array:21 [
  "pii" => "X2013251409003738"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2009;29:500-1"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4700
    "formatos" => array:3 [
      "EPUB" => 264
      "HTML" => 3960
      "PDF" => 476
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509003730"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:500-1"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6414
        "formatos" => array:3 [
          "EPUB" => 243
          "HTML" => 5660
          "PDF" => 511
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Diálisis peritoneal tras la retirada del catéter por peritonitis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "500"
            "paginaFinal" => "501"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Peritoneal dialysis after removing the catheter because of peritonitis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "434527_figura1.jpg"
                "Alto" => 384
                "Ancho" => 512
                "Tamanyo" => 10452
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Santos Nores, M. Camba Caride, J.J. Bravo López, C. Pérez Melón"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Juan"
                "apellidos" => "Santos Nores"
              ]
              1 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Camba Caride"
              ]
              2 => array:2 [
                "Iniciales" => "J.J."
                "apellidos" => "Bravo López"
              ]
              3 => array:2 [
                "Iniciales" => "C."
                "apellidos" => "Pérez Melón"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409003738"
          "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
          "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/X2013251409003738?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003730?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000005/v0_201502091404/X0211699509003730/v0_201502091405/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325140900372X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5540.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:501-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4061
      "formatos" => array:3 [
        "EPUB" => 252
        "HTML" => 3354
        "PDF" => 455
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Isolated tubulointerstitial nephritis in a patient with systemic lupus erythematosus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "501"
          "paginaFinal" => "502"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Nefritis túbulointersticial aislada en paciente con lupus eritematoso sistémico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "43518078_f1_pag502.jpg"
              "Alto" => 191
              "Ancho" => 260
              "Tamanyo" => 15646
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "María Jesús Moyano Franco, J. Amor Sánchez, R. Ortega Ruano, JR. Armas Padrón"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "María Jesús"
              "apellidos" => "Moyano Franco"
            ]
            1 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Amor Sánchez"
            ]
            2 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "Ortega Ruano"
            ]
            3 => array:2 [
              "Iniciales" => "JR."
              "apellidos" => "Armas Padrón"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003722"
        "doi" => "10.3265/Nefrologia.2009.29.5.5540.en.full"
        "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/X0211699509003722?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900372X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X201325140900372X/v0_201502091626/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409003746"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5431.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:499-500"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3896
      "formatos" => array:3 [
        "EPUB" => 250
        "HTML" => 3184
        "PDF" => 462
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Distal renal tubular acidosis with neurosensory deafness. Clinical evolution after 30 years of follow-up"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "499"
          "paginaFinal" => "500"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidosis tubular renal distal con sordera neurosensorial. Evolución clínica tras 30 años de seguimiento"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "43318078_t1_pag499.jpg"
              "Alto" => 219
              "Ancho" => 543
              "Tamanyo" => 14794
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raquel López Hidalgo, A. Polo Moyano, M. Manjón Rodríguez, S. Cerezo Morales"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "López Hidalgo"
            ]
            1 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Polo Moyano"
            ]
            2 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Manjón Rodríguez"
            ]
            3 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Cerezo Morales"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003749"
        "doi" => "10.3265/Nefrologia.2009.29.5.5431.en.full"
        "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/X0211699509003749?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003746?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003746/v0_201502091626/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Peritoneal dialysis after removing the catheter because of peritonitis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "500"
        "paginaFinal" => "501"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Juan Santos Nores, M. Camba Caride, J.J. Bravo López, C. Pérez Melón"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Juan"
            "apellidos" => "Santos Nores"
            "email" => array:1 [
              0 => "juansn_5@hotmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Camba Caride"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "J.J."
            "apellidos" => "Bravo L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "C."
