Role played by peritoneal dialysis in treating refractory heart failure
Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardiaca refractaria
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Montejo, M.ª Auxiliadora Bajo Rubio, G. del Peso, R. Selgas" "autores" => array:4 [ 0 => array:3 [ "Iniciales" => "J.D." "apellidos" => "Montejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "M.ª Auxiliadora" "apellidos" => "Bajo Rubio" "email" => array:1 [ 0 => "mabajo.hulp@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "G." "apellidos" => "del Peso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "R." "apellidos" => "Selgas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario La Paz. REDinREN (RETICS, Red 06/0016, Instituto de Salud Carlos III). Instituto Reina Sofía de Investigaciones Nefrológicas, Madrid, Madrid, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardiaca refractaria" ] ] "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" => "1020418078_t1_pag22.jpg" "Alto" => 241 "Ancho" => 827 "Tamanyo" => 43778 ] ] "descripcion" => array:1 [ "en" => "Heart failure classification" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">HF is a chronic progressive disorder with increasing incidence and prevalence due to the aging of the population and innovation in the treatment of patients with coronary and hypertensive pathologies, which are its principal causes. HF is one of the major causes of morbidity and mortality in the general population and it is responsible for high rates of hospitalisation and readmission;<span class="elsevierStyleSup">1</span> in spite of the advances made in its treatment, the overall mortality rate at 8 years reaches 80%.<span class="elsevierStyleSup">2</span> Among treatment strategies, diuretics are the most useful tools for eliminating excess fluids. However, heart failure refractory to conventional treatment (RHF) is an increasing pathology.<span class="elsevierStyleSup">1</span> HF is a public health problem and its worldwide prevalence is estimated at 23 million people. In the USA. it affects 2.3% of the population with increased incidence among the elderly.<span class="elsevierStyleSup">2,3</span> In Europe the prevalence in patients between 70 and 80 years of age is 10-20% and in Spain it is the main cause of hospitalisation in people over 65.<span class="elsevierStyleSup">4,5</span> Every year in the USA some 550,000 new cases are diagnosed; in 2003 it was the cause of one million hospital admissions and 57,000 deaths and its cost in 2005 was 27.9 billion dollars.<span class="elsevierStyleSup">2,3,6</span> RHF is not uncommon: it is estimated that in the USA between 50,000 and 200,000 patients have the condition and their survival rate is less than 50% at 6 months.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Renal dysfunction is a common pathology in HF patients</span>, with a prevalence of 36-50% and up to 25% of patients with CKD are diagnosed with HF, a figure that rises to 64% among patients who start dialysis.<span class="elsevierStyleSup">8-10</span> Furthermore, episodes of acute deterioration of renal function are often observed during the decompensation stages of HF.<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">HEART FAILURE. CLASSIFICATION, PHYSIOPATHOLOGY AND PROGNOSIS FACTORS</span></p><p class="elsevierStylePara">HF is a consequence of diverse diseases that affect cardiac tissue. There are two classification scales: that of the New York Heart Association (NYHA), which is based on symptoms and physical activity, and that designed by the American College of Cardiology/American Heart Association (ACC/AHA), based on structural abnormalities of the cardiac tissue (Table 1).<span class="elsevierStyleSup">4,12</span></p><p class="elsevierStylePara">Diverse haemodynamic, neurohormonal and immunological mechanisms participate in the physiopathology of HF that also affect renal function.<span class="elsevierStyleSup">2</span> The coexistance of HF and CKD is deleterious for both and it is associated with accelerated atherosclerosis, alteration in the regulation of intravascular volume and inadequate compensation of regulatory mechanisms, which finally leads to morbidity and mortality.<span class="elsevierStyleSup">13</span> Both share a common group of risk factors such as arterial hypertension (AH), diabetes mellitus (DM) and atherosclerosis.<span class="elsevierStyleSup">14</span> In HF the triggering factor is low cardiac output which leads to activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), alteration in the nitric oxide balance and release of antidiuretic hormone. All of these produce systemic vasoconstriction and the retention of sodium and water (antinatriuretic and antidiuretic effects). The latter causes progressive volume overload, contributes to the major symptoms referred by patients, unleashes the main cause of hospitalisation and has an effect on the progression of HF.