="table-entry  " align="left" valign="top">4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;9<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><td class="td" title="table-entry  " align="left" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemoglobin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#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">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HbA1c &#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">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1<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><td class="td" title="table-entry  " align="left" valign="top">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1921375.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">General demographic data&#44; cardiovascular comorbidity and relevant biochemical parameters&#44; grouped according to whether they had been in ER or admitted to the Hospital during 2015&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">n</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">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cerebrovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&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;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripherovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&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;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nephrology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&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;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1921374.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Causes of emergency attendance and Hospitalization grouped by relevant pathology and frequency&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">CV&#58; cardiovascular&#59; MDRD&#58; Modification of Diet in Renal Disease Study equation&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">Programmed&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">Programmable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57<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">77<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">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Start in the emergency department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;15&#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">8 &#40;100&#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">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;14&#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">7 &#40;88&#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">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pre initial MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1921373.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Comparison of patients that started on a scheduled basis versus those that we consider not programmed&#44; but potentially programmable&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Chronic renal failure outpatient clinic&#46; A 12 years experience&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Lorenzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "425"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17944579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predialysis nephrologic care and a functioning arteriovenous fistula at entry are associated with better survival in incident hemodialysis patients&#58; an observational cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Lorenzo"
                            1 => "M&#46; Martn"
                            2 => "M&#46; Rufino"
                            3 => "D&#46; Hernandez"
                            4 => "A&#46; Torres"
                            5 => "J&#46;C&#46; Ayus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2004"
                        "volumen" => "43"
                        "paginaInicial" => "999"
                        "paginaFinal" => "1007"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15168379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Netherlands Cooperative Study on the Adequacy of Dialysis Study G&#58; When to initiate dialysis&#58; effect of proposed US guidelines on survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Korevaar"
                            1 => "M&#46;A&#46; Jansen"
                            2 => "F&#46;W&#46; Dekker"
                            3 => "K&#46;J&#46; Jager"
                            4 => "E&#46;W&#46; Boeschoten"
                            5 => "R&#46;T&#46; Krediet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(01)06180-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2001"
                        "volumen" => "358"
                        "paginaInicial" => "1046"
                        "paginaFinal" => "1050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11589934"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of DOQI guidelines&#58; early start of dialysis treatment is not associated with better health-related quality of life"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;C&#46; Korevaar"
                            1 => "M&#46;A&#46; Jansen"
                            2 => "F&#46;W&#46; Dekker"
                            3 => "E&#46;W&#46; Boeschoten"
                            4 => "P&#46;M&#46; Bossuyt"
                            5 => "R&#46;T&#46; Krediet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/ajkd.2002.29896"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2002"
                        "volumen" => "39"
                        "paginaInicial" => "108"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11774109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;P&#46; Traynor"
                            1 => "K&#46; Simpson"
                            2 => "C&#46;C&#46; Geddes"
                            3 => "C&#46;J&#46; Deighan"
                            4 => "J&#46;G&#46; Fox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2002"
                        "volumen" => "13"
                        "paginaInicial" => "2125"
                        "paginaFinal" => "2132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12138145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "KDIGO Clinical practice guideline for the evaluation and management of chronic kidney disease"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Kidney Int Suppl"
                        "fecha" => "2013"
                        "volumen" => "3"
                        "paginaInicial" => "1"
                        "paginaFinal" => "150"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Longer pre-dialysis nephrological care is associated with improved long-term survival of dialysis patients&#46; More facts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Gorriz"
                            1 => "A&#46; Sancho"
                            2 => "L&#46;M&#46; Pallardo"
                            3 => "M&#46;L&#46; Amoedo"
                            4 => "G&#46; Barril"
                            5 => "M&#46; Salgueira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "1354"
                        "paginaFinal" => "1355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12105267"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;G&#46; Stack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/ajkd.2003.50038"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2003"
                        "volumen" => "41"
                        "paginaInicial" => "310"
                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12552491"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinants of delayed nephrologist referral in patients with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;C&#46; Winkelmayer"
                            1 => "R&#46;J&#46; Glynn"
                            2 => "R&#46; Levin"
                            3 => "W&#46;F&#46; Owen Jr&#46;"
                            4 => "J&#46; Avorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/ajkd.2001.29207"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2001"
                        "volumen" => "38"
                        "paginaInicial" => "1178"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11728948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Prognostic significance of programmed dialysis in patients who initiate renal substitutive treatment&#46; Multicenter study in Spain&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Gorriz"
                            1 => "A&#46; Sancho"
                            2 => "L&#46;M&#46; Pallardo"
