array:21 [
  "pii" => "X2013251409005178"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
  "estado" => "S300"
  "fechaPublicacion" => "2009-02-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2009;29:10-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9128
    "formatos" => array:3 [
      "EPUB" => 268
      "HTML" => 8187
      "PDF" => 673
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509005170"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
      "estado" => "S300"
      "fechaPublicacion" => "2009-02-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:10-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 82790
        "formatos" => array:3 [
          "EPUB" => 265
          "HTML" => 79223
          "PDF" => 3302
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Aporte de calcio en la insuficiencia renal crónica"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "10"
            "paginaFinal" => "12"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Calcium supplements in chronic renal failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "José Luis Teruel, Milagros Fernández Lucas, Nuria Rodríguez Mendiola"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "José Luis"
                "apellidos" => "Teruel"
              ]
              1 => array:2 [
                "nombre" => "Milagros"
                "apellidos" => "Fernández Lucas"
              ]
              2 => array:2 [
                "nombre" => "Nuria"
                "apellidos" => "Rodríguez Mendiola"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409005178"
          "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005178?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005170?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000001/v0_201502091413/X0211699509005170/v0_201502091413/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251409005143"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.1.13.1.en.full.pdf"
    "estado" => "S300"
    "fechaPublicacion" => "2009-02-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:13-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4078
      "formatos" => array:3 [
        "EPUB" => 232
        "HTML" => 3247
        "PDF" => 599
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Transcriptomics illustrate a deadly TRAIL to diabetic nephropathy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "13"
          "paginaFinal" => "19"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La transcriptómica ilustra nuevas vías letales en la nefropatía diabética"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "22618078_f1_p14.jpg"
              "Alto" => 625
              "Ancho" => 399
              "Tamanyo" => 38235
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A. Benito-Martín, A.C. Ucero, B. Santamaría, M.D. Sánchez-Niño, A. Sanz, M.C. Izquierdo, M. Ruiz-Ortega, J. Egido, A. Ortiz, C. Lorz, M. Kretzler, M.P. Rastaldi"
          "autores" => array:12 [
            0 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Benito-Martín"
            ]
            1 => array:2 [
              "Iniciales" => "A.C."
              "apellidos" => "Ucero"
            ]
            2 => array:2 [
              "Iniciales" => "B."
              "apellidos" => "Santamaría"
            ]
            3 => array:2 [
              "Iniciales" => "M.D."
              "apellidos" => "Sánchez-Niño"
            ]
            4 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Sanz"
            ]
            5 => array:2 [
              "Iniciales" => "M.C."
              "apellidos" => "Izquierdo"
            ]
            6 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Ruiz-Ortega"
            ]
            7 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Egido"
            ]
            8 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Ortiz"
            ]
            9 => array:2 [
              "Iniciales" => "C."
              "apellidos" => "Lorz"
            ]
            10 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Kretzler"
            ]
            11 => array:2 [
              "Iniciales" => "M.P."
              "apellidos" => "Rastaldi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509005146"
        "doi" => "10.3265/Nefrologia.2009.29.1.13.1.en.full.pdf"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005146?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005143?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000001/v0_201502091632/X2013251409005143/v0_201502091633/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325140900516X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.1.6.1.en.full.pdf"
    "estado" => "S300"
    "fechaPublicacion" => "2009-02-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2009;29:6-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3218
      "formatos" => array:3 [
        "EPUB" => 234
        "HTML" => 2477
        "PDF" => 507
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Cardiovascular, renal and other chronic diseases. Early intervention is necessary in chronic kidney disease."
