Is there a relationship between cystatin C and inflammatory status, oxidative stress and other cardiovascular risk factors in non-diabetic patients with chronic kidney disease?

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stress and other cardiovascular risk factors in non-diabetic patients with chronic kidney disease?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "228" "paginaFinal" => "235" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "R. Font, M. Prats, Alberto Martínez Vea, C. Gutiérrez, A. Bardají, M. Lalana, J. Marsillach, J. Camps" "autores" => array:8 [ 0 => array:3 [ "Iniciales" => "R." "apellidos" => "Font" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M." "apellidos" => "Prats" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 2 => array:4 [ "nombre" => "Alberto" "apellidos" => "Martínez Vea" "email" => array:1 [ 0 => "amartinezv.hj23.ics@gencat.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "C." 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Universitat Rovira i Virgili, Tarragona, Tarragona, España, " "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Unidad de Investigación, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España, " "etiqueta" => "b" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España, " "etiqueta" => "c" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España, " "etiqueta" => "d" "identificador" => "affd" ] 4 => array:3 [ "entidad" => "5Centro de Investigación Biomédica, Hospital Sant Joan de Reus, Reus, Tarragona, España, " "etiqueta" => "e" "identificador" => "affe" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "EXISTE RELACIÓN ENTRE LOS NIVELES DE CISTATINA C Y EL ESTADO INFLAMATORIO, EL ESTRÉS OXIDATIVO Y OTROS FACTORES DE RIESGO CARDIOVASCULAR EN PACIENTES NO DIABÉTICOS CON ENFERMEDAD RENAL CRÓNICA?" ] ] "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" => "19518078_t1_p230.jpg" "Alto" => 461 "Ancho" => 827 "Tamanyo" => 72440 ] ] "descripcion" => array:1 [ "en" => "Patient Demographic characteristics" ] ] ] "textoCompleto" => "INTRODUCTIONCystatin C is a non-glycosylated, low molecular weight protein that is produced by nucleated cells at a constant rate.It is filtered through the glomerulus and reabsorbed and degraded at the tubular level, without being reabsorbed into the plasma and without undergoing a tubular secretion process.1 This protein is considered to be a better renal function marker than serum creatinine, particularly in the elderly and in patients with moderate kidney dysfunction.2,3 Epidemiological studies have shown, based on equations derived from creatinine, that cystatin C is better than creatinine or glomerular filtrate as a predictive factor for cardiovascular morbidity and mortality,4-7 especially in elderly patients6,8 and in the general population with no known CKD.9 There has also been recent evidence that cystatin C is associated to global and cardiovascular mortality in nondiabetic patients with stage 3-4 CKD.10 Although it was initially believed that this protein was independent from extra-renal factors,2,11,12 in recent years it has been shown that cystatin C levels may be conditioned by diverse clinical and demographic factors. In this way, age, sex, body type, lipoprotein anomalies, presence of metabolic syndrome, inflammation, arterial hypertension and other factors have been linked in the general population to serum cystatin C levels.13-18 On the contrary, it is not well known what extrarenal factors are related to levels of this protein in pre-dialysis patients with CKD.The aim of our study was the evaluation of the relationship existing between cystatin C levels and various cardiovascular risk factors, the inflammatory state and oxidative stress in pre-dialysis patients with CKDMATERIAL AND METHODSPatientsProspective transversal study including 52 non-diabetic patients (38 men, 14 women) ranging in age from 30 to 60 years, and with serum creatinine levels between 2 and 8mg/dl. Patients were chosen from those receiving outpatient services at the Nephrology Department at the Joan XXIII University Hospital in Tarragona.MethodologyFor all patients, we proceeded to:1. Determine the demographic, clinical and therapeutic variables, including BMI and blood pressure, which was measured with an automatic oscillometric monitor (OMRON 705 CP, Healthcare GMBH, Hamburg, Germany) on the seated patient following five minutes of repose, according to the recommendations of the European Societies of Hypertension and Cardiology.192. Determine conventional analysis factors, including glycaemia, total cholesterol, high density cholesterol (HDL), low density cholesterol (LDL), triglycerides, albumin, haemoglobin and fibrinogen.3. Determine the urinary excretion of proteins in urine over 24 hours using the turbidimetric method (Modular DP Hitachi, Roche), with a chemical reagent for precipitation.4. Determine the oxidative state markers. Paraoxonase: the calculation for serum PON-1 activity is determined by the hydrolysed paraoxonase value at 410mm and 37ºC.20 The reagent contained 1 mM paraoxonase and 1mM CaCl2 in 0.05M glycine buffer solution (pH: 10.5) and the calculation was made in an Ilab 1800 automatic analyser (Instrumentation Laboratory, Milan, Italy) with security measures for manipulating stocks of paraoxonase solution (extraction chamber and protective gloves and mask for the operator). Paraoxonase activity was expressed in IU/l. Serum PON-1 concentration was determined using the ELISA technique.21 Antibodies to oxidized LDL: the detection of antibodies against oxidized LDL was carried out using the ELISA technique and the commercial kit IMTEC-ox-LDL-Antibodies (Immunodiagnostika GmbH) with an intra-essay variation coefficient of 4.6% and inter-assay coefficient of 5.8%.5. Determine the renal function parameters: serum creatinine levels (modified colourimetric Jaffé method) and estimated glomerular filtration rate calculated using the abbreviated formula (four variables) derived from the serum creatinine values (MDRD).226. Determine the serum cystatin C levels in serum that had previously been frozen to -70ºC after thawing using the particle-enhanced immunonephelometry method (N Latex Cystatin C, BN Dade Behring) in a nephelometer (BNII, Dade Behring).23 Reference values ranged from 0.53 to 0.95mg/l. The trial sensitivity was 0.05mg/l; the intra-and inter-assay variation coefficients were under 3.1 and 3.5%, respectively.7. Determine inflammatory markers:high sensitivity interleukin-6 and high-sensitivity C-reactive protein. We used the kit Human IL-6 Quantikine HS High Sensitivity, R&D Systems. The method sensitivity was 0.016pg/ml and the intra- and inter-assay coefficients were less than 7.8 and 9.6% respectively. High-sensitivity C-reactive protein (hsCRP) was determined in serum samples using the immunonephelometry method (N High Sensitivity CRP) in a nephelometer (BNII, Dade Behring). The sensitivity was 0.175mg/l. The intra- and inter-assay variation coefficients were less than 4.44 and 5.7%, respectively.8. Standard echocardiographic evaluation in 2D and M mode guided by 2D, using Diasonic 700 or 800 Vingmed Sound device (Horten, Norway) with a 3.5 MHz transductor in parasternal longitudinal and transverse views and subcostal apical 2-chamber and 4-chamber views. According to recommendations by the American Society of Echocardiography,24 we determined the telesystolic and telediastolic diameter of the left ventricle, the thickness of the interventricular septum (IVS) and the thickness of the posterior ventricular wall. The left ventricular mass (LV mass) was calculated using the following formula25: MVI(g) = 0.8 x 1.04 [(DTDVI + SIV + PPVI)3– DTDVI3) + 0.6. The LV mass index was calculated by dividing the LV26 mass by body height and expressed in g/m.2.7Statistical analysisStatistical analysis was carried out using the SPSS v11.5 program. The values are expressed as the mean ± standard deviation for variables with a normal distribution.The hsCRP and IL-6 levels did not present a normal distribution, and were therefore transformed in logarithms for use in the statistical analysis.The single-variable relationship between cystatin C and the different parameters is determined by using Pearson’s and/or the Spearman correlation coefficient. Multiple linear regression was applied to analyse the relationship between variables. The confidence interval was 95% and differences were considered to be statistically significant at p < 0.05.RESULTS1. Patient characteristics: the demographic, clinical and analytical characteristics are shown in Table 1. All patients had hypertension; 49 were taking antihypertension drugs and 40 were being treated with angiotensin converting enzyme inhibitors and/or angiotensin II receptor antagonists. Sixteen patients were being treated with statin drugs. Twenty-two patients had stage 3 CKD, 25 had stage 4 and five had stage 5. None of the stage-5 patients was on dialysis. The most prevalent cause of CKD was glomerularbased nephropathy (18 patients), followed by nephropathy of tubulo-interstitial origin and polycystic disease, (15 patients), vascular origin (9 patients) and unknown in 10 patients.2. Cystatin C, renal function and cardiovascular risk factors: cystatin C levels were 2.35 ± 0.9mg/l; no significant differences between men and women were observed. Cystatin C was significantly related to the creatinine, the MDRD and PTH levels. We did not observe any correlation between this protein and age, BMI, blood pressure, proteinuria, total and partial cholesterol, triglycerides, or with the LV mass index (table 2).3. Cystatin C, inflammation, and oxidative state: cystatin C levels are negatively correlated with antibodies to oxidized LDL, while no correlations were found between PON activity and concentration or between any of the analysed inflammation markers (table 2). No correlation was observed between HDL and LDL cholesterol levels and the inflammation and oxidation parameters.4. Factors independent from cystatin C levels: in a multiple regression analysis, after having adjusted for PTH and antibodies to oxidized LDL, the estimated glomerular filtration rate was independently related to cystatin C levels (table 3).DISCUSSIONOur results show that in middle-aged non-diabetic patients with pre-dialysis CKD, cystatin C levels are closely related to renal function parameters, and that estimated glomerular filtration rate is the most important and independent predictive factor from the levels of that protein. The relationship between cystatin C levels and PTH was dependent on the renal function, since in the multiple regression analysis the relationship disappeared after adjusting for estimated glomerular filtration rate. On the contrary, diverse cardiovascular risk factors such as age, blood pressure, body mass index, total and partial cholesterol levels, triglyceride level and inflammatory status – all of which have been linked