            "apellidos" => "P&#233;rez Mel&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Complexo Hospitalario de Ourense, Ourense, Ourense, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Di&#225;lisis peritoneal tras la retirada del cat&#233;ter por peritonitis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f1_pag501.jpg"
            "Alto" => 193
            "Ancho" => 261
            "Tamanyo" => 8017
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Peritoneal dialysis &#40;PD&#41; after removing the catheter due to peritonitis in patients with chronic kidney disease is a treatment option that is certainly not free from subsequent complications and technique failures&#46;</p><p class="elsevierStylePara">We present two clinical cases with early malfunction of the peritoneal catheter due to multiple adhesions&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 1</span>&#58; patient 67 years of age with a history of diabetes mellitus on automatic peritoneal dialysis &#40;APD&#41; who was admitted with a case of peritonitis and exit orifice infected with Burckolderia cepacia and an abdominal ultrasound image suggesting chronic cholecystitis&#46; Given the poor clinical evolution and the persistent cloudy peritoneal fluid&#44; we decided to remove the catheter and perform cholecystectomy in the same surgical procedure&#46; Subsequently&#44; the patient underwent haemodialysis &#40;HD&#41; and received antibiotic treatment &#40;cyprofloxacine and meropenem&#41; for two weeks after removal of the catheter according to the antibiogram&#46;</p><p class="elsevierStylePara">The patient decided to have the new peritoneal dialysis catheter implanted a month and a half after its removal &#40;abdominal CAT showed no changes&#41;&#46; The procedure was performed by general surgery&#44; during which the lax adhesions that were observed were liberated&#46; One month after implantation&#44; we observed that draining was difficult&#46; A peritoneography was taken &#40;50ml iobitridol 300mg&#47;l&#41;&#44; revealing the presence of contrast limited to a small cavity &#40;figure 1&#41;&#46;</p><p class="elsevierStylePara">In light of these results&#44; we decided to transfer the patient to HD and remove the peritoneal catheter&#44; which was completely clogged by omental adhesions&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 2</span>&#58; male patient aged 78 with a personal history of ischaemichypertensive cardiopathy&#44; diverticulosis&#44; chronic kidney disease &#40;ischaemic type&#41;&#44; undergoing APD since February 2005&#46; He had suffered various peritonitis episodes&#58; Klebsiella in March 2005&#44; E&#46; coli in August 2005 and Serratia marcescens and E&#46; faecalis in September 2005&#46; The abdominal CAT images were compatible with diverticulitis&#44; and antibiotic treatment was administered&#46; In October 2006&#44; he presented a new episode of peritonitis with Pseudomona aeruginosa&#44; and for this reason&#44; it was decided to remove the peritoneal catheter&#44; transfer the patient to haemodialysis and administer further antibiotic treatment according to the antibiogram&#46;</p><p class="elsevierStylePara">In December 2006&#44; at the patient&#191;s request and due to significant vascular access difficulties&#44; we decided to implant a peritoneal dialysis catheter &#40;abdominal CAT was normal&#41;&#44; liberate lax adhesions during the procedure and verify catheter function whilst in the operating room&#46;</p><p class="elsevierStylePara">At 15 days after implantation&#44; the peritoneal catheter was malfunctioning and provoking difficulties during both infusion and drainage&#46; The peritoneography showed an image similar to that described for the previous case &#40;figure 2&#41;&#46;</p><p class="elsevierStylePara">The patient made the definitive transfer to HD once the catheter was removed&#59; multiple adhesions were observed&#46;</p><p class="elsevierStylePara">Removal of the peritoneal catheter is necessary when treating certain types of peritonitis&#44; principally those caused by funghi&#44; enterobacteria&#44; or where there is a coexisting subcutaneous tunnel infection&#46;</p><p class="elsevierStylePara">There is no reliable objective method for identifying irreversible peritoneal damage prior to reinsertion of a new catheter&#46; Ultrasound and abdominal CAT images are the most widely-used tests&#44; but they have a low sensitivity&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">After a review of 189 cases of peritonitis in which a catheter was removed and subsequently replaced&#44; Troidle et al&#46; concluded that only 20&#37; continue with that method one year after the removal&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">If the decision is made to return to PD&#44; we recommend implanting the catheter using open surgery or laparoscopic surgery that allows us to obtain more information on the abdominal cavity condition&#46;<span class="elsevierStyleSup">3</span> This reimplantation should be performed at least 3-4 weeks after remission of the infection&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">In order to make this decision&#44; we must take into account such factors as the severity of the peritonitis&#44; residual diuresis&#44; previous ultrafiltration capacity&#44; aetiological agent&#44; etc&#46; With all of the above in mind&#44; the decision must be a personalised one&#46; <br></br></p><p class="elsevierStylePara"><a href="grande&#47;43418078&#95;f1&#95;pag501&#46;jpg" class="elsevierStyleCrossRefs"><img src="43418078_f1_pag501.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;43418078&#95;f2&#95;pag501&#46;jpg" class="elsevierStyleCrossRefs"><img src="43418078_f2_pag501.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p>"