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "6"
          "paginaFinal" => "9"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad cardiovascular, enfermedad renal y otras enfermedades crónicas. Es necesaria una intervención más temprana en la enfermedad renal crónica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "AL M de Francisco, L Aguilera, V Fuster"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "AL"
              "apellidos" => "M de Francisco"
            ]
            1 => array:2 [
              "Iniciales" => "L"
              "apellidos" => "Aguilera"
            ]
            2 => array:2 [
              "Iniciales" => "V"
              "apellidos" => "Fuster"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509005162"
        "doi" => "10.3265/Nefrologia.2009.29.1.6.1.en.full.pdf"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005162?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900516X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000001/v0_201502091632/X201325140900516X/v0_201502091632/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Calcium supplements in chronic renal failure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "10"
        "paginaFinal" => "12"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "José Luis Teruel, Milagros Fernández Lucas, Nuria Rodríguez Mendiola"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "José Luis"
            "apellidos" => "Teruel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Milagros"
            "apellidos" => "Fern&#225;ndez Lucas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nuria"
            "apellidos" => "Rodr&#237;guez Mendiola"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => " Hospital Ramón y Cajal, Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Aporte de calcio en la insuficiencia renal cr&#243;nica"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Alteration in calcium-phosphorus metabolism in chronic renal failure &#40;CRF&#41; is one of the fields within Nephrology that has undergone more changes in terms of theoretical concepts&#44; clinical repercussions and treatment objectives&#46; The subsequent opinions have always coincided with the appearance of new therapeutic measures on the market&#46; These are very often completely different to the previous opinions and&#44; at times&#44; emphatically defended by the authors themselves&#46;</p><p class="elsevierStylePara">While phosphorus retention and the importance of its control are concepts that have remained unchanged since their appearance more than 40 years ago&#44; the opinions on the calcium balance in CRF have been less consistent and even controversial&#46; Initial publications highlighted that patients suffering from these diseases had a negative calcium balance due to reduced intestinal absorption&#44; which is dependent on vitamin D&#44; and that poor calcium absorption was one of the causes of secondary hyperparathyroidism<span class="elsevierStyleSup">1&#44;2</span>&#46; The classic book on this subject&#44; published by D&#46;S&#46; David in 1977&#44; indicates that to prevent and treat secondary hyperparathyroidism the negative calcium balance must be corrected via one of the following three procedures&#58; calcium supplements in the diet to bring about passive absorption &#40;which is gradient-dependent&#41;&#59; administration of vitamin D to correct poor calcium absorption&#59; or the transfer of calcium during dialysis using a concentration of calcium in the dialysis solution &#8805; 6mg&#47;dl &#40;3mEq&#47;l&#41;&#46;<span class="elsevierStyleSup">2</span> The author recommended that treatment should be started by administering calcium alkaline salts&#44; which provide the said element and prevent phosphorus retention due to its binding effect on the latter&#46; The oral dose of calcium required to correct the balance increased as the renal failure developed&#44; and depended on whether the other two measures were adopted or not&#58; &#40;use of vitamin D analogues and concentration of calcium in the dialysis solution&#46;&#41;</p><p class="elsevierStylePara">The theory of the existence of a negative calcium balance and the need for its correction to prevent the development of secondary hyperparathyroidism began to lose relevance as attention was being given to the appearance and development of vascular calcification&#46; Current reviews of the pathogenesis of mineral metabolism alterations do not include poor calcium absorption as one of the factors involved in the appearance of secondary hyperparathyroidism&#46;<span class="elsevierStyleSup">3&#44;4</span> Some authors even believe that not only is the calcium balance in CRF not negative&#44; but rather the balance tends to be positive&#44; since decreased urinary excretion of calcium compensates for intestinal absorption&#46;<span class="elsevierStyleSup">5</span> According to this approach the intake of calcium must be controlled&#44; since its retention may contribute to the appearance of vascular calcification&#46;</p><p class="elsevierStylePara">The study group for the K&#47;DOQI Guide on bone metabolism and disease in CRF supports the theory of a positive calcium balance and the control of oral intake to prevent its retention&#46; Recommendations 5&#46;5 and 6&#46;4&#44; which are opinion-based recommendations&#44; advise on reducing the oral intake of calcium up to a maximum of 2000mg&#47;day &#40;500mg&#47;day as dietary content and 1500mg&#47;day as calciumbased phosphorus binders&#41;&#46;<span class="elsevierStyleSup">6</span> The guide of the Spanish Society of Nephrology &#40;<span class="elsevierStyleItalic">Gu&#237;a de la Sociedad Espa&#241;ola de Nefrolog&#237;a</span>&#41;&#44; which has recently been published&#44; adopts the same opinion&#46;<span class="elsevierStyleSup">7&#44;8</span> In all these clinical guides the oral administration of calcium salts is restricted to its phosphorus binding effect&#44; and&#44; under no circumstances&#44; would they be considered as a calcium supplement&#46;</p><p class="elsevierStylePara">It is to be noted that limitations on oral calcium intake is not universally accepted and is a quite controversial subject&#46; Friedman and other nephrologists believe that tests relating oral calcium supplements to vascular calcification are very weak and they defend the use of calcium-based binders in doses greater than the limit established in the guides&#46;<span class="elsevierStyleSup">9&#44;10</span> This opinion is supported by a recent experimental study in which it was stated that not only did calcium carbonate not increase vascular calcifications but rather reduced these in apolipoprotein E deficient mice with CRF&#46;<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">Regardless