array:21 [
  "pii" => "X2013251409004638"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.3.5152.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-06-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2009;29:208-13"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5011
    "formatos" => array:3 [
      "EPUB" => 255
      "HTML" => 4138
      "PDF" => 618
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509004630"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.3.5152.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-06-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:208-13"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 22822
        "formatos" => array:3 [
          "EPUB" => 230
          "HTML" => 21677
          "PDF" => 915
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "titulo" => "Deterioro de Función Renal Inducido por Fibratos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "208"
            "paginaFinal" => "213"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Fibrate-induced deterioration of renal function"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Natalia Polanco, E. Hernández, E. González, E. Gutiérrez Martínez, I. Bello, V. Gutiérrez-Millet, F. García, E. Morales, M. Praga"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "Natalia"
                "apellidos" => "Polanco"
              ]
              1 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Hernández"
              ]
              2 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "González"
              ]
              3 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Gutiérrez Martínez"
              ]
              4 => array:2 [
                "Iniciales" => "I."
                "apellidos" => "Bello"
              ]
              5 => array:2 [
                "Iniciales" => "V."
                "apellidos" => "Gutiérrez-Millet"
              ]
              6 => array:2 [
                "Iniciales" => "F."
                "apellidos" => "García"
              ]
              7 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Morales"
              ]
              8 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Praga"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409004638"
          "doi" => "10.3265/Nefrologia.2009.29.3.5152.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/X2013251409004638?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004630?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000003/v0_201502091409/X0211699509004630/v0_201502091409/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325140900462X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.3.5103.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-06-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:214-21"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4405
      "formatos" => array:3 [
        "EPUB" => 237
        "HTML" => 3564
        "PDF" => 604
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Prevalence and functional effect of arteriovenous fistula calcifications, evaluated by spiral CT in chronic haemodialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "214"
          "paginaFinal" => "221"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia y efecto funcional de las calcificaciones de la fistula arteriovenosa evaluadas mediante TAC helicoidal en pacientes en hemodiálisis crónica."
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "17318078_t1_p216.jpg"
              "Alto" => 368
              "Ancho" => 400
              "Tamanyo" => 30749
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics of patients examined under a spiral CT (n = 45)"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ramon Roca-Tey, Rafael Páez, Amelia Rivas, Rosa Samon, Omar Ibrik, Isabel Giménez, Jordi Viladoms"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Ramon"
              "apellidos" => "Roca-Tey"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Páez"
            ]
            2 => array:2 [
              "nombre" => "Amelia"
              "apellidos" => "Rivas"
            ]
            3 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Samon"
            ]
            4 => array:2 [
              "nombre" => "Omar"
              "apellidos" => "Ibrik"
            ]
            5 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Giménez"
            ]
            6 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Viladoms"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509004622"
        "doi" => "10.3265/Nefrologia.2009.29.3.5103.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/X0211699509004622?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900462X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000003/v0_201502091629/X201325140900462X/v0_201502091629/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409004564"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.3.5078.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-06-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:203-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3748
      "formatos" => array:3 [
        "EPUB" => 224
        "HTML" => 3009
        "PDF" => 515
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Cardio-metabolic properties of manidipine: beyond lowering arterial pressure?"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "203"
          "paginaFinal" => "207"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Propiedades cardiometabólicas del Manidipino: ¿Más allá de la reducción de la presión arterial?"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "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" => "17118078_f1_p205.jpg"
              "Alto" => 434
              "Ancho" => 824
              "Tamanyo" => 24773
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nisa Buset Ríos, Francisco Rodríguez Esparragón, José Carlos Rodríguez Pérez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Nisa"
              "apellidos" => "Buset Ríos"
            ]
            1 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Rodríguez Esparragón"
            ]
            2 => array:2 [
              "nombre" => "José Carlos"
              "apellidos" => "Rodríguez Pérez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509004567"
        "doi" => "10.3265/Nefrologia.2009.29.3.5078.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/X0211699509004567?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004564?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004564/v0_201502091629/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Fibrate-induced deterioration of renal function"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "208"
        "paginaFinal" => "213"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Natalia Polanco, E. Hernández, E. González, E. Gutiérrez Martínez, I. Bello, V. Gutiérrez-Millet, F. García, E. Morales, M. Praga"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "Natalia"
            "apellidos" => "Polanco"
            "email" => array:1 [
              0 => "nipolanco@yahoo.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Guti&#233;rrez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Bello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "V."
            "apellidos" => "Guti&#233;rrez-Millet"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          6 => array:3 [
            "Iniciales" => "F."
            "apellidos" => "Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          7 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Morales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          8 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Praga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Deterioro de Funci&#243;n Renal Inducido por Fibratos"
      ]
    ]
    "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" => "17218078_f1_p209.jpg"
            "Alto" => 252
            "Ancho" => 397
            "Tamanyo" => 21230
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Dyslipidaemia commonly affects both the general population and patients with CRF&#46;<span class="elsevierStyleSup">1</span> Several strategies and hypolipaemiant agents have been employed in the treatment of this condition&#44; including fibric acid derivatives&#46; Fibric acid derivatives are especially recommended for those patients with hypertriglyceridaemia and low HDL cholesterol levels&#44; regardless of the presence of CRF&#46;<span class="elsevierStyleSup">2&#44;3</span> The most common side effects associated with fibrates are gastrointestinal and muscular complaints&#46;<span class="elsevierStyleSup">4</span> However&#44; different studies have indicated an increase in serum creatinine following the use the of these agents&#44; which calls into question the use of fibrates in patients with altered renal function&#46;<span class="elsevierStyleSup">5-10</span> The mechanism that causes this reaction is still unknown&#46; Different hypotheses and arguments have been put forward&#44; however none have been fully proven&#46;</p><p class="elsevierStylePara">The first patient with increased serum creatinine levels caused by fibrate was diagnosed in our department over two years ago&#46; Since then&#44; another twelve cases have been identified&#46; The aim of this study is to analyse these cases and review the literature on the physiopathology of this phenomenon&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara">From March 2006 to May 2008 thirteen patients were identified in the Department of Nephrology as having high serum creatinine levels after initiating treatment with the three fibrates that are commercially available in Spain &#40;fenofibrate&#44; bezafibrate and gemfibrozil&#41;&#46; The diagnosis of increased serum creatinine associated with fibrate treatment was made in patients that met the following criteria&#58; 1&#41; an increase in creatinine of at least 20&#37; compared to baseline levels&#59; 2&#41; temporal relationship between the increase in creatinine and fibrate treatment&#59; 3&#41; no other concomitant nephrotoxic medications were being used&#59; 4&#41; all other causes of deterioration of renal function had been reasonably ruled out&#59; and 5&#41; serum creatinine levels improved once the medication was suspended&#46; The patients that met these criteria are the subject of this retrospective review&#46;</p><p class="elsevierStylePara">Clinical data was collected from all the patients&#44; including age&#44; sex&#44; medical history&#44; the presence of CRF &#40;defined as SCr &#62; 1&#46;2mg&#47;dl and&#47;or MDRD values &#60; 60ml&#47;min&#41; and its cause&#46; The type of fibrate and the use of concomitant medications if applicable were also included&#59; the use of potentially nephrotoxic agents