<span class="elsevierStyleSup">15</span> Moreover, diverse inflammatory factors participate in the progressive damage to renal and cardiac tissue.<span class="elsevierStyleSup">9</span> Low cardiac output implies low renal perfusion and, in addition, the pharmacological treatment used in HF with diuretics and RAAS inhibitors may worsen renal function, especially during HF decompensation episodes or with previous renal dysfunction.<span class="elsevierStyleSup">6,16</span> Cardiorenal syndrome (CRS) appears, due to the worsening of HF and leads to renal failure (RF) causing hydric overload, resistance to the effect of diuretics and, finally, the development of HF refractory to treatment.<span class="elsevierStyleSup">1</span> There are two situations which favour renal resistance to the diuretic effect: the state of hypervolaemia secondary to the retention of liquids and sodium, and azotaemia secondary to renal hypoperfusion.<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">TREATMENT OF HEART FAILURE</span></p><p class="elsevierStylePara">There are a number of alternatives for the treatment of HF. Figure 1 shows the objectives of the therapy. Standard therapy includes RAAS antagonists, beta-blockers, conventional diuretics and digitalic drugs. One of the fundamental pillars in the treatment of HF is the control of sodium and water balance. 80% of hospitalisations in HF cases are due to acute decompensations and the majority of these patients are admitted for hydric overload, while only 5% admissions are caused by low cardiac output.<span class="elsevierStyleSup">2</span> Many patients respond to standard treatment but the use of diuretics is not always effective. Mortality for this patient group is close to 75% in the following year.<span class="elsevierStyleSup">5</span> HF is considered terminal in those HF patients who are not candidates for heart transplant and who can only be offered palliative treatment. RHF symptoms are attributed particularly to the retention of sodium and water. Response to diuretics, which oscillates between 65 and 70%,<span class="elsevierStyleSup">17</span> is altered by many factors. Furthermore, some studies have shown an association between some classes of diuretics and mortality. The SOLVD study mentions an association between non potassium-sparing diuretics and an increased risk of hospitalisation and mortality.<span class="elsevierStyleSup">18</span> The challenge in the treatment of RHF patients to improve symptoms, reduce continuous hospitalisation and try to prolong survival has led to the development of new therapies to enhance myocardial contractility (inotropic and vasodilator drugs, resynchronization therapies, mechanical circulatory support, etc.). However, little progress has been made in hydric overload, the principal cause of symptoms in these patients. Refractoriness to diuretic treatment has led to the use of new strategies for the excretion and/or elimination of excess sodium and water and here is where nephrology can play a fundamental role.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">ALTERNATIVE TREATMENTS TO IMPROVE THE EXCRETION OF SODIUM AND WATER</span></p><p class="elsevierStylePara">Among alternative treatments are the use of vasopressin receptor antagonists and ultrafiltration (UF) techniques.<span class="elsevierStyleSup">19,20</span></p><p class="elsevierStylePara">Vasopressin receptor antagonists (<span class="elsevierStyleItalic">vaptans</span>), whose pharmacological aim is to inhibit the V2 receptors of the medullary collecting duct segment, seem to be, in theory, an adequate strategy for inducing aqueous diuresis, reducing hydric overload and improving hyponatraemia. There are studies that have shown its usefulness in weight loss, hyponatraemia correction and mortality reduction.<span class="elsevierStyleSup">14</span> In contrast, in the EVEREST study of more than 4,000 recruited patients, which compared patients treated with tolvaptan in addition to standard treatment against patients receiving only standard treatment, no differences were observed in morbidity and mortality (improvement in functional class, reduction in hospital readmissions, reduction in mortality).<span class="elsevierStyleSup">21</span></p><p class="elsevierStylePara">Natriuretic peptides, in theory, induce vasodilation, natriuresis and RAAS suppression and SNS inhibition and among those assayed are recombinant brain natriuretic peptide (nesiritide) and ularitide (urodilatin). In the case of nesiritide, a meta-analysis has shown no theoretical benefit in the improvement of renal function and, in fact, it shows an increase in mortality.<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ULTRAFILTRATION TECHNIQUES</span></p><p class="elsevierStylePara">The national register of decompensated HF cites that 42% of patients are discharged without resolving their symptomatology and up to 70% with inadequate weight loss, which produces high rates of hospital readmission.