Letter to the Editor
Evolution of renal replacement therapy in Mexico in the last 10 years
Evolución del tratamiento sustitutivo de la función renal en México en los últimos 10 años
Antonio Méndez-Durán
Corresponding author
Coordinación de Servicios Indirectos, Coordinación de Planeación de Infraestructura Médica, Dirección de Prestaciones Médicas del Instituto Mexicano del Seguro Social, Mexico
Read
5223
Timeswas read the article
2586
Total PDF
2637
Total HTML
Share statistics
array:24 [ "pii" => "S2013251421000067" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2020.02.005" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "709" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2021;41:82-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699520300382" "issn" => "02116995" "doi" => "10.1016/j.nefro.2020.02.004" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "709" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2021;41:82-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Evolución del tratamiento sustitutivo de la función renal en México en los últimos 10 años" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "82" "paginaFinal" => "83" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evolution of renal replacement therapy in Mexico in the last 10 years" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1432 "Ancho" => 2667 "Tamanyo" => 236985 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comportamiento de las terapias dialíticas y estimación de los próximos 5 años.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Méndez-Durán" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Antonio" "apellidos" => "Méndez-Durán" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251421000067" "doi" => "10.1016/j.nefroe.2020.02.005" "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/S2013251421000067?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520300382?idApp=UINPBA000064" "url" => "/02116995/0000004100000001/v2_202105230524/S0211699520300382/v2_202105230524/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251421000080" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2020.04.005" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "719" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2021;41:84-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Renal infaction in a patient with COVID-19" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "84" "paginaFinal" => "87" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto renal en paciente con COVID-19" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1371 "Ancho" => 1500 "Tamanyo" => 224628 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT scan on days 10 (A) and 18 (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guillermo Cuevas Tascón, Danilo E. Salazar Chiriboga, Rosa Lorente Ramos, Domingo Díaz Díaz, Covadonga Rodríguez Ruiz, Fabio L. Procaccini, Esther Torres Aguilera, Juan A. Martín Navarro, Beatriz Mestre Gómez, Nuria Muñoz Rivas, Roberto Alcázar Arroyo" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Cuevas Tascón" ] 1 => array:2 [ "nombre" => "Danilo E." "apellidos" => "Salazar Chiriboga" ] 2 => array:2 [ "nombre" => "Rosa" "apellidos" => "Lorente Ramos" ] 3 => array:2 [ "nombre" => "Domingo" "apellidos" => "Díaz Díaz" ] 4 => array:2 [ "nombre" => "Covadonga" "apellidos" => "Rodríguez Ruiz" ] 5 => array:2 [ "nombre" => "Fabio L." "apellidos" => "Procaccini" ] 6 => array:2 [ "nombre" => "Esther" "apellidos" => "Torres Aguilera" ] 7 => array:2 [ "nombre" => "Juan A." "apellidos" => "Martín Navarro" ] 8 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Mestre Gómez" ] 9 => array:2 [ "nombre" => "Nuria" "apellidos" => "Muñoz Rivas" ] 10 => array:2 [ "nombre" => "Roberto" "apellidos" => "Alcázar Arroyo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699520300485" "doi" => "10.1016/j.nefro.2020.04.008" "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/S0211699520300485?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000080?idApp=UINPBA000064" "url" => "/20132514/0000004100000001/v1_202103250823/S2013251421000080/v1_202103250823/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251421000043" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2020.01.002" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "696" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2021;41:81-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Renal involvement in Sneddon's syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "81" "paginaFinal" => "82" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afectación renal en el síndrome de Sneddon" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Hernández García, María José Sánchez Torres" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Hernández García" ] 1 => array:2 [ "nombre" => "María José" "apellidos" => "Sánchez Torres" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699520300254" "doi" => "10.1016/j.nefro.2020.01.001" "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/S0211699520300254?