was of particular interest&#46; The analytical data collected included SCr&#44; estimated glomerular filtration rate using MDRD&#44; proteinuria&#44; triglycerides&#44; cholesterol and CPK whenever possible &#40;76&#46;9&#37; of patients&#41;&#46; The variables of all the cases were analysed and afterwards patients were divided into two comparative groups&#46; Group 1&#58; patients that fully recovered baseline creatinine levels &#40;cases 1-9&#41;&#59; group 2&#58; patients with partial recovery of renal function &#40;cases 10-13&#41;&#46;</p><p class="elsevierStylePara">The numerical values are expressed as the mean &#177; standard deviation and the comparisons were carried out using nonparametric tests for paired and unpaired samples&#46; A p &#60; 0&#46;05 value was considered significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">The mean age of the thirteen patients &#40;eight men and five women&#41; was 65&#46;5 &#177; 12&#46;2 years&#46; The presence of CRF before initiating fibrate treatment was detected in seven patients &#40;53&#46;8&#37;&#41;&#46; None of our patients had undergone a kidney transplant&#46; Their clinical characteristics&#44; including the causes of CRF can be found in table 1&#46;</p><p class="elsevierStylePara">The fibrates given to our patients included fenofibrate &#40;eleven patients&#41;&#44; gemfibrozil &#40;two patients&#44; one of which was previously treated with fenofibrate&#41; and bezafibrate &#40;one patient&#41;&#46; With regard to concomitant treatments&#44; nine of our patients were being treated with renin-angiotensin system blocking agents &#40;ACEIs and&#47;or ARBs&#41;&#44; however all patients were receiving these treatments regularly before experiencing deterioration of renal function&#44; except one patient who started treatment afterwards&#46; This medication was not suspended in any of the cases&#46; Only two patients received combined treatment with statins and high levels of CPK were not observed in either of them&#46;</p><p class="elsevierStylePara">Before fibrate treatment SCr was 1&#46;33 &#177; 0&#46;36mg&#47;dl&#44; and MDRD was 63&#46;2 &#177; 26&#46;6ml&#47;min&#44; compared with the maximum creatinine level during treatment which was 2&#46;22 &#177; 0&#46;49mg&#47;dl&#44; and MDRD which fell to 33&#46;4 &#177; 8&#46;1ml&#47;min &#40;p &#60;0&#46;05&#41;&#46; After suspending fibrate treatment SCr fell to 1&#46;45 &#177; 0&#46;38mg&#47;dl&#44; and MDRD increased to 58&#46;8 &#177; 16&#46;6ml&#47;min &#40;p &#60;0&#46;05 in comparison with the maximum SCr value and little difference was observed when compared with baseline SCr levels&#41; &#40;figure 1&#41;&#46; The average percentage increase of serum creatinine was 74&#46;6 &#177; 55&#46;8&#37;&#46; None of the patients required renal replacement treatment&#46; One of the patients presented two episodes of increased SCr during the two periods throughout the follow up and fibrates were recommended as shown in figure 2&#46;</p><p class="elsevierStylePara">The mean time elapsed until an increase in creatinine observed was 6&#46;7 &#177; 5&#46;8 months after initiating treatment&#44; while patients experienced a recovery of renal function after 3&#46;8 &#177; 3&#46;5 months following the suspension of fibrate treatment&#46;</p><p class="elsevierStylePara">Four patients &#40;30&#46;8&#37;&#41; did not fully recover renal function &#40;group 2&#58; cases 10-13&#41; and two of them did not present CRF before initiating fibrate treatment&#46; The SCr percentage increase of these four patients was 104&#46;4 &#177; 87&#46;9&#37; compared with an increase of 60&#46;6 &#177; 35&#46;8&#37; in patients who did fully recover renal function &#40;group 1&#58; cases 1-9&#41;&#46; Patients underwent fibrate treatment for 19&#46;8 &#177; 15&#46;5 months&#46; In the comparison of both groups&#44; the patients in group one received treatment for an average of 18&#46;4 &#177; 19&#46;8 months compared with the patients in group 2 who received treatment over a period of 22&#46;3 &#177; 3&#46;1 months &#40;table 2&#41;&#46;</p><p class="elsevierStylePara">With regard to proteinuria&#44; there were no differences in the values before and during the fibrate treatment period&#46; Mean proteinuria before starting treatment was 0&#46;89 &#177; 1&#46;4g&#47;day&#44; and during fibrate treatment was 0&#46;84 &#177; 1&#46;1g&#47;day&#46; In those cases where it was possible to obtain CPK levels&#44; these were normal&#46;</p><p class="elsevierStylePara">A kidney biopsy was carried out on two patients and no alterations that could justify an increase in SCr were identified in either of the cases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">This study highlights our experience regarding fibrateinduced deterioration of renal function&#46; Our sample is the second largest of all the studies that have been published up until now&#46; It is also worth highlighting that all thirteen patients were diagnosed within a period of only 26 months&#44; which indirectly implies a high incidence of this phenomenon and further emphasises its importance&#46;</p><p class="elsevierStylePara">Although the increase in creatinine levels experienced by our patients was mainly associated with fenofibrate&#44; it was also observed in patients treated with bezafibrate and gemfibrozil&#46; These findings do not support the theory put forward by Broeders et al&#46;&#44; that states that gemfibrozil is the only fibrate that does not alter renal function&#46;<span class="elsevierStyleSup">6</span> Despite this&#44; the creatinine percentage increase was higher in the group of patients treated with fenofibrate compared with the gemfibrozil group &#40;82&#46;1 &#177; 65&#46;2&#37; <span class="elsevierStyleItalic">versus</span> 38&#46;7 &#177; 4&#46;1&#37;&#41;&#44; although the difference was not significant&#46; Moreover&#44; of the two patients from the gemfibrozil group&#44; one patient had already been treated with fenofibrate&#46; Both these findings could indicate the less deleterious effect of gemfibrozil&#46; The hypothesis that has been put forward to explain this highlights the reduced stimulating effect of gemfibrozil on peroxisome proliferator activated receptors &#40;PPAR-&#945;&#41;&#44; which are responsible for inhibiting the synthesis of vasodilating prostaglandins&#46;<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">Our patients recorded a mean increase in SCr levels of 74&#46;6 &#177; 55&#46;8&#37; and a reduction in MDRD following fibrate treatment&#46; These results can be added to those already described by other authors&#44; although the percentage increase is higher in our group of patients in comparison with the papers reviewed&#44; which could be linked to the increased duration of fibrate treatment&#46;<span class="elsevierStyleSup">5-10</span> Urea or cystatin C levels were not recorded in this series&#44; however when other authors have recorded these values an increase in both has been observed in correlation with SCr&#46;<span class="elsevierStyleSup">6&#44;7&#44;9&#44;10</span> These results suggest that there is a reduction in glomerular filtration as a result of fibrate treatment&#46; However&#44; in the studies carried out by Hottelart et al&#46; and Ansquer et al&#46;<span class="elsevierStyleSup">10&#44;12</span> which analysed renal plasma flow and glomerular filtration using paraaminohippurate &#40;PAH&#41; and insulin clearance in patients receiving fibrate treatment&#44; no significant changes were observed&#46; A possible explanation for this could be the short duration of treatment in both studies &#40;two and six weeks&#41;&#46;</p><p class="elsevierStylePara">Like other studies&#44; our series involved patients with normal renal function prior to treatment as well as patients with different grades of CRF&#46;6&#44;7 No studies have been carried out involving the general population or patients with CRF prior to treatment in order to establish the incidence of this phenomenon&#46; A 60&#37; increase in SCr has been obtained from more vulnerable study groups like those that include kidney transplant patients treated with fibrates&#46;<span class="elsevierStyleSup">6</span> This is a highly significant finding given that irreversible increases in SCr have been identified specifically in kidney transplant patients after medication is suspended&#46; In our experience&#44; 30&#46;8&#37; of patients did not fully recover their previous renal function&#46; None of our patients had undergone a kidney transplant and 50&#37; of those who did not fully recover their creatinine values had normal renal function&#46; Two factors that could have contributed to causing this irreversible damage are the percentage increase of SCr &#40;104&#46;4 &#177; 87&#46;9&#37; in cases 10-13 compared with 60&#46;6 &#177; 35&#46;8&#37; in patients that fully recovered renal function&#41; and the duration of fibrate treatment&#44; which was also longer in the group of patients who only experienced a partial recovery of their renal function &#40;22&#46;3 &#177; 3&#46;1 months&#41; compared with those whose creatinine increase was completely reversible &#40;18&#46;4 &#177; 19&#46;8 months&#41;&#44; although the differences were not statistically significant&#46; These findings have not been reported in any other series that have already been published&#44; however when the patient data from the Broeders et al&#46; study was analysed a similar trend was identified&#46; This suggests that patients with a greater increase in SCr are less likely to fully recover renal function&#46;</p><p class="elsevierStylePara">The mechanism implicated in this apparent deterioration of renal function following fibrate treatment has not yet been clearly defined&#46; There are many theories that attempt to explain it&#59; however none have been fully proven&#46;</p><p class="elsevierStylePara">The most widely accepted hypothesis is based on the haemodynamic changes that fibrates may cause&#46; Fibric acid derivatives are known for stimulating PPAR-&#945; which can lead to reduced renal plasma flow&#46;<span class="elsevierStyleSup">12-14</span> This supports the theory that increased creatinine is triggered by haemodynamic factors&#46; However&#44; when the renal plasma flow has been studied using PAH clearance&#44;<span class="elsevierStyleSup">10&#44;11</span> no statistically significant changes have been observed that support this theory&#46; In the study by Ansquer et al&#46; which analyses the effect of fibrate treatment over a period of six weeks in patients with normal renal function prior to treatment&#44; a reduction in PAH clearance is observed in the group that received treatment although it is not significant &#40;p &#61; 0&#46;05&#41;&#46;15 However&#44; this result could indicate a real reduction in the renal plasma flow that does not reach statistical