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the sympathetic system activity or the reduced synthesis of nitric oxide&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The control of volume by means of ultrafiltration and appropriate adjustment of dry weight&#44; the restriction of salt intake and the reduction of sodium concentration in the dialysis bath are the first step for the control of blood pressure &#40;BP&#41; in these patients&#46; Yet&#44; despite the pharmacological treatment&#44; in many in hemodialysis patients the HTN is refractory&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">There is no uniformity about the appropriate calcium concentration in the dialysis fluid&#46; The use of a calcium concentration of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L reduces the calcium balance as compared with the 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L and may induce an increase in PTH&#44; together with other effects such as a decrease in BP&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Elevated calcium levels have been associated with hypertension&#44; however the mechanisms by which variations in ionic calcium influence the BP independently of extracellular volume and changes in electrolytes are poorly understood&#46; Different mechanisms of action have been postulated&#44; among which are the increased vasoconstriction and myocardial contractility&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">14&#8211;17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study is to analyze the effect that changes in the calcium concentration of dialysis fluid exert on BP in normovolemic hemodialysis patients&#44; during a 12-month follow-up&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a prospective&#44; interventional study&#44; before&#8211;after in a single group&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">From a total of 75 prevalent elderly patients of the Hemodialysis Unit of the Gregorio Mara&#241;&#243;n Hospital&#44; we selected all non-volume-dependent hypertensive patients during a 9-month recruitment period&#46; Hypertension was defined as pre-dialysis BP values greater than 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg during the previous month or the need for antihypertensive drugs to control BP independently of the actual values of BP&#46; Patients were informed of the study and written informed consent was obtained&#46; The exclusion criteria were the voluntary refusal to participate in the study and the failure to meet the criteria for HTN&#46; Finally&#44; 24 patients were selected&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All patients were on a regime of 3 weekly sessions of conventional hemodialysis or on-line hemodiafiltration&#44; of 240<span class="elsevierStyleHsp" style=""></span>min duration&#46; The dialysis fluid had a calcium concentration of 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L and a conductivity of 13&#46;8<span class="elsevierStyleHsp" style=""></span>mS&#47;cm&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">All data was collected at baseline&#44; 3&#44; 6 and 12 months&#46; The variables were the BP values&#44; number of antihypertensive drugs&#44; number of episodes of arterial hypotension in each dialysis session&#44; interdialysis weight gain&#44; predialysis plasma levels of calcium&#44; phosphorus and PTH&#44; and treatment for control of calcium and phosphate metabolism&#46; The values of predialysis BP and the interdialysis weight gain were collected as the average of the values obtained during the week prior to collection&#46; The episodes of intradialytic arterial hypotension collected were the symptomatic episodes that required fluid therapy or a decrease in the ultrafiltration rate during the month prior to the data collection&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The blood volume was measured by bioimpedance at baseline&#44; 6 and 12 months&#44; using a spectroscopic bioimpedance monitor &#40;BCM&#44; Fresenius Medical Care&#44; Bad Homburg&#44; Germany&#41;&#46; Overhydration &#40;OH&#41; and total body water &#40;TBW&#41; were measured&#46; OH is defined as water not included in lean or fat tissue&#46; Normal hydration is defined as a OH&#47;VEC ratio less than 15&#37; before the hemodialysis session&#44; as previously defined in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">18&#44;19</span></a> All patients included in the study met the criteria of normal hydration and therefore it was considered that these patients had non-volume-dependent hypertension&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Follow up</span><p id="par0060" class="elsevierStylePara elsevierViewall">The calcium concentration of the dialysis fluid was reduced in all patients to 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L and this concentration were maintained throughout the follow-up&#46; The baseline data was compared with the data collected at 3&#44; 6 and 12 months&#46; The reasons for not completing the study were&#58; kidney transplant&#44; death or need to modify the calcium concentration in the dialysis fluid due to medical criteria&#44; hypocalcemia or development of severe secondary hyperparathyroidism&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistic analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The data of the quantitative variables are expressed as means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or median<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>Interquartile range depending on the distribution of the variable&#46; Qualitative variables are described as frequencies&#46; The variables were compared using the <span class="elsevierStyleItalic">t</span>-student test and nonparametric tests &#40;Wilcoxon signed rank test and McNemar test&#41;&#44; depending on the nature of the variables&#46; A statistically significance was considered if <span class="elsevierStyleItalic">p</span> value was lower than 0&#46;05&#46; The statistical analysis performed using SPSS V&#46; 17&#46;0&#46; &#40;Chicago&#44; IL&#44; USA&#41;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 75 patients prevalent in the Hemodialysis Unit 24 met the criteria to be included in the study&#44; these represents a 32&#37; of HTN in our Hemodialysis Unit&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The baseline characteristics of the 24 hypertensive patients and the 51 non-hypertensive patients are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Throughout the 12 months of follow-up&#44; of the 24 patients included&#44; 