Editorial
Individualisation and challenges for haemodialysis in the next decade
Individualización y desafíos para la hemodiálisis de la próxima década
Itziar Castañoa,
, Gregorio Romero-Gonzálezb, Marta Ariasc, Almudena Vegad, Javier Deirae, Pablo Molinaf, Raquel Ojedag, Francisco Maduellc, En nombre del grupo de trabajo de Hemodiálisis en centro
Corresponding author
a Hospital Universitario de Navarra, Pamplona, Spain
b Hospital Germans Trias i Pujol, Badalona, Spain
c Hospital Clinic de Barcelona, Barcelona, Spain
d Hospital Gregorio Marañón, Madrid, Spain
e Hospital San Pedro de Alcantara, Cáceres, Spain
f Hospital Universitario Doctor Peset, Valencia, Spain
g Hospital Universitario Reina Sofía, Córdoba, Spain
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=> "Hospital Clinic de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Gregorio Marañón, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital San Pedro de Alcantara, Cáceres, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Hospital Universitario Doctor Peset, Valencia, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Individualización y desafíos para la hemodiálisis de la próxima década" ] ] "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" => 1402 "Ancho" => 2508 "Tamanyo" => 267339 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the main care of the hemodialysis patient.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">VA: vascular access; A/B: acid-base; BioIM: bioimpedance; BioM: biomarkers of congestion; PE: physical examination; eKt/V: equilibrated Kt/V urea; CKD: chronic kidney disease; ACKD: advanced chronic kidney disease; Kt: sitting clearance; BMM: bone-mineral metabolism; nPCR: normalized protein catabolism rate; PoCUS: Point-of- care ultrasonography; std Kt/V: standard weekly Kt/V.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The number of patients starting renal replacement therapy increases every year, with hemodialysis (HD) being the therapy with the highest incidence and second in prevalence, only behind renal transplantation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Over the years, the HD population has become progressively older and more comorbid, with a high mortality rate of around 13–14%, much higher than that of other forms of renal replacement therapy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Historically, the assessment of "adequate dialysis" has been based on the clearance of small molecular weight solutes. However, the 2019 KDIGO guidelines on dialysis initiation, the choice of dialysis modality, access and prescription of dialysis remind us to pursue patient-centered treatment goals having in mind the patient preferences, being required the use of multiple measures to assess dialysis adequacy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Aware of all these challenges, and with the aim of promoting collaboration between different centers and professionals to achieve true individualization in the prescription of HD, the In-center Hemodialysis Group of the Spanish Society of Nephrology has been formed recently. The aim of this article is to highlight the main aspects that form part of the individualization of prescription and the challenges of in-center HD for the coming years.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The path to carry out this individualization begins in the clinics of advanced chronic kidney disease, which have among other objectives the appropriate information on the different modalities of renal replacement therapy. For those who choose the modality of HD in a center, it continues to be a challenge to do so in a programmed manner with permanent and mature vascular access. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a schematic representation of the main care of the dialysis patient in which some of the aspects that form part of this individualization can be perceived.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">The heart in the core of hemodialysis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the important technological evolution of HD, cardiovascular diseases are the main cause of mortality in this group of patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In addition to the traditional risk factors, factors related to uremia and dialysis technique, such as arteriovenous fistulas, especially high flow, electrolyte gradients and interaction with membranes are additional mechanisms that facilitate the development of morphological and functional alterations in the heart,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> increasing the risk of cardiovascular pathologies such as heart failure, which appears in 20–40% of HD patients.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently, congestion has become of special interest in HD patients as it is associated with high mortality<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and morphological alterations of the heart such as left ventricular hypertrophy, diastolic dysfunction, tricuspid regurgitation or right ventricular dysfunction.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> One of the greatest challenges when dealing with congestion in the HD patient is its difficult quantification by clinical parameters such as <span class="elsevierStyleItalic">dry weight</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> or even by bioimpedance.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> These, assessed in isolation, have a low sensitivity and their interpretation is complex, so the concept of <span class="elsevierStyleItalic">multiparametric assessment</span> of congestion emerges.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This new vision includes the use of new tools such as point-of-care ultrasonography (PoCUS<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and the use of novel biomarkers of congestion such as carbohydrate antigen 125.