significance because of the limited number of patients and the short period of time analysed&#46;</p><p class="elsevierStylePara">Another hypothesis put forward by Hottelart et al&#46;&#44; is the increase in serum creatinine as a result of an increase in endogenous creatinine production&#46;<span class="elsevierStyleSup">10</span> Several papers have been published that describe increases in SCr without altered creatinine clearance&#46;<span class="elsevierStyleSup">10&#44;11&#44;16&#44;17</span> On the basis of this&#44; the authors conclude that there should be an increase in endogenous creatinine production&#44; presumably from muscle&#44; given that muscular toxicity is associated with this group of drugs&#46; However&#44; this theory does not explain the increase in urea or cystatin C which has been identified in several studies&#46;</p><p class="elsevierStylePara">Following on from this point&#44; rhabdomyolisis could be considered a cause of increased creatinine&#46; Many studies have been published describing episodes of rhabdomyolisis following treatment&#44; either with fibrate treatment alone or combined with statins&#46;<span class="elsevierStyleSup">18-20</span> CPK levels were analysed and were always within the normal range for most patients in this study &#40;76&#46;9&#37;&#41;&#46; In those cases in this study which involved a kidney biopsy&#44; myoglobin in the renal tubules was not detected&#46;</p><p class="elsevierStylePara">There is a fourth hypothesis which is defended in the study by &#161;ngeles et al&#46; which analyses the histopathological results from the biopsies of three transplant patients who experienced a reversible increase in creatinine levels following treatment with fenofibrate&#46;<span class="elsevierStyleSup">9</span> The kidney biopsies showed toxic tubular damage in the form of cytoplasmic degeneration affecting the proximal tubule cells and the presence of prominent hyaline granules&#46; These findings do not coincide with those obtained from the biopsies of the two patients in our series which did not show any pathological lesions&#46;</p><p class="elsevierStylePara">Finally&#44; in the case of transplant patients undergoing treatment with calcineurin inhibitors&#44; several authors have highlighted the deleterious effects of combining this group of immunosuppressants with fibrates&#46; Different studies have identified an increase in cyclosporin levels which could contribute to nephrotoxicity&#46;<span class="elsevierStyleSup">21</span> The possible role of fibrates in enhancing the nephrotoxicity of calcineurin inhibitors without altering serum levels has also been suggested&#46; Regardless of the mechanism&#44; this could explain the high incidence of increased creatinine levels as a result of fibrate treatment identified in transplant patients&#46;</p><p class="elsevierStylePara">We believe&#44; on the basis of our own experience&#44; that a fibrate-induced increase in SCr may be the result of haemodynamic factors&#46; Deterioration of renal function is potentially reversible&#44; however if the duration of fibrate treatment is too long this could result in permanent kidney damage&#46;</p><p class="elsevierStylePara">To conclude&#44; fibrate treatment may induce an increase in SCr and the deterioration of renal function&#46; This is particularly relevant when dealing with patients with CRF since&#44; if during the follow up they experience deterioration of renal function&#44; the possibility of increased creatinine associated with fibrate treatment should be weighed up against the possibility of disease progression&#46; The physiopathology of this phenomenon is not yet known&#44; however it is becoming increasingly relevant given that in over 30&#37; of the cases in our series&#44; the increase in creatinine levels was not completely reversible&#46; The renal function of all patients who undergo fibrate treatment should be monitored and patients with a significant degree of renal failure prior to treatment require special attention&#46; If an increase SCr levels is detected&#44; treatment should be suspended&#46;</p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;f1&#95;p209&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_f1_p209.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;t1&#95;p210&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_t1_p210.jpg" alt="Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function</p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;f2&#95;p211&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_f2_p211.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;t2&#95;p211&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_t2_p211.jpg" alt="Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function"></img></a></p><p class="elsevierStylePara">Table 2&#46; Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function</p>"
    "pdfFichero" => "P-E-S-A172-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440029"
          "palabras" => array:1 [
            0 => "Fracaso renal agudo"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440031"
          "palabras" => array:1 [
            0 => "Fibratos"
          ]
        ]
      ]
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440030"
          "palabras" => array:1 [
            0 => "Acute renal failure"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440032"
          "palabras" => array:1 [
            0 => "Fibrates"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Los fibratos representan uno de los grupos de f&#225;rmacos indicados para el tratamiento de la hiperlipidemia&#46; Uno de sus efectos secundarios&#44; a&#250;n poco conocido&#44; es el deterioro agudo de la funci&#243;n renal&#46; En los &#250;ltimos 26 meses hemos objetivado en nuestra consulta externa de Nefrolog&#237;a un total de 13 pacientes con deterioro de la funci&#243;n renal asociado al uso de fibratos&#46; Material y m&#233;todos&#58; El objetivo de nuestro estudio es evaluar nuestra experiencia en el incremento de Creatinina s&#233;rica &#40;Crs&#41; inducido por fibratos&#46; Se trata de una revisi&#243;n retrospectiva de una serie de casos&#46; Resultados&#58; De los 13 pacientes &#40;8 hombres&#47;5 mujeres&#41; con edad media de 65&#44;5 &#177; 12&#44;2 a&#241;os&#44; diez fueron tratados con fenofibrato&#44; uno con bezafibrato y dos con gemfibrozilo&#46; Seis pacientes part&#237;an de una funci&#243;n renal normal y los otros siete presentaban una Insuficiencia Renal Cr&#243;nica &#40;IRC&#41; leve-moderada previamente al inicio del tratamiento&#46; El incremento de creatinina con respecto a la basal expresado en porcentaje fue superior al 74&#37;&#46; En nueve de los pacientes el deterioro de funci&#243;n renal fue completamente reversible &#40;grupo 1&#41;&#44; mientras que en cuatro de ellos la recuperaci&#243;n fue parcial &#40;grupo 2&#41;&#46; La media de creatinina antes de recibir tratamiento con fibratos fue de 1&#44;33 &#177; 0&#44;36 mg&#47;dl &#40;aclaramiento de creatinina 63&#44;2 &#177; 26&#44;6 ml&#47;min&#41; y la media de la creatinina m&#225;xima durante el tratamiento fue de 2&#44;22 &#177; 0&#44;49 mg&#47;dl &#40;aclaramiento de creatinina 33&#44;4 &#177; 8&#44;1 ml&#47;min&#41;&#46; El tiempo medio de evoluci&#243;n hasta objetivarse el incremento de creatinina fue de 6&#44;7 &#177; 5&#44;8 meses y la recuperaci&#243;n de la funci&#243;n renal ocurri&#243; a los 3&#44;8 &#177; 3&#44;5 meses de la suspensi&#243;n del tratamiento con fibratos&#46; En los pacientes del grupo 2 se objetiv&#243; un mayor incremento de Crs y un tiempo de tratamiento con fibratos m&#225;s prolongado&#46; En los pacientes en los que se obtuvieron niveles de CPK&#44; &#233;stos fueron normales&#46; En dos de nuestros pacientes se realizaron biopsias renales sin objetivarse alteraciones significativas&#46; Conclusiones&#58; El tratamiento con fibratos puede inducir un deterioro de funci&#243;n renal&#46; En el 30&#37; de los casos de nuestra serie&#44; el aumento de creatinina s&#243;lo fue parcialmente reversible tras la suspensi&#243;n del fibrato&#46; En todos los pacientes que se inicie tratamiento con fibratos se debe monitorizar la funci&#243;n renal con especial atenci&#243;n en aquellos pacientes con cierto grado de insuficiencia renal previa&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Fibrates represent one of the medications used to treat patients with hyperlipemia&#46; Deterioration in renal function is not a very known adverse effect of fibric acid derivates&#46; In the last 26 months we have detected thirteen patients with acute renal failure associated to fibrates in our outpatients&#8217; clinic&#46; Subjects and methods&#58; The aim of our study is to analyze our experience in deterioration in renal function associated to fibrates use&#46; This is a retrospective charts review&#46; Results&#58; From the thirteen patients &#40;8 males&#47;5 females&#41; with mean age of 65&#46;5 &#177; 12&#46;2 years&#44; ten received Fenofibrate &#40;FN&#41;&#44; one Bezafibrate &#40;BZ&#41; and two Gemfibrozil &#40;GF&#41;&#46; Six cases had previously normal renal function and the seven remaining had mild chronic renal failure &#40;CRF&#41;&#46; The increase of serum Creatinine &#40;Crs&#41; value was higher than 74&#37;&#46; Acute renal failure was reversible in 9 patients &#40;group 1&#41;&#44; but the other 4 did not recover their previous renal function &#40;group 2&#41;&#46; The average of Crs before fibrate treatment was 1&#46;33 &#177; 0&#46;36 mg&#47;dl &#40;Creatinine clearance 63&#46;2 &#177; 26&#46;6 ml&#47;min&#41; and the highest average of Crs during the treatment was 2&#46;22 &#177; 0&#46;49 mg&#47;d &#40;Creatinine clearance 37&#46;3 &#177; 11&#46;9 ml&#47;min&#41;&#46; The average time until acute renal failure diagnosis was 6&#46;7 &#177; 5&#46;8 months and the recovery of renal function was delayed an average of 3&#46;8 &#177; 3&#46;5 months after fibrates withdrawn&#46; Group 2 patients had a higuer Crs and longer time with fibrates than group 1 patients&#46; CPK values were normal in all cases&#46; In two patients renal biopsy was performed and no significant lesions were detected&#46; Conclusion&#58; The fibrate treatment can induce an acute renal failure&#46; Four patients &#40;30&#46;8&#37;&#41; did not recover their basal renal function&#46; When fibrate treatment begins a renal function should be monitored specially in patients with CRF&#46;ABSTRACT Introduction&#58; Fibrates represent one of the medications used to treat patients with hyperlipemia&#46; Deterioration in renal function is not a very known adverse effect of fibric acid derivates&#46; In the last 26 months we have detected thirteen patients with acute renal failure associated to fibrates in our outpatients&#8217; clinic&#46; Subjects and methods&#58; The aim of our study is to analyze