    "pdfFichero" => "P-E-S-A434-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f1_pag501.jpg"
            "Alto" => 193
            "Ancho" => 261
            "Tamanyo" => 8017
          ]
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f2_pag501.jpg"
            "Alto" => 192
            "Ancho" => 259
            "Tamanyo" => 7889
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pérez Fontán M, Rodríguez-Carmona A. Peritoneal catheter removal for severe peritonitis: lanscape after a lost battle. Peritl Dial Int 2007;27:155-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Troidle L, Gorban-Brennan N, Finkelstein FO. Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis. Adv Perit Dial Int 2005;21:98-101."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wang JY, Chen FM, Huang TJ, Hou MF, Huang CJ, Chan HM, et al. Laparoscopy assisted placement of peritoneal dialysis catheters for selected patients with previous abdominal operation. J Invest Surg 2005;18:59-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16036773" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, et al. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005;25:107-31.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15796137" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003738/v0_201502091626/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/20132514/0000002900000005/v0_201502091625/X2013251409003738/v0_201502091626/en/P-E-S-A434-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003738?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Peritoneal dialysis after removing the catheter because of peritonitis
Diálisis peritoneal tras la retirada del catéter por peritonitis
Juan Santos Noresa, M.. Camba Caridea, J.J.. Bravo Lópeza, C.. Pérez Melóna
a Servicio de Nefrología, Complexo Hospitalario de Ourense, Ourense, Ourense, España,
Read
9286
Times
was read the article
1883
Total PDF
7403
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251409003738"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:500-1"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4700
    "formatos" => array:3 [
      "EPUB" => 264
      "HTML" => 3960
      "PDF" => 476
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509003730"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:500-1"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6414
        "formatos" => array:3 [
          "EPUB" => 243
          "HTML" => 5660
          "PDF" => 511
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Di&#225;lisis peritoneal tras la retirada del cat&#233;ter por peritonitis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "500"
            "paginaFinal" => "501"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Peritoneal dialysis after removing the catheter because of peritonitis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "434527_figura1.jpg"
                "Alto" => 384
                "Ancho" => 512
                "Tamanyo" => 10452
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan Santos Nores, M. Camba Caride, J.J. Bravo L&#243;pez, C. P&#233;rez Mel&#243;n"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Juan"
                "apellidos" => "Santos Nores"
              ]
              1 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Camba Caride"
              ]
              2 => array:2 [
                "Iniciales" => "J.J."
                "apellidos" => "Bravo L&#243;pez"
              ]
              3 => array:2 [
                "Iniciales" => "C."
                "apellidos" => "P&#233;rez Mel&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409003738"
          "doi" => "10.3265/Nefrologia.2009.29.5.5433.en.full"
          "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/X2013251409003738?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509003730?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000005/v0_201502091404/X0211699509003730/v0_201502091405/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325140900372X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5540.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:501-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4061
      "formatos" => array:3 [
        "EPUB" => 252
        "HTML" => 3354
        "PDF" => 455
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Isolated tubulointerstitial nephritis in a patient with systemic lupus erythematosus"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "501"
          "paginaFinal" => "502"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Nefritis t&#250;bulointersticial aislada en paciente con lupus eritematoso sist&#233;mico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "43518078_f1_pag502.jpg"
              "Alto" => 191
              "Ancho" => 260
              "Tamanyo" => 15646
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Jes&#250;s Moyano Franco, J. Amor S&#225;nchez, R. Ortega Ruano, JR. Armas Padr&#243;n"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mar&#237;a Jes&#250;s"
              "apellidos" => "Moyano Franco"
            ]
            1 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Amor S&#225;nchez"
            ]
            2 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "Ortega Ruano"
            ]
            3 => array:2 [
              "Iniciales" => "JR."