to cystatin C in the general population - showed no relationship in our study. Nor were oxidative state and cardiac mass shown to be linked to this protein. Therefore, in advanced CKD cystatin C levels would be strictly dependant on renal function, and the other extra-renal factors that have traditionally been described in the general population would have a decreasing effect on this protein.Cystatin C and cardiovascular risk factorsIt is well known that cystatin C levels are higher than that estimated glomerular filtration rate derived from serum creatinine as a predictive factor for cardiovascular morbidity and mortality.4-7 This fact is even more noticeable in elderly patients6,8 and in patients with estimated glomerular filtration rate higher than 60ml/min.9 Cystatin C’s superiority over creatinine as a cardiovascular risk factor in patients known to have CKD has been studied less, as has this protein’s dependence on various cardiovascular risk factors. In a recent study10 of non-diabetic patients with stage 3 or 4 CKD which analysed the influence of cystatin C as a global and cardiovascular risk factor, this protein was associated with a higher risk of mortality, as has been similarly observed with serum creatinine or with glomerular filtration rate calculated using iodothalamate. In this study, C cystatin was correlated with BMI, proteinuria, systolic arterial pressure, and inversely correlated with HDL cholesterol levels. However, these correlations were not adjusted for the degree of renal failure, and therefore we cannot exclude a possible influence, per se, of renal failure in some of these correlations.In our study, we found no association between cystatin C and BMI, systolic arterial pressure, HDL cholesterol levels or triglyceride levels, which are all factors that have been related to this protein in the general population.13,14 The lack of correlation between cystatin C and BMI could probably have been influenced by the different representation of both sexes among the patients included in our study.Cystatin C and inflammatory statusIn the general population, particularly in elderly patients, cystatin C has been correlated with various inflammatory markers.27,28 In our study we found no relationship between cystatin C and CRP, IL-6, or any other component of inflammatory response, such as albumin or fibrinogen. This relationship is dependent on renal function29 in some studies, and it has been suggested that cystatin C, as the most sensitive renal function marker, would be better to reflect the well-known association between the inflammatory state that has been described in patients with subclinical renal dysfunction29 and the characteristic inflammatory state of CKD30 and of patients on dialysis.31We found no relationship between cystatin C and CRP, IL-6 or any other element of the inflammatory response such as albumin or fibrinogen.These results are similar to those shown by Menon et al.10 in the above mentioned study of patients found to have CKD. These authors also found no relationship between cystatin C levels and CRP and the association between cystatin C and cardiovascular mortality was independent from the CRP.The discrepancy observed in various studies between the association of CRP and the severity of renal dysfunction10,32,33 could be due to the fact that the mechanisms in CKD that are responsible for inflammation are not well-defined, and to the presence of various co-morbidities in CKD that also contribute to inflammation in these patients.32 Inflammation markers are predictors of cardiovascular events and mortality in patients on pre-dialysis and dialysis.31,34 Nevertheless, the question has been raised of whether inflammation has causal relevance in the morbidity and mortality of this population. This association could be the result of an inverted causality by which the CKD would cause inflammation and, by means of other mechanisms independent from the inflammation, would also cause an increased risk of cardiovascular events. All of this could suggest that the impact of inflammation on cardiovascular risk in CKD, especially for pre-dialysis CKD patients, could be more modest.32Cystatin C and oxidative statusVarious studies have demonstrated that with CKD there is an increase in the oxidative state characterised by an increase in production of products derived from lipid peroxidation and a decrease in anti-oxidant capacity.35-37 In our study we use two markers to evaluate oxidative status: the antibodies to oxidized LDL and PON. Antibodies to oxidized LDL are atherogenic modulators that have been related to the severity of atherosclerosis and cardiovascular disease,38,39 and some studies have shown that uraemic patients have higher levels of these antibodies than the general population does.40,41PON is an esterase/lactonase associated with high-density lipoprotein and which circulates in plasma. It is speculated that it degrades active oxidized lipids, acting like an antioxidant system.42 The levels of this enzyme are lower in patients with CKD43-45 and they are a predictive factor that is independent from cardiovascular mortality in this population.46The relationship between cystatin C and the two oxidative status markers evaluated in our study had not been previously analysed. Our results show that cystatin C is not related with PON activity and concentration, while it is inversely correlated with the level of antibodies to oxidized LDL. Nevertheless, this correlation was dependent upon renal function, since it disappeared when we adjusted for the estimated glomerular filtration rate. In a certain way, these results corroborate the lack of correlation between the severity of the renal failure and the various oxidation markers33 in CKD patients, although they contradict the close relationship shown by other studies between lipid oxidation markers and various antioxidant systems and the degree of renal failure.41The controversy that exists between the degree of renal dysfunction and the oxidative state could partly be explained by the scarce number of patients in some studies, the presence of other pro-oxidant factors independent from glomerular filtration in CKD patients, and the complexity of evaluation oxidation in those patients. Many of the markers that are used to evaluate the oxidative state are eliminated by the kidney by tubular transport and metabolism, and not by glomerular filtration.33Cystatin C and cardiac massIn patients with essential arterial hypertension, cystatin C is an early marker for lesions on target organs related with hypertension, such as the left ventricular mass, the carotid artery intima-media thickness and microalbuminuria.47In a study previously carried out by our group on hypertensive patients with normal renal function, cystatin C, unlike creatinine and estimated glomerular filtration rate, was independently related the left ventricular mass index, which suggests that this protein could be an early marker of cardiac hypertrophy in the hypertensive population.48 In the Heart and Soul49 study of patients with coronary disease with clinical cardiac failure, cystatin C levels were related to the presence of left ventricular hypertrophy and diastolic dysfunction, and this relationship was closer than that observed with the estimated glomerular filtration rate. We have not found any previous references that evaluate the association between cystatin C and cardiac mass in CKD patients. In our study we could not show any relationship between these two parameters, which was surprising, given that throughout the course of CKD there is a precocious development of left ventricular hypertrophy, and its presence increases as the renal function level decreases.50 In our study, the lack of correlation between cystatin C and cardiac mass could be due to the scarce number of patients and the presence of diverse interrelated factors, including high blood pressure and its treatment. All of the patients were hypertensive: most were receiving treatment, 70% were being treated with renin-angiotensin system blockers, and the degree of control over blood pressure was not equal. All of these factors may have altered the relationship between cystatin c and cardiac mass in some way.Limitations of the studyThe low number of patients included in the study may have influenced the results that were obtained, particularly in the lack of association observed between cystatin C levels and different cardiovascular risk factors, including inflammatory status and oxidative stress.In conclusion, in advanced CKD cystatin C levels are closely related to the parameters of renal function. On the contrary, inflammatory status, oxidative stress, cardiac mass and other cardiovascular risk factors do not determine the serum levels of this protein.<a href="grande/19518078_t1_p230.jpg" class="elsevierStyleCrossRefs"><img src="19518078_t1_p230.jpg" alt="Patient Demographic characteristics"></img></a>Table 1. Patient Demographic characteristics<a href="grande/19518078_t2_p231.jpg" class="elsevierStyleCrossRefs"><img src="19518078_t2_p231.jpg" alt="Cystatin C, renal function and cardiovascular risk factors"></img></a>Table 2. Cystatin C, renal function and cardiovascular risk factors<a href="grande/19518078_t3_p232.jpg" class="elsevierStyleCrossRefs"><img src="19518078_t3_p232.jpg" alt="Cystatin C, inflammation, and oxidative status"></img></a>Table 3. Cystatin C, inflammation, and oxidative status<a href="grande/19518078_t4_p232.jpg" class="elsevierStyleCrossRefs"><img src="19518078_t4_p232.jpg" alt="Multiple logistic regression analysis with cystatin C as an independent variable"></img></a>Table 4. Multiple logistic regression analysis with cystatin C as an independent variable" "pdfFichero" => "P-E-S-A195-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440041" "palabras" => array:1 [ 0 => "factores de riesgo" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440043" "palabras" => array:1 [ 0 => "enfermedad renal crónica" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440045" "palabras" => array:1 [ 0 => "paraoxonasa-1" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440047" "palabras" => array:1 [ 0 => "estrés oxidativo" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440049" "palabras" => array:1 [ 0 => "inflamación" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440051" "palabras" => array:1 [ 0 => "Cistatina C" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440042" "palabras" => array:1 [ 0 => "risk factors" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440044" "palabras" => array:1 [ 0 => "chronic kidney disease" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440046" "palabras" => array:1 [ 0 => "paraoxonase-1" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440048" "palabras" => array:1 [ 0 => "oxidative stress" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440050" "palabras" => array:1 [ 0 => "inflammation" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440052" "palabras" => array:1 [ 0 => "Cystatin C" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "La cistatina C es un marcador de función renal y predictor de morbi-mortalidad cardiovascular. En la población general, la cistatina C está condicionada por diversos factores independientes de la función renal, pero es poco conocido qué factores se relacionan con esta proteína en fases avanzadas de la enfermedad renal crónica (ERC). Pacientes y métodos: se estudian 52 pacientes no diabéticos (38 hombres, edad media 49 años) en diferentes estadíos de ERC (22 en estadío 3, 25 en estadío 4 y 5 en estadío 5), en los que se determinaron los niveles de cistatina C, filtrado glomerular estimado (MDRD), estado inflamatorio (PCR, IL-6 y fibrinógeno), estrés oxidativo [anticuerpos anti-LDL oxidada, actividad y concentración de paraoxonasa-1 (PON-1)], masa ventricular izquierda (ecocardiograma) y otros factores de riesgo cardiovascular. Resultados: los niveles medios de cistatina C fueron de 2.35±0.9 mg/L. La cistatina C se correlacionó con los niveles séricos de creatinina, filtrado glomerular estimado, niveles de PTH y negativamente con los anticuerpos anti-LDL oxidada. Por el contrario, no se encontró ninguna relación entre esta proteína y los marcadores de inflamación, la actividad y concentración de PON, los niveles de colesterol y sus fracciones, triglicéridos, proteinuria, masa ventricular izquierda ni parámetros demográficos como edad, índice de masa corporal (IMC) o tensión arterial. En un análisis de regresión múltiple, después de ajustar por los niveles de PTH y anticuerpos anti-LDL oxidada, sólo el filtrado glomerular estimado se relacionó independientemente con los niveles de cistatina C (β=-0.500, p=0.001). Conclusión: en pacientes no diabéticos con ERC prediálisis, los niveles de cistatina C están estrechamente relacionados con el grado de disfunción renal. El estado inflamatorio, el estrés oxidativo, la masa cardíaca y otros factores de riesgo cardiovascular no son determinantes de los niveles de cistatina C en fases avanzadas de la ERC. Palabras clave: Cistatina C, inflamación, estrés oxidativo, paraoxonasa-1, factores de riesgo, enfermedad renal crónica." ] "en" => array:1 [ "resumen" => "Cystatin C is a marker of renal function and a major cardiovascular risk factor. In the general population, cystatin C appears to be influenced by factors other than renal function alone. However, information for serum cystatin C levels in chronic kidney disease (CKD) is lacking. Methods: We studied 52 nondiabetic patients (38 men, mean age 49 years) with CKD stage 3 (22), 4 (25) or 5 (5) who had measurements of serum cystatin C levels, estimated glomerular filtration rate (MDRD), inflammatory (C-reactive protein, interleukin-6 and fibrinogen), and oxidative markers (anti-oxidized LDL antibodies, serum paraoxonase-1 activity and concentration), left ventricular mass index by echocardiography and other cardiovascular risk factors. Results: Mean cystatin C levels were 2.35 ± 0.9 mg/l. Cystatin C was positively correlated with creatinine serum levels, estimated glomerular filtration rate, PTH levels and negatively with anti-oxidized LDL antibodies. On the other hand, cystatin C was not related to inflammatory markers, serum paraoxonase-1 activity and concentration, proteinuria, HDL or LDL cholesterol, serum triglycerides, left ventricular mass index or demographic factors such as age, body mass index and blood pressure. After adjustment for PTH levels and anti- oxidized LDL antibodies, only estimated glomerular filtration rate was independently related serum cystatin C levels (β = -0.500, p = 0.001). Conclusion: In nondiabetic patients with CKD, cystatin C is closely related to the degree of renal dysfunction. In contrast, inflammatory state, oxidative stress, left ventricular mass index and other cardiovascular risk factors are not related to cystatin C levels in this population." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "19518078_t1_p230.jpg" "Alto" => 461 "Ancho" => 827 "Tamanyo" => 72440 ] ] "descripcion" => array:1 [ "en" => "Patient Demographic characteristics" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "19518078_t2_p231.jpg" "Alto" => 306 "Ancho" => 827 "Tamanyo" => 42135 ] ] "descripcion" => array:1 [ "en" => "Cystatin C, renal function and cardiovascular risk factors" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "19518078_t3_p232.jpg" "Alto" => 133 "Ancho" => 827 "Tamanyo" => 22873 ] ] "descripcion" => array:1 [ "en" => "Cystatin C, inflammation, and oxidative status" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "19518078_t4_p232.jpg" "Alto" => 188 "Ancho" => 400 "Tamanyo" => 14251 ] ] "descripcion" => array:1 [ "en" => "Multiple logistic regression analysis with cystatin C as an independent variable" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tenstad O, Roald AB, Grubb A, Auckland K. Renal handling of radiolabelled human cystatin C in the rat. Scand J Clin Lab Invest 1996;56:409-414. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8869663" 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" => "Fliser D, Ritz E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001;37:79-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11136171" 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" => "Herget-Rosenthal S, Trabold S, Pietruck F, Holtmann M, Philipp T, Kribben A. Cystatin C: efficacy as screening test for reduce glomerular filtration rate. Am J Nephrol 2000; 20:97-102 <a href="http://www.ncbi.nlm.nih.gov/pubmed/10773608" 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" => "Jernberg T, Lindahal B, James S, Larsson A, Hansson LO, Wallentin L. Cystatin C: A novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary síndrome. Circulation 2004;110:2342-2348. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15477399" 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" => "Shilpak MG, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and mortality in elderly persons with heart failure, J Am Coll Cardiol 2005;45:268-271. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15653026" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005; 352:2049-2060. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15901858" 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" => "Sarnak MJ, Katz R, Stehman-Breen CO, Fried LF, Jenny NS, Psaty BM, Newman AB, Siscovick DS, Schlipak MG. Cystatin C concentration as a risk factor for heart failure in older adults. Ann Intern Med 2005;142:497-505. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15809461" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shlipak MG, Wassel FCL, Chertow GM, Harris TB, Kritchevsky SB, Tylavsky FA, Satterfield S, Cummings SR, Newman AB, Fried LF. Cystatin C and mortality risk in the elderly: The health, aging and body composition study. J Am Soc Nephrol 2006;17:254-261. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16267155" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, Seliger SL, Kestenbaum B, Psaty B, Tracy RP, Siscovick DS. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 2006;145:237-246. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16908914" 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" => "Menon V, Shlipak MG, Wang X, Coresh J, Greene T, Stevens L, Kusek JW, Beck GJ, Collins AJ, Levey AS, Sarnak MJ. Cystatin C as a risk factor for outcomes in chronic kidney disease. Ann Intern Med 2007;147:19-27. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17606957" 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" => "Newman DJ, Takkar H, Edwards RG, Wlikie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney Int 1995;47:312-318. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7731163" 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" => "Coll E, Botey A, Alvarez L, Poch E, Quinto L, Taurina A, Vera M, Piera C, Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000;36:29-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10873868" 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" => "Knight EL, Verhave JC, Spiegelman D, Hillege HL, De Zeeuw D, Curhan GC, De Jong PE. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004;65:1416-1421. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15086483" 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" => "Köttgen A, Selvin E, Stevens LA, Levey AS, Van Lente F, Coresh J. Serum cystatin C in the United States: The Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2008;51:385-394. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18295054" 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" => "Macdonald J, Marcora S, Jibani M, Roberts G, Kumwenda M, Glover R, Barron J, Lemmey A. GFR estimation using Cystatin C is not independent of body composition. Am J Kidney Dis 2006;48:712-719. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17059990" 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" => "de Boer IH, Astor BC, Kramer H, Palmas W, Seliger SL, Shlipak MG, Siscovick DS, Tsai MY, Kestenbaum B. Lipoprotein abnormalities associated with mild impairment of kidney function in the Multi-Ethnic study of atherosclerosis. Clin J Am Soc Nephrol 2008;3:125-132. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18057305" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Servais A, Giral P, Bernard M, Bruckert E, Deray G, Bagnis CI. Is serum cystatin C a reliable marker for metabolic syndrome?. Am J Med 2008; 121:426-432. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18456039" 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" => "Peralta CA, Whooley MA, Ix JH, Shlipak MG. Kidney function and systolic blood pressure. New insights from cystatin C: Data from the Heart and Soul Study. Am J Hypertens 2006;19.939-946. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16942937" 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" => "Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HAJ, Zanchetti A. 2007 Guidelines for the management of arterial hypertension. Eur Heart J 2007; 28:1462-1536. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17562668" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ferre N, Camps J, Prats E, Vilella E, Paul A, Figuera L, Joven J. Serum paraoxonase activity: a new additional test for the improved evaluation of chronic liver damage. Clin Chem 2002 ; 48:261-268. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11805006" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Abbott CA, Mackness MI, Kumar S, Boulton AJ, Durrington PN. Serum paraoxonase activity, concentration, and phenotype distribution in diabetes mellitus and its relationship to serum lipids and lipoproteins. Arterioscler Thromb Vasc Biol 1995 ;15:1812-1818. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7583560" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group. Ann Intern Med 1999; 130:461-470." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Erlandsen EJ, Randers E, Kristensen JH. Evaluation of the Dade Behring N Latex Cystatin C assay on the Dade Behring Nephelometer II system. Scand J Clin Lab invest 1999; 59:1-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10206092" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schiller NB, Shah PM, Crawford M, De Maria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahna D, Schnittger I, Silverman NH, Tajik AJ. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-367." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Devereux RB, Reicheck N. Echocardiographic determination of left ventricular mass in men: anatomic validation of the method. Circulation 1977; 55:613-618. <a href="http://www.ncbi.nlm.nih.gov/pubmed/138494" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, Lee ET, Devereux RB; Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Stydy. Am J Hypertens 2005;18:191-196. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15752946" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shlipak MG, Katz R, Cushman M, Sarnak MJ, Stehman-Breen C, Psaty BM, Siscovick DS, Tracy RP, Newman A, Fried L. Cystatin C and inflammatory markers in the ambulatory elderly. Am J Med 2005;118:1416.e25-1416.e31 . <a href="http://www.ncbi.nlm.nih.gov/pubmed/16378799" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Keller CR, Odden MC, Fried LF, Newman AB, Angleman S, Green CA, Cummings SR, Harris TB, Shlipak MG. Kidney function and markers of inflammation in elderly persons without chronic kidney disease: The Health, aging and body composition study. Kidney Int 2007;71:239-244. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17183246" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Singh D, Whooley MA, Ix JH, Ali S, Shlipak MG. Association of cystatin C and estimated GFR with inflammatory biomarkers: The Heart and Sould Study. Nephrol Dial Tranplant 2007;22:1087-1092." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yilmaz MI, Carrero JJ, Axelsson J, Lindholm B, Stenvinkel P. Low-grade inflammation in chronic kidney disease patients before the start of renal replacement therapy: sources and consequences. Clin Nephrol 2007;68:1-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17703829" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Owen WF, Lowrie EG. C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 1998;54:627-636. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9690231" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Landray MJ, Wheeler DC, Lip GYH, Newman DJ, Blann AD, McGlynn FJ, Ball S, Townend JN, Baigent C. Inflammation, endothelial dysfunction, and platelet activitation in patients with chronic kidney disease: The Chroni Renal Impairment in Birmingham(CRIB) Study. Am J Kidney Dis 2004; 43:244-253. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14750089" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Oberg BP, McMenamin E, Lucas FL, McMonagle E, Morrow J, Ikizler TA, Himmelfarb J. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004;65:1009-1016. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14871421" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, Kusek JW, Collins AJ, Levey AS, Sarnak MJ. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005; 68:766-772. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16014054" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Annuk M, Fellström B, Akerblom O, Zilmer K, Vihalemn T, Zilmer M. Oxidative stress markers in pre-uremic patients. Clin Nephrol 2001;56:308-314. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11680661" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Locatelli F, Canaud B, Eckardt KU, Stenvinkel P, Wanner C, Zoccali C. Oxidative stress in end-stage renal disease. An emerging threat to patient outcome. Nephrol Dial Transplant 2003;18:1272-1280. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12808161" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vaziri ND. Oxidative stress in uremia: Nature, mechanisms, and potencial consequences. Semin Nephrol 2004;25:469-473." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shoenfeld Y, Wu R, Dearing LD, Matsuura E. Are anti-oxidized low-density lipoprotein antibodies pathogenic or protective?, Circulation 2004;110:2552-2558." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shoji T, Fukumoto M, Kimono E, Shinohara K, Emoto M, Tahara H, Koyama H, Ishimura E, Nakatani T, Miki T, Tsujimoto Y, Tabata T, Nishizawa Y. Antibody to oxidized low-densitiy lipoprotein and cardiovascular mortality in end-stage renal disease. Kidney Int 2002;62:2230-2237. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12427150" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Maggi E, Bellazi R, Gazo A, Seccia M, Bellomo G. Autoantibodies against oxidatively-modified LDL in uremic patients undergoing dialysis. Kidney Int 1994;46:869-876. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7996809" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yilmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T, Aydin A, Eyileten T, Ozcan O, Acikel C, Tasar M, Genctoy G, Erbil K, Vural A, Zoccali C. The determinants of endotelial dysfunction in CKD: oxidative stress and asymmetric dimethylarginine. Am J Kidney Dis 2005;47:42-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16377384" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watson AD, Berliner JA, Hama SY, LaDu BN, Faull KF, Fogelman AM, Navab M. Protective effect of high density lipoprotein associated paraoxonase. Inhibition of the biological activity of minimally oxidized low density lipoprotein. J Clin Invest 1995;96:2882-2891. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8675659" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Paragh G, Seres I, Valgo Z, Varga Z, Kárpáti I, Mátyus J, Ujhelyi L, Kakuk G. The serum paraoxonase activity in patients with chronic renal failure and hyperlipidemia. Nephron 1998;80:166-170. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9736814" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Paragh G, Asztalos L, Seres I, Valgo Z, Löcsey L, Kárpáti I, Mátyus J, Katona E, Harangi M, Kakuk G. Serum paraoxonase activity changes in uremia and kidney-transplanted patients. Nephron 1999;83:126-131. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10516491" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Suehiro T, Ikeda Y, Shiinoki T, Inoue M, Kumon Y, Tiara T, Hashimoto K. Serum paraoxonase(PON1) concentration in patients undergoing hemodialysis. J Atheroscler Thromb 2002;9:133-138. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12226554" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ikeda Y, Suehiro T, Tiara T, INRI Y, Chikazawa H, Inoue M, Arii K, Hashimoto K. Human serum paraoxonase concentration predicts cardiovascular mortality in hemodialysis patients. Clin Nephrol 2007;67:358-365. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17598371" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watanabe S, Okura T, liu J, Miyoshi K, Fukuoka T, Hiwada K, Higaki J. Serum cystatin C level is a marker of end-organ damage in patients with essential hypertension. Hypertens Res 2003;26:895-899. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14714581" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 47 => array:3 [ "identificador" => "bib48" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Prats M, Font R, Bardají A, Gutierrez C, Lalana M, Vilanova A, Martinez-Vea A. Cystatin C, cardiac hypertrophy and diastolic dysfunction in hypertensive patients with normal renal function. Rev Esp Cardiol (in press)." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 48 => array:3 [ "identificador" => "bib49" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ix JH, Shlipak MG, Chertow GM, Ali S, Schiller NB, Whooley MA. Cystatin C, left ventricular hypertrophy and diastolic dysfunction: data from the Heart and Soul Study. J Cardiac Fail 2006;12:601-607." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 49 => array:3 [ "identificador" => "bib50" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. 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EXISTE RELACIÓN ENTRE LOS NIVELES DE CISTATINA C Y EL ESTADO INFLAMATORIO, EL ESTRÉS OXIDATIVO Y OTROS FACTORES DE RIESGO CARDIOVASCULAR EN PACIENTES NO DIABÉTICOS CON ENFERMEDAD RENAL CRÓNICA?

R.. Fonta, M.. Pratsa, Alberto Martínez Veaa, C.. Gutiérrezb, A.. Bardajíc, M.. Lalanad, J.. Marsillache, J.. Campse

a Servicio de Nefrología, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España,

b Unidad de Investigación, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España,

c Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España,

d Servicio de Análisis Clínicos, Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira i Virgili, Tarragona, Tarragona, España,

e 5Centro de Investigación Biomédica, Hospital Sant Joan de Reus, Reus, Tarragona, España,

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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Cystatin C is a non-glycosylated&#44; low molecular weight protein that is produced by nucleated cells at a constant rate&#46;</p><p class="elsevierStylePara">It is filtered through the glomerulus and reabsorbed and degraded at the tubular level&#44; without being reabsorbed into the plasma and without undergoing a tubular secretion process&#46;<span class="elsevierStyleSup">1</span> This protein is considered to be a better renal function marker than serum creatinine&#44; particularly in the elderly and in patients with moderate kidney dysfunction&#46;<span class="elsevierStyleSup">2&#44;3</span> Epidemiological studies have shown&#44; based on equations derived from creatinine&#44; that cystatin C is better than creatinine or glomerular filtrate as a predictive factor for cardiovascular morbidity and mortality&#44;<span class="elsevierStyleSup">4-7</span> especially in elderly patients<span class="elsevierStyleSup">6&#44;8</span> and in the general population with no known CKD&#46;<span class="elsevierStyleSup">9</span> There has also been recent evidence that cystatin C is associated to global and cardiovascular mortality in nondiabetic patients with stage 3-4 CKD&#46;<span class="elsevierStyleSup">10</span> Although it was initially believed that this protein was independent from extra-renal factors&#44;<span class="elsevierStyleSup">2&#44;11&#44;12</span> in recent years it has been shown that cystatin C levels may be conditioned by diverse clinical and demographic factors&#46; In this way&#44; age&#44; sex&#44; body type&#44; lipoprotein anomalies&#44; presence of metabolic syndrome&#44; inflammation&#44; arterial hypertension and other factors have been linked in the general population to serum cystatin C levels&#46;<span class="elsevierStyleSup">13-18</span> On the contrary&#44; it