23 were studied at 6 months and 18 completed one year follow-up&#46; The causes of exclusion from the study were 3 transplants&#44; one death due to cerebrovascular accident and in 2 patients&#44; the Ca concentration in the dialysis fluid was modified to 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L by decision of their responsible physician based on the presence of hypocalcemia and marked secondary hyperparathyroidism&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the HTN group&#44; the initial mean predialysis systolic BP was 162&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;9<span class="elsevierStyleHsp" style=""></span>mmHg and the average diastolic BP was 76&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;7<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Systolic and diastolic BP decreased significantly at 12 months of follow-up&#46; This occurred while the dry weight was maintained and with a non significant reduction in the number of antihypertensive drugs &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Analysis the data obtained by bioimpedance revealed that all the hypertensive patients included were normovolemic with a mean of the baseline predialysis OH&#47;TBW ratio of 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;7&#37;&#46; Throughout the study&#44; there were no significant changes in the hydration status or interdialysis weight gain in these hypertensive patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The baseline data of hypertensive patients were compared with the obtained in the 51 non-hypertensive patients and no significant differences were found regarding hydration status or interdialysis weight gain &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the data on calcium and phosphate metabolism in hypertensive patients on hemodialysis with a dialysate containing 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L of calcium during 12 months follow up&#46; There were no significant changes in the plasma levels of calcium and phosphorus throughout the study&#46; PTH levels increase at 6 months although the increase was not statistically significant&#46; At baseline&#44; 4 patients &#40;16&#46;7&#37;&#41; were in treatment with calcitriol and the same percentage received cinacalcet&#59; 13 patients &#40;54&#46;2&#37;&#41; required calcium based binders and 10 &#40;41&#46;7&#37;&#41; non-calcium binders&#46; There were no significant differences in calcium intake&#44; or in the doses of calcitriol and cinacalcet throughout the study&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Hemodynamic instability intradialysis was not increased by a dialysate calcium of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#59; the percentage or the number of hypotension episodes were not increased &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7 respectively&#41;&#46; Seven patients &#40;29&#46;2&#37;&#41; had at least one episode of symptomatic hypotension intradialysis during the month being dialyzed with Ca 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; in number of 1 &#40;12&#46;5&#37;&#41;&#44; 2 &#40;12&#44; 5&#37;&#41; and 3 or more &#40;4&#46;2&#37;&#41;&#46; The same percentage also had at least one intradialytic arterial hypotension while being dialyzing with Ca 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; in number of 1 &#40;16&#46;7&#37;&#41;&#44; 2 &#40;8&#46;3&#37;&#41; and 3 or more &#40;4&#46;2&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Of the 18 patients who complete the study&#44; 10 achieve the goals of predialysis TA less than 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; although most of them still required some antihypertensive drug&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In our study&#44; the decrease in dialysate calcium concentration in hemodialysis patients is able to reduce the BP in patients with non-volume-dependent hypertension without changes in intradialysis hemodynamic stability&#44; although with a non-significant tendency to increase the levels of PTH&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The hypertension is a frequent and relevant clinical problem in hemodialysis patients&#46; It implies a greater cardiovascular risk and it is difficult to manage&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;7</span></a> In these patients&#44; hypertension is fundamentally volume-dependent&#44; which is why the first step in the control of BP is the correct adjustment of the dry weight&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#8211;10</span></a> For this&#44; in addition to the clinic&#44; we currently have the fundamental aid of bioimpedance&#44; which allows the quantitative determination of hydration status&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">It is noteworthy that the initial prevalence of hypertension in our Hemodialysis Unit &#40;32&#37;&#41; is very low as compared to other series showing prevalence of hypertension of 56&#8211;90&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1&#8211;5</span></a> This is probably due to the maintained effort and conviction over the years about the importance of the control of ECV with dietary salt restriction&#44; optimization of ultrafiltration&#44; adequate quantification of the dry weight and individualizing the hemodialysis technique&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The default basal conductivity of our hemodialysis unit is 13&#46;8<span class="elsevierStyleHsp" style=""></span>mS&#47;cm&#46; The decrease or individualization of sodium in the dialysis fluid reduces thirst and the interdialysis weight gain and the BP&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Despite the dietary advice&#44; the adequate control of dry weight&#44; the maintenance of patients in a normovolemic status and the individualization of the conductivity of the dialysis fluid&#44; there is a percentage of patients who continue to be hypertensive&#46; In this situation&#44; we decided to analyze the effect of reducing the calcium concentration of the dialysis fluid on the BP&#46; Our idea was to provide another tool for the treatment of hypertension in HD patients&#46; With the data obtained from bioimpedance at the beginning of the study&#44; we showed that all patients included in our study were in a situation of normal hydration&#46; Wabel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> established the cut-off threshold for the definition of OH by 15&#37; in relation to the ECV&#44; which represents an approximate excess of ECV of 2&#46;5<span