<span class="elsevierStyleSup">9,22</span> This situation has led to the use of UF techniques, including peritoneal dialysis (PD), in acute and chronic situations to eliminate excess fluids. Extracorporeal UF was proposed by Silverstein in 1974 as a modification of the haemodialysis circuit. Since 1979 several studies have been published using this technique for the treatment of RHF patients.<span class="elsevierStyleSup">23</span> It has been proposed as an alternative treatment method in patients with acute decompensations and a rapid improvement of symptoms, reduction in the rate of readmission, reduction of pulmonary and peripheral oedema, improvement in functional class, restoration of the diuretic response and reduction of circulatory proinflammatory cytokines have been observed.<span class="elsevierStyleSup">2,24-26</span> However, other studies have shown the appearance of frequent episodes of hypotension, an increase in the need for diuretic treatment, lack of renal function recovery, anaemia and catheter-associated infections.<span class="elsevierStyleSup">2,24</span> The multicentric (UNLOAD) study, which included 200 acute decompensated HF patients, who were randomly selected to receive intravenous diuretics or early extracorporeal UF, reported a greater reduction in weight and loss of liquids as well as a lower incidence of readmission in the UF group, but no differences were observed in creatinine levels or mortality.<span class="elsevierStyleSup">27</span> There is a portable UF device on the market which can be used even at home with prior training.<span class="elsevierStyleSup">23</span> There is no doubt that extracorporeal UF, despite having no impact on mortality, is an additional tool in the treatment of patients with acute HF decompensation.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PERITONEAL DIALYSIS: AN ALTERNATIVE TREATMENT IN REFRACTORY HEART FAILURE</span></p><p class="elsevierStylePara">PD may be a treatment option for chronic RHF,<span class="elsevierStyleSup">6</span> with some advantages over haemodialysis (HD) in the treatment of these patients, such as greater preservation of residual renal function (RRF), continuous UF, enhanced haemodynamic stability, improved clearance of medium-sized molecules, sodium sieving with maintenance of normonatremia and less systemic inflammation.<span class="elsevierStyleSup">2</span> PD also favours the clearance of inflammatory molecules such as interleukin-1 (IL-1) and tumour necrosis factor (TNF) which play an important role in HF progression (myocardial depressors).<span class="elsevierStyleSup">2,28</span> PD, as a UF technique in RHF, was described by Schneierson<span class="elsevierStyleSup">29</span> in 1949 and has since been used in acute HF decompensations as well as in the ongoing treatment of chronic HF patients. The therapeutic modalities employed have varied from the initial intermittent PD (IPD) to continuous ambulatory PD (CAPD), APD and the use of new solutions such as icodextrin.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Intermittent peritoneal dialysis</span></p><p class="elsevierStylePara">Many publications have reported that treatment with PD in acute decompensated HF patients has resulted in a reduction of pulmonary wedge pressure, restoration of the response to diuretics and even enhanced glomerular filtration.<span class="elsevierStyleSup">6</span> Mailloux, in a group of 15 patients, observed an improvement in the response to diuretics in 12 cases, weight reduction (5.2kg on average) and improved cardiac output.<span class="elsevierStyleSup">30</span> Shapira communicated his experience with 10 patients, observing weight reduction, improved clinical symptoms, increased diuresis with response to diuretics and normalization of sodium levels. These advantages were offset by the necessity for hospital treatment and the high rate of peritonitis by gramnegative bacteria he described.<span class="elsevierStyleSup">31</span> He has also described the appearance of arterial hypotension as a result of rapid UF.<span class="elsevierStyleSup">1</span> Due to the technical difficulties of acute IPD, extracorporeal UF methods are generally preferred as rescue therapy in hospitalised RHF patients who do not respond to diuretics.<span class="elsevierStyleSup">6,32</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Chronic peritoneal dialysis (continuous ambulatory peritoneal dialysis and automated peritoneal dialysis)</span></p><p class="elsevierStylePara">The role of chronic PD in the long term treatment of RHF patients has not been formally evaluated in large clinical studies and the data available up to now are, overall, from small series.<span class="elsevierStyleSup">6</span> The first published cases were RHF and non-terminal CKD patients treated with CAPD.