              "apellidos" => "Armas Padr&#243;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003722"
        "doi" => "10.3265/Nefrologia.2009.29.5.5540.en.full"
        "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/X0211699509003722?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900372X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X201325140900372X/v0_201502091626/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409003746"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.5.5431.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:499-500"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3896
      "formatos" => array:3 [
        "EPUB" => 250
        "HTML" => 3184
        "PDF" => 462
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Distal renal tubular acidosis with neurosensory deafness&#46; Clinical evolution after 30 years of follow-up"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "499"
          "paginaFinal" => "500"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidosis tubular renal distal con sordera neurosensorial&#46; Evoluci&#243;n cl&#237;nica tras 30 a&#241;os de seguimiento"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "43318078_t1_pag499.jpg"
              "Alto" => 219
              "Ancho" => 543
              "Tamanyo" => 14794
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Raquel L&#243;pez Hidalgo, A. Polo Moyano, M. Manj&#243;n Rodr&#237;guez, S. Cerezo Morales"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "L&#243;pez Hidalgo"
            ]
            1 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Polo Moyano"
            ]
            2 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Manj&#243;n Rodr&#237;guez"
            ]
            3 => array:2 [
              "Iniciales" => "S."
              "apellidos" => "Cerezo Morales"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509003749"
        "doi" => "10.3265/Nefrologia.2009.29.5.5431.en.full"
        "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/X0211699509003749?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003746?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003746/v0_201502091626/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Peritoneal dialysis after removing the catheter because of peritonitis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "500"
        "paginaFinal" => "501"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Juan Santos Nores, M. Camba Caride, J.J. Bravo L&#243;pez, C. P&#233;rez Mel&#243;n"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Juan"
            "apellidos" => "Santos Nores"
            "email" => array:1 [
              0 => "juansn&#95;5&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Camba Caride"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "J.J."
            "apellidos" => "Bravo L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "C."
            "apellidos" => "P&#233;rez Mel&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Complexo Hospitalario de Ourense, Ourense, Ourense, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Di&#225;lisis peritoneal tras la retirada del cat&#233;ter por peritonitis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f1_pag501.jpg"
            "Alto" => 193
            "Ancho" => 261
            "Tamanyo" => 8017
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">Peritoneal dialysis &#40;PD&#41; after removing the catheter due to peritonitis in patients with chronic kidney disease is a treatment option that is certainly not free from subsequent complications and technique failures&#46;</p><p class="elsevierStylePara">We present two clinical cases with early malfunction of the peritoneal catheter due to multiple adhesions&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 1</span>&#58; patient 67 years of age with a history of diabetes mellitus on automatic peritoneal dialysis &#40;APD&#41; who was admitted with a case of peritonitis and exit orifice infected with Burckolderia cepacia and an abdominal ultrasound image suggesting chronic cholecystitis&#46; Given the poor clinical evolution and the persistent cloudy peritoneal fluid&#44; we decided to remove the catheter and perform cholecystectomy in the same surgical