of the controversy relating to the calcium balance in CRF and its possible influence on the appearance of vascular calcifications&#44; the practical problem lies in ascertaining whether it is possible to control secondary hyperparathyroidism without administering a calcium supplement&#44; as David suggested more than 30 years ago&#46; There would be very few dialysis patients not receiving oral calcium supplements or vitamin D analogues or not using a concentration of calcium in the dialysis solution &#8805; 3mEq&#47;l&#46; The three measures provide calcium to the organism and increase its concentration in the blood&#46; However&#44; it appears the scientific community is only concerned about the oral supplement&#44; since it is the only calcium intake subject to control&#46; Is it only the calcium absorbed passively in the intestine theoretically able to cause vascular calcifications&#63; Is this not caused by calcium absorption resulting from vitamin D analogues or the calcium supply transferred directly to the blood after each dialysis session when a concentration of calcium of 3mEq&#47;l is used in the dialysis solution&#44; as recommended by the Spanish Society of Nephrology &#40;<span class="elsevierStyleItalic">SEN</span>&#41; Guide&#63; There is no simple and reliable procedure to indicate the intake of calcium supplied by each of the above-mentioned procedures&#44; nor which part of this calcium supply is deposited in the osseous and extra osseous tissues&#46; The concentration of calcium in the blood does not indicate the calcium balance&#46; However&#44; it is the only parameter available to adjust the different treatments&#46; Furthermore&#44; daily practice indicates that the oral intake reduction of calcium salts to the doses recommended by the clinical guides in patients who are or are not treated with calcimimetics&#44; must be counterbalanced with the administration of vitamin D analogues or a concentration of calcium in the dialysis solution &#8805; 3mEq&#47;l&#44; to prevent hypocalcaemia and control PTH synthesis and secretion&#46; Are these measures more reassuring than the increased oral dose of calcium salts&#63; Is it better to keep a high PTH concentration rather than increasing the calcium supplement&#63; It must be noted that some experimental studies suggest that vitamin D itself can induce vascular calcifications&#44;<span class="elsevierStyleSup">12&#44;13</span> and that the development of vascular calcifications has been associated to the calcium transferred in each haemodialysis session when a solution with a concentration of 3mEq&#47;l is used<span class="elsevierStyleSup">14</span> and that hyperparathyroidism is another factor implicated in the calcium storage in the vessel wall&#46;<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara">In 1989&#44; Slatopolsky et al&#46;<span class="elsevierStyleSup">16</span> published that the administration of high doses of a calcium alkaline salt associated with a concentration of calcium of 2&#46;5mEq&#47;l in the dialysis solution&#44; without vitamin D analogues&#44; facilitates the control of serum concentrations of phosphorus and PTH with low risk of causing hypercalcaemia&#46; This is the basic treatment regime followed in our Haemodialysis Unit for alterations in the metabolism of calcium-phosphorus since 1993&#44; with an average oral intake of calcium of 3&#46;5g&#47;day&#46;<span class="elsevierStyleSup">17</span> If this regime is not successful in adequately controlling serum concentrations of phosphorus and PTH&#44; other phosphorus binders or calcimimetics are added respectively&#46; Vitamin D analogues are retained for the third level of treatment after calcimimetics&#44; in case of hypocalcaemia not controllable with oral calcium supplements are used&#44; or persistent hyperparathyroidism with concentrations of phosphorus and calcium in normal ranges&#46;</p><p class="elsevierStylePara">In our opinion&#44; clinical practice shows that the control of secondary hyperparathyroidism in chronic renal failure requires calcium intake via one of the three procedures indicated by David in 1977&#46; If it is proved that calcium intake is one of the causes of vascular calcifications&#44; the importance of this factor compared to uncontrolled hyperparathyroidism regarding calcium storage should be determined&#44; as well as the less harmful administration method&#58; oral supplements&#44; increased intestinal absorption induced by vitamin D analogues or the transfer of calcium directly to the blood in dialysis sessions&#46; In the mean time&#44; we prefer to keep using the regime put forward by Slatopolsky 20 years ago&#46;</p>"
    "pdfFichero" => "P-E-S-A224-EN.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "1.-Avioli LV, Teitelbaum SL: The renal osteodystrophies. En The Kidney. Brenner BM, Rector FC (editores). W.B. Saunders Company, Philadelphia, 1976, pp 1542-1591."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2.-David DS: Mineral and Bone Homeostasis in Renal Failure: Pathophysiology and Management. En: Calcium Metabolism in Renal Failure and Nephrolithiasis. David DS (editor). John Wiley & Sons, Inc, New York, 1977, pp1-76."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3.-Henrich WL: Pathogenesis of renal osteodystrophy.UpToDate 2008. http://www.uptodate.com/."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4.-Goto S, Komaba H, Fukagawa M: Pathophysiology of parathyroid hyperplasia in chronic kidney disease: preclinical and clinical basis for parathyroid intervention. Nephrol Dial Transplant 2008; 1 (Suppl 3): iii2 ¿ iii8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710035436"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5.-Moe SM, Chertow GM: The case against calcium-based phosphate binders. Clin J Am Soc Nephrol 2006; 1: 697-703. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17699275" 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" => "6.-K/DOQI, NFK: Clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42 (Suppl 3): S1-S201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14520607" 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" => "7.-Guías SEN: Recomendaciones de la Sociedad Española de Nefrología para el Manejo de las Alteraciones del Metabolismo Óseo-mineral en los Pacientes con Enfermedad Renal Crónica. Nefrología 2008: 28 (Supl 1): 1-22."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.- Lorenzo Sellares V, Torregrosa V: Alteraciones del metabolismo mineral en la enfermedad renal crónica estadios III, IV y V (no en diálisis). En Guía SEN de Enfermedad Renal Crónica Avanzada y Pre-diálisis. Nefrología 2008: 28 (Supl 3): 67-78. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19018742" 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" => "9.