<span class="elsevierStyleSup">33-37</span> The number of patients included was small and the duration of treatment varied between 5 and 24 months. The results were almost unanimous in improved clinical symptoms, functional class and reduction in the frequency of hospitalisation, although a high rate of peritonitis was also observed with no impact on mortality. The use of APD began in the 1990s. Since then, several reports have confirmed clinical improvement, a reduction in the expected mortality at one year, and improved cardiovascular parameters such as ejection fraction (EF) and pulmonary systolic blood pressure.<span class="elsevierStyleSup">2,6,7</span> Table 2 compiles the most important data from these studies in which, in addition, problems related to the technique, such as peritonitis, were significantly reduced.<span class="elsevierStyleSup">7,38-42</span> Gotloib’s prospective study includes the greatest number of patients and his main results are shown in Table 3.<span class="elsevierStyleSup">42</span> In this study, as in the others, patients were initially treated with extracorporeal UF to stabilize them during acute decompensation and they subsequently began chronic PD. This technique has also been used as a bridge for subsequent heart transplant treatment, and even in non-transplant candidates (terminal HF) as palliative treatment.<span class="elsevierStyleSup">43</span> There are currently no studies which compare PD treatment against the non-chronic use of a UF technique.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Opportunities related to icodextrin solution</span></p><p class="elsevierStylePara">Icodextrin is a high molecular weight glucose polymer that generates a prolonged oncotic pressure, which enhances UF during periods of extended stay. The use of icodextrin in PD solutions, compared to glucose solutions, has been associated with reduced generation of glucose degradation products (GDP), less intraperitoneal inflammation, a reduction in systemic glucose absorption, fewer carbohydrate and lipid metabolism alterations and greater UF with longer stays.<span class="elsevierStyleSup">6</span> These characteristics make it the ideal solution for the treatment of RHF, even using a single night exchange,<span class="elsevierStyleSup">1</span> although existing studies are still scarce. Bertoli used a nocturnal exchange with icodextrin in 2 non-uremic patients with NYHA function class III-IV. The daily UF obtained oscillated between 500 and 1,000ml and there was an improvement in functional class, an increase in EF (from 22 to 27% and from 25 to 50%) and better renal function, without the need for hospitalisation during the follow-up period.<span class="elsevierStyleSup">44</span> Díez’s Spanish group has published their experience with 5 patients with RHF and non-terminal CKD. In 3 cases they used a single exchange with icodextrin and in the remaining patients the classic CAPD treatment with nocturnal icodextrin. The follow-up period varied between 5 and 19 months and showed an improvement in the functional class of all patients and a reduction in hospitalisation rate (an average of 139 days/year before the therapy to 12 days/year after starting). One patient’s EF increased from 35 to 45% and two had a reduction in pulmonary systolic pressure, increasing glomerular filtration in one case.<span class="elsevierStyleSup">45</span> More recently, Basile has published his results in 4 patients treated with a single nocturnal icodextrin exchange and one with nocturnal icodextrin plus a 1.36% glucose exchange, with follow-up of between 11 and 43 months. In all cases there was an improvement in functional class and a reduction in hospitalisation, with increased urinary volume in one case. Patients did not develop peritonitis during the follow-up period.<span class="elsevierStyleSup">46</span> In spite of these promising results, only a few reviews of RHF therapy recommend the use of this kind of coadjuvant therapy in the chronic treatment of RHF patients.<span class="elsevierStyleSup">47</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">PROPOSAL FOR FUTURE STUDIES</span></p><p class="elsevierStylePara">In light of evidence-based medicine and in order to draw conclusions that help to answer some of those questions it would be appropriate to initiate several prospective studies in RHF and non-terminal CKD patients:</p><p class="elsevierStylePara">Comparative studies of patients treated with PD against standard treatment evaluating survival, quality of life, morbidity and cost-benefit advantages.</p><p class="elsevierStylePara">Comparative studies of patients treated with PD against standard treatment and observing the impact on baseline diseases: preservation of renal function and delayed HF progression.</p><p class="elsevierStylePara">Comparative studies of patients treated with different PD strategies: daily nocturnal icodextrin and daytime APD with icodextrin, to evaluate the repercussions on morbidity and mortality and complications associated with the technique.