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000043?idApp=UINPBA000064" "url" => "/20132514/0000004100000001/v1_202103250823/S2013251421000043/v1_202103250823/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Evolution of renal replacement therapy in Mexico in the last 10 years" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "82" "paginaFinal" => "83" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio Méndez-Durán" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Antonio" "apellidos" => "Méndez-Durán" "email" => array:1 [ 0 => "amd740522@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Coordinación de Servicios Indirectos, Coordinación de Planeación de Infraestructura Médica, Dirección de Prestaciones Médicas del Instituto Mexicano del Seguro Social, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución del tratamiento sustitutivo de la función renal en México en los últimos 10 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1185 "Ancho" => 1488 "Tamanyo" => 46312 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of treatment by type of dialysis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Mexico, 11% of the general population suffers from some degree of chronic kidney disease. The main causes are diabetes mellitus and arterial hypertension. There is no kidney health programme and 6% of patients are admitted for dialysis each year.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the last 10 years, dialysis treatments have increased at the expense of haemodialysis, which goes against current evidence.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The Instituto Mexicano del Seguro Social [Mexican Institute of Social Security] (IMSS) covers 65 million users in its different administrative regimes that offer its social security, and includes 50% of the patients that are on dialysis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 10-year retrospective study (June 2008–June 2018) was conducted based on the institutional registry of adult and paediatric patients in chronic dialysis. It did not include continuous renal replacement therapy. It included 73,730 patients, of which 70,158 (95%) were being treated in secondary healthcare. A 57.5% were male, the average age was 63 years (range: 1–90), with the highest prevalence in the 60–69 years age group (24.5%); and 27,399 (37%) were retired. The distribution of patients by dialysis treatment revealed that 40,968 (56%) were undergoing peritoneal dialysis (PD) and 32,762 (44%) were on haemodialysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The incidence of PD decreased by 10% in the study period, 1% yearly in a sustained manner. The linear regression analysis estimated that there will be more than 110,000 prevalent patients by the year 2027, and by the year 2022 the same number of patients will be receiving PD as haemodialysis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). This will result in greater financial investment in a programme that already jeopardises the economic stability of the Institute. The main causes of kidney failure were diabetes (53.3%) and high blood pressure (35.2%). The prevalence was estimated to be 1134 beneficiaries/million and an incidence of 474 beneficiaries/million. In total, 18,330 patients were referred for a kidney transplant study (average of 3055 per year), 87% with a living donor, 9% for predialysis, 54% male and 46% female, with an average age of 39.2 years (range: 5–65). The most common complications were peritonitis (29.8%), mechanical complication of the peritoneal catheter (8%) and vascular access dysfunction (5.9%). The final programme drop-outs (1181 average/month) were attributed to death from myocardial infarction (24.6%), septic shock (16.5%), multiple organ failure (8%) and kidney transplantation (3.4%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The findings indicates the need for implementation of effective strategies in primary healthcare to reduce the incidence of chronic kidney disease, improve healthcare procedures for chronic kidney disease in all its stages, perform more transplants, promote and improve professional skills and have an influence on factors related to lack of supplies and lack of adherence to international management recommendations.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Currently, the direct cost of dialysis treatment in the IMSS is about 5.5 billion pesos and it is estimated that at least the same amount is invested in indirect expenses. This undermines the financial stability of the institute, since a minimum percentage of CKD patients on dialysis (0.1%) exceeds the cost of other health programmes, such as for breast cancer, cervical cancer, prostate cancer and the care of patients with HIV-AIDS.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This public health problem is difficult to control as it specifically affects education and behavioural changes that hinder human development and limit the expression of health as a whole, not just kidney health. The Institute and the Mexican National Health System have been slow to introduce a kidney health programme with specific strategies to contain the "large-scale disease" that is chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-14" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Méndez-Durán A. Evolución del tratamiento sustitutivo de la función renal en México en los últimos 10 años. Nefrologia. 