is not well known what extrarenal factors are related to levels of this protein in pre-dialysis patients with CKD&#46;</p><p class="elsevierStylePara">The aim of our study was the evaluation of the relationship existing between cystatin C levels and various cardiovascular risk factors&#44; the inflammatory state and oxidative stress in pre-dialysis patients with CKD</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">Prospective transversal study including 52 non-diabetic patients &#40;38 men&#44; 14 women&#41; ranging in age from 30 to 60 years&#44; and with serum creatinine levels between 2 and 8mg&#47;dl&#46; Patients were chosen from those receiving outpatient services at the Nephrology Department at the Joan XXIII University Hospital in Tarragona&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methodology</span></p><p class="elsevierStylePara">For all patients&#44; we proceeded to&#58;</p><p class="elsevierStylePara">1&#46; Determine the demographic&#44; clinical and therapeutic variables&#44; including BMI and blood pressure&#44; which was measured with an automatic oscillometric monitor &#40;OMRON 705 CP&#44; Healthcare GMBH&#44; Hamburg&#44; Germany&#41; on the seated patient following five minutes of repose&#44; according to the recommendations of the European Societies of Hypertension and Cardiology&#46;<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara">2&#46; Determine conventional analysis factors&#44; including glycaemia&#44; total cholesterol&#44; high density cholesterol &#40;HDL&#41;&#44; low density cholesterol &#40;LDL&#41;&#44; triglycerides&#44; albumin&#44; haemoglobin and fibrinogen&#46;</p><p class="elsevierStylePara">3&#46; Determine the urinary excretion of proteins in urine over 24 hours using the turbidimetric method &#40;Modular DP Hitachi&#44; Roche&#41;&#44; with a chemical reagent for precipitation&#46;</p><p class="elsevierStylePara">4&#46; Determine the oxidative state markers&#46; Paraoxonase&#58; the calculation for serum PON-1 activity is determined by the hydrolysed paraoxonase value at 410mm and 37&#186;C&#46;<span class="elsevierStyleSup">20</span> The reagent contained 1 mM paraoxonase and 1mM CaCl2 in 0&#46;05M glycine buffer solution &#40;pH&#58; 10&#46;5&#41; and the calculation was made in an Ilab 1800 automatic analyser &#40;Instrumentation Laboratory&#44; Milan&#44; Italy&#41; with security measures for manipulating stocks of paraoxonase solution &#40;extraction chamber and protective gloves and mask for the operator&#41;&#46; Paraoxonase activity was expressed in IU&#47;l&#46; Serum PON-1 concentration was determined using the ELISA technique&#46;<span class="elsevierStyleSup">21</span> Antibodies to oxidized LDL&#58; the detection of antibodies against oxidized LDL was carried out using the ELISA technique and the commercial kit IMTEC-ox-LDL-Antibodies &#40;Immunodiagnostika GmbH&#41; with an intra-essay variation coefficient of 4&#46;6&#37; and inter-assay coefficient of 5&#46;8&#37;&#46;</p><p class="elsevierStylePara">5&#46; Determine the renal function parameters&#58; serum creatinine levels &#40;modified colourimetric Jaff&#233; method&#41; and estimated glomerular filtration rate calculated using the abbreviated formula &#40;four variables&#41; derived from the serum creatinine values &#40;MDRD&#41;&#46;<span class="elsevierStyleSup">22</span></p><p class="elsevierStylePara">6&#46; Determine the serum cystatin C levels in serum that had previously been frozen to -70&#186;C after thawing using the particle-enhanced immunonephelometry method &#40;N Latex Cystatin C&#44; BN Dade Behring&#41; in a nephelometer &#40;BNII&#44; Dade Behring&#41;&#46;<span class="elsevierStyleSup">23</span> Reference values ranged from 0&#46;53 to 0&#46;95mg&#47;l&#46; The trial sensitivity was 0&#46;05mg&#47;l&#59; the intra-and inter-assay variation coefficients were under 3&#46;1 and 3&#46;5&#37;&#44; respectively&#46;</p><p class="elsevierStylePara">7&#46; Determine inflammatory markers&#58;high sensitivity interleukin-6 and high-sensitivity C-reactive protein&#46; We used the kit Human IL-6 Quantikine HS High Sensitivity&#44; R&#38;D Systems&#46; The method sensitivity was 0&#46;016pg&#47;ml and the intra- and inter-assay coefficients were less than 7&#46;8 and 9&#46;6&#37; respectively&#46; High-sensitivity C-reactive protein &#40;hsCRP&#41; was determined in serum samples using the immunonephelometry method &#40;N High Sensitivity CRP&#41; in a nephelometer &#40;BNII&#44; Dade Behring&#41;&#46; The sensitivity was 0&#46;175mg&#47;l&#46; The intra- and inter-assay variation coefficients were less than 4&#46;44 and 5&#46;7&#37;&#44; respectively&#46;</p><p class="elsevierStylePara">8&#46; Standard echocardiographic evaluation in 2D and M mode guided by 2D&#44; using Diasonic 700 or 800 Vingmed Sound device &#40;Horten&#44; Norway&#41; with a 3&#46;5 MHz transductor in parasternal longitudinal and transverse views and subcostal apical 2-chamber and 4-chamber views&#46; According to recommendations by the <span class="elsevierStyleItalic">American Society of Echocardiography</span>&#44;<span class="elsevierStyleSup">24</span> we determined the telesystolic and telediastolic diameter of the left ventricle&#44; the thickness of the interventricular septum &#40;IVS&#41; and the thickness of the posterior ventricular wall&#46; The left ventricular mass &#40;LV mass&#41; was calculated using the following formula<span class="elsevierStyleSup">25</span>&#58; MVI&#40;g&#41; &#61; 0&#46;8 x 1&#46;04 &#91;&#40;DTDVI &#43; SIV &#43; PPVI&#41;3&#8211; DTDVI3&#41; &#43; 0&#46;6&#46; The LV mass index was calculated by dividing the LV<span class="elsevierStyleSup">26</span> mass by body height and expressed in g&#47;m&#46;2&#46;7</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara">Statistical analysis was carried out using the SPSS v11&#46;5 program&#46; The values are expressed as the mean &#177; standard deviation for variables with a normal distribution&#46;</p><p class="elsevierStylePara">The hsCRP and IL-6 levels did not present a normal distribution&#44; and were therefore transformed in logarithms for use in the statistical analysis&#46;</p><p class="elsevierStylePara">The single-variable relationship between cystatin C and the different parameters is determined by using Pearson&#8217;s and&#47;or the Spearman correlation coefficient&#46; Multiple linear regression was applied to analyse the relationship between variables&#46; The confidence interval was 95&#37; and differences were considered to be statistically significant at p &#60; 0&#46;05&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">1&#46; Patient characteristics&#58; the demographic&#44; clinical and analytical characteristics are shown in Table 1&#46; All patients had hypertension&#59; 49 were taking antihypertension drugs and 40 were being treated with angiotensin converting enzyme inhibitors and&#47;or angiotensin II receptor antagonists&#46; Sixteen patients were being treated with statin drugs&#46; Twenty-two patients had stage 3 CKD&#44; 25 had stage 4 and five had stage 5&#46; None of the stage-5 patients was on dialysis&#46; The most prevalent cause of CKD was glomerularbased nephropathy &#40;18 patients&#41;&#44; followed by nephropathy of tubulo-interstitial origin and polycystic disease&#44; &#40;15 patients&#41;&#44; vascular origin &#40;9 patients&#41; and unknown in 10 patients&#46;</p><p class="elsevierStylePara">2&#46; Cystatin C&#44; renal function and cardiovascular risk factors&#58; cystatin C levels were 2&#46;35 &#177; 0&#46;9mg&#47;l&#59; no significant differences between men and women were observed&#46; Cystatin C was significantly related to the creatinine&#44; the MDRD and PTH levels&#46; We did not observe any correlation between this protein and age&#44; BMI&#44; blood pressure&#44; proteinuria&#44; total and partial cholesterol&#44; triglycerides&#44; or with the LV mass index &#40;table 2&#41;&#46;</p><p class="elsevierStylePara">3&#46; Cystatin C&#44; inflammation&#44; and oxidative state&#58; cystatin C levels are negatively correlated with antibodies to oxidized LDL&#44; while no correlations were found between PON activity and concentration or between any of the analysed inflammation markers &#40;table 2&#41;&#46; No correlation was observed between HDL and LDL cholesterol levels and the inflammation and oxidation parameters&#46;</p><p class="elsevierStylePara">4&#46; Factors independent from cystatin C levels&#58; in a multiple regression analysis&#44; after having adjusted for PTH and antibodies to oxidized LDL&#44; the estimated glomerular filtration rate was independently related to cystatin C levels &#40;table 3&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Our results show that in middle-aged non-diabetic patients with pre-dialysis CKD&#44; cystatin C levels are closely related to renal function parameters&#44; and that estimated glomerular filtration rate is the most important and independent predictive factor from the levels of that protein&#46; The relationship between cystatin C levels and PTH was dependent on the renal function&#44; since in the multiple regression analysis the relationship disappeared after adjusting for estimated glomerular filtration rate&#46; On the contrary&#44; diverse cardiovascular risk factors such as age&#44; blood pressure&#44; body mass index&#44; total and partial cholesterol levels&#44; triglyceride level and inflammatory status &#8211; all of which have been linked to cystatin C in the general population - showed no relationship in our study&#46; Nor were oxidative state and cardiac mass shown to be linked to this protein&#46; Therefore&#44; in advanced CKD cystatin C levels would be strictly dependant on renal function&#44; and the other extra-renal factors that have traditionally been described in the general population would have a decreasing effect on this protein&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cystatin C and cardiovascular risk factors</span></p><p class="elsevierStylePara">It is well known that cystatin C levels are higher than that estimated glomerular filtration rate derived from serum creatinine as a predictive factor for cardiovascular morbidity and mortality&#46;<span class="elsevierStyleSup">4-7</span> This fact is even more noticeable in elderly patients<span class="elsevierStyleSup">6&#44;8</span> and in patients with estimated glomerular filtration rate higher than 60ml&#47;min&#46;<span class="elsevierStyleSup">9</span> Cystatin C&#8217;s superiority over creatinine as a cardiovascular risk factor in patients known to have CKD has been studied less&#44; as has this protein&#8217;s dependence on various cardiovascular risk factors&#46; In a recent study<span class="elsevierStyleSup">10</span> of non-diabetic patients with stage 3 or 4 CKD which analysed the influence of cystatin C as a global and cardiovascular risk factor&#44; this protein