procedure&#46; Subsequently&#44; the patient underwent haemodialysis &#40;HD&#41; and received antibiotic treatment &#40;cyprofloxacine and meropenem&#41; for two weeks after removal of the catheter according to the antibiogram&#46;</p><p class="elsevierStylePara">The patient decided to have the new peritoneal dialysis catheter implanted a month and a half after its removal &#40;abdominal CAT showed no changes&#41;&#46; The procedure was performed by general surgery&#44; during which the lax adhesions that were observed were liberated&#46; One month after implantation&#44; we observed that draining was difficult&#46; A peritoneography was taken &#40;50ml iobitridol 300mg&#47;l&#41;&#44; revealing the presence of contrast limited to a small cavity &#40;figure 1&#41;&#46;</p><p class="elsevierStylePara">In light of these results&#44; we decided to transfer the patient to HD and remove the peritoneal catheter&#44; which was completely clogged by omental adhesions&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Case 2</span>&#58; male patient aged 78 with a personal history of ischaemichypertensive cardiopathy&#44; diverticulosis&#44; chronic kidney disease &#40;ischaemic type&#41;&#44; undergoing APD since February 2005&#46; He had suffered various peritonitis episodes&#58; Klebsiella in March 2005&#44; E&#46; coli in August 2005 and Serratia marcescens and E&#46; faecalis in September 2005&#46; The abdominal CAT images were compatible with diverticulitis&#44; and antibiotic treatment was administered&#46; In October 2006&#44; he presented a new episode of peritonitis with Pseudomona aeruginosa&#44; and for this reason&#44; it was decided to remove the peritoneal catheter&#44; transfer the patient to haemodialysis and administer further antibiotic treatment according to the antibiogram&#46;</p><p class="elsevierStylePara">In December 2006&#44; at the patient&#191;s request and due to significant vascular access difficulties&#44; we decided to implant a peritoneal dialysis catheter &#40;abdominal CAT was normal&#41;&#44; liberate lax adhesions during the procedure and verify catheter function whilst in the operating room&#46;</p><p class="elsevierStylePara">At 15 days after implantation&#44; the peritoneal catheter was malfunctioning and provoking difficulties during both infusion and drainage&#46; The peritoneography showed an image similar to that described for the previous case &#40;figure 2&#41;&#46;</p><p class="elsevierStylePara">The patient made the definitive transfer to HD once the catheter was removed&#59; multiple adhesions were observed&#46;</p><p class="elsevierStylePara">Removal of the peritoneal catheter is necessary when treating certain types of peritonitis&#44; principally those caused by funghi&#44; enterobacteria&#44; or where there is a coexisting subcutaneous tunnel infection&#46;</p><p class="elsevierStylePara">There is no reliable objective method for identifying irreversible peritoneal damage prior to reinsertion of a new catheter&#46; Ultrasound and abdominal CAT images are the most widely-used tests&#44; but they have a low sensitivity&#46;<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">After a review of 189 cases of peritonitis in which a catheter was removed and subsequently replaced&#44; Troidle et al&#46; concluded that only 20&#37; continue with that method one year after the removal&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">If the decision is made to return to PD&#44; we recommend implanting the catheter using open surgery or laparoscopic surgery that allows us to obtain more information on the abdominal cavity condition&#46;<span class="elsevierStyleSup">3</span> This reimplantation should be performed at least 3-4 weeks after remission of the infection&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">In order to make this decision&#44; we must take into account such factors as the severity of the peritonitis&#44; residual diuresis&#44; previous ultrafiltration capacity&#44; aetiological agent&#44; etc&#46; With all of the above in mind&#44; the decision must be a personalised one&#46; <br></br></p><p class="elsevierStylePara"><a href="grande&#47;43418078&#95;f1&#95;pag501&#46;jpg" class="elsevierStyleCrossRefs"><img src="43418078_f1_pag501.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;43418078&#95;f2&#95;pag501&#46;jpg" class="elsevierStyleCrossRefs"><img src="43418078_f2_pag501.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p>"