class="elsevierStyleHsp" style=""></span>L&#46; Based on this separation of patients in normally hydrated and overhydrated&#44; a survival study was carried out with 269 prevalent hemodialysis patients and after a follow-up period of 3&#46;5 years&#44; it was found that the hydration status was an independent predictor of mortality in hemodialysis patients&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">After 12 months with a dialysis fluid calcium concentration of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; and maintaining the rest of the variables constant&#44; it was observed a significant average reduction of 20&#46;1<span class="elsevierStyleHsp" style=""></span>mmHg in the predialysis systolic BP&#44; which was already evident at the third month of study&#46; However&#44; the reduction of predialysis diastolic BP is more gradual and was significant only at sixth month&#44; and at month 12&#44; the average decrease was 11&#46;7<span class="elsevierStyleHsp" style=""></span>mmHg&#46; These reductions in BP are not the result of better control of the patient hydration status&#44; since the percentage of excess ECV &#40;OH&#47;ECV&#41; or dry weight was not significantly modified throughout the study&#44; neither it was the interdialysis weight gain&#46; In addition to a better blood pressure control&#44; there was a tendency to reduce the number of antihypertensive drugs&#44; although this was not statistically significant&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the negative effects of hemodialysis with low calcium&#44; it has been observed that the negative calcium balance during dialysis stimulates the secretion of PTH&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">23&#44;24</span></a> Strict control of phosphate and calcium metabolism is important to avoid accelerated progression of secondary hyperparathyroidism in these patients&#46; In our study&#44; plasma phosphate levels remained unchanged&#44; however plasma levels of calcium decreased discretely and PTH levels increased&#44; although not statistically significant&#46; The needs for calcium and phosphate binders were not significantly modified&#44; although there was a tendency to increase the doses of calcium carbonate&#46; It was observed an increase in the number of patients requiring calcitriol and cinacalcet for the control of secondary hyperparathyroidism&#44; so that initially 16&#37; of the patients were on calcitriol treatment and 16&#37; on cinacalcet&#44; and at month12 they were 33&#37; respectively&#46; If patients are dialysed with calcium of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; it is important to adjust the treatment correctly to maintain a strict control of plasma levels of calcium&#44; phosphorus and PTH&#44; so that unnecessary increases in PTH are avoided&#46; The consequence may be an increase in the needs of calcium and vitamin D&#46; Among our patients&#44; there was a moderate increase in PTH&#44; which&#44; perhaps&#44; could have been avoided with higher doses of calcium supplements or calcitriol&#46; Other limitations of the study are that we have not confirmed the loss of calcium by convective transport&#59; another limitation is the limited number of patients and a short follow-up period&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The effects of low calcium hemodialysis in terms of decreased myocardial contractility<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">17&#44;25</span></a> would be a contraindication for patients with severe heart disease and may result in worse tolerance for intradialytic arterial hypotension&#46; In our study&#44; where patients did not present severe cardiac disease&#44; no greater hemodynamic instability was observed when patients were dialyzed with calcium of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L compared to their baseline situation &#40;Ca&#58; 3<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#41;&#46; Intradialysis hypotension is associated with an increase in morbidity and mortality&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In summary&#44; hemodialysis with calcium in the dialysis fluid of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L is an effective and safe therapeutic alternative for the control of non-volume-dependent hypertension in patients on hemodialysis&#46; Its limitations are a stimulation of PTH secretion and a decrease in cardiac contractility&#44; with a risk of a negative evolution of secondary hyperparathyroidism&#44; an increase in calcium or vitamin D requirements&#44; and an increased risk of intradialysis hemodynamic instability&#46; Strict control of phosphate and calcium metabolism is required&#59; the severe secondary hyperparathyroidism&#44; severe heart disease and arrhythmias may contraindicate this treatment&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2017-06-24"
    "fechaAceptado" => "2018-04-04"
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            0 => "Calcium"
            1 => "Concentrate"
            2 => "Haemodialysis"
            3 => "Dialysis fluid"
            4 => "Hypertension"
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            0 => "Calcio"
            1 => "Concentrado"
            2 => "Hemodi&#225;lisis"
            3 => "L&#237;quido de di&#225;lisis"
            4 => "Tensi&#243;n arterial"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypertension is a highly prevalent disorder among patients undergoing haemodialysis&#46; It contributes to greater cardiovascular risk and must be controlled&#46; However&#44; despite dietary measures&#44; haemodialysis regimen optimization and pharmacological treatment&#44; some patients in our units continue to maintain high blood pressure levels&#46; The objective of the study is to demonstrate that reducing calcium in dialysis fluid can help treat hypertension patients undergoing haemodialysis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We selected all of the hypertensive patients from our haemodialysis unit&#46; We checked their normovolemic status by means of bioimpedance spectroscopy&#44; decreasing the haemodialysis fluid&#39;s calcium concentration to 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L&#44; with a follow-up period of 12 months&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 24 patients met the non-volume dependent hypertension criteria &#40;age 61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 years&#44; males 48&#37;&#44; diabetes 43&#37;&#41;&#46; A significant systolic and diastolic blood pressure decrease was observed at 6 and 12 