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The integration of clinical, ultrasound, biochemical</p><p id="par0035" class="elsevierStylePara elsevierViewall">parameters and bioimpedance will make it possible in the future to personalize congestion and establish individualized decongestion strategies with the aim of achieving adequate ultrafiltration.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">The art of ultrafiltration</span><p id="par0040" class="elsevierStylePara elsevierViewall">In recent years we have learned that depletion states due to high ultrafiltrations (>13 ml/kg/h) are also associated with increased mortality due to tissue ischemia and development of inflammatory states,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> which underscores the need for individualized volemia monitoring and ultrafiltration. HD monitors are equipped with biosensors and biocontrols based on ultrafiltration adjusted to intravascular volume, modification of conductivity, blood pressure, vascular filling rate, temperature modification, or oscillations in oxygen saturation. An adequate knowledge of the tools will be useful to improve the tolerance to ultrafiltration.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Therefore, in the "art of ultrafiltration" we must take into account several issues: it is necessary to objectively estimate the dry weight without forgetting to individualize it through clinical assessment, as well as recalculate it when the patient's situation changes. In addition, we must use all the tools provided by the monitors to carry out adequate ultrafiltration, avoiding excessive losses and ensuring adequate tolerance. Our objective in the next decade must be to continue incorporating all these biosensors into our routine practice.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Search for the ideal frequency</span><p id="par0050" class="elsevierStylePara elsevierViewall">The optimal number of weekly sessions that a patient should receive is currently unknown and is likely to vary depending on the patient's clinical situation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Most patients receive 3 weekly sessions based arbitrary reasons and on the management of the dialysis unit. This frequency with a duration of 3−5 h per session is considered by the KDOQI/2015 Guidelines<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> as "conventional HD program". However, this approach is questionable as it does not differentiate between incident or prevalent patients, with or without residual renal function (RRF).</p><p id="par0060" class="elsevierStylePara elsevierViewall">In addition, in prevalent patients a higher number of sessions would be more similar to native renal clearance. Thus, programs with 5–7 weekly sessions are defined as <span class="elsevierStyleItalic">frequent</span> HD.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However, this approach has obtained inconclusive results in several trials.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–20</span></a> Moreover, frequent HD is associated with a deleterious effect on vascular access and an accelerated loss of RRF.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">On the contrary, in incident patients it can be implemented an incremental HD program, starting with one or two weekly sessions depending on their renal urea clearance and quantifying periodically their RRF. The published data from the first trial with incremental HD are very promising,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and there are other studies underway.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We should also consider alternate-day HD programs (every 48 h), which avoid the long period and its high mortality<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> or palliative or decremental dialysis, which shortens the sessions prioritizing the patient's well-being and quality of life. Thus, the optimal frequency should be dynamic, patient-centered, with 1–2 sessions at the beginning (if the patient maintains RRF), moving to conventional (3–4 sessions) or frequent (5–7) according to the need of the patient and decreasing their number in final stages to improve their quality of life.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Individualizing dialysis fluid</span><p id="par0070" class="elsevierStylePara elsevierViewall">Dialysis fluid (DF) plays a crucial role in each HD session because depending on its composition, it will produce changes in the patient's blood that can have clinical consequences.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The composition of the DF is key to obtain the purification efficacy being pursued, without forgetting that it must be performed under optimal safety conditions.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> When prescribing the session, we must bear in mind what is our objective, according to the characteristics of each patient. We know that we can modify certain parameters in the DF, which allows us to improve the patient's tolerance to the session, such as sodium or potassium,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> or improve certain clinical parameters such as the control of bone- mineral metabolism, by means of changes in the concentration of calcium<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> or magnesium.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">One of the key points in the individualization of the LOD is conductivity, since small changes can have relevant clinical consequences in the patient. Two of the chemical components essential for maintaining correct conductivity of the DF, and therefore the conductivity with which we dialyze the patient, are sodium<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and bicarbonate.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Another element that will directly influence the conductivity of the LOD is temperature; in general, the specific conductivity increases by 2% of its value for each one-degree increase in temperature.