-Friedman EA: Calcium-based phosphate binders are appropriate in chronic renal failure. Clin J Am Soc Nephrol 2006; 1: 704-709. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17699276" 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" => "10.-Shahapuni I, Mansour J, Harbouche L, Maouad B, Benyahia M, Rahmouni K, Oprisiu R, Bonne JF, Monge M, El Esper N, Presne C, Moriniere P, Choukroun G, Fournier A: How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? Seminars in Dialysis 2005; 18: 226-238."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "11.-Phan O, Ivanovski O, Nikoloy IG, Joki N, Maizel J, Louvet L, Chasseraud M, Nguyen-Khoa T, Lacour B, Drüeke TB, Massy ZA: Effect of oral calcium carbonate on aortic calcification in apolipoprotein E-deficient (apo E -/-) mice with chronic renal failure. Nephrol Dial Transplant 2008; 23: 82-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17977878" 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" => "12.-Jono S, Nishizawa Y, Shioi A, Morii H: 1,25-Dihydroxyvitamin D3 increases in vitro vascular calcification by modulating secretion of endogenous parathyroid hormone-related peptide. Circulation 1998; 98: 1302-1306."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "13.-Henley C, Colloton M, Cattley RC, Shatzen E, Towler DA, Lacey D, Martin D: 1,25-Dihydroxyvitamin D3 but not cinacalcet HCl (Sensipar/Mimpara) treatment mediates aortic calcification in a rat model of secondary hyperparathyroidism. Nephrol Dial Transplant 2005; 20: 1370-1377."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14.-Yamada K, Fujimoto S, Nishiura R, Komatsu H, Tatsumoto M, Sato Y, Hara S, Hisanaga S, Ochiai H, Nakao H, Eto T: Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant 2007; 22: 2032-2037. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17395663" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710000902"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "15.- Moe SM, Chen NX: Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol 2008; 19: 213-216. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18094365" 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" => "16.-Slatopolsky E, Weerts C, Norwood K, Giles K, Fryer P, Finch J, Windus D, Delmez: Long-term effects of calcium carbonate and 2.5 mEq/liter calcium dialysate on mineral metabolism. Kidney Int 1989; 36: 897-903. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2615197" 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" => "17.-Teruel JL, Tenorio MT, Rodríguez JR, Marcén R, Orofino L, Rivera M, Ortuño J: Treatment of secondary hyperparathyroidism in hemodialyzed patients with high-dose calcium carbonate without vitamin D3. Am J Nephrol 1999; 19: 428-432. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10393383" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000001/v0_201502091632/X2013251409005178/v0_201502091633/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35429"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000001/v0_201502091632/X2013251409005178/v0_201502091633/en/P-E-S-A224-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005178?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Calcium supplements in chronic renal failure
Aporte de calcio en la insuficiencia renal crónica
José Luis Teruela, Milagros Fernández Lucasa, Nuria Rodríguez Mendiolaa
a Hospital Ramón y Cajal, Madrid, Madrid, España,
Read
25592
Times
was read the article
2712
Total PDF
22880
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251409005178"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
  "estado" => "S300"
  "fechaPublicacion" => "2009-02-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:10-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 9128
    "formatos" => array:3 [
      "EPUB" => 268
      "HTML" => 8187
      "PDF" => 673
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699509005170"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
      "estado" => "S300"
      "fechaPublicacion" => "2009-02-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2009;29:10-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 82790
        "formatos" => array:3 [
          "EPUB" => 265
          "HTML" => 79223
          "PDF" => 3302
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Aporte de calcio en la insuficiencia renal cr&#243;nica"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "10"
            "paginaFinal" => "12"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Calcium supplements in chronic renal failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Jos&#233; Luis Teruel, Milagros Fern&#225;ndez Lucas, Nuria Rodr&#237;guez Mendiola"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Jos&#233; Luis"
                "apellidos" => "Teruel"
              ]
              1 => array:2 [
                "nombre" => "Milagros"
                "apellidos" => "Fern&#225;ndez Lucas"
              ]
              2 => array:2 [
                "nombre" => "Nuria"
                "apellidos" => "Rodr&#237;guez Mendiola"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251409005178"
          "doi" => "10.3265/Nefrologia.2009.29.1.10.1.en.full.pdf"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005178?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005170?idApp=UINPBA000064"
      "url" => "/02116995/0000002900000001/v0_201502091413/X0211699509005170/v0_201502091413/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251409005143"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.1.13.1.en.full.pdf"
    "estado" => "S300"
    "fechaPublicacion" => "2009-02-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:13-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4078
      "formatos" => array:3 [
        "EPUB" => 232
        "HTML" => 3247
        "PDF" => 599
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Transcriptomics illustrate a deadly TRAIL to diabetic nephropathy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "13"
          "paginaFinal" => "19"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La transcript&#243;mica ilustra nuevas v&#237;as letales en la nefropat&#237;a diab&#233;tica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "22618078_f1_p14.jpg"
              "Alto" => 625
              "Ancho" => 399
              "Tamanyo" => 38235
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A. Benito-Mart&#237;n, A.C. Ucero, B. Santamar&#237;a, M.D. S&#225;nchez-Ni&#241;o, A. Sanz, M.C. Izquierdo, M. Ruiz-Ortega, J. Egido, A. Ortiz, C. Lorz, M. Kretzler, M.P. Rastaldi"
          "autores" => array:12 [
            0 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Benito-Mart&#237;n"
            ]
            1 => array:2 [
              "Iniciales" => "A.C."