2021;41:82–83.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1185 "Ancho" => 1488 "Tamanyo" => 46312 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of treatment by type of dialysis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1432 "Ancho" => 2667 "Tamanyo" => 236985 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dialysis treatment trends and estimation for the next 5 years.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estado actual de las terapias sustitutivas de la función renal en el Instituto Mexicano del Seguro Social" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Méndez-Durán" 1 => "M.H. Ignorosa-Luna" 2 => "G. Pérez-Aguilar" 3 => "F.J. Rivera-Rodríguez" 4 => "J.J. González-Izquierdo" 5 => "J. Dávila-Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Med Inst Mex Seguro Soc." "fecha" => "2016" "volumen" => "54" "paginaInicial" => "588" "paginaFinal" => "593" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peritoneal dialysis first: rationale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Chaudhary" 1 => "H. Sangha" 2 => "R. Khanna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin J Am Soc Nephrol." "fecha" => "2011" "volumen" => "6" "paginaInicial" => "447" "paginaFinal" => "456" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Programa Institucional del Instituto Mexicano del Seguro Social. 2014–2018. Capítulo I. Diagnóstico. I.1 El IMSS y la Seguridad Social en México. Pág. 7. Gobierno de la República. México. Available from: <a target="_blank" href="http://www.imss.gob.mx/sites/all/statics/pdf/PIIMSS_2014-2018_FINAL_230414.pdf">http://www.imss.gob.mx/sites/all/statics/pdf/PIIMSS_2014-2018_FINAL_230414.pdf</a> [Accessed 28 February 2019]." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuidados de enfermería en el paciente con enfermedad renal crónica en hemodiálisis: una revisión sistemática" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z.E. Ángel Ángel" 1 => "G.A. Duque Castaño" 2 => "D.L. Tovar Cortes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Enferm Nefrol." "fecha" => "2016" "volumen" => "19" "paginaInicial" => "202" "paginaFinal" => "213" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Informe al Ejecutivo Federal y al Congreso de la Unión Sobre la Situación Financiera y los Riesgos del Instituto Mexicano del Seguro Social. 2017-2018. Capítulo V. pág. 127 Available from: <a target="_blank" href="http://www.imss.gob.mx/conoce-al-imss/informe-2017-2018">http://www.imss.gob.mx/conoce-al-imss/informe-2017-2018</a> [Accessed 30 December 2018]." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of global kidney health care status" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.K. Bello" 1 => "A. Levin" 2 => "M. Tonelli" 3 => "I.G. Okpechi" 4 => "J. Feehally" 5 => "D. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2017.4046" "Revista" => array:6 [ "tituloSerie" => "JAMA." "fecha" => "2017" "volumen" => "317" "paginaInicial" => "1864" "paginaFinal" => "1919" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28430830" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack521213" "titulo" => "Acknowledgement" "texto" => "<p id="par0020" class="elsevierStylePara elsevierViewall">To Pedro Jiménez Aranda for his valuable support in the analysis and presentation of the data.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004100000001/v1_202103250823/S2013251421000067/v1_202103250823/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000004100000001/v1_202103250823/S2013251421000067/v1_202103250823/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000067?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 80 | 40 | 120 |
| 2024 September | 103 | 34 | 137 |
| 2024 August | 104 | 72 | 176 |
| 2024 July | 64 | 34 | 98 |
| 2024 June | 70 | 55 | 125 |
| 2024 May | 81 | 44 | 125 |
| 2024 April | 63 | 30 | 93 |
| 2024 March | 60 | 28 | 88 |
| 2024 February | 58 | 51 | 109 |
| 2024 January | 46 | 26 | 72 |
| 2023 December | 29 | 29 | 58 |
| 2023 November | 55 | 55 | 110 |
| 2023 October | 81 | 37 | 118 |
| 2023 September | 58 | 33 | 91 |
| 2023 August | 61 | 26 | 87 |
| 2023 July | 72 | 33 | 105 |
| 2023 June | 61 | 30 | 91 |
| 2023 May | 60 | 35 | 95 |
| 2023 April | 70 | 714 | 784 |
| 2023 March | 72 | 37 | 109 |
| 2023 February | 47 | 21 | 68 |
| 2023 January | 55 | 47 | 102 |
| 2022 December | 70 | 41 | 111 |
| 2022 November | 55 | 36 | 91 |
| 2022 October | 69 | 60 | 129 |
| 2022 September | 67 | 44 | 111 |
| 2022 August | 66 | 56 | 122 |
| 2022 July | 41 | 59 | 100 |
| 2022 June | 45 | 39 | 84 |
| 2022 May | 63 | 49 | 112 |
| 2022 April | 47 | 53 | 100 |
| 2022 March | 58 | 66 | 124 |
| 2022 February | 55 | 42 | 97 |
| 2022 January | 52 | 43 | 95 |
| 2021 December | 36 | 50 | 86 |
| 2021 November | 45 | 31 | 76 |
| 2021 October | 71 | 71 | 142 |
| 2021 September | 50 | 54 | 104 |
| 2021 August | 71 | 55 | 126 |
| 2021 July | 44 | 45 | 89 |
| 2021 June | 41 | 31 | 72 |
| 2021 May | 40 | 48 | 88 |
| 2021 April | 65 | 62 | 127 |
| 2021 March | 31 | 38 | 69 |
Show all