</p><p id="par0085" class="elsevierStylePara elsevierViewall">At present, it is possible to quickly, easily and effectively individualize the DF in each HD session for each patient. This possibility is a powerful tool available to us in our daily clinical practice, allowing us to improve tolerance to HD sessions without losing efficacy.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Choice of membranes - dialyzer</span><p id="par0090" class="elsevierStylePara elsevierViewall">The evolution in the development of dialysis membranes has been really very productive and always in line with the technological evolution of dialysis monitors and modalities. Continuous improvement in these membranes, with better production systems, such as nanotechnology, have provided new generations of dialyzers with improved efficiency. Most high-flux dialyzers may be used in high-flux HD and hemodiafiltration modalities. Other membranes have the property of higher adsorption capacity, such as PMMA,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> being one of the membranes with the best survival results in HD modality in Japanese studies.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> As an alternative to synthetic dialyzers are the latest generation cellulosic dialyzers, such as cellulose triacetate, with similar efficacy and biocompatibility to synthetics. Even the latest generation can be used in hemodiafiltration techniques with high convective volume.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> At present we have an unsolved problem with synthetic membranes which is that in a small percentage (3%) they present moderate or severe adverse reactions, which disappear when changing to a cellulose membrane. It is important to identify the cause and triggering factors to avoid this complication.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Recently, a new advance in membranes has been made by increasing the pore size, <span class="elsevierStyleItalic">half-cut-off</span> pores, which allow higher permeability without the need for convection.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In fact, these dialyzers should only be used in HD, or as it has been called, <span class="elsevierStyleItalic">extended</span> HD.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">There is last step in which further progress could be made which is that of adding a second membrane (activated carbon or hydrophobic resins) to the diffusive and convective membranes to enhance adsorption. We refer to double filter dialysis with regeneration of the ultrafiltrate from the patient after passing through an adsorbing cartridge,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> or experiences coming mainly from China that are working with an adsorbing cartridge that they add to the conventional HD treatment.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The use of adsorption for the removal of protein-bound uremic toxins, such as p-cresol sulfate and indoxyl sulfate, could be a useful tool to decrease morbidity and mortality in dialysis patients, since the elevation of their plasma levels has been associated with increased mortality and cardiovascular events in patients with chronic kidney disease.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">An aspect that is becoming increasingly relevant is the exposure of HD patients to bisphenol A, an environmental toxicant that forms part of the polycarbonate present in the casings or in the membrane of some dialysis filters, as is the case of polysulfone or polyester-polymer alloy.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Several studies, among which we highlight a Spanish one, have shown that the use of polysulfone versus polynephron (without bisphenol A) was associated in these patients with an increase in blood levels of bisphenol A and, secondarily, in the levels of intracellular free radicals and circulating inflammatory markers (IL-6, TNF-α, C-reactive protein).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Reversing fragility</span><p id="par0115" class="elsevierStylePara elsevierViewall">Despite the progressive aging of the population, a better management of cardiovascular complications and an improved tolerance to the treatment thanks to technological advances have allowed greater flexibility in the inclusion in HD programs HD of increasingly older patients with greater comorbidity. These patients have an increased prevalence of frailty, considered a predictor of disability, hospitalization, falls, loss of mobility, cardiovascular disease and death.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> People with CKD are more predisposed to develop frailty (15–21%), especially those on HD (up to 73% depending on the tool used).<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Frailty is a biological syndrome of decreased reserve and resistance to stressors and may be associated with malnutrition, sarcopenia, dynapenia and other complications of CKD.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">This situation poses a change of scenario in HD patient care, being essential the systematic introduction of frailty screening, in order to identify those frail and pre-frail people, more vulnerable to the occurrence of adverse events so that they can benefit from preventive or therapeutic measures to reverse all or part of this state.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Despite the clinical implications of frailty, screening is currently not routinely performed in many HD units, perhaps because there is no consensus on which tool to use.