our experience in deterioration in renal function associated to fibrates use&#46; This is a retrospective charts review&#46; Results&#58; From the thirteen patients &#40;8 males&#47;5 females&#41; with mean age of 65&#46;5 &#177; 12&#46;2 years&#44; ten received Fenofibrate &#40;FN&#41;&#44; one Bezafibrate &#40;BZ&#41; and two Gemfibrozil &#40;GF&#41;&#46; Six cases had previously normal renal function and the seven remaining had mild chronic renal failure &#40;CRF&#41;&#46; The increase of serum Creatinine &#40;Crs&#41; value was higher than 74&#37;&#46; Acute renal failure was reversible in 9 patients &#40;group 1&#41;&#44; but the other 4 did not recover their previous renal function &#40;group 2&#41;&#46; The average of Crs before fibrate treatment was 1&#46;33 &#177; 0&#46;36 mg&#47;dl &#40;Creatinine clearance 63&#46;2 &#177; 26&#46;6 ml&#47;min&#41; and the highest average of Crs during the treatment was 2&#46;22 &#177; 0&#46;49 mg&#47;d &#40;Creatinine clearance 37&#46;3 &#177; 11&#46;9 ml&#47;min&#41;&#46; The average time until acute renal failure diagnosis was 6&#46;7 &#177; 5&#46;8 months and the recovery of renal function was delayed an average of 3&#46;8 &#177; 3&#46;5 months after fibrates withdrawn&#46; Group 2 patients had a higuer Crs and longer time with fibrates than group 1 patients&#46; CPK values were normal in all cases&#46; In two patients renal biopsy was performed and no significant lesions were detected&#46; Conclusion&#58; The fibrate treatment can induce an acute renal failure&#46; Four patients &#40;30&#46;8&#37;&#41; did not recover their basal renal function&#46; When fibrate treatment begins a renal function should be monitored specially in patients with CRF&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      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" => "17218078_f1_p209.jpg"
            "Alto" => 252
            "Ancho" => 397
            "Tamanyo" => 21230
          ]
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_t1_p210.jpg"
            "Alto" => 302
            "Ancho" => 828
            "Tamanyo" => 68071
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_f2_p211.jpg"
            "Alto" => 369
            "Ancho" => 825
            "Tamanyo" => 29021
          ]
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_t2_p211.jpg"
            "Alto" => 152
            "Ancho" => 826
            "Tamanyo" => 28722
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Attman PO, Alaupovic P, Tavella M, Knight-Gibson C. Abnormal lipid and apolipoprotein composition of major lipoprotein density classes in patients with chronic renal failure. Nephrol Dial Transplant 1996;11:63-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8649654" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Miller DB, Spence JD. Clinical pharmacokinetics of fibric acid derivates. Clin Pharmacokinet 1998;34:155-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9515185" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fernández Vega F. Terapéutica hipolipemiante en pacientes con enfermedad renal crónica. Nefrología 2004;24(S6):113. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15696902" 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" => "Blane GF. Comparative toxicity and safety profile of fenofibrate and other fibric acid derivates. Am J Med 1987;83(S5B):26-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3318450" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cumming A. Acute renal failure and interstitial nephritis after clofibrate treatment. British Medical J 1980;281:1529."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Broeders N, Knoop C, Antoine M, Tielemans C, Abramowicz D. Fibrate-induced increase in blood urea and creatinine: is gemfibrozil the only innocuous agent? Nephrol Dial Transplant 2000;15:1993-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11096145" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lipscombe J, Lewis GF, Cattran D, Bargman JM. Deterioration in renal function associated with fibrate therapy. Clin Nephrology 2001;55:39-44."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gajdos M, Dzúrik R. Fibrates and renal function. Clin Nephrology 2003;60:65."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ángeles C, Lane BP, Miller F, Nord EP. Fenofibrate-associated reversible acute allograft dysfunction in 3 renal transplant recipients: biopsy evidence of tubular toxicity. Am J Kidney Dis 2004;44:543-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15332227" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hottelart C, El Esper N, Rose F, Achard JM, Fournier A. Fenofibrate increases creatininemia by increasing metabolic production of creatinine. Nephron 2002;92:536-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12372935" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Krey G, Braissant O, L¿Horset F. Fatty acids, eicosanoids and hypolipidemic agents identified as ligands of peroxisome proliferators by coactivator-dependent receptor ligand assay. Mol Endocrinol 1999;11:779-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9171241" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ansquer JC, Dalton RN, Caussè E, Crimet D, Le Malicot K, Foucher C. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis 2008;51:904-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18501783" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Alonso-Galicia M, Frohlich B, Roman RJ. Induction of P450A activity improves pressure-natriuresis in Dahl S rats. Hypertension 1998;31:232-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9453308" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wilson MW, Lay LT, Chow CK, Tai H, Robertson LW, Glauert HP. Altered hepatic eicosanoid concentrations in rats treated with the peroxisome proliferators ciprofibrate and perfluorodecanoic acid. Arch Toxicol 1995;69:491-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8526745" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chu X-Y, Bleasby K, Yabut J, et al. Transport of the dipeptidyl peptidase-4 inhibitor sitagliptin by human organic anion transporter 3, organic anion transporting polypeptide 4c1 and multidrug resistance p-glycoprotein. J Pharmacol Exp Ther 2007;321:673-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17314201" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Duncan L, Djurdjev O, Shapiro RJ, Frolich J, Belanger A, et al. A randomized placebo-controlled double-blind trial of lipid lowering strategies in patients with renal insufficiency: diet modification with or without fenofibrate. Clin Nephrology 2000;53:140-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Deighan C, Caslake M, McConnell M, Boulton-Jones J, Packard C. Comparative effects of cerivastatin and fenofibrate on the atherogenic lipoprotein phenotype in proteinuric renal disease. J Am Soc Nephrol 2001;12:341-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11158224" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Clouatre Y, Leblanc M, Ouimet D, Pichette V. Fenofibrate-induced rhabdomyolysis in two dialysis patients with hypothyroidism. Nephrol Dial Transplant 1999;14:1047. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10328516" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sirvent AE, Cabezuelo JB, Enríquez R, Amorós F, González C, Reyes A. Rabdomiolisis y fracaso renal anúrico inducidos por el tratamiento combinado de gemfibrozil y cerivastatina. Nefrología 2001;5:497-500."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate plus statin versus gemfibrozil plus any statin. J Am Cardiol 2004;95:120-2."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hirai M, Tatuso E, Sakurai M, Ichikawa M, Matsuya F, Saito Y. Elevated blood concentrations of cyclosporine and kidney failure after benzofibrate in renal graft recipient. Ann Pharmacother 1996;30:883-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8826580" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004638/v0_201502091629/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000003/v0_201502091629/X2013251409004638/v0_201502091629/en/P-E-S-A172-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004638?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Fibrate-induced deterioration of renal function
Deterioro de Función Renal Inducido por Fibratos
Natalia Polancoa, E.. Hernándeza, E.. Gonzáleza, E.. Gutiérrez Martíneza, I.. Belloa, V.. Gutiérrez-Milleta, F.. Garcíaa, E.. Moralesa, M.. Pragaa
a Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Madrid, España,
Read
9376
Times
was read the article
2467
Total PDF
6909
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251409004638"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.3.5152.en.full"
  "estado" => "S300"
  "fechaPublicacion" => "2009-06-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:208-13"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5011
    "formatos" => array:3 [
      "EPUB" => 255
      "HTML" => 4138
      "PDF" => 618
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509004630"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.3.5152.en.full"
      "estado" => "S300"
      "fechaPublicacion" => "2009-06-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:208-13"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 22822
        "formatos" => array:3 [
          "EPUB" => 230
          "HTML" => 21677
          "PDF" => 915
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "titulo" => "Deterioro de Funci&#243;n Renal Inducido por Fibratos"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "208"
            "paginaFinal" => "213"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Fibrate-induced deterioration of renal function"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Natalia Polanco, E. Hern&#225;ndez, E. Gonz&#225;lez, E. Guti&#233;rrez Mart&#237;nez, I. Bello, V. Guti&#233;rrez-Millet, F. Garc&#237;a, E. Morales, M. Praga"
            "autores" => array:9 [
              0 => array:2 [
                "nombre" => "Natalia"
                "apellidos" => "Polanco"
              ]
              1 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Hern&#225;ndez"
              ]
              2 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Gonz&#225;lez"
              ]
              3 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Guti&#233;rrez Mart&#237;nez"
              ]
              4 => array:2 [
                "Iniciales" => "I."
                "apellidos" => "Bello"
              ]
              5 => array:2 [
                "Iniciales" => "V."
                "apellidos" => "Guti&#233;rrez-Millet"
              ]
              6 => array:2 [
                "Iniciales" => "F."
                "apellidos" => "Garc&#237;a"
              ]
              7 => array:2 [
                "Iniciales" => "E."