                            3 => "M&#46;L&#46; Amoedo"
                            4 => "M&#46; Martin"
                            5 => "P&#46; Sanz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "49"
                        "paginaFinal" => "59"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11987685"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;The start of renal replacement therapy in a Spanish department&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Castellano"
                            1 => "S&#46; Gallego"
                            2 => "P&#46;J&#46; Labrador"
                            3 => "J&#46;R&#46; Gomez-Martino"
                            4 => "A&#46; Covarsi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "445"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17058856"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Causes of unplanned hemodialysis initiation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Gomis Couto"
                            1 => "J&#46;L&#46; Teruel Briones"
                            2 => "M&#46; Fernandez Lucas"
                            3 => "M&#46; Rivera Gorrin"
                            4 => "N&#46; Rodriguez Mendiola"
                            5 => "S&#46; Jimenez Alvaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2011.Sep.10927"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2011"
                        "volumen" => "31"
                        "paginaInicial" => "733"
                        "paginaFinal" => "737"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22130290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular access for haemodialysis&#58; an epidemiological study of the Catalan Renal Registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Rodriguez"
                            1 => "J&#46; Lopez"
                            2 => "M&#46; Cleries"
                            3 => "E&#46; Vela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10435872"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular access use and outcomes&#58; an international perspective from the Dialysis Outcomes and Practice Patterns Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Ethier"
                            1 => "D&#46;C&#46; Mendelssohn"
                            2 => "S&#46;J&#46; Elder"
                            3 => "T&#46; Hasegawa"
                            4 => "T&#46; Akizawa"
                            5 => "T&#46; Akiba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfn261"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2008"
                        "volumen" => "23"
                        "paginaInicial" => "3219"
                        "paginaFinal" => "3226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18511606"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Terminal kidney disease associated with diabetes in the Canary Islands&#58; a public heath problem with high economic cost and human suffering&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Lorenzo"
                            1 => "M&#46; Boronat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2010.Jun.10455"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "381"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20651878"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disproportionately high incidence of diabetes-related end-stage renal disease in the Canary Islands&#46; An analysis based on estimated population at risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Lorenzo"
                            1 => "M&#46; Boronat"
                            2 => "P&#46; Saavedra"
                            3 => "M&#46; Rufino"
                            4 => "B&#46; Maceira"
                            5 => "F&#46;J&#46; Novoa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfp761"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2010"
                        "volumen" => "25"
                        "paginaInicial" => "2283"
                        "paginaFinal" => "2288"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20064954"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal replacement therapy in the Canary Islands&#58; demographic and survival analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Lorenzo"
                            1 => "E&#46; Sanchez"
                            2 => "N&#46; Vega"
                            3 => "D&#46; Hernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nephrol"
                        "fecha" => "2006"
                        "volumen" => "19"
                        "paginaInicial" => "97"
                        "paginaFinal" => "103"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16523433"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Doctor&#44; how much should I drink&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Lorenzo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2014.Jul.12610"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "paginaInicial" => "693"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25415568"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiorenal syndromes&#58; an executive summary from the consensus conference of the Acute Dialysis Quality Initiative &#40;ADQI&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Ronco"
                            1 => "P&#46;A&#46; McCullough"
                            2 => "S&#46;D&#46; Anker"
                            3 => "I&#46; Anand"
                            4 => "N&#46; Aspromonte"
                            5 => "S&#46;M&#46; Bagshaw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000313745"
                      "Revista" => array:6 [
                        "tituloSerie" => "Contrib Nephrol"
                        "fecha" => "2010"
                        "volumen" => "165"
                        "paginaInicial" => "54"
                        "paginaFinal" => "67"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20427956"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease&#46; A collaborative meta-analysis of kidney disease population cohorts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;C&#46; Astor"
                            1 => "K&#46; Matsushita"
                            2 => "R&#46;T&#46; Gansevoort"
                            3 => "M&#46; van der Velde"
                            4 => "M&#46; Woodward"
                            5 => "A&#46;S&#46; Levey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2010.550"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2011"
                        "volumen" => "79"
                        "paginaInicial" => "1331"
                        "paginaFinal" => "1340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21289598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retarding the progression of renal disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;M&#46; Brenner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1523-1755.2003.t01-2-00052.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2003"
                        "volumen" => "64"
                        "paginaInicial" => "370"
                        "paginaFinal" => "378"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12787440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes&#46; A collaborative meta-analysis of general and high-risk population cohorts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;T&#46; Gansevoort"
                            1 => "K&#46; Matsushita"
                            2 => "M&#46; van der Velde"
                            3 => "B&#46;C&#46; Astor"
                            4 => "M&#46; Woodward"
                            5 => "A&#46;S&#46; Levey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2010.531"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2011"
                        "volumen" => "80"
                        "paginaInicial" => "93"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21289597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proteinuria as a therapeutic target in patients with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;F&#46; Palmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000101958"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "287"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17457028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies&#46; Gruppo Italiano di Studi Epidemiologici in Nefrologia &#40;GISEN&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Ruggenenti"
                            1 => "A&#46; Perna"
                            2 => "L&#46; Mosconi"
                            3 => "R&#46; Pisoni"