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Current frailty assessment tools can be divided into those based on physical frailty such as Fried's frailty phenotype,<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> which focuses on functional assessment and is the most accepted definition at present, or multidimensional, the most widely used being the <span class="elsevierStyleItalic">Frailty Index</span>,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> derived from this, the <span class="elsevierStyleItalic">Clinical Frailty Scale</span>,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a><span class="elsevierStyleItalic">the Edmonton Frailty Scale</span><a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> or the FRAIL scale,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> validated for the dialysis population. The implementation of the use of these scales in daily clinical practice is not easy because some are time- consuming and require auxiliary instruments.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Vascular access and nutritional status</span><p id="par0135" class="elsevierStylePara elsevierViewall">It is well known that starting dialysis with a permanent access is associated with better patient outcomes, however, starting dialysis with a mature and functional access remains a challenge.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Although the benefits of fistulas are widely accepted,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> the 2019 KDIGO guidelines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> remind us that "fistula first" is not appropriate for all patients, the established paradigms for vascular access need to be reconsidered within the structure of the individual "life plan" of the patient with chronic kidney disease, taking into account, not only their vascular characteristics, but also their goals and preferences.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The prevalence of protein-energy wasting is much more frequent in dialysis (up to 20–50 %) than in pre-dialysis phases because the dialysis procedure induces a net protein catabolic state, influenced by the dialysis technique and a systemic inflammatory response in relation to the biocompatibility of the system.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Given that nutritional status is one of the main treatable factors affecting the prognosis and evolution of patients with chronic kidney disease, the only way to prevent and treat these patients early is to perform an assessment of the nutritional status of patients with chronic kidney disease, if possible as early as the pre-dialysis stage. The simplest way is to carry out a 3-day dietary record (including dialysis, non-dialysis and holidays), but there are different validated tests in the dialysis population such as the <span class="elsevierStyleItalic">Malnutrition Inflammation Score</span> (MIS) or the Subjective Global Assessment, as well as new practical computer tools (<a href="http://www.nutrendial.cat">www.nutrendial.cat</a>)<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> that allow us to easily calculate the prevalence of protein energy wasting (PEW) and compare it with these <span class="elsevierStyleItalic">scores</span> (MIS and SGA).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0150" class="elsevierStylePara elsevierViewall">In-center HD has undergone important changes both from the technological point of view and in its concept of appropriateness, as well as in the profile of the patients it serves, making it essential to truly individualize dialysis prescription based on patient- centered treatment objectives.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "The heart in the core of hemodialysis" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "The art of ultrafiltration" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Search for the ideal frequency" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Individualizing dialysis fluid" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Choice of membranes - dialyzer" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Reversing fragility" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Vascular access and nutritional status" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-03-20" "fechaAceptado" => "2023-09-11" "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1402 "Ancho" => 2508 "Tamanyo" => 267339 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the main care of the hemodialysis patient.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">VA: vascular access; A/B: acid-base; BioIM: bioimpedance; BioM: biomarkers of congestion; PE: physical examination; eKt/V: equilibrated Kt/V urea; CKD: chronic kidney disease; ACKD: advanced chronic kidney disease; Kt: sitting clearance; BMM: bone-mineral metabolism; nPCR: normalized protein catabolism rate; PoCUS: Point-of- care ultrasonography; std Kt/V: standard weekly Kt/V.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Registro de Enfermos Renales | Otro sitio realizado con WordPress. Accessed November 27, 2022. <a target="_blank" href="http://www.registrorenal.es/">http://www.registrorenal.es/</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.T. Chan" 1 => "P.J. Blankestijn" 2 => "L.M. Dember" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.kint.2019.01.017" "Revista" => array:7 [ "tituloSerie" => "Kidney Int" "fecha" => "2019" "volumen" => "96" "numero" => "1" "paginaInicial" => "37" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30987837" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The renal replacement therapy landscape in 2030: reducing the global cardiovascular burden in dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Canaud" 1 => "A. Collins" 2 => "F. Maddux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/NDT/GFAA005" "Revista" => array:7 [ "tituloSerie" => "Nephrol Dial Transplant." "fecha" => "2020" "volumen" => "35" "numero" => "Supplement_2" "paginaInicial" => "ii51" "paginaFinal" => "ii57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32162663" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden and challenges of heart failure in patients with chronic kidney disease. A call to action" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Romero-González" 1 => "S. Ravassa" 2 => "O. González" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.NEFRO.2019.10.005" "Revista" => array:7 [ "tituloSerie" => "Nefrología" "fecha" => "2020" "volumen" => "40" "numero" => "3" "paginaInicial" => "223" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31901373" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.K. Cheung" 1 => "M.J. Sarnak" 2 => "G. Yan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1523-1755.2004.00657.x" "Revista" => array:6 [ "tituloSerie" => "Kidney Int." "fecha" => "2004" "volumen" => "65" "numero" => "6" "paginaInicial" => "2380" "paginaFinal" => "2389" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.A. House" 1 => "C. Wanner" 2 => "M.J. Sarnak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.KINT.2019.02.022/ATTACHMENT/0868CB0F-C918-4127-94C5-CFA36BB98BE2/MMC2.PDF" "Revista" => array:8 [ "tituloSerie" => "Kidney Int." "fecha" => "2019" "volumen" => "95" "numero" => "6" "paginaInicial" => "1304" "paginaFinal" => "1317" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31053387" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0883944120308005" "estado" => "S300" "issn" => "08839441" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Kalantar-Zadeh" 1 => "D.L. Regidor" 2 => "C.P. Kovesdy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.108.807362" "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2009" "volumen" => "119" "numero" => "5" "paginaInicial" => "671" "paginaFinal" => "679" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19171851" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive hemodialysis and health-related quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.A. Kraus" 1 => "R.J. Fluck" 2 => "E.D. Weinhandl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2016.05.023" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis." "fecha" => "2016" "volumen" => "68" "numero" => "5" "paginaInicial" => "S33" "paginaFinal" => "S42" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Agarwal" 1 => "M.R. Weir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.01760210" "Revista" => array:7 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2010" "volumen" => "5" "numero" => "7" "paginaInicial" => "1255" "paginaFinal" => "1260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20507951" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of bioimpedance spectroscopy to guide fluid management in patients receiving dialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Tabinor" 1 => "S.J. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MNH.0000000000000445" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Nephrol Hypertens." "fecha" => "2018" "volumen" => "27" "numero" => "6" "paginaInicial" => "406" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30063488" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cuantificación y tratamiento de la congestión en insuficiencia cardíaca: una visión clínica y fisiopatológica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. de la Espriella" 1 => "E. Santas" 2 => "I. Zegri Reiriz" 3 => "J.L. Górriz" 4 => "M. Cobo Marcos" 5 => "J. Núñez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.NEFRO.2021.04.006" "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "2022" "volumen" => "42" "paginaInicial" => "113" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36153906" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PoCUS in nephrology: a new tool to improve our diagnostic skills" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Romero-González" 1 => "J. Manrique" 2 => "M.F. Slon-Roblero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/CKJ/SFAC203" "Revista" => array:7 [ "tituloSerie" => "Clin Kidney J." "fecha" => "2022" "volumen" => "16" "paginaInicial" => "218" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36755847" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0883944117306688" "estado" => "S300" "issn" => "08839441" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical role of CA125 in worsening heart failure: a BIOSTAT-CHF study subanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Núñez" 1 => "A. Bayés-Genís" 2 => "E. Revuelta-López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.JCHF.2019.12.005" "Revista" => array:7 [ "tituloSerie" => "JACC Heart Fail." "fecha" => "2020" "volumen" => "8" "numero" => "5" "paginaInicial" => "386" "paginaFinal" => "397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32171764" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Canaud" 1 => "C. Chazot" 2 => "J. Koomans" 3 => "A. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/2175-8239-JBN-2019-0135" "Revista" => array:6 [ "tituloSerie" => "Braz J Nephrol." "fecha" => "2019" "volumen" => "41" "numero" => "4" "paginaInicial" => "550" "paginaFinal" => "559" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrafiltration rate and mortality in maintenance hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.M. Assimon" 1 => "J.B. Wenger" 2 => "L. Wang" 3 => "J.E. Flythe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2016.06.020" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis." "fecha" => "2016" "volumen" => "68" "numero" => "6" "paginaInicial" => "911" "paginaFinal" => "922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27575009" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Rocco" 1 => "J.T. Daugirdas" 2 => "T.A. Depner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/J.AJKD.2015.07.015" "Revista" => array:7 [ "tituloSerie" => "Am J Kidney Dis." "fecha" => "2015" "volumen" => "66" "numero" => "5" "paginaInicial" => "884" "paginaFinal" => "930" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26498416" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In-center