                "apellidos" => "Morales"
              ]
              8 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Praga"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409004638"
          "doi" => "10.3265/Nefrologia.2009.29.3.5152.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/X2013251409004638?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004630?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000003/v0_201502091409/X0211699509004630/v0_201502091409/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325140900462X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.3.5103.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-06-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:214-21"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4405
      "formatos" => array:3 [
        "EPUB" => 237
        "HTML" => 3564
        "PDF" => 604
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Prevalence and functional effect of arteriovenous fistula calcifications&#44; evaluated by spiral CT in chronic haemodialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "214"
          "paginaFinal" => "221"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia y efecto funcional de las calcificaciones de la fistula arteriovenosa evaluadas mediante TAC helicoidal en pacientes en hemodi&#225;lisis cr&#243;nica&#46;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "17318078_t1_p216.jpg"
              "Alto" => 368
              "Ancho" => 400
              "Tamanyo" => 30749
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics of patients examined under a spiral CT &#40;n &#61; 45&#41;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ramon Roca-Tey, Rafael P&#225;ez, Amelia Rivas, Rosa Samon, Omar Ibrik, Isabel Gim&#233;nez, Jordi Viladoms"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Ramon"
              "apellidos" => "Roca-Tey"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "P&#225;ez"
            ]
            2 => array:2 [
              "nombre" => "Amelia"
              "apellidos" => "Rivas"
            ]
            3 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Samon"
            ]
            4 => array:2 [
              "nombre" => "Omar"
              "apellidos" => "Ibrik"
            ]
            5 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Gim&#233;nez"
            ]
            6 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Viladoms"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509004622"
        "doi" => "10.3265/Nefrologia.2009.29.3.5103.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/X0211699509004622?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900462X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000003/v0_201502091629/X201325140900462X/v0_201502091629/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251409004564"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.3.5078.en.full"
    "estado" => "S300"
    "fechaPublicacion" => "2009-06-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:203-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3748
      "formatos" => array:3 [
        "EPUB" => 224
        "HTML" => 3009
        "PDF" => 515
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Cardio-metabolic properties of manidipine&#58; beyond lowering arterial pressure&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "203"
          "paginaFinal" => "207"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Propiedades cardiometab&#243;licas del Manidipino&#58; &#191;M&#225;s all&#225; de la reducci&#243;n de la presi&#243;n arterial&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "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" => "17118078_f1_p205.jpg"
              "Alto" => 434
              "Ancho" => 824
              "Tamanyo" => 24773
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Nisa Buset R&#237;os, Francisco Rodr&#237;guez Esparrag&#243;n, Jos&#233; Carlos Rodr&#237;guez P&#233;rez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Nisa"
              "apellidos" => "Buset R&#237;os"
            ]
            1 => array:2 [
              "nombre" => "Francisco"
              "apellidos" => "Rodr&#237;guez Esparrag&#243;n"
            ]
            2 => array:2 [
              "nombre" => "Jos&#233; Carlos"
              "apellidos" => "Rodr&#237;guez P&#233;rez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509004567"
        "doi" => "10.3265/Nefrologia.2009.29.3.5078.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/X0211699509004567?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004564?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004564/v0_201502091629/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Fibrate-induced deterioration of renal function"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "208"
        "paginaFinal" => "213"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Natalia Polanco, E. Hern&#225;ndez, E. Gonz&#225;lez, E. Guti&#233;rrez Mart&#237;nez, I. Bello, V. Guti&#233;rrez-Millet, F. Garc&#237;a, E. Morales, M. Praga"
        "autores" => array:9 [
          0 => array:4 [
            "nombre" => "Natalia"
            "apellidos" => "Polanco"
            "email" => array:1 [
              0 => "nipolanco&#64;yahoo&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Guti&#233;rrez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Bello"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "V."
            "apellidos" => "Guti&#233;rrez-Millet"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          6 => array:3 [
            "Iniciales" => "F."
            "apellidos" => "Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          7 => array:3 [
            "Iniciales" => "E."
            "apellidos" => "Morales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          8 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Praga"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Deterioro de Funci&#243;n Renal Inducido por Fibratos"
      ]
    ]
    "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" => "17218078_f1_p209.jpg"
            "Alto" => 252
            "Ancho" => 397
            "Tamanyo" => 21230
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Dyslipidaemia commonly affects both the general population and patients with CRF&#46;<span class="elsevierStyleSup">1</span> Several strategies and hypolipaemiant agents have been employed in the treatment of this condition&#44; including fibric acid derivatives&#46; Fibric acid derivatives are especially recommended for those patients with hypertriglyceridaemia and low HDL cholesterol levels&#44; regardless of the presence of CRF&#46;<span class="elsevierStyleSup">2&#44;3</span> The most common side effects associated with fibrates are gastrointestinal and muscular complaints&#46;<span class="elsevierStyleSup">4</span> However&#44; different studies have indicated an increase in serum creatinine following the use the of these agents&#44; which calls into question the use of fibrates in patients with altered renal function&#46;<span class="elsevierStyleSup">5-10</span> The mechanism that causes this reaction is still unknown&#46; Different hypotheses and arguments have been put forward&#44; however none have been fully proven&#46;</p><p class="elsevierStylePara">The first patient with increased serum creatinine levels caused by fibrate was diagnosed in our department over two years ago&#46; Since then&#44; another twelve cases have been identified&#46; The aim of this study is to analyse these cases and review the literature on the physiopathology of this phenomenon&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara">From March 2006 to May 2008 thirteen patients were identified in the Department of Nephrology as having high serum creatinine levels after initiating treatment with the three fibrates that are commercially available in Spain &#40;fenofibrate&#44; bezafibrate and gemfibrozil&#41;&#46; The diagnosis of increased serum creatinine associated with fibrate treatment was made in patients that met the following criteria&#58; 1&#41; an increase in creatinine of at least 20&#37; compared to baseline levels&#59; 2&#41; temporal relationship between the increase in creatinine and fibrate treatment&#59; 3&#41; no other concomitant nephrotoxic medications were being used&#59; 4&#41; all other causes of deterioration of renal function had been reasonably ruled out&#59; and 5&#41; serum creatinine levels improved once the medication was suspended&#46; The patients that met these criteria are the subject of this retrospective review&#46;</p><p class="elsevierStylePara">Clinical data was collected from all the patients&#44; including age&#44; sex&#44; medical history&#44; the presence of CRF &#40;defined as SCr &#62; 1&#46;2mg&#47;dl and&#47;or MDRD values &#60; 60ml&#47;min&#41; and its cause&#46; The type of fibrate and the use of concomitant medications if applicable were also included&#59; the use of potentially nephrotoxic agents was of particular interest&#46; The analytical data collected included SCr&#44; estimated glomerular filtration rate using MDRD&#44; proteinuria&#44; triglycerides&#44; cholesterol and CPK whenever possible &#40;76&#46;9&#37; of patients&#41;&#46; The variables of all the cases were analysed and afterwards patients were divided into two comparative groups&#46; Group 1&#58; patients that fully recovered baseline creatinine levels &#40;cases 1-9&#41;&#59; group 2&#58; patients with partial recovery of renal function &#40;cases 10-13&#41;&#46;</p><p class="elsevierStylePara">The numerical values are expressed as the mean &#177; standard deviation and the comparisons were carried out using nonparametric tests for paired and unpaired samples&#46; A p &#60; 0&#46;05 value was considered significant&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">The mean age of the thirteen patients &#40;eight men and five women&#41; was 65&#46;5 &#177; 12&#46;2 years&#46; The presence of CRF before initiating fibrate treatment was detected in seven patients &#40;53&#46;8&#37;&#41;&#46; None of our patients had undergone a kidney transplant&#46; Their clinical characteristics&#44; including the causes of CRF can be found in table 1&#46;</p><p class="elsevierStylePara">The fibrates given to our patients included fenofibrate &#40;eleven patients&#41;&#44; gemfibrozil &#40;two patients&#44; one of which was previously treated with fenofibrate&#41; and