was associated with a higher risk of mortality&#44; as has been similarly observed with serum creatinine or with glomerular filtration rate calculated using iodothalamate&#46; In this study&#44; C cystatin was correlated with BMI&#44; proteinuria&#44; systolic arterial pressure&#44; and inversely correlated with HDL cholesterol levels&#46; However&#44; these correlations were not adjusted for the degree of renal failure&#44; and therefore we cannot exclude a possible influence&#44; per se&#44; of renal failure in some of these correlations&#46;</p><p class="elsevierStylePara">In our study&#44; we found no association between cystatin C and BMI&#44; systolic arterial pressure&#44; HDL cholesterol levels or triglyceride levels&#44; which are all factors that have been related to this protein in the general population&#46;<span class="elsevierStyleSup">13&#44;14</span> The lack of correlation between cystatin C and BMI could probably have been influenced by the different representation of both sexes among the patients included in our study&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cystatin C and inflammatory status</span></p><p class="elsevierStylePara">In the general population&#44; particularly in elderly patients&#44; cystatin C has been correlated with various inflammatory markers&#46;<span class="elsevierStyleSup">27&#44;28</span> In our study we found no relationship between cystatin C and CRP&#44; IL-6&#44; or any other component of inflammatory response&#44; such as albumin or fibrinogen&#46; This relationship is dependent on renal function<span class="elsevierStyleSup">29</span> in some studies&#44; and it has been suggested that cystatin C&#44; as the most sensitive renal function marker&#44; would be better to reflect the well-known association between the inflammatory state that has been described in patients with subclinical renal dysfunction<span class="elsevierStyleSup">29</span> and the characteristic inflammatory state of CKD30 and of patients on dialysis&#46;<span class="elsevierStyleSup">31</span></p><p class="elsevierStylePara">We found no relationship between cystatin C and CRP&#44; IL-6 or any other element of the inflammatory response such as albumin or fibrinogen&#46;</p><p class="elsevierStylePara">These results are similar to those shown by Menon et al&#46;<span class="elsevierStyleSup">10</span> in the above mentioned study of patients found to have CKD&#46; These authors also found no relationship between cystatin C levels and CRP and the association between cystatin C and cardiovascular mortality was independent from the CRP&#46;</p><p class="elsevierStylePara">The discrepancy observed in various studies between the association of CRP and the severity of renal dysfunction<span class="elsevierStyleSup">10&#44;32&#44;33</span> could be due to the fact that the mechanisms in CKD that are responsible for inflammation are not well-defined&#44; and to the presence of various co-morbidities in CKD that also contribute to inflammation in these patients&#46;<span class="elsevierStyleSup">32</span> Inflammation markers are predictors of cardiovascular events and mortality in patients on pre-dialysis and dialysis&#46;<span class="elsevierStyleSup">31&#44;34</span> Nevertheless&#44; the question has been raised of whether inflammation has causal relevance in the morbidity and mortality of this population&#46; This association could be the result of an inverted causality by which the CKD would cause inflammation and&#44; by means of other mechanisms independent from the inflammation&#44; would also cause an increased risk of cardiovascular events&#46; All of this could suggest that the impact of inflammation on cardiovascular risk in CKD&#44; especially for pre-dialysis CKD patients&#44; could be more modest&#46;<span class="elsevierStyleSup">32</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cystatin C and oxidative status</span></p><p class="elsevierStylePara">Various studies have demonstrated that with CKD there is an increase in the oxidative state characterised by an increase in production of products derived from lipid peroxidation and a decrease in anti-oxidant capacity&#46;<span class="elsevierStyleSup">35-37</span> In our study we use two markers to evaluate oxidative status&#58; the antibodies to oxidized LDL and PON&#46; Antibodies to oxidized LDL are atherogenic modulators that have been related to the severity of atherosclerosis and cardiovascular disease&#44;<span class="elsevierStyleSup">38&#44;39</span> and some studies have shown that uraemic patients have higher levels of these antibodies than the general population does&#46;<span class="elsevierStyleSup">40&#44;41</span></p><p class="elsevierStylePara">PON is an esterase&#47;lactonase associated with high-density lipoprotein and which circulates in plasma&#46; It is speculated that it degrades active oxidized lipids&#44; acting like an antioxidant system&#46;<span class="elsevierStyleSup">42</span> The levels of this enzyme are lower in patients with CKD<span class="elsevierStyleSup">43-45</span> and they are a predictive factor that is independent from cardiovascular mortality in this population&#46;<span class="elsevierStyleSup">46</span></p><p class="elsevierStylePara">The relationship between cystatin C and the two oxidative status markers evaluated in our study had not been previously analysed&#46; Our results show that cystatin C is not related with PON activity and concentration&#44; while it is inversely correlated with the level of antibodies to oxidized LDL&#46; Nevertheless&#44; this correlation was dependent upon renal function&#44; since it disappeared when we adjusted for the estimated glomerular filtration rate&#46; In a certain way&#44; these results corroborate the lack of correlation between the severity of the renal failure and the various oxidation markers<span class="elsevierStyleSup">33</span> in CKD patients&#44; although they contradict the close relationship shown by other studies between lipid oxidation markers and various antioxidant systems and the degree of renal failure&#46;<span class="elsevierStyleSup">41</span></p><p class="elsevierStylePara">The controversy that exists between the degree of renal dysfunction and the oxidative state could partly be explained by the scarce number of patients in some studies&#44; the presence of other pro-oxidant factors independent from glomerular filtration in CKD patients&#44; and the complexity of evaluation oxidation in those patients&#46; Many of the markers that are used to evaluate the oxidative state are eliminated by the kidney by tubular transport and metabolism&#44; and not by glomerular filtration&#46;<span class="elsevierStyleSup">33</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cystatin C and cardiac mass</span></p><p class="elsevierStylePara">In patients with essential arterial hypertension&#44; cystatin C is an early marker for lesions on target organs related with hypertension&#44; such as the left ventricular mass&#44; the carotid artery intima-media thickness and microalbuminuria&#46;<span class="elsevierStyleSup">47</span></p><p class="elsevierStylePara">In a study previously carried out by our group on hypertensive patients with normal renal function&#44; cystatin C&#44; unlike creatinine and estimated glomerular filtration rate&#44; was independently related the left ventricular mass index&#44; which suggests that this protein could be an early marker of cardiac hypertrophy in the hypertensive population&#46;<span class="elsevierStyleSup">48</span> In the Heart and Soul<span class="elsevierStyleSup">49</span> study of patients with coronary disease with clinical cardiac failure&#44; cystatin C levels were related to the presence of left ventricular hypertrophy and diastolic dysfunction&#44; and this relationship was closer than that observed with the estimated glomerular filtration rate&#46; We have not found any previous references that evaluate the association between cystatin C and cardiac mass in CKD patients&#46; In our study we could not show any relationship between these two parameters&#44; which was surprising&#44; given that throughout the course of CKD there is a precocious development of left ventricular hypertrophy&#44; and its presence increases as the renal function level decreases&#46;<span class="elsevierStyleSup">50 </span>In our study&#44; the lack of correlation between cystatin C and cardiac mass could be due to the scarce number of patients and the presence of diverse interrelated factors&#44; including high blood pressure and its treatment&#46; All of the patients were hypertensive&#58; most were receiving treatment&#44; 70&#37; were being treated with renin-angiotensin system blockers&#44; and the degree of control over blood pressure was not equal&#46; All of these factors may have altered the relationship between cystatin c and cardiac mass in some way&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Limitations of the study</span></p><p class="elsevierStylePara">The low number of patients included in the study may have influenced the results that were obtained&#44; particularly in the lack of association observed between cystatin C levels and different cardiovascular risk factors&#44; including inflammatory status and oxidative stress&#46;</p><p class="elsevierStylePara">In conclusion&#44; in advanced CKD cystatin C levels are closely related to the parameters of renal function&#46; On the contrary&#44; inflammatory status&#44; oxidative stress&#44; cardiac mass and other cardiovascular risk factors do not determine the serum levels of this protein&#46;</p><p class="elsevierStylePara"><a href="grande&#47;19518078&#95;t1&#95;p230&#46;jpg" class="elsevierStyleCrossRefs"><img src="19518078_t1_p230.jpg" alt="Patient Demographic characteristics"></img></a></p><p class="elsevierStylePara">Table 1&#46; Patient Demographic characteristics</p><p class="elsevierStylePara"><a href="grande&#47;19518078&#95;t2&#95;p231&#46;jpg" class="elsevierStyleCrossRefs"><img src="19518078_t2_p231.jpg" alt="Cystatin C&#44; renal function and cardiovascular risk factors"></img></a></p><p class="elsevierStylePara">Table 2&#46; Cystatin C&#44; renal function and cardiovascular risk factors</p><p class="elsevierStylePara"><a href="grande&#47;19518078&#95;t3&#95;p232&#46;jpg" class="elsevierStyleCrossRefs"><img src="19518078_t3_p232.jpg" alt="Cystatin C&#44; inflammation&#44; and oxidative status"></img></a></p><p class="elsevierStylePara">Table 3&#46; Cystatin C&#44; inflammation&#44; and oxidative status</p><p class="elsevierStylePara"><a href="grande&#47;19518078&#95;t4&#95;p232&#46;jpg" class="elsevierStyleCrossRefs"><img src="19518078_t4_p232.jpg" alt="Multiple logistic regression analysis with cystatin C as an independent variable"></img></a></p><p class="elsevierStylePara">Table 4&#46; Multiple logistic regression analysis with cystatin C as an independent variable</p>"