hemodialysis six times per week versus three times per week" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.M. Chertow" 1 => "N.W. Levin" 2 => "G.J. Beck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMOA1001593/SUPPL_FILE/NEJMOA1001593_DISCLOSURES.PDF" "Revista" => array:7 [ "tituloSerie" => "New Engl J Med." "fecha" => "2010" "volumen" => "363" "numero" => "24" "paginaInicial" => "2287" "paginaFinal" => "2300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21091062" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of frequent nocturnal home hemodialysis: the frequent hemodialysis network nocturnal trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.V. Rocco" 1 => "R.S. Lockridge" 2 => "G.J. Beck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.2011.213" "Revista" => array:6 [ "tituloSerie" => "Kidney Int." "fecha" => "2011" "volumen" => "80" "numero" => "10" "paginaInicial" => "1080" "paginaFinal" => "1091" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A trial of extending hemodialysis hours and quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.J. Jardine" 1 => "L. Zuo" 2 => "N.A. Gray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2015111225/-/DCSUPPLEMENTAL" "Revista" => array:7 [ "tituloSerie" => "J Am Soc Nephrol." "fecha" => "2017" "volumen" => "28" "numero" => "6" "paginaInicial" => "1898" "paginaFinal" => "1911" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28151412" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does delivering more dialysis improve clinical outcomes? What randomized controlled trials have shown" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Deira" 1 => "M. Murea" 2 => "K. Kalantar-Zadeh" 3 => "F.G. Casino" 4 => "C. Basile" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/S40620-022-01246-8" "Revista" => array:7 [ "tituloSerie" => "J Nephrol" "fecha" => "2022" "volumen" => "35" "numero" => "5" "paginaInicial" => "1315" "paginaFinal" => "1327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35041196" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multicenter feasibility randomized controlled trial to assess the impact of incremental versus conventional initiation of hemodialysis on residual kidney function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Vilar" 1 => "R.M. Kaja Kamal" 2 => "J. Fotheringham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.kint.2021.07.025" "Revista" => array:7 [ "tituloSerie" => "Kidney Int." "fecha" => "2022" "volumen" => "101" "numero" => "3" "paginaInicial" => "615" "paginaFinal" => "625" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34418414" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "IHDIP: a controlled randomized trial to assess the security and effectiveness of the incremental hemodialysis in incident patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Deira" 1 => "M.A. Suárez" 2 => "F. López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/S12882-018-1189-6/FIGURES/1" "Revista" => array:7 [ "tituloSerie" => "BMC Nephrol." "fecha" => "2019" "volumen" => "20" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30606155" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long interdialytic interval and mortality among patients receiving hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.N. Foley" 1 => "D.T. Gilbertson" 2 => "T. Murray" 3 => "A.J. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMOA1103313/SUPPL_FILE/NEJMOA1103313_DISCLOSURES.PDF" "Revista" => array:7 [ "tituloSerie" => "New Engl J Med." "fecha" => "2011" "volumen" => "365" "numero" => "12" "paginaInicial" => "1099" "paginaFinal" => "1107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21992122" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimizing haemodialysate composition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Locatelli" 1 => "V. la Milia" 2 => "L. Violo" 3 => "L. del Vecchio" 4 => "S. di Filippo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/CKJ/SFV057" "Revista" => array:7 [ "tituloSerie" => "Clin Kidney J." "fecha" => "2015" "volumen" => "8" "numero" => "5" "paginaInicial" => "580" "paginaFinal" => "589" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26413285" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Mercadal" 1 => "O. Lambert" 2 => "C. Couchoud" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/NDT/GFAA077" "Revista" => array:7 [ "tituloSerie" => "Nephrol Dial Transplant." "fecha" => "2021" "volumen" => "36" "numero" => "1" "paginaInicial" => "151" "paginaFinal" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32582941" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Executive summary of the 2017 KDIGO Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Ketteler" 1 => "G.A. Block" 2 => "P. Evenepoel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.kint.2017.04.006" "Revista" => array:7 [ "tituloSerie" => "Kidney Int." "fecha" => "2017" "volumen" => "92" "numero" => "1" "paginaInicial" => "26" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28646995" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La hipomagnesemia en hemodiálisis se asocia a mayor riesgo de mortalidad: su relación con el líquido de diálisis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Pérez-García" 1 => "M.T. Jaldo" 2 => "M. Puerta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.NEFRO.2020.04.013" "Revista" => array:7 [ "tituloSerie" => "Nefrología" "fecha" => "2020" "volumen" => "40" "numero" => "5" "paginaInicial" => "552" "paginaFinal" => "562" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32651086" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dialysate bicarbonate concentration: too much of a good thing?