months as a result of reducing the dialysis calcium concentration&#59; this was not accompanied by greater hemodynamic instability &#40;baseline systolic blood pressure&#58; 162<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>mmHg&#59; at 6 months&#58; 146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>mmHg&#59; at 12 months&#58; 141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mmHg&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;baseline diastolic blood pressure&#58; 76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>mmHg&#59; at 6 months&#58; 70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mmHg&#59; at 12 months&#58; 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mmHg&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; A non-significant increase in plasma parathyroid hormone levels was also found&#46; No side effects were observed&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adding 2&#46;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;L of calcium to dialysis fluid is a safe and effective therapeutic alternative to control hard-to-manage hypertension among haemodialysis patients&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La hipertensi&#243;n arterial es altamente prevalente en los pacientes en hemodi&#225;lisis&#46; Implica un mayor riesgo cardiovascular y es fundamental su control&#46; A pesar de medidas diet&#233;ticas&#44; optimizaci&#243;n de la pauta de hemodi&#225;lisis y tratamiento farmacol&#243;gico&#44; existe un porcentaje de pacientes en nuestras unidades que contin&#250;an hipertensos&#46; Es por ello que nos planteamos que la reducci&#243;n de calcio en el l&#237;quido de di&#225;lisis puede ayudar al manejo de los pacientes hipertensos en hemodi&#225;lisis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron todos los pacientes hipertensos de nuestra unidad de hemodi&#225;lisis&#46; Se comprob&#243; estado de normovolemia mediante bioimpedancia espectrosc&#243;pica y se disminuy&#243; la concentraci&#243;n de calcio del l&#237;quido de hemodi&#225;lisis a 2&#44;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#44; con un seguimiento de 12 meses&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cumplieron criterios de hipertensi&#243;n arterial no volumen-dependiente 24 pacientes &#40;edad 61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os&#44; varones el 48&#37;&#44; diabetes el 43&#37;&#41;&#46; Se observ&#243; una disminuci&#243;n significativa en la tensi&#243;n arterial sist&#243;lica y diast&#243;lica a los 6 y 12 meses de la reducci&#243;n de la concentraci&#243;n del calcio de di&#225;lisis&#44; sin acompa&#241;arse de mayor inestabilidad hemodin&#225;mica &#40;tensi&#243;n arterial sist&#243;lica basal 162<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#59; a los 6 meses 146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#59; a los 12 meses 141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mmHg&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;tensi&#243;n arterial diast&#243;lica basal 76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#59; a los 6 meses 70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#59; a los 12 meses 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mmHg&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; Existi&#243; un aumento de los niveles plasm&#225;ticos de PTH de forma no significativa&#46; No se evidenciaron efectos secundarios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La hemodi&#225;lisis con calcio en el l&#237;quido de 2&#44;5<span class="elsevierStyleHsp" style=""></span>mEq&#47;l es una alternativa terap&#233;utica eficaz y segura para el control de hipertensi&#243;n arterial de dif&#237;cil manejo en los pacientes de hemodi&#225;lisis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0065">Please cite this article as&#58; Ampuero Menc&#237;a J&#44; Vega A&#44; Abad S&#44; Ruiz Caro C&#44; Verdalles &#218;&#44; L&#243;pez G&#243;mez JM&#46; Influencia de la concentraci&#243;n de calcio en el l&#237;quido de hemodi&#225;lisis sobre el control de la tensi&#243;n arterial&#46; Nefrologia&#46; 2019&#59;39&#58;44&#8211;49&#46;</p>"
      ]
    ]
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      0 => array:8 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes mellitus&#59; CKD&#58; chronic kidney disease&#59; RAAS&#58; renin-angiotensin-aldosterone system&#59; RRT&#58; renal replacement therapy&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HTN &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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">Gender &#40;&#37; male&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#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"><span class="elsevierStyleItalic">DM &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#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">29&#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"><span class="elsevierStyleItalic">Time in RRT &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;1&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#8211;14&#41;&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"><span class="elsevierStyleItalic">Previous transplant &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#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">27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Etiology of CKD &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#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">23&#46;5&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"><span class="elsevierStyleHsp" style=""></span>Diabetic nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;7&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"><span class="elsevierStyleHsp" style=""></span>Polycystic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&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&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"><span class="elsevierStyleHsp" style=""></span>Vascular&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;7&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;8&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"><span class="elsevierStyleHsp" style=""></span>Not affiliated&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;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#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"><span class="elsevierStyleHsp" style=""></span>Interstitial&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&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;8&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"><span