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        "resumen" => "<p class="elsevierStylePara">La cistatina C es un marcador de funci&#243;n renal y predictor de morbi-mortalidad cardiovascular&#46; En la poblaci&#243;n general&#44; la cistatina C est&#225; condicionada por diversos factores independientes de la funci&#243;n renal&#44; pero es poco conocido qu&#233; factores se relacionan con esta prote&#237;na en fases avanzadas de la enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; Pacientes y m&#233;todos&#58; se estudian 52 pacientes no diab&#233;ticos &#40;38 hombres&#44; edad media 49 a&#241;os&#41; en diferentes estad&#237;os de ERC &#40;22 en estad&#237;o 3&#44; 25 en estad&#237;o 4 y 5 en estad&#237;o 5&#41;&#44; en los que se determinaron los niveles de cistatina C&#44; filtrado glomerular estimado &#40;MDRD&#41;&#44; estado inflamatorio &#40;PCR&#44; IL-6 y fibrin&#243;geno&#41;&#44; estr&#233;s oxidativo &#91;anticuerpos anti-LDL oxidada&#44; actividad y concentraci&#243;n de paraoxonasa-1 &#40;PON-1&#41;&#93;&#44; masa ventricular izquierda &#40;ecocardiograma&#41; y otros factores de riesgo cardiovascular&#46; Resultados&#58; los niveles medios de cistatina C fueron de 2&#46;35&#177;0&#46;9 mg&#47;L&#46; La cistatina C se correlacion&#243; con los niveles s&#233;ricos de creatinina&#44; filtrado glomerular estimado&#44; niveles de PTH y negativamente con los anticuerpos anti-LDL oxidada&#46; Por el contrario&#44; no se encontr&#243; ninguna relaci&#243;n entre esta prote&#237;na y los marcadores de inflamaci&#243;n&#44; la actividad y concentraci&#243;n de PON&#44; los niveles de colesterol y sus fracciones&#44; triglic&#233;ridos&#44; proteinuria&#44; masa ventricular izquierda ni par&#225;metros demogr&#225;ficos como edad&#44; &#237;ndice de masa corporal &#40;IMC&#41; o tensi&#243;n arterial&#46; En un an&#225;lisis de regresi&#243;n m&#250;ltiple&#44; despu&#233;s de ajustar por los niveles de PTH y anticuerpos anti-LDL oxidada&#44; s&#243;lo el filtrado glomerular estimado se relacion&#243; independientemente con los niveles de cistatina C &#40;&#946;&#61;-0&#46;500&#44; p&#61;0&#46;001&#41;&#46; Conclusi&#243;n&#58; en pacientes no diab&#233;ticos con ERC predi&#225;lisis&#44; los niveles de cistatina C est&#225;n estrechamente relacionados con el grado de disfunci&#243;n renal&#46; El estado inflamatorio&#44; el estr&#233;s oxidativo&#44; la masa card&#237;aca y otros factores de riesgo cardiovascular no son determinantes de los niveles de cistatina C en fases avanzadas de la ERC&#46; Palabras clave&#58; Cistatina C&#44; inflamaci&#243;n&#44; estr&#233;s oxidativo&#44; paraoxonasa-1&#44; factores de riesgo&#44; enfermedad renal cr&#243;nica&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">Cystatin C is a marker of renal function and a major cardiovascular risk factor&#46; In the general population&#44; cystatin C appears to be influenced by factors other than renal function alone&#46; However&#44; information for serum cystatin C levels in chronic kidney disease &#40;CKD&#41; is lacking&#46; Methods&#58; We studied 52 nondiabetic patients &#40;38 men&#44; mean age 49 years&#41; with CKD stage 3 &#40;22&#41;&#44; 4 &#40;25&#41; or 5 &#40;5&#41; who had measurements of serum cystatin C levels&#44; estimated glomerular filtration rate &#40;MDRD&#41;&#44; inflammatory &#40;C-reactive protein&#44; interleukin-6 and fibrinogen&#41;&#44; and oxidative markers &#40;anti-oxidized LDL antibodies&#44; serum paraoxonase-1 activity and concentration&#41;&#44; left ventricular mass index by echocardiography and other cardiovascular risk factors&#46; Results&#58; Mean cystatin C levels were 2&#46;35 &#177; 0&#46;9 mg&#47;l&#46; Cystatin C was positively correlated with creatinine serum levels&#44; estimated glomerular filtration rate&#44; PTH levels and negatively with anti-oxidized LDL antibodies&#46; On the other hand&#44; cystatin C was not related to inflammatory markers&#44; serum paraoxonase-1 activity and concentration&#44; proteinuria&#44; HDL or LDL cholesterol&#44; serum triglycerides&#44; left ventricular mass index or demographic factors such as age&#44; body mass index and blood pressure&#46; After adjustment for PTH levels and anti- oxidized LDL antibodies&#44; only estimated glomerular filtration rate was independently related serum cystatin C levels &#40;&#946; &#61; -0&#46;500&#44; p &#61; 0&#46;001&#41;&#46; Conclusion&#58; In nondiabetic patients with CKD&#44; cystatin C is closely related to the degree of renal dysfunction&#46; In contrast&#44; inflammatory state&#44; oxidative stress&#44; left ventricular mass index and other cardiovascular risk factors are not related to cystatin C levels in this population&#46;</p>"
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                  "referenciaCompleta" => "Tenstad O, Roald AB, Grubb A, Auckland K. Renal handling of radiolabelled human cystatin C in the rat. Scand J Clin Lab Invest 1996;56:409-414. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8869663" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Fliser D, Ritz E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001;37:79-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11136171" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Herget-Rosenthal S, Trabold S, Pietruck F, Holtmann M, Philipp T, Kribben A. Cystatin C: efficacy as screening test for reduce glomerular filtration rate. Am J Nephrol 2000; 20:97-102 <a href="http://www.ncbi.nlm.nih.gov/pubmed/10773608" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Jernberg T, Lindahal B, James S, Larsson A, Hansson LO, Wallentin L. Cystatin C: A novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary síndrome. Circulation 2004;110:2342-2348. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15477399" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Shilpak MG, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and mortality in elderly persons with heart failure, J Am Coll Cardiol 2005;45:268-271. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15653026" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005; 352:2049-2060. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15901858" 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" => "Sarnak MJ, Katz R, Stehman-Breen CO, Fried LF, Jenny NS, Psaty BM, Newman AB, Siscovick DS, Schlipak MG. Cystatin C concentration as a risk factor for heart failure in older adults. Ann Intern Med 2005;142:497-505. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15809461" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shlipak MG, Wassel FCL, Chertow GM, Harris TB, Kritchevsky SB, Tylavsky FA, Satterfield S, Cummings SR, Newman AB, Fried LF. Cystatin C and mortality risk in the elderly: The health, aging and body composition study. J Am Soc Nephrol 2006;17:254-261. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16267155" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, Seliger SL, Kestenbaum B, Psaty B, Tracy RP, Siscovick DS. Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 2006;145:237-246. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16908914" 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" => "Menon V, Shlipak MG, Wang X, Coresh J, Greene T, Stevens L, Kusek JW, Beck GJ, Collins AJ, Levey AS, Sarnak MJ. Cystatin C as a risk factor for outcomes in chronic kidney disease. Ann Intern Med 2007;147:19-27. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17606957" 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" => "Newman DJ, Takkar H, Edwards RG, Wlikie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney Int 1995;47:312-318. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7731163" 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" => "Coll E, Botey A, Alvarez L, Poch E, Quinto L, Taurina A, Vera M, Piera C, Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000;36:29-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10873868" 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" => "Knight EL, Verhave JC, Spiegelman D, Hillege HL, De Zeeuw D, Curhan GC, De Jong PE. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004;65:1416-1421. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15086483" 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" => "Köttgen A, Selvin E, Stevens LA, Levey AS, Van Lente F, Coresh J. Serum cystatin C in the United States: The Third National Health and Nutrition Examination Survey (NHANES III). Am J Kidney Dis 2008;51:385-394. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18295054" 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" => "Macdonald J, Marcora S, Jibani M, Roberts G, Kumwenda M, Glover R, Barron J, Lemmey A. GFR estimation using Cystatin C is not independent of body composition. Am J Kidney Dis 2006;48:712-719. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17059990" 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" => "de Boer IH, Astor BC, Kramer H, Palmas W, Seliger SL, Shlipak MG, Siscovick DS, Tsai MY, Kestenbaum B. Lipoprotein abnormalities associated with mild impairment of kidney function in the Multi-Ethnic study of atherosclerosis. Clin J Am Soc Nephrol 2008;3:125-132. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18057305" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Servais A, Giral P, Bernard M, Bruckert E, Deray G, Bagnis CI. Is serum cystatin C a reliable marker for metabolic syndrome?. Am J Med 2008; 121:426-432. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18456039" 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" => "Peralta CA, Whooley MA, Ix JH, Shlipak MG. Kidney function and systolic blood pressure. New insights from cystatin C: Data from the Heart and Soul Study. Am J Hypertens 2006;19.939-946. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16942937" 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" => "Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HAJ, Zanchetti A. 2007 Guidelines for the management of arterial hypertension. Eur Heart J 2007; 28:1462-1536. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17562668" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ferre N, Camps J, Prats E, Vilella E, Paul A, Figuera L, Joven J. Serum paraoxonase activity: a new additional test for the improved evaluation of chronic liver damage. Clin Chem 2002 ; 48:261-268. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11805006" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Abbott CA, Mackness MI, Kumar S, Boulton AJ, Durrington PN. Serum paraoxonase activity, concentration, and phenotype distribution in diabetes mellitus and its relationship to serum lipids and lipoproteins. Arterioscler Thromb Vasc Biol 1995 ;15:1812-1818. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7583560" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group. Ann Intern Med 1999; 130:461-470."