bezafibrate &#40;one patient&#41;&#46; With regard to concomitant treatments&#44; nine of our patients were being treated with renin-angiotensin system blocking agents &#40;ACEIs and&#47;or ARBs&#41;&#44; however all patients were receiving these treatments regularly before experiencing deterioration of renal function&#44; except one patient who started treatment afterwards&#46; This medication was not suspended in any of the cases&#46; Only two patients received combined treatment with statins and high levels of CPK were not observed in either of them&#46;</p><p class="elsevierStylePara">Before fibrate treatment SCr was 1&#46;33 &#177; 0&#46;36mg&#47;dl&#44; and MDRD was 63&#46;2 &#177; 26&#46;6ml&#47;min&#44; compared with the maximum creatinine level during treatment which was 2&#46;22 &#177; 0&#46;49mg&#47;dl&#44; and MDRD which fell to 33&#46;4 &#177; 8&#46;1ml&#47;min &#40;p &#60;0&#46;05&#41;&#46; After suspending fibrate treatment SCr fell to 1&#46;45 &#177; 0&#46;38mg&#47;dl&#44; and MDRD increased to 58&#46;8 &#177; 16&#46;6ml&#47;min &#40;p &#60;0&#46;05 in comparison with the maximum SCr value and little difference was observed when compared with baseline SCr levels&#41; &#40;figure 1&#41;&#46; The average percentage increase of serum creatinine was 74&#46;6 &#177; 55&#46;8&#37;&#46; None of the patients required renal replacement treatment&#46; One of the patients presented two episodes of increased SCr during the two periods throughout the follow up and fibrates were recommended as shown in figure 2&#46;</p><p class="elsevierStylePara">The mean time elapsed until an increase in creatinine observed was 6&#46;7 &#177; 5&#46;8 months after initiating treatment&#44; while patients experienced a recovery of renal function after 3&#46;8 &#177; 3&#46;5 months following the suspension of fibrate treatment&#46;</p><p class="elsevierStylePara">Four patients &#40;30&#46;8&#37;&#41; did not fully recover renal function &#40;group 2&#58; cases 10-13&#41; and two of them did not present CRF before initiating fibrate treatment&#46; The SCr percentage increase of these four patients was 104&#46;4 &#177; 87&#46;9&#37; compared with an increase of 60&#46;6 &#177; 35&#46;8&#37; in patients who did fully recover renal function &#40;group 1&#58; cases 1-9&#41;&#46; Patients underwent fibrate treatment for 19&#46;8 &#177; 15&#46;5 months&#46; In the comparison of both groups&#44; the patients in group one received treatment for an average of 18&#46;4 &#177; 19&#46;8 months compared with the patients in group 2 who received treatment over a period of 22&#46;3 &#177; 3&#46;1 months &#40;table 2&#41;&#46;</p><p class="elsevierStylePara">With regard to proteinuria&#44; there were no differences in the values before and during the fibrate treatment period&#46; Mean proteinuria before starting treatment was 0&#46;89 &#177; 1&#46;4g&#47;day&#44; and during fibrate treatment was 0&#46;84 &#177; 1&#46;1g&#47;day&#46; In those cases where it was possible to obtain CPK levels&#44; these were normal&#46;</p><p class="elsevierStylePara">A kidney biopsy was carried out on two patients and no alterations that could justify an increase in SCr were identified in either of the cases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">This study highlights our experience regarding fibrateinduced deterioration of renal function&#46; Our sample is the second largest of all the studies that have been published up until now&#46; It is also worth highlighting that all thirteen patients were diagnosed within a period of only 26 months&#44; which indirectly implies a high incidence of this phenomenon and further emphasises its importance&#46;</p><p class="elsevierStylePara">Although the increase in creatinine levels experienced by our patients was mainly associated with fenofibrate&#44; it was also observed in patients treated with bezafibrate and gemfibrozil&#46; These findings do not support the theory put forward by Broeders et al&#46;&#44; that states that gemfibrozil is the only fibrate that does not alter renal function&#46;<span class="elsevierStyleSup">6</span> Despite this&#44; the creatinine percentage increase was higher in the group of patients treated with fenofibrate compared with the gemfibrozil group &#40;82&#46;1 &#177; 65&#46;2&#37; <span class="elsevierStyleItalic">versus</span> 38&#46;7 &#177; 4&#46;1&#37;&#41;&#44; although the difference was not significant&#46; Moreover&#44; of the two patients from the gemfibrozil group&#44; one patient had already been treated with fenofibrate&#46; Both these findings could indicate the less deleterious effect of gemfibrozil&#46; The hypothesis that has been put forward to explain this highlights the reduced stimulating effect of gemfibrozil on peroxisome proliferator activated receptors &#40;PPAR-&#945;&#41;&#44; which are responsible for inhibiting the synthesis of vasodilating prostaglandins&#46;<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">Our patients recorded a mean increase in SCr levels of 74&#46;6 &#177; 55&#46;8&#37; and a reduction in MDRD following fibrate treatment&#46; These results can be added to those already described by other authors&#44; although the percentage increase is higher in our group of patients in comparison with the papers reviewed&#44; which could be linked to the increased duration of fibrate treatment&#46;<span class="elsevierStyleSup">5-10</span> Urea or cystatin C levels were not recorded in this series&#44; however when other authors have recorded these values an increase in both has been observed in correlation with SCr&#46;<span class="elsevierStyleSup">6&#44;7&#44;9&#44;10</span> These results suggest that there is a reduction in glomerular filtration as a result of fibrate treatment&#46; However&#44; in the studies carried out by Hottelart et al&#46; and Ansquer et al&#46;<span class="elsevierStyleSup">10&#44;12</span> which analysed renal plasma flow and glomerular filtration using paraaminohippurate &#40;PAH&#41; and insulin clearance in patients receiving fibrate treatment&#44; no significant changes were observed&#46; A possible explanation for this could be the short duration of treatment in both studies &#40;two and six weeks&#41;&#46;</p><p class="elsevierStylePara">Like other studies&#44; our series involved patients with normal renal function prior to treatment as well as patients with different grades of CRF&#46;6&#44;7 No studies have been carried out involving the general population or patients with CRF prior to treatment in order to establish the incidence of this phenomenon&#46; A 60&#37; increase in SCr has been obtained from more vulnerable study groups like those that include kidney transplant patients treated with fibrates&#46;<span class="elsevierStyleSup">6</span> This is a highly significant finding given that irreversible increases in SCr have been identified specifically in kidney transplant patients after medication is suspended&#46; In our experience&#44; 30&#46;8&#37; of patients did not fully recover their previous renal function&#46; None of our patients had undergone a kidney transplant and 50&#37; of those who did not fully recover their creatinine values had normal renal function&#46; Two factors that could have contributed to causing this irreversible damage are the percentage increase of SCr &#40;104&#46;4 &#177; 87&#46;9&#37; in cases 10-13 compared with 60&#46;6 &#177; 35&#46;8&#37; in patients that fully recovered renal function&#41; and the duration of fibrate treatment&#44; which was also longer in the group of patients who only experienced a partial recovery of their renal function &#40;22&#46;3 &#177; 3&#46;1 months&#41; compared with those whose creatinine increase was completely reversible &#40;18&#46;4 &#177; 19&#46;8 months&#41;&#44; although the differences were not statistically significant&#46; These findings have not been reported in any other series that have already been published&#44; however when the patient data from the Broeders et al&#46; study was analysed a similar trend was identified&#46; This suggests that patients with a greater increase in SCr are less likely to fully recover renal function&#46;</p><p class="elsevierStylePara">The mechanism implicated in this apparent deterioration of renal function following fibrate treatment has not yet been clearly defined&#46; There are many theories that attempt to explain it&#59; however none have been fully proven&#46;</p><p class="elsevierStylePara">The most widely accepted hypothesis is based on the haemodynamic changes that fibrates may cause&#46; Fibric acid derivatives are known for stimulating PPAR-&#945; which can lead to reduced renal plasma flow&#46;<span class="elsevierStyleSup">12-14</span> This supports the theory that increased creatinine is triggered by haemodynamic factors&#46; However&#44; when the renal plasma flow has been studied using PAH clearance&#44;<span class="elsevierStyleSup">10&#44;11</span> no statistically significant changes have been observed that support this theory&#46; In the study by Ansquer et al&#46; which analyses the effect of fibrate treatment over a period of six weeks in patients with normal renal function prior to treatment&#44; a reduction in PAH clearance is observed in the group that received treatment although it is not significant &#40;p &#61; 0&#46;05&#41;&#46;15 However&#44; this result could indicate a real reduction in the renal plasma flow that does not reach statistical significance because of the limited number of patients and the short period of time analysed&#46;</p><p class="elsevierStylePara">Another hypothesis put forward by Hottelart et al&#46;&#44; is the increase in serum creatinine as a result of an increase in endogenous creatinine production&#46;<span class="elsevierStyleSup">10</span> Several papers have been published that describe increases in SCr without altered creatinine clearance&#46;<span class="elsevierStyleSup">10&#44;11&#44;16&#44;17</span> On the basis of this&#44; the authors conclude that there should be an increase in endogenous creatinine production&#44; presumably from muscle&#44; given that muscular toxicity is associated with this group of drugs&#46; However&#44; this theory does not explain the increase in urea or cystatin C which has been identified in several studies&#46;</p><p class="elsevierStylePara">Following on from this point&#44; rhabdomyolisis could be considered a cause of increased creatinine&#46; Many studies have been published describing episodes of rhabdomyolisis following treatment&#44; either