              "apellidos" => "Ucero"
            ]
            2 => array:2 [
              "Iniciales" => "B."
              "apellidos" => "Santamar&#237;a"
            ]
            3 => array:2 [
              "Iniciales" => "M.D."
              "apellidos" => "S&#225;nchez-Ni&#241;o"
            ]
            4 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Sanz"
            ]
            5 => array:2 [
              "Iniciales" => "M.C."
              "apellidos" => "Izquierdo"
            ]
            6 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Ruiz-Ortega"
            ]
            7 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "Egido"
            ]
            8 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Ortiz"
            ]
            9 => array:2 [
              "Iniciales" => "C."
              "apellidos" => "Lorz"
            ]
            10 => array:2 [
              "Iniciales" => "M."
              "apellidos" => "Kretzler"
            ]
            11 => array:2 [
              "Iniciales" => "M.P."
              "apellidos" => "Rastaldi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509005146"
        "doi" => "10.3265/Nefrologia.2009.29.1.13.1.en.full.pdf"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005146?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005143?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000001/v0_201502091632/X2013251409005143/v0_201502091633/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325140900516X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.2009.29.1.6.1.en.full.pdf"
    "estado" => "S300"
    "fechaPublicacion" => "2009-02-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2009;29:6-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3218
      "formatos" => array:3 [
        "EPUB" => 234
        "HTML" => 2477
        "PDF" => 507
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Cardiovascular&#44; renal and other chronic diseases&#46; Early intervention is necessary in chronic kidney disease&#46;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "6"
          "paginaFinal" => "9"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad cardiovascular&#44; enfermedad renal y otras enfermedades cr&#243;nicas&#46; Es necesaria una intervenci&#243;n m&#225;s temprana en la enfermedad renal cr&#243;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "AL M de Francisco, L Aguilera, V Fuster"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "AL"
              "apellidos" => "M de Francisco"
            ]
            1 => array:2 [
              "Iniciales" => "L"
              "apellidos" => "Aguilera"
            ]
            2 => array:2 [
              "Iniciales" => "V"
              "apellidos" => "Fuster"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699509005162"
        "doi" => "10.3265/Nefrologia.2009.29.1.6.1.en.full.pdf"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509005162?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325140900516X?idApp=UINPBA000064"
    "url" => "/20132514/0000002900000001/v0_201502091632/X201325140900516X/v0_201502091632/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Calcium supplements in chronic renal failure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "10"
        "paginaFinal" => "12"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Jos&#233; Luis Teruel, Milagros Fern&#225;ndez Lucas, Nuria Rodr&#237;guez Mendiola"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "Teruel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Milagros"
            "apellidos" => "Fern&#225;ndez Lucas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Nuria"
            "apellidos" => "Rodr&#237;guez Mendiola"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => " Hospital Ramón y Cajal, Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Aporte de calcio en la insuficiencia renal cr&#243;nica"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Alteration in calcium-phosphorus metabolism in chronic renal failure &#40;CRF&#41; is one of the fields within Nephrology that has undergone more changes in terms of theoretical concepts&#44; clinical repercussions and treatment objectives&#46; The subsequent opinions have always coincided with the appearance of new therapeutic measures on the market&#46; These are very often completely different to the previous opinions and&#44; at times&#44; emphatically defended by the authors themselves&#46;</p><p class="elsevierStylePara">While phosphorus retention and the importance of its control are concepts that have remained unchanged since their appearance more than 40 years ago&#44; the opinions on the calcium balance in CRF have been less consistent and even controversial&#46; Initial publications highlighted that patients suffering from these diseases had a negative calcium balance due to reduced intestinal absorption&#44; which is dependent on vitamin D&#44; and that poor calcium absorption was one of the causes of secondary hyperparathyroidism<span class="elsevierStyleSup">1&#44;2</span>&#46; The classic book on this subject&#44; published by D&#46;S&#46; David in 1977&#44; indicates that to prevent and treat secondary hyperparathyroidism the negative calcium balance must be corrected via one of the following three procedures&#58; calcium supplements in the diet to bring about passive absorption &#40;which is