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Basile" 1 => "L. Rossi" 2 => "C. Lomonte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/SDI.12716" "Revista" => array:7 [ "tituloSerie" => "Semin Dial." "fecha" => "2018" "volumen" => "31" "numero" => "6" "paginaInicial" => "576" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29885083" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combining diffusion, convection and absorption: a pilot study of polymethylmethacrylate versus polysulfone membranes in the removal of P-Cresyl sulfate by postdilution on-line hemodiafiltration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Molina" 1 => "J. Peiró" 2 => "M.A. Martínez-Gómez" 3 => "B. Vizcaíno" 4 => "C. Esteller" 5 => "M. González-Moya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/kidneydial1020015" "Revista" => array:6 [ "tituloSerie" => "Kidney Dial." "fecha" => "2021" "volumen" => "1" "numero" => "2" "paginaInicial" => "121" "paginaFinal" => "134" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of dialyzer membrane materials on survival in chronic hemodialysis patients: results from the annual survey of the Japanese Nationwide Dialysis Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Abe" 1 => "T. Hamano" 2 => "A. Wada" 3 => "S. Nakai" 4 => "I. Masakane" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/JOURNAL.PONE.0184424" "Revista" => array:4 [ "tituloSerie" => "PLoS One." "fecha" => "2017" "volumen" => "12" "numero" => "9" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new generation of cellulose triacetate suitable for online haemodiafiltration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Maduell" 1 => "R. Ojeda" 2 => "M. Arias-Guillén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/J.NEFROE.2017.10.012" "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2018" "volumen" => "38" "numero" => "2" "paginaInicial" => "161" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29198593" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypersensitivity reactions to synthetic haemodialysis membranes — an emerging issue?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Alvarez-de Lara" 1 => "A. Martín-Malo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/NEFROLOGIA.PRE2014.JUL.12682" "Revista" => array:8 [ "tituloSerie" => "Nefrologia" "fecha" => "2014" "volumen" => "34" "numero" => "6" "paginaInicial" => "698" "paginaFinal" => "702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25415569" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347610004695" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MCO membranes: enhanced selectivity in high-flux class" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Boschetti-De-Fierro" 1 => "M. Voigt" 2 => "M. Storr" 3 => "B. Krause" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/srep18448" "Revista" => array:7 [ "tituloSerie" => "Sci Rep" "fecha" => "2015" "volumen" => "5" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "7" "itemHostRev" => array:3 [ "pii" => "S1807593222011917" "estado" => "S300" "issn" => "18075932" ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Expanded haemodialysis: from operational mechanism to clinical results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Ronco" 1 => "N. Marchionna" 2 => "A. Brendolan" 3 => "M. Neri" 4 => "A. Lorenzin" 5 => "A.J. Martínez Rueda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/NDT/GFY202" "Revista" => array:7 [ "tituloSerie" => "Nephrol Dial Transplant." "fecha" => "2018" "volumen" => "33" "numero" => "suppl_3" "paginaInicial" => "iii41" "paginaFinal" => "iii47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30281134" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodiafiltration with endogenous reinfusion improved microinflammation and endothelial damage compared with online-hemodiafiltration: a hypothesis generating study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Esquivias-Motta" 1 => "A. Martín-Malo" 2 => "P. Buendia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/AOR.12704" "Revista" => array:7 [ "tituloSerie" => "Artif Organs." "fecha" => "2017" "volumen" => "41" "numero" => "1" "paginaInicial" => "88" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182679" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new series of sorbent devices for multiple clinical purposes: current evidence and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Ankawi" 1 => "W. Fan" 2 => "D. Pomarè Montin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000493523" "Revista" => array:7 [ "tituloSerie" => "Blood Purif." "fecha" => "2019" "volumen" => "47" "numero" => "1-3" "paginaInicial" => "94" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30253409" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of the asssociations of p-Cresyl Sulfate (PSC) and Indoxyl Sulfate (IS) with cardiovascular events and all-cause mortality in patients with chronic renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.J. Lin" 1 => "V. Wu" 2 => "P.C. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0132589" "Revista" => array:4 [ "tituloSerie" => "PLoS One." "fecha" => "2015" "volumen" => "10" "numero" => "7" ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of bisphenol A, an ureamic toxin from exogenous sources, in haemodialysis patients" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en representación del Grupo de Análisis del Papel del Bisfenol A en pacientes en hemodiálisis" "etal" => false "autores" => array:3 [ 0 => "S. Mas" 1 => "J. Egido" 2 => "E. González-Parra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nefro.2017.01.011" "Revista" => array:7 [ "tituloSerie" => "Nefrologia" "fecha" => "2017" "volumen" => "37" "numero" => "3" "paginaInicial" => "229" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28392019" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The choice of hemodialysis membrane affects bisphenol A levels in blood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Bosch-Panadero" 1 => "S. Mas" 2 => "D. Sanchez-Ospina" 3 => "V. Camarero" 4 => "M.V. Perez-Gomez" 5 => "I. Saez-Calero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2015030312" "Revista" => array:2 