    "pdfFichero" => "P-E-S-A434-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f1_pag501.jpg"
            "Alto" => 193
            "Ancho" => 261
            "Tamanyo" => 8017
          ]
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "43418078_f2_pag501.jpg"
            "Alto" => 192
            "Ancho" => 259
            "Tamanyo" => 7889
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pérez Fontán M, Rodríguez-Carmona A. Peritoneal catheter removal for severe peritonitis: lanscape after a lost battle. Peritl Dial Int 2007;27:155-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Troidle L, Gorban-Brennan N, Finkelstein FO. Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis. Adv Perit Dial Int 2005;21:98-101."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wang JY, Chen FM, Huang TJ, Hou MF, Huang CJ, Chan HM, et al. Laparoscopy assisted placement of peritoneal dialysis catheters for selected patients with previous abdominal operation. J Invest Surg 2005;18:59-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16036773" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, et al. Peritoneal dialysis-related infections recommendations: 2005 update. Perit Dial Int 2005;25:107-31.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15796137" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000005/v0_201502091625/X2013251409003738/v0_201502091626/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/20132514/0000002900000005/v0_201502091625/X2013251409003738/v0_201502091626/en/P-E-S-A434-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409003738?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 8 1 9
2024 October 76 34 110
2024 September 97 24 121
2024 August 121 70 191
2024 July 68 34 102
2024 June 96 39 135
2024 May 85 29 114
2024 April 70 24 94
2024 March 103 22 125
2024 February 91 29 120
2024 January 87 30 117
2023 December 91 24 115
2023 November 84 31 115
2023 October 87 37 124
2023 September 70 27 97
2023 August 49 23 72
2023 July 79 22 101
2023 June 57 15 72
2023 May 69 32 101
2023 April 83 21 104
2023 March 56 25 81
2023 February 75 21 96
2023 January 67 13 80
2022 December 60 27 87
2022 November 71 26 97
2022 October 64 26 90
2022 September 68 23 91
2022 August 81 41 122
2022 July 62 32 94
2022 June 75 21 96
2022 May 46 36 82
2022 April 49 37 86
2022 March 85 46 131
2022 February 53 27 80
2022 January 42 33 75
2021 December 45 46 91
2021 November 49 35 84
2021 October 58 37 95
2021 September 37 31 68
2021 August 45 29 74
2021 July 32 31 63
2021 June 25 23 48
2021 May 28 15 43
2021 April 56 18 74
2021 March 37 18 55
2021 February 52 17 69
2021 January 47 11 58
2020 December 51 7 58
2020 November 37 19 56
2020 October 28 8 36
2020 September 29 6 35
2020 August 41 7 48
2020 July 41 5 46
2020 June 34 5 39
2020 May 46 10 56
2020 April 44 10 54
2020 March 37 9 46
2020 February 46 16 62
2020 January 82 17 99
2019 December 118 26 144
2019 November 106 16 122
2019 October 77 9 86
2019 September 136 12 148
2019 August 61 9 70
2019 July 78 23 101
2019 June 92 12 104
2019 May 81 7 88
2019 April 112 21 133
2019 March 74 27 101
2019 February 27 16 43
2019 January 45 10 55
2018 December 62 20 82
2018 November 74 14 88
2018 October 71 12 83
2018 September 65 9 74
2018 August 43 13 56
2018 July 55 11 66
2018 June 56 9 65
2018 May 50 11 61
2018 April 45 9 54
2018 March 63 8 71
2018 February 44 5 49
2018 January 52 10 62
2017 December 49 8 57
2017 November 47 5 52
2017 October 29 5 34
2017 September 41 12 53
2017 August 31 4 35
2017 July 22 7 29
2017 June 24 3 27
2017 May 41 13 54
2017 April 28 13 41
2017 March 30 4 34
2017 February 28 15 43
2017 January 38 12 50
2016 December 51 3 54
2016 November 78 9 87
2016 October 104 5 109
2016 September 118 1 119
2016 August 137 8 145
2016 July 113 5 118
2016 June 163 0 163
2016 May 126 0 126
2016 April 98 0 98
2016 March 82 0 82
2016 February 71 0 71
2016 January 107 0 107
2015 December 102 0 102
2015 November 73 0 73
2015 October 62 0 62
2015 September 55 0 55
2015 August 64 0 64
2015 July 65 0 65
2015 June 30 0 30
2015 May 52 0 52
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?