                            4 => "G&#46; Remuzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1523-1755.1998.00874.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "1998"
                        "volumen" => "53"
                        "paginaInicial" => "1209"
                        "paginaFinal" => "1216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9573535"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retarding progression of chronic renal disease&#58; the neglected issue of residual proteinuria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Ruggenenti"
                            1 => "A&#46; Perna"
                            2 => "G&#46; Remuzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1523-1755.2003.00033.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2003"
                        "volumen" => "63"
                        "paginaInicial" => "2254"
                        "paginaFinal" => "2261"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12753315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Supratherapeutic doses of angiotensin receptor blockers to decrease proteinuria in patients with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;F&#46; Palmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000112270"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "2008"
                        "volumen" => "28"
                        "paginaInicial" => "381"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18063856"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolving strategies for renoprotection&#58; diabetic nephropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;H&#46; Parving"
                            1 => "P&#46; Hovind"
                            2 => "K&#46; Rossing"
                            3 => "S&#46; Andersen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Nephrol Hypertens"
                        "fecha" => "2001"
                        "volumen" => "10"
                        "paginaInicial" => "515"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11458033"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progression&#44; remission&#44; regression of chronic renal diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Ruggenenti"
                            1 => "A&#46; Schieppati"
                            2 => "G&#46; Remuzzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(00)04728-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2001"
                        "volumen" => "357"
                        "paginaInicial" => "1601"
                        "paginaFinal" => "1608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11377666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Developing a clinical performance measures system for hemodialysis&#44; Quality Group Spanish Society of Nephrology&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Lopez Revuelta"
                            1 => "G&#46; Barril"
                            2 => "C&#46; Caramelo"
                            3 => "R&#46; Delgado"
                            4 => "F&#46; Garcia Lopez"
                            5 => "J&#46; Garcia Valdecasas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "542"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18045030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial of telephone intervention in chronic heart failure &#40;DIAL&#41;&#58; study design and preliminary observations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Grancelli"
                            1 => "S&#46; Varini"
                            2 => "D&#46; Ferrante"
                            3 => "R&#46; Schwartzman"
                            4 => "C&#46; Zambrano"
                            5 => "S&#46; Soifer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1054/jcaf.2003.33"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2003"
                        "volumen" => "9"
                        "paginaInicial" => "172"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12815566"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergency department use among patients with CKD&#58; a population-based analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;E&#46; Ronksley"
                            1 => "M&#46; Tonelli"
                            2 => "B&#46;J&#46; Manns"
                            3 => "R&#46;G&#46; Weaver"
                            4 => "C&#46;M&#46; Thomas"
                            5 => "J&#46;M&#46; MacRae"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.06280616"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2017"
                        "volumen" => "12"
                        "paginaInicial" => "304"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28119410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Suboptimal initiation of dialysis with and without early referral to a nephrologist"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;C&#46; Mendelssohn"
                            1 => "B&#46; Curtis"
                            2 => "K&#46; Yeates"
                            3 => "S&#46; Langlois"
                            4 => "J&#46;M&#46; MacRae"
                            5 => "L&#46;M&#46; Semeniuk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfq843"
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "2959"
                        "paginaFinal" => "2965"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21282303"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674908011354"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to access before initiation of hemodialysis&#58; a single-center review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Bhan"
                            1 => "S&#46; Soroka"
                            2 => "C&#46; Constantine"
                            3 => "B&#46;A&#46; Kiberd"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1542-4758.2007.00191.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hemodial Int"
                        "fecha" => "2007"
                        "volumen" => "11"
                        "paginaInicial" => "349"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17576301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;in Spanish&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Economic evaluation of haemodialysis&#46; Analysis of cost components based on patient-specific data&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Lorenzo"
                            1 => "L&#46; Perestelo"
                            2 => "M&#46; Barroso"
                            3 => "A&#46; Torres"
                            4 => "J&#46; Nazco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2010.Jun.10264"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "403"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20651881"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost analysis and sociocultural profile of kidney patients&#46; Impact of the treatment method"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Lorenzo-Sellares"
                            1 => "M&#46;I&#46; Pedrosa"
                            2 => "B&#46; Santana-Exposito"
                            3 => "Z&#46; Garcia-Gonzalez"
                            4 => "M&#46; Barroso-Montesinos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2014.Apr.12501"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "paginaInicial" => "458"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25036059"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Chronic Kidney Disease Epidemiology Collaboration"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Levey"
                            1 => "J&#46; Coresh"
                            2 => "T&#46; Greene"
                            3 => "L&#46;A&#46; Stevens"
                            4 => "Y&#46;L&#46; Zhang"
                            5 => "S&#46; Hendriksen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2006"
                        "volumen" => "145"
                        "paginaInicial" => "247"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16908915"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0923181113001291"
                          "estado" => "S300"
                          "issn" => "09231811"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418301354/v1_201812140610/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "42660"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003800000006/v1_201812140610/S2013251418301354/v1_201812140610/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418301354?idApp=UINPBA000064"
]