</p><p class="elsevierStylePara">Comparative studies of patients treated with PD against the use of new therapeutic strategies in the elimination of liquids (<span class="elsevierStyleItalic">vaptans</span>) and to observe the results of morbidity and mortality and public health costs.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">KEY CONCEPTS</span></p><p class="elsevierStylePara">1. RHF is a frequent situation within the group of HF patients. This situation leads to an important deterioration in functional class with a high rate of hospitalisation due to frequent decompensations.</p><p class="elsevierStylePara">2. HF patients often have associated renal dysfunction that contributes to the refractoriness of diuretic treatment.</p><p class="elsevierStylePara">3. Different PD modalities (CAPD or APD) constitute an adjuvant therapy for the treatment of RHF patients, improving functional class and reducing the rate of hospitalisation.</p><p class="elsevierStylePara">4. PD solutions with icodextrin allow RHF patients to be treated with a single nocturnal exchange, which facilitates treatment and reduces complications associated with the technique.</p><p class="elsevierStylePara"><a href="grande/1020418078_t1_pag22.jpg" class="elsevierStyleCrossRefs"><img src="1020418078_t1_pag22.jpg" alt="Heart failure classification"></img></a></p><p class="elsevierStylePara">Table 1. Heart failure classification</p><p class="elsevierStylePara"><a href="grande/1020418078_f1_pag23.jpg" class="elsevierStyleCrossRefs"><img src="1020418078_f1_pag23.jpg" alt="Treatment objectives in heart failure."></img></a></p><p class="elsevierStylePara">Figure 1. Treatment objectives in heart failure.</p><p class="elsevierStylePara"><a href="grande/1020418078_t2_pag24.jpg" class="elsevierStyleCrossRefs"><img src="1020418078_t2_pag24.jpg" alt="Published studies in which chronic peritoneal dialysis is used in the treatment of congestive heart failure"></img></a></p><p class="elsevierStylePara">Table 2. Published studies in which chronic peritoneal dialysis is used in the treatment of congestive heart failure</p><p class="elsevierStylePara"><a href="grande/1020418078_t3_pag25.jpg" class="elsevierStyleCrossRefs"><img src="1020418078_t3_pag25.jpg" alt="Characteristics of patients with refractory heart failure before and after APD treatment (three weekly sessions of 8 hours)42"></img></a></p><p class="elsevierStylePara">Table 3. Characteristics of patients with refractory heart failure before and after APD treatment (three weekly sessions of 8 hours)42</p>" "pdfFichero" => "P1-E43-S1790-A10204-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437717" "palabras" => array:1 [ 0 => "Icodextrina" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437719" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437721" "palabras" => array:1 [ 0 => "Insuficiencia cardíaca refractaria" ] ] ] "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437718" "palabras" => array:1 [ 0 => "Icodextrin" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437720" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437722" "palabras" => array:1 [ 0 => "Refractory heart failure" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Associated renal and cardiac diseases have a high prevalence among the population in several clinical contexts: acute renal failure in the context of decompensated heart failure (HF), HF patients who develop chronic kidney disease (CKD) and patients with CKD who develop HF. In recent years, cardiorenal syndrome has been described as deteriorating kidney function in the context of HF. However, there are other clinical situations for which nephrologists can contribute their knowledge as a part of an integral treatment strategy, as is the case with refractory HF (RHF). All of these situations require an interdisciplinary cooperative effort between cardiologists and nephrologists with the aim of providing integral treatment. This article aims to review the role of the nephrologist in HF treatment, with an emphasis on the subgroup of patients with RHF and current evidence regarding the usefulness of peritoneal dialysis (PD) as a chronic coadjuvant treatment.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Las patologías renal y cardíaca asociadas son de alta prevalencia en la población en diferentes contextos clínicos: fracaso renal agudo en el contexto de insuficiencia cardíaca (IC) descompensada, pacientes con IC que desarrollan enfermedad renal crónica (ERC) o pacientes con ERC que desarrollan IC. En los últimos años se ha descrito el síndrome cardiorrenal (SCR) como el deterioro de la función renal en el contexto de IC. Sin embargo, existen otras situaciones clínicas en las que la Nefrología puede aportar su conocimiento como parte de la estrategia de tratamiento integral, como es el caso de la IC refractaria (ICR). Todas estas situaciones obligan a un trabajo conjunto interdisciplinario entre cardiólogos y nefrólogos con el fin de proporcionar un tratamiento integral. Este documento pretende hacer una revisión del papel del nefrólogo en el tratamiento de la IC haciendo hincapié en el subgrupo de pacientes con ICR y la evidencia actual de la utilidad de la diálisis peritoneal (DP) como tratamiento crónico coadyuvante.