with fibrate treatment alone or combined with statins&#46;<span class="elsevierStyleSup">18-20</span> CPK levels were analysed and were always within the normal range for most patients in this study &#40;76&#46;9&#37;&#41;&#46; In those cases in this study which involved a kidney biopsy&#44; myoglobin in the renal tubules was not detected&#46;</p><p class="elsevierStylePara">There is a fourth hypothesis which is defended in the study by &#161;ngeles et al&#46; which analyses the histopathological results from the biopsies of three transplant patients who experienced a reversible increase in creatinine levels following treatment with fenofibrate&#46;<span class="elsevierStyleSup">9</span> The kidney biopsies showed toxic tubular damage in the form of cytoplasmic degeneration affecting the proximal tubule cells and the presence of prominent hyaline granules&#46; These findings do not coincide with those obtained from the biopsies of the two patients in our series which did not show any pathological lesions&#46;</p><p class="elsevierStylePara">Finally&#44; in the case of transplant patients undergoing treatment with calcineurin inhibitors&#44; several authors have highlighted the deleterious effects of combining this group of immunosuppressants with fibrates&#46; Different studies have identified an increase in cyclosporin levels which could contribute to nephrotoxicity&#46;<span class="elsevierStyleSup">21</span> The possible role of fibrates in enhancing the nephrotoxicity of calcineurin inhibitors without altering serum levels has also been suggested&#46; Regardless of the mechanism&#44; this could explain the high incidence of increased creatinine levels as a result of fibrate treatment identified in transplant patients&#46;</p><p class="elsevierStylePara">We believe&#44; on the basis of our own experience&#44; that a fibrate-induced increase in SCr may be the result of haemodynamic factors&#46; Deterioration of renal function is potentially reversible&#44; however if the duration of fibrate treatment is too long this could result in permanent kidney damage&#46;</p><p class="elsevierStylePara">To conclude&#44; fibrate treatment may induce an increase in SCr and the deterioration of renal function&#46; This is particularly relevant when dealing with patients with CRF since&#44; if during the follow up they experience deterioration of renal function&#44; the possibility of increased creatinine associated with fibrate treatment should be weighed up against the possibility of disease progression&#46; The physiopathology of this phenomenon is not yet known&#44; however it is becoming increasingly relevant given that in over 30&#37; of the cases in our series&#44; the increase in creatinine levels was not completely reversible&#46; The renal function of all patients who undergo fibrate treatment should be monitored and patients with a significant degree of renal failure prior to treatment require special attention&#46; If an increase SCr levels is detected&#44; treatment should be suspended&#46;</p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;f1&#95;p209&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_f1_p209.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;t1&#95;p210&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_t1_p210.jpg" alt="Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function</p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;f2&#95;p211&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_f2_p211.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p><p class="elsevierStylePara"><a href="grande&#47;17218078&#95;t2&#95;p211&#46;jpg" class="elsevierStyleCrossRefs"><img src="17218078_t2_p211.jpg" alt="Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function"></img></a></p><p class="elsevierStylePara">Table 2&#46; Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function</p>"
    "pdfFichero" => "P-E-S-A172-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440029"
          "palabras" => array:1 [
            0 => "Fracaso renal agudo"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440031"
          "palabras" => array:1 [
            0 => "Fibratos"
          ]
        ]
      ]
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440030"
          "palabras" => array:1 [
            0 => "Acute renal failure"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440032"
          "palabras" => array:1 [
            0 => "Fibrates"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Los fibratos representan uno de los grupos de f&#225;rmacos indicados para el tratamiento de la hiperlipidemia&#46; Uno de sus efectos secundarios&#44; a&#250;n poco conocido&#44; es el deterioro agudo de la funci&#243;n renal&#46; En los &#250;ltimos 26 meses hemos objetivado en nuestra consulta externa de Nefrolog&#237;a un total de 13 pacientes con deterioro de la funci&#243;n renal asociado al uso de fibratos&#46; Material y m&#233;todos&#58; El objetivo de nuestro estudio es evaluar nuestra experiencia en el incremento de Creatinina s&#233;rica &#40;Crs&#41; inducido por fibratos&#46; Se trata de una revisi&#243;n retrospectiva de una serie de casos&#46; Resultados&#58; De los 13 pacientes &#40;8 hombres&#47;5 mujeres&#41; con edad media de 65&#44;5 &#177; 12&#44;2 a&#241;os&#44; diez fueron tratados con fenofibrato&#44; uno con bezafibrato y dos con gemfibrozilo&#46; Seis pacientes part&#237;an de una funci&#243;n renal normal y los otros siete presentaban una Insuficiencia Renal Cr&#243;nica &#40;IRC&#41; leve-moderada previamente al inicio del tratamiento&#46; El incremento de creatinina con respecto a la basal expresado en porcentaje fue superior al 74&#37;&#46; En nueve de los pacientes el deterioro de funci&#243;n renal fue completamente reversible &#40;grupo 1&#41;&#44; mientras que en cuatro de ellos la recuperaci&#243;n fue parcial &#40;grupo 2&#41;&#46; La media de creatinina antes de recibir tratamiento con fibratos fue de 1&#44;33 &#177; 0&#44;36 mg&#47;dl &#40;aclaramiento de creatinina 63&#44;2 &#177; 26&#44;6 ml&#47;min&#41; y la media de la creatinina m&#225;xima durante el tratamiento fue de 2&#44;22 &#177; 0&#44;49 mg&#47;dl &#40;aclaramiento de creatinina 33&#44;4 &#177; 8&#44;1 ml&#47;min&#41;&#46; El tiempo medio de evoluci&#243;n hasta objetivarse el incremento de creatinina fue de 6&#44;7 &#177; 5&#44;8 meses y la recuperaci&#243;n de la funci&#243;n renal ocurri&#243; a los 3&#44;8 &#177; 3&#44;5 meses de la suspensi&#243;n del tratamiento con fibratos&#46; En los pacientes del grupo 2 se objetiv&#243; un mayor incremento de Crs y un tiempo de tratamiento con fibratos m&#225;s prolongado&#46; En los pacientes en los que se obtuvieron niveles de CPK&#44; &#233;stos fueron normales&#46; En dos de nuestros pacientes se realizaron biopsias renales sin objetivarse alteraciones significativas&#46; Conclusiones&#58; El tratamiento con fibratos puede inducir un deterioro de funci&#243;n renal&#46; En el 30&#37; de los casos de nuestra serie&#44; el aumento de creatinina s&#243;lo fue parcialmente reversible tras la suspensi&#243;n del fibrato&#46; En todos los pacientes que se inicie tratamiento con fibratos se debe monitorizar la funci&#243;n renal con especial atenci&#243;n en aquellos pacientes con cierto grado de insuficiencia renal previa&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Fibrates represent one of the medications used to treat patients with hyperlipemia&#46; Deterioration in renal function is not a very known adverse effect of fibric acid derivates&#46; In the last 26 months we have detected thirteen patients with acute renal failure associated to fibrates in our outpatients&#8217; clinic&#46; Subjects and methods&#58; The aim of our study is to analyze our experience in deterioration in renal function associated to fibrates use&#46; This is a retrospective charts review&#46; Results&#58; From the thirteen patients &#40;8 males&#47;5 females&#41; with mean age of 65&#46;5 &#177; 12&#46;2 years&#44; ten received Fenofibrate &#40;FN&#41;&#44; one Bezafibrate &#40;BZ&#41; and two Gemfibrozil &#40;GF&#41;&#46; Six cases had previously normal renal function and the seven remaining had mild chronic renal failure &#40;CRF&#41;&#46; The increase of serum Creatinine &#40;Crs&#41; value was higher than 74&#37;&#46; Acute renal failure was reversible in 9 patients &#40;group 1&#41;&#44; but the other 4 did not recover their previous renal function &#40;group 2&#41;&#46; The average of Crs before fibrate treatment was 1&#46;33 &#177; 0&#46;36 mg&#47;dl &#40;Creatinine clearance 63&#46;2 &#177; 26&#46;6 ml&#47;min&#41; and the highest average of Crs during the treatment was 2&#46;22 &#177; 0&#46;49 mg&#47;d &#40;Creatinine clearance 37&#46;3 &#177; 11&#46;9 ml&#47;min&#41;&#46; The average time until acute renal failure diagnosis was 6&#46;7 &#177; 5&#46;8 months and the recovery of renal function was delayed an average of 3&#46;8 &#177; 3&#46;5 months after fibrates withdrawn&#46; Group 2 patients had a higuer Crs and longer time with fibrates than group 1 patients&#46; CPK values were normal in all cases&#46; In two patients renal biopsy was performed and no significant lesions were detected&#46; Conclusion&#58; The fibrate treatment can induce an acute renal failure&#46; Four patients &#40;30&#46;8&#37;&#41; did not recover their basal renal function&#46; When fibrate treatment begins a renal function should be monitored specially in patients with CRF&#46;ABSTRACT Introduction&#58; Fibrates represent one of the medications used to treat patients with hyperlipemia&#46; Deterioration in renal function is not a very known adverse effect of fibric acid derivates&#46; In the last 26 months we have detected thirteen patients with acute renal failure associated to fibrates in our outpatients&#8217; clinic&#46; Subjects and methods&#58; The aim of our study is to analyze our experience in deterioration in renal function associated to fibrates use&#46; This is a retrospective charts review&#46; Results&#58; From the thirteen patients &#40;8 males&#47;5 females&#41; with mean age of 65&#46;5 &#177; 12&#46;2 years&#44; ten received Fenofibrate &#40;FN&#41;&#44; one Bezafibrate &#40;BZ&#41; and two Gemfibrozil &#40;GF&#41;&#46; Six cases had previously normal renal function and the seven remaining had mild chronic renal failure &#40;CRF&#41;&#46; The increase of serum Creatinine &#40;Crs&#41; value was higher than 74&#37;&#46; Acute renal failure was reversible in 9 patients &#40;group 1&#41;&#44; but the other 4 did not recover their previous renal function &#40;group 2&#41;&#46; The average of Crs before fibrate treatment was 1&#46;33 &#177; 0&#46;36 mg&#47;dl &#40;Creatinine clearance 63&#46;2 &#177; 26&#46;6 ml&#47;min&#41; and the highest average of Crs during the treatment was 2&#46;22 &#177; 0&#46;49 mg&#47;d &#40;Creatinine clearance 37&#46;3 &#177; 11&#46;9 ml&#47;min&#41;&#46; The average time until acute renal failure diagnosis was 6&#46;7 &#177; 5&#46;8 months and the recovery of renal function was delayed an average of 3&#46;8 &#177; 3&#46;5 months after fibrates withdrawn&#46; Group 2 patients had a higuer Crs and longer time with fibrates than group 1 patients&#46; CPK values were normal in all cases&#46; In two patients renal biopsy was performed and no significant lesions were detected&#46; Conclusion&#58; The fibrate treatment can induce an acute renal failure&#46; Four patients &#40;30&#46;8&#37;&#41; did not recover their basal renal function&#46; When fibrate treatment begins a renal function should be monitored specially in patients with CRF&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      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" => "17218078_f1_p209.jpg"