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Erlandsen EJ, Randers E, Kristensen JH. Evaluation of the Dade Behring N Latex Cystatin C assay on the Dade Behring Nephelometer II system. Scand J Clin Lab invest 1999; 59:1-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10206092" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schiller NB, Shah PM, Crawford M, De Maria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahna D, Schnittger I, Silverman NH, Tajik AJ. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-367."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Devereux RB, Reicheck N. Echocardiographic determination of left ventricular mass in men: anatomic validation of the method. Circulation 1977; 55:613-618. <a href="http://www.ncbi.nlm.nih.gov/pubmed/138494" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "De Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, Lee ET, Devereux RB; Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Stydy. Am J Hypertens 2005;18:191-196. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15752946" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shlipak MG, Katz R, Cushman M, Sarnak MJ, Stehman-Breen C, Psaty BM, Siscovick DS, Tracy RP, Newman A, Fried L. Cystatin C and inflammatory markers in the ambulatory elderly. Am J Med 2005;118:1416.e25-1416.e31 . <a href="http://www.ncbi.nlm.nih.gov/pubmed/16378799" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Keller CR, Odden MC, Fried LF, Newman AB, Angleman S, Green CA, Cummings SR, Harris TB, Shlipak MG. Kidney function and markers of inflammation in elderly persons without chronic kidney disease: The Health, aging and body composition study. Kidney Int 2007;71:239-244. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17183246" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Singh D, Whooley MA, Ix JH, Ali S, Shlipak MG. Association of cystatin C and estimated GFR with inflammatory biomarkers: The Heart and Sould Study. Nephrol Dial Tranplant 2007;22:1087-1092."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yilmaz MI, Carrero JJ, Axelsson J, Lindholm B, Stenvinkel P. Low-grade inflammation in chronic kidney disease patients before the start of renal replacement therapy: sources and consequences. Clin Nephrol 2007;68:1-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17703829" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Owen WF, Lowrie EG. C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 1998;54:627-636. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9690231" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Landray MJ, Wheeler DC, Lip GYH, Newman DJ, Blann AD, McGlynn FJ, Ball S, Townend JN, Baigent C. Inflammation, endothelial dysfunction, and platelet activitation in patients with chronic kidney disease: The Chroni Renal Impairment in Birmingham(CRIB) Study. Am J Kidney Dis 2004; 43:244-253. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14750089" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Oberg BP, McMenamin E, Lucas FL, McMonagle E, Morrow J, Ikizler TA, Himmelfarb J. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int 2004;65:1009-1016. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14871421" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Menon V, Greene T, Wang X, Pereira AA, Marcovina SM, Beck GJ, Kusek JW, Collins AJ, Levey AS, Sarnak MJ. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005; 68:766-772. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16014054" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Annuk M, Fellström B, Akerblom O, Zilmer K, Vihalemn T, Zilmer M. Oxidative stress markers in pre-uremic patients. Clin Nephrol 2001;56:308-314. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11680661" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Locatelli F, Canaud B, Eckardt KU, Stenvinkel P, Wanner C, Zoccali C. Oxidative stress in end-stage renal disease. An emerging threat to patient outcome. Nephrol Dial Transplant 2003;18:1272-1280. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12808161" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vaziri ND. Oxidative stress in uremia: Nature, mechanisms, and potencial consequences. Semin Nephrol 2004;25:469-473."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shoenfeld Y, Wu R, Dearing LD, Matsuura E. Are anti-oxidized low-density lipoprotein antibodies pathogenic or protective?, Circulation 2004;110:2552-2558."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shoji T, Fukumoto M, Kimono E, Shinohara K, Emoto M, Tahara H, Koyama H, Ishimura E, Nakatani T, Miki T, Tsujimoto Y, Tabata T, Nishizawa Y. Antibody to oxidized low-densitiy lipoprotein and cardiovascular mortality in end-stage renal disease. Kidney Int 2002;62:2230-2237. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12427150" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maggi E, Bellazi R, Gazo A, Seccia M, Bellomo G. Autoantibodies against oxidatively-modified LDL in uremic patients undergoing dialysis. Kidney Int 1994;46:869-876. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7996809" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yilmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T, Aydin A, Eyileten T, Ozcan O, Acikel C, Tasar M, Genctoy G, Erbil K, Vural A, Zoccali C. The determinants of endotelial dysfunction in CKD: oxidative stress and asymmetric dimethylarginine. Am J Kidney Dis 2005;47:42-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16377384" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Watson AD, Berliner JA, Hama SY, LaDu BN, Faull KF, Fogelman AM, Navab M. Protective effect of high density lipoprotein associated paraoxonase. Inhibition of the biological activity of minimally oxidized low density lipoprotein. J Clin Invest 1995;96:2882-2891. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8675659" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
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                  "referenciaCompleta" => "Paragh G, Seres I, Valgo Z, Varga Z, Kárpáti I, Mátyus J, Ujhelyi L, Kakuk G. The serum paraoxonase activity in patients with chronic renal failure and hyperlipidemia. Nephron 1998;80:166-170. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9736814" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Paragh G, Asztalos L, Seres I, Valgo Z, Löcsey L, Kárpáti I, Mátyus J, Katona E, Harangi M, Kakuk G. Serum paraoxonase activity changes in uremia and kidney-transplanted patients. Nephron 1999;83:126-131. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10516491" target="_blank">[Pubmed]</a>"
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                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Suehiro T, Ikeda Y, Shiinoki T, Inoue M, Kumon Y, Tiara T, Hashimoto K. Serum paraoxonase(PON1) concentration in patients undergoing hemodialysis. J Atheroscler Thromb 2002;9:133-138. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12226554" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Ikeda Y, Suehiro T, Tiara T, INRI Y, Chikazawa H, Inoue M, Arii K, Hashimoto K. Human serum paraoxonase concentration predicts cardiovascular mortality in hemodialysis patients. Clin Nephrol 2007;67:358-365. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17598371" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Watanabe S, Okura T, liu J, Miyoshi K, Fukuoka T, Hiwada K, Higaki J. Serum cystatin C level is a marker of end-organ damage in patients with essential hypertension. Hypertens Res 2003;26:895-899. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14714581" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Prats M, Font R, Bardají A, Gutierrez C, Lalana M, Vilanova A, Martinez-Vea A. Cystatin C, cardiac hypertrophy and diastolic dysfunction in hypertensive patients with normal renal function. Rev Esp Cardiol (in press)."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ix JH, Shlipak MG, Chertow GM, Ali S, Schiller NB, Whooley MA. Cystatin C, left ventricular hypertrophy and diastolic dysfunction: data from the Heart and Soul Study. J Cardiac Fail 2006;12:601-607."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996;27:347-354. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8604703" target="_blank">[Pubmed]</a>"
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Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.2009.29.3.5242.en.full

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	7	10	17
2024 October	59	41	100
2024 September	69	54	123
2024 August	84	49	133
2024 July	113	41	154
2024 June	97	41	138
2024 May	88	41	129
2024 April	88	27	115
2024 March	60	22	82
2024 February	63	38	101
2024 January	51	25	76
2023 December	65	27	92
2023 November	49	46	95
2023 October	45	35	80
2023 September	39	36	75
2023 August	40	26	66
2023 July	64	62	126
2023 June	92	37	129
2023 May	85	37	122
2023 April	48	18	66
2023 March	98	25	123
2023 February	60	19	79
2023 January	64	30	94
2022 December	54	26	80
2022 November	52	30	82
2022 October	66	38	104
2022 September	65	25	90
2022 August	71	49	120
2022 July	77	43	120
2022 June	67	26	93
2022 May	66	42	108
2022 April	76	42	118
2022 March	62	49	111
2022 February	72	34	106
2022 January	62	33	95
2021 December	61	46	107
2021 November	62	39	101
2021 October	72	40	112
2021 September	57	45	102
2021 August	59	23	82
2021 July	68	53	121
2021 June	64	21	85
2021 May	78	29	107
2021 April	182	41	223
2021 March	106	29	135
2021 February	131	21	152
2021 January	66	14	80
2020 December	49	9	58
2020 November	70	19	89
2020 October	60	9	69
2020 September	78	11	89
2020 August	75	8	83
2020 July	73	13	86
2020 June	80	7	87
2020 May	93	14	107
2020 April	87	26	113
2020 March	61	15	76
2020 February	77	31	108
2020 January	79	17	96
2019 December	106	22	128
2019 November	79	16	95
2019 October	46	12	58
2019 September	62	18	80
2019 August	60	18	78
2019 July	61	19	80
2019 June	62	9	71
2019 May	57	6	63
2019 April	116	39	155
2019 March	50	15	65
2019 February	26	13	39
2019 January	40	27	67
2018 December	72	28	100
2018 November	83	11	94
2018 October	91	12	103
2018 September	79	11	90
2018 August	45	10	55
2018 July	32	7	39
2018 June	49	11	60
2018 May	42	8	50
2018 April	27	11	38
2018 March	40	8	48
2018 February	26	6	32
2018 January	43	6	49
2017 December	45	10	55
2017 November	32	6	38
2017 October	34	9	43
2017 September	39	8	47
2017 August	28	5	33
2017 July	29	8	37
2017 June	44	4	48
2017 May	45	6	51
2017 April	37	7	44
2017 March	39	4	43
2017 February	33	11	44
2017 January	27	11	38
2016 December	74	13	87
2016 November	86	9	95
2016 October	118	15	133
2016 September	137	8	145
2016 August	197	11	208
2016 July	187	14	201
2016 June	121	0	121
2016 May	124	0	124
2016 April	125	0	125
2016 March	83	0	83
2016 February	126	0	126
2016 January	107	0	107
2015 December	98	0	98
2015 November	75	0	75
2015 October	77	0	77
2015 September	75	0	75
2015 August	62	0	62
2015 July	60	0	60
2015 June	39	0	39
2015 May	45	0	45
2015 April	5	0	5

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