class="elsevierStyleHsp" style=""></span>Others&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Antihypertensive drugs &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&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"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;7&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"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;4&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"><span class="elsevierStyleHsp" style=""></span>3 or more&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Tipe of drugs &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;5&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"><span class="elsevierStyleHsp" style=""></span>RAAS Blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;7&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"><span class="elsevierStyleHsp" style=""></span>Calcium antagonists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;1&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;7&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
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of hypertensive and non-hypertensive patients &#40;values are expressed in percentages&#44; except for time on renal replacement therapy shown as median and interquartile range and age in mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#41;&#46;</p>"
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                  <table border="0" frame="\n
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                  \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><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&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><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">141<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76<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">71<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="char" valign="top">0&#46;07&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>12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56<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="char" valign="top">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56<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="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;75&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \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><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \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><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&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><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison of the OH&#47;ECV ratio and interdialysis weight gain in hypertensive vs&#46; non-hypertensive patients at baseline and at 12 months&#46;</p>"
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                  \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
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">283&#46;5 &#40;128&#8211;497&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#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">515 &#40;134&#8211;718&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">341 &#40;211&#8211;781&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;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">Calcitriol &#40;mcg&#47;week&#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;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#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">0&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;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;82<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="char" valign="top">0&#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;87<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&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"><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">4 &#40;16&#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">5 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;33&#37;&#41;&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">Cinacalcet &#40;mg&#47;day&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;16&#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">4 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;33&#37;&#41;&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1250<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>470&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1307<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>662&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1687<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1330&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;44&#37;&#41;&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></tbody></table>
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              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0050"><span class="elsevierStyleItalic">p</span> Value&#44; baseline vs&#46; 6 months&#46;</p>"
            ]
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              "identificador" => "tblfn0055"
              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0055"><span class="elsevierStyleItalic">p</span> Value&#44; basal vs&#46; 12 months&#46;</p> <p class="elsevierStyleNotepara" id="npar0060">The mean values of cinacalcet&#44; calcitriol and calcium carbonate refer only to patients who were on the medication&#59; <span class="elsevierStyleItalic">n</span> is the number of patients taking the medication at each time of the study&#46;</p>"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Baseline data of mineral metabolism and the changes in serum levels of calcium&#44; phosphorus and PTH as well as in the treatment for secondary hyperparathyroidism at baseline&#44; 3&#44; 6 and 12 months&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of comorbid conditions and mortality in hemodialysis patients in Europe&#44; Japan&#44; and the United States&#58; the Dialysis Outcomes and Practice Patterns Study &#40;DOPPS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Goodkin"
                            1 => "J&#46; Bragg-Gresham"
                            2 => "K&#46; Koenig"
                            3 => "R&#46; Wolfe"
                            4 => "T&#46; Akiba"
                            5 => "V&#46; Andreucci"
                          ]
                        ]
                      ]
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