gradient-dependent&#41;&#59; administration of vitamin D to correct poor calcium absorption&#59; or the transfer of calcium during dialysis using a concentration of calcium in the dialysis solution &#8805; 6mg&#47;dl &#40;3mEq&#47;l&#41;&#46;<span class="elsevierStyleSup">2</span> The author recommended that treatment should be started by administering calcium alkaline salts&#44; which provide the said element and prevent phosphorus retention due to its binding effect on the latter&#46; The oral dose of calcium required to correct the balance increased as the renal failure developed&#44; and depended on whether the other two measures were adopted or not&#58; &#40;use of vitamin D analogues and concentration of calcium in the dialysis solution&#46;&#41;</p><p class="elsevierStylePara">The theory of the existence of a negative calcium balance and the need for its correction to prevent the development of secondary hyperparathyroidism began to lose relevance as attention was being given to the appearance and development of vascular calcification&#46; Current reviews of the pathogenesis of mineral metabolism alterations do not include poor calcium absorption as one of the factors involved in the appearance of secondary hyperparathyroidism&#46;<span class="elsevierStyleSup">3&#44;4</span> Some authors even believe that not only is the calcium balance in CRF not negative&#44; but rather the balance tends to be positive&#44; since decreased urinary excretion of calcium compensates for intestinal absorption&#46;<span class="elsevierStyleSup">5</span> According to this approach the intake of calcium must be controlled&#44; since its retention may contribute to the appearance of vascular calcification&#46;</p><p class="elsevierStylePara">The study group for the K&#47;DOQI Guide on bone metabolism and disease in CRF supports the theory of a positive calcium balance and the control of oral intake to prevent its retention&#46; Recommendations 5&#46;5 and 6&#46;4&#44; which are opinion-based recommendations&#44; advise on reducing the oral intake of calcium up to a maximum of 2000mg&#47;day &#40;500mg&#47;day as dietary content and 1500mg&#47;day as calciumbased phosphorus binders&#41;&#46;<span class="elsevierStyleSup">6</span> The guide of the Spanish Society of Nephrology &#40;<span class="elsevierStyleItalic">Gu&#237;a de la Sociedad Espa&#241;ola de Nefrolog&#237;a</span>&#41;&#44; which has recently been published&#44; adopts the same opinion&#46;<span class="elsevierStyleSup">7&#44;8</span> In all these clinical guides the oral administration of calcium salts is restricted to its phosphorus binding effect&#44; and&#44; under no circumstances&#44; would they be considered as a calcium supplement&#46;</p><p class="elsevierStylePara">It is to be noted that limitations on oral calcium intake is not universally accepted and is a quite controversial subject&#46; Friedman and other nephrologists believe that tests relating oral calcium supplements to vascular calcification are very weak and they defend the use of calcium-based binders in doses greater than the limit established in the guides&#46;<span class="elsevierStyleSup">9&#44;10</span> This opinion is supported by a recent experimental study in which it was stated that not only did calcium carbonate not increase vascular calcifications but rather reduced these in apolipoprotein E deficient mice with CRF&#46;<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">Regardless of the controversy relating to the calcium balance in CRF and its possible influence on the appearance of vascular calcifications&#44; the practical problem lies in ascertaining whether it is possible to control secondary hyperparathyroidism without administering a calcium supplement&#44; as David suggested more than 30 years ago&#46; There would be very few dialysis patients not receiving oral calcium supplements or vitamin D analogues or not using a concentration of calcium in the dialysis solution &#8805; 3mEq&#47;l&#46; The three measures provide calcium to the organism and increase its concentration in the blood&#46; However&#44; it appears the scientific community is only concerned about the oral supplement&#44; since it is the only calcium intake subject to control&#46; Is it only the calcium absorbed passively in the intestine theoretically able to cause vascular calcifications&#63; Is this not caused by calcium absorption resulting from vitamin D analogues or the calcium supply transferred directly to the blood after each dialysis session when a concentration of calcium of 3mEq&#47;l is used in the dialysis solution&#44; as recommended by the Spanish Society of Nephrology &#40;<span class="elsevierStyleItalic">SEN</span>&#41; Guide&#63; There is no simple and reliable procedure to indicate the intake of calcium supplied by each of the above-mentioned procedures&#44; nor which part of this calcium supply is deposited in the osseous and extra osseous tissues&#46; The concentration of calcium in the blood does not indicate the calcium balance&#46; However&#44; it is the only parameter available to adjust the different treatments&#46; Furthermore&#44; daily practice indicates that the oral intake reduction of calcium salts to the doses recommended by the clinical guides in patients who are or are not treated with calcimimetics&#44; must be counterbalanced with the administration of vitamin D analogues or a concentration of calcium in the dialysis solution &#8805; 3mEq&#47;l&#44; to prevent hypocalcaemia and control PTH synthesis and secretion&#46; Are these measures more reassuring than the increased oral dose of calcium salts&#63; Is it better to keep a high PTH concentration rather than increasing the calcium supplement&#63; It must be noted that some experimental studies suggest that vitamin D itself can induce vascular calcifications&#44;<span class="elsevierStyleSup">12&#44;13</span> and that the development of vascular calcifications has been associated to the calcium transferred in each haemodialysis session when a solution with a concentration of 3mEq&#47;l is used<span class="elsevierStyleSup">14</span> and that hyperparathyroidism is another factor implicated in the calcium storage in the vessel wall&#46;<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara">In 1989&#44; Slatopolsky et al&#46;<span class="elsevierStyleSup">16</span> published that the administration of high doses of a calcium alkaline salt associated with a concentration of calcium of 2&#46;5mEq&#47;l in the dialysis solution&#44; without vitamin D analogues&#44; facilitates the control of serum concentrations of phosphorus and PTH with low risk of causing hypercalcaemia&#46; This is the basic treatment regime followed in our Haemodialysis Unit for alterations in the metabolism of calcium-phosphorus since 1993&#44; with an average oral intake of calcium of 3&#46;5g&#47;day&#46;<span class="elsevierStyleSup">17</span> If this regime is not successful in adequately controlling serum concentrations of phosphorus and PTH&#44; other phosphorus binders or calcimimetics are added respectively&#46; Vitamin D analogues are retained for the third level of treatment after calcimimetics&#44; in case of hypocalcaemia not controllable with oral calcium supplements are used&#44; or persistent hyperparathyroidism with concentrations of phosphorus and calcium in normal ranges&#46;</p><p class="elsevierStylePara">In our opinion&#44; clinical practice shows that the control of secondary hyperparathyroidism in chronic renal failure requires calcium intake via one of the three procedures indicated by David in 1977&#46; If it is proved that calcium intake is one of the causes of vascular calcifications&#44; the importance of this factor compared to uncontrolled hyperparathyroidism regarding calcium storage should be determined&#44; as well as the less harmful administration method&#58; oral supplements&#44; increased intestinal absorption induced by vitamin D analogues or the transfer of calcium directly to the blood in dialysis sessions&#46; In the mean time&#44; we prefer to keep using the regime put forward by Slatopolsky 20 years ago&#46;</p>"
    "pdfFichero" => "P-E-S-A224-EN.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "1.-Avioli LV, Teitelbaum SL: The renal osteodystrophies. En The Kidney. Brenner BM, Rector FC (editores). W.B. Saunders Company, Philadelphia, 1976, pp 1542-1591."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2.-David DS: Mineral and Bone Homeostasis in Renal Failure: Pathophysiology and Management. En: Calcium Metabolism in Renal Failure and Nephrolithiasis. David DS (editor). John Wiley & Sons, Inc, New York, 1977, pp1-76."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3.-Henrich WL: Pathogenesis of renal osteodystrophy.UpToDate 2008. http://www.uptodate.com/."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4.-Goto S, Komaba H, Fukagawa M: Pathophysiology of parathyroid hyperplasia in chronic kidney disease: preclinical and clinical basis for parathyroid intervention. Nephrol Dial Transplant 2008; 1 (Suppl 3): iii2 ¿ iii8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710035436"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5.-Moe SM, Chertow GM: The case against calcium-based phosphate binders. Clin J Am Soc Nephrol 2006; 1: 697-703. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17699275" 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" => "6.-K/DOQI, NFK: Clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42 (Suppl 3): S1-S201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14520607" 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" => "7.-Guías SEN: Recomendaciones de la Sociedad Española de Nefrología para el Manejo de las Alteraciones del Metabolismo Óseo-mineral en los Pacientes con Enfermedad Renal Crónica. Nefrología 2008: 28 (Supl 1): 1-22."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8.- Lorenzo Sellares V, Torregrosa V: Alteraciones del metabolismo mineral en la enfermedad renal crónica estadios III, IV y V (no en diálisis). En Guía SEN de Enfermedad Renal Crónica Avanzada y Pre-diálisis. Nefrología 2008: 28 (Supl 3): 67-78. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19018742" 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" => "9.-Friedman EA: Calcium-based phosphate binders are appropriate in chronic renal failure. Clin J Am Soc Nephrol 2006; 1: 704-709. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17699276" 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" => "10.-Shahapuni I, Mansour J, Harbouche L, Maouad B, Benyahia M, Rahmouni K, Oprisiu R, Bonne JF, Monge M, El Esper N, Presne C, Moriniere P, Choukroun G, Fournier A: How do calcimimetics fit into the management of parathyroid hormone, calcium, and phosphate disturbances in dialysis patients? Seminars in Dialysis 2005; 18: 226-238."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "11.