            "Alto" => 252
            "Ancho" => 397
            "Tamanyo" => 21230
          ]
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_t1_p210.jpg"
            "Alto" => 302
            "Ancho" => 828
            "Tamanyo" => 68071
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Clinical and analytical patient characteristics Group 1&#58; Complete recovery of renal function&#46; Group 2&#58; Partial recovery of renal function"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig3"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_f2_p211.jpg"
            "Alto" => 369
            "Ancho" => 825
            "Tamanyo" => 29021
          ]
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "17218078_t2_p211.jpg"
            "Alto" => 152
            "Ancho" => 826
            "Tamanyo" => 28722
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the groups with complete recovery &#40;group 1&#41; or partial recovery &#40;group 2&#41; of renal function"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Attman PO, Alaupovic P, Tavella M, Knight-Gibson C. Abnormal lipid and apolipoprotein composition of major lipoprotein density classes in patients with chronic renal failure. Nephrol Dial Transplant 1996;11:63-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8649654" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Miller DB, Spence JD. Clinical pharmacokinetics of fibric acid derivates. Clin Pharmacokinet 1998;34:155-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9515185" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fernández Vega F. Terapéutica hipolipemiante en pacientes con enfermedad renal crónica. Nefrología 2004;24(S6):113. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15696902" 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" => "Blane GF. Comparative toxicity and safety profile of fenofibrate and other fibric acid derivates. Am J Med 1987;83(S5B):26-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3318450" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cumming A. Acute renal failure and interstitial nephritis after clofibrate treatment. British Medical J 1980;281:1529."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Broeders N, Knoop C, Antoine M, Tielemans C, Abramowicz D. Fibrate-induced increase in blood urea and creatinine: is gemfibrozil the only innocuous agent? Nephrol Dial Transplant 2000;15:1993-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11096145" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lipscombe J, Lewis GF, Cattran D, Bargman JM. Deterioration in renal function associated with fibrate therapy. Clin Nephrology 2001;55:39-44."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gajdos M, Dzúrik R. Fibrates and renal function. Clin Nephrology 2003;60:65."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ángeles C, Lane BP, Miller F, Nord EP. Fenofibrate-associated reversible acute allograft dysfunction in 3 renal transplant recipients: biopsy evidence of tubular toxicity. Am J Kidney Dis 2004;44:543-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15332227" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hottelart C, El Esper N, Rose F, Achard JM, Fournier A. Fenofibrate increases creatininemia by increasing metabolic production of creatinine. Nephron 2002;92:536-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12372935" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Krey G, Braissant O, L¿Horset F. Fatty acids, eicosanoids and hypolipidemic agents identified as ligands of peroxisome proliferators by coactivator-dependent receptor ligand assay. Mol Endocrinol 1999;11:779-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9171241" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ansquer JC, Dalton RN, Caussè E, Crimet D, Le Malicot K, Foucher C. Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people. Am J Kidney Dis 2008;51:904-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18501783" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Alonso-Galicia M, Frohlich B, Roman RJ. Induction of P450A activity improves pressure-natriuresis in Dahl S rats. Hypertension 1998;31:232-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9453308" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wilson MW, Lay LT, Chow CK, Tai H, Robertson LW, Glauert HP. Altered hepatic eicosanoid concentrations in rats treated with the peroxisome proliferators ciprofibrate and perfluorodecanoic acid. Arch Toxicol 1995;69:491-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8526745" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chu X-Y, Bleasby K, Yabut J, et al. Transport of the dipeptidyl peptidase-4 inhibitor sitagliptin by human organic anion transporter 3, organic anion transporting polypeptide 4c1 and multidrug resistance p-glycoprotein. J Pharmacol Exp Ther 2007;321:673-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17314201" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Duncan L, Djurdjev O, Shapiro RJ, Frolich J, Belanger A, et al. A randomized placebo-controlled double-blind trial of lipid lowering strategies in patients with renal insufficiency: diet modification with or without fenofibrate. Clin Nephrology 2000;53:140-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Deighan C, Caslake M, McConnell M, Boulton-Jones J, Packard C. Comparative effects of cerivastatin and fenofibrate on the atherogenic lipoprotein phenotype in proteinuric renal disease. J Am Soc Nephrol 2001;12:341-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11158224" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Clouatre Y, Leblanc M, Ouimet D, Pichette V. Fenofibrate-induced rhabdomyolysis in two dialysis patients with hypothyroidism. Nephrol Dial Transplant 1999;14:1047. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10328516" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sirvent AE, Cabezuelo JB, Enríquez R, Amorós F, González C, Reyes A. Rabdomiolisis y fracaso renal anúrico inducidos por el tratamiento combinado de gemfibrozil y cerivastatina. Nefrología 2001;5:497-500."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate plus statin versus gemfibrozil plus any statin. J Am Cardiol 2004;95:120-2."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hirai M, Tatuso E, Sakurai M, Ichikawa M, Matsuya F, Saito Y. Elevated blood concentrations of cyclosporine and kidney failure after benzofibrate in renal graft recipient. Ann Pharmacother 1996;30:883-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8826580" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004638/v0_201502091629/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000003/v0_201502091629/X2013251409004638/v0_201502091629/en/P-E-S-A172-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004638?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 9 9 18
2024 October 49 63 112
2024 September 53 54 107
2024 August 74 73 147
2024 July 44 42 86
2024 June 65 45 110
2024 May 55 46 101
2024 April 40 27 67
2024 March 50 26 76
2024 February 29 39 68
2024 January 29 30 59
2023 December 45 20 65
2023 November 53 41 94
2023 October 67 38 105
2023 September 86 34 120
2023 August 61 26 87
2023 July 76 47 123
2023 June 58 17 75
2023 May 61 43 104
2023 April 70 26 96
2023 March 57 23 80
2023 February 47 19 66
2023 January 59 29 88
2022 December 48 36 84
2022 November 49 26 75
2022 October 77 42 119
2022 September 29 32 61
2022 August 46 49 95
2022 July 46 44 90
2022 June 57 37 94
2022 May 57 50 107
2022 April 38 48 86
2022 March 74 55 129
2022 February 37 41 78
2022 January 74 45 119
2021 December 35 48 83
2021 November 40 41 81
2021 October 37 51 88
2021 September 35 42 77
2021 August 45 25 70
2021 July 50 35 85
2021 June 26 27 53
2021 May 55 29 84
2021 April 47 42 89
2021 March 57 26 83
2021 February 56 27 83
2021 January 28 15 43
2020 December 29 15 44
2020 November 35 12 47
2020 October 23 8 31
2020 September 27 20 47
2020 August 36 5 41
2020 July 54 7 61
2020 June 31 8 39
2020 May 53 14 67
2020 April 35 10 45
2020 March 41 11 52
2020 February 57 18 75
2020 January 49 16 65
2019 December 65 15 80
2019 November 50 12 62
2019 October 61 9 70
2019 September 41 11 52
2019 August 30 6 36
2019 July 42 18 60
2019 June 45 15 60
2019 May 39 4 43
2019 April 112 31 143
2019 March 58 14 72
2019 February 17 21 38
2019 January 72 25 97
2018 December 78 29 107
2018 November 84 18 102
2018 October 75 20 95
2018 September 84 6 90
2018 August 47 22 69
2018 July 47 15 62
2018 June 24 8 32
2018 May 39 15 54
2018 April 38 8 46
2018 March 42 16 58
2018 February 52 10 62
2018 January 41 9 50
2017 December 45 11 56
2017 November 38 15 53
2017 October 42 8 50
2017 September 35 10 45
2017 August 52 20 72
2017 July 41 14 55
2017 June 67 14 81
2017 May 56 12 68
2017 April 38 14 52
2017 March 60 8 68
2017 February 40 18 58
2017 January 46 12 58
2016 December 86 8 94
2016 November 101 21 122
2016 October 125 10 135
2016 September 170 6 176
2016 August 188 13 201
2016 July 225 22 247
2016 June 135 0 135
2016 May 161 0 161
2016 April 95 0 95
2016 March 97 0 97
2016 February 125 0 125
2016 January 105 0 105
2015 December 121 0 121
2015 November 95 0 95
2015 October 88 0 88
2015 September 77 0 77
2015 August 74 0 74
2015 July 52 0 52
2015 June 37 0 37
2015 May 54 0 54
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?