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2015" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty consensus: a call to action" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.E. Morley" 1 => "B. Vellas" 2 => "G. Abellan van Kan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jamda.2013.03.022" "Revista" => array:7 [ "tituloSerie" => "J Am Med Dir Assoc" "fecha" => "2013" "volumen" => "14" "numero" => "6" "paginaInicial" => "392" "paginaFinal" => "397" "itemHostRev" => array:3 [ "pii" => "S0022347616304012" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and associated factors of frailty and mortality in patients with end-stage renal disease undergoing hemodialysis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.J. Lee" 1 => "Y.J. Son" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/IJERPH18073471" "Revista" => array:5 [ "tituloSerie" => "Int J Environ Res Public Health" "fecha" => "2021" "volumen" => "18" "numero" => "7" "paginaInicial" => "3471" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty and protein-energy wasting in elderly patients with end stage kidney disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. Kim" 1 => "K. Kalantar-Zadeh" 2 => "J.D. Kopple" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2012010047" "Revista" => array:7 [ "tituloSerie" => "J Am Soc Nephrol." "fecha" => "2013" "volumen" => "24" "numero" => "3" "paginaInicial" => "337" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23264684" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlations, agreement and utility of frailty instruments in prevalent haemodialysis patients: baseline cohort data from the FITNESS study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.M. Anderson" 1 => "M. Qasim" 2 => "G. Correa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/CKJ/SFAB13742" "Revista" => array:6 [ "tituloSerie" => "Clin Kidney J." "fecha" => "2022" "volumen" => "15" "numero" => "1" "paginaInicial" => "145" "paginaFinal" => "152" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty in older adults evidence for a phenotype" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.P. Fried" 1 => "C.M. Tangen" 2 => "J. Walston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/GERONA/56.3.M146" "Revista" => array:6 [ "tituloSerie" => "J Gerontol Series A." "fecha" => "2001" "volumen" => "56" "numero" => "3" "paginaInicial" => "M146" "paginaFinal" => "M157" ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty defined by deficit accumulation and geriatric medicine defined by frailty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Rockwood" 1 => "A. Mitnitski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cger.2010.08.008" "Revista" => array:6 [ "tituloSerie" => "Clin Geriatr Med." "fecha" => "2011" "volumen" => "27" "numero" => "1" "paginaInicial" => "17" "paginaFinal" => "26" ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A global clinical measure of fitness and frailty in elderly people" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Rockwood" 1 => "X. Song" 2 => "C. MacKnight" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/CMAJ.050051" "Revista" => array:6 [ "tituloSerie" => "CMAJ." "fecha" => "2005" "volumen" => "173" "numero" => "5" "paginaInicial" => "489" "paginaFinal" => "495" ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validity and reliability of the Edmonton Frail Scale" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.B. Rolfson" 1 => "S.R. Majumdar" 2 => "R.T. Tsuyuki" 3 => "A. Tahir" 4 => "K. Rockwood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/AGEING/AFL041" "Revista" => array:7 [ "tituloSerie" => "Age Ageing." "fecha" => "2006" "volumen" => "35" "numero" => "5" "paginaInicial" => "526" "paginaFinal" => "529" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16757522" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simple self-report FRAIL scale might be more closely associated with dialysis complications than other frailty screening instruments in rural chronic dialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.T. Chao" 1 => "Y.H. Hsu" 2 => "P.Y. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/NEP.12401" "Revista" => array:7 [ "tituloSerie" => "Nephrology" "fecha" => "2015" "volumen" => "20" "numero" => "5" "paginaInicial" => "321" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31419967" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative assessment and planning of haemodialysis vascular access" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Lomonte" 1 => "C. Basile" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ckj/sfv022" "Revista" => array:6 [ "tituloSerie" => "Clin Kidney J." "fecha" => "2015" "volumen" => "8" "paginaInicial" => "278" "paginaFinal" => "281" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26034588" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of protein-energy wasting in dialysis patients using a practical online tool to compare with other nutritional scores: results of the nutrendial study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Arias-Guillén" 1 => "S. Collado" 2 => "E. Coll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu14163375" "Revista" => array:6 [ "tituloSerie" => "Nutrients" "fecha" => "2022" "volumen" => "14" "numero" => "16" "paginaInicial" => "3375" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36014879" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004400000004/v1_202408300447/S2013251424001627/v1_202408300447/en/main.assets" "Apartado" => array:4 [ "identificador" => "38706" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000004400000004/v1_202408300447/S2013251424001627/v1_202408300447/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251424001627?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
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| 2024 October | 445 | 110 | 555 |
| 2024 September | 425 | 87 | 512 |
| 2024 August | 49 | 24 | 73 |