-Phan O, Ivanovski O, Nikoloy IG, Joki N, Maizel J, Louvet L, Chasseraud M, Nguyen-Khoa T, Lacour B, Drüeke TB, Massy ZA: Effect of oral calcium carbonate on aortic calcification in apolipoprotein E-deficient (apo E -/-) mice with chronic renal failure. Nephrol Dial Transplant 2008; 23: 82-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17977878" 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" => "12.-Jono S, Nishizawa Y, Shioi A, Morii H: 1,25-Dihydroxyvitamin D3 increases in vitro vascular calcification by modulating secretion of endogenous parathyroid hormone-related peptide. Circulation 1998; 98: 1302-1306."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "13.-Henley C, Colloton M, Cattley RC, Shatzen E, Towler DA, Lacey D, Martin D: 1,25-Dihydroxyvitamin D3 but not cinacalcet HCl (Sensipar/Mimpara) treatment mediates aortic calcification in a rat model of secondary hyperparathyroidism. Nephrol Dial Transplant 2005; 20: 1370-1377."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14.-Yamada K, Fujimoto S, Nishiura R, Komatsu H, Tatsumoto M, Sato Y, Hara S, Hisanaga S, Ochiai H, Nakao H, Eto T: Risk factors of the progression of abdominal aortic calcification in patients on chronic haemodialysis. Nephrol Dial Transplant 2007; 22: 2032-2037. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17395663" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710000902"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "15.- Moe SM, Chen NX: Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol 2008; 19: 213-216. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18094365" 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" => "16.-Slatopolsky E, Weerts C, Norwood K, Giles K, Fryer P, Finch J, Windus D, Delmez: Long-term effects of calcium carbonate and 2.5 mEq/liter calcium dialysate on mineral metabolism. Kidney Int 1989; 36: 897-903. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2615197" 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" => "17.-Teruel JL, Tenorio MT, Rodríguez JR, Marcén R, Orofino L, Rivera M, Ortuño J: Treatment of secondary hyperparathyroidism in hemodialyzed patients with high-dose calcium carbonate without vitamin D3. Am J Nephrol 1999; 19: 428-432. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10393383" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002900000001/v0_201502091632/X2013251409005178/v0_201502091633/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35429"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000001/v0_201502091632/X2013251409005178/v0_201502091633/en/P-E-S-A224-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409005178?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 19 11 30
2024 October 124 30 154
2024 September 184 42 226
2024 August 143 57 200
2024 July 162 36 198
2024 June 180 57 237
2024 May 181 47 228
2024 April 139 35 174
2024 March 140 28 168
2024 February 170 40 210
2024 January 157 37 194
2023 December 182 27 209
2023 November 200 37 237
2023 October 229 45 274
2023 September 217 39 256
2023 August 189 29 218
2023 July 167 28 195
2023 June 233 28 261
2023 May 188 45 233
2023 April 148 18 166
2023 March 181 24 205
2023 February 143 26 169
2023 January 182 19 201
2022 December 157 30 187
2022 November 173 32 205
2022 October 177 43 220
2022 September 236 54 290
2022 August 213 50 263
2022 July 147 31 178
2022 June 199 31 230
2022 May 201 54 255
2022 April 223 39 262
2022 March 272 54 326
2022 February 279 47 326
2022 January 302 40 342
2021 December 279 50 329
2021 November 300 38 338
2021 October 311 60 371
2021 September 357 55 412
2021 August 308 38 346
2021 July 303 45 348
2021 June 329 38 367
2021 May 339 32 371
2021 April 843 66 909
2021 March 545 33 578
2021 February 434 29 463
2021 January 416 34 450
2020 December 398 20 418
2020 November 370 31 401
2020 October 247 17 264
2020 September 310 19 329
2020 August 313 26 339
2020 July 285 14 299
2020 June 300 23 323
2020 May 291 29 320
2020 April 369 27 396
2020 March 380 19 399
2020 February 460 27 487
2020 January 412 29 441
2019 December 415 31 446
2019 November 376 42 418
2019 October 381 17 398
2019 September 401 24 425
2019 August 343 24 367
2019 July 379 46 425
2019 June 304 12 316
2019 May 260 25 285
2019 April 361 31 392
2019 March 353 38 391
2019 February 182 22 204
2019 January 143 21 164
2018 December 202 29 231
2018 November 206 16 222
2018 October 252 7 259
2018 September 186 13 199
2018 August 123 17 140
2018 July 91 11 102
2018 June 92 8 100
2018 May 87 13 100
2018 April 82 6 88
2018 March 71 11 82
2018 February 47 2 49
2018 January 35 9 44
2017 December 39 12 51
2017 November 46 4 50
2017 October 55 12 67
2017 September 58 18 76
2017 August 37 18 55
2017 July 44 19 63
2017 June 34 4 38
2017 May 41 5 46
2017 April 37 7 44
2017 March 18 3 21
2017 February 17 4 21
2017 January 14 6 20
2016 December 64 9 73
2016 November 65 10 75
2016 October 73 4 77
2016 September 117 3 120
2016 August 183 4 187
2016 July 189 6 195
2016 June 99 0 99
2016 May 107 0 107
2016 April 92 0 92
2016 March 73 0 73
2016 February 80 0 80
2016 January 75 0 75
2015 December 95 0 95
2015 November 85 0 85
2015 October 71 0 71
2015 September 56 0 56
2015 August 65 0 65
2015 July 50 0 50
2015 June 41 0 41
2015 May 47 0 47
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

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

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