</p>" ] ] "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" => "1020418078_t1_pag22.jpg" "Alto" => 241 "Ancho" => 827 "Tamanyo" => 43778 ] ] "descripcion" => array:1 [ "en" => "Heart failure classification" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1020418078_f1_pag23.jpg" "Alto" => 202 "Ancho" => 827 "Tamanyo" => 20631 ] ] "descripcion" => array:1 [ "en" => "Treatment objectives in heart failure." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1020418078_t2_pag24.jpg" "Alto" => 155 "Ancho" => 830 "Tamanyo" => 31779 ] ] "descripcion" => array:1 [ "en" => "Published studies in which chronic peritoneal dialysis is used in the treatment of congestive heart failure" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1020418078_t3_pag25.jpg" "Alto" => 211 "Ancho" => 830 "Tamanyo" => 36296 ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients with refractory heart failure before and after APD treatment (three weekly sessions of 8 hours)42" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Khalifeh N, Vychytil A, Hörl WH. The role of peritoneal dialysis in the management of treatment-resistant congestive heart failure: A European prospective. Kidney Int 2006;70:S72-S75." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Krisham A, Oreopulos D. Peritoneal dialysis in congestive heart failure. Advances in Peritoneal Dialysis 2007;23:82-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17886609" 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" => "Vasan R, Wilson P. Epidemiology and causes of heart failure. Up To Date 16.3." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dickstein K, Cohen-Solal A, Filippatos G, et al. Treatment of acute and chronic Heart failure 2008. Eur Heart J 2008;29:2388-42." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Crespo M, Paniagua M. Tratamiento de la insuficiencia cardiaca refractaria o avanzada. Rev Esp Cardiol\u{A0} 2004;57:869-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15373993" 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" => "Mehrotra R, Kathuria P. Place of peritoneal dialysis in the management of treatment-resistant congestive heart failure. Kidney Int 2006;70:S67-S71." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kagan A, Rapoport J. The role of peritoneal dialysis in the treatment of refractory heart failure. Nephrol Dial Transplant 2005;(Suppl 7):S28-S31." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rubinger D. Management of refractory congestive heart failure-a nephrological challenge. Nephrol Dial Transplant\u{A0} 2005;(Suppl 7):S37-S40." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Arora N, Dellsperger K. Heart failure and dialysis: New thoughts and trends. Advances in Peritoneal Dialysis 2007;23:72-5." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Silverberg D, Wexler K, Blum M, et al. The association between congestive heart failure and chronic renal disease. Curr Opin Nephrol Hypertens 2004;13:163-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15202610" 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" => "Gotlieb SS, Abraham W, Butler J, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Cardiol Failure 2002;8:136-41." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. Circulation 2001;104:2996-3007. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11739319" 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" => "Klein L, O¿Connor CM, et al. Lower serum sodium is associated with increased short term mortality in hospitalized patients with worsening Heart failure: results from the Outcomes of a prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (Optime-CHF) study. Circulation 2005;111:2454-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15867182" 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" => "Gheorgiade M, Gattis WA, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized control trial. JAMA 2004;291:1963-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15113814" 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" => "Jessup M, Brozena S. Heart failure. N Engl J Med 2003;348:2007-18. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12748317" 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" => "Gil P, Justo S, Castilla M, et al. Cardio-renal insufficiency: the search for management strategies. Curr Opin Nephrol Hypertens 2005;14:442-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16046902" 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" => "Ellison D. Diuretic therapy and resistance in congestive heart failure. Cardiology 2001;96:132-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11805380" 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" => "Domansky M, Norman J, Pitt B, et al. Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol 2003;42:705-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12932605" 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" => "De Goma E, Vagelos R, Fowler M, et al. Emerging therapies for the management of descompensated heart failure. J Am Coll Cardiol 2006;48:2397. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17174176" 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" => "Kazory A, Ross E. Contemporary trends in the pharmacological and extracorporeal management of heart failure: A Nephrologic perspective. Circulation 2008;117:975-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18285578" 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" => "Gheorgiade M, Konstam M, Burnett J, et al. Short term clinical effects of tolvaptan, an oral vasopressin antagonist in patients hospitalized for heart failure. The Everest clinical status trials. JAMA 2007;297:1332-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17384438" 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" => "Constanzo MR, Saltzberg M, O¿Sullivan J, et al. Early ultrafiltration in patients with descompensated heart failure and diuretic resistance. J Am Coll Cardiol 2005;46:2047-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16325040" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kazory A, Ejaz A, Ross E. Ultrafiltration for heart failure: How fast should we move? Am Heart J 2009;157:205-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19185626" 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" => "Costanzo MR, Saltzberg M, et al. Early ultrafiltration in patients with descompensated heart failure and diuretic resistance. J Am Coll Cardiol 2005;46:2047-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16325040" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Libetta C, Sepe V, Zucchi M, et al. Intermittent haemodiafiltration in refractory NP and balance of inflammatory cytokines. Nephrol Dial Transplant 2007;22:2013-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17298996" 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" => "Bourge RC, Tallaj JA. Ultrafiltration: a new approach toward mechanical diuresis in heart failure. J Am Coll Cardiol 2005;46:2052-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16325041" 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" => "Costanzo MR, Guglin M, Saltzberg M, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute descompensated heart failure. J Am Coll Cardiol 2007;49:675-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17291932" 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" => "Zemel D, Imholz AL, De Waart DR, et al. Appearance of tumor necrosis factor-alpha and soluble TNF-receptors I and II in peritoneal effluent of CAPD. Kidney Int 1994;46:1422-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7853803" 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" => "Schneierson SJ. Continuous peritoneal irrigation in the treatment of intractable edema of cardiac origin. Am J Med Sci 1949;218:76-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18133659" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mailloux LU, Swartz CD, Onesti G, et al. Peritoneal dialysis for refractory congestive heart failure. JAMA 1967;199:873-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6071553" 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" => "Shapira J, Lang R, Jutrin I, et al. Peritoneal dialysis in refractory congestive heart failure. Part I: intermittent peritoneal dialysis (IPD). Perit Dial Bull 1983;3:130-1." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the relief for acutely fluid overloaded patients with decompensated congestive heart failure (RAPID-CHF) trial. J Am Coll Cardiol 2005;46:2043-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16325039" 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" => "Rubin J, Ball R. Continuous ambulatory peritoneal dialysis as treatment of severe congestive heart failure in the face of chronic renal failure. Report of eight cases. Arch Intern Med 1986;146:1533-5." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Robson M, Biro A, Knobel B, et al. Peritoneal dialysis in refractory congestive Heart failure part II: continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Bull 1983; 3: 133-134, 1983" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kim D, Khanna R, Wu G, et al. Succesful use of continuous ambulatory peritoneal dialysis in refractory heart failure. Perit Dial Bull 1985;5:127-30." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mc Kinnie JJ, Bourgeois RJ, Hosserl FE. Long-term therapy for heart failure with continuous ambulatory peritoneal dialysis. Arch Intern Med 1985;145:1128-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/4004439" 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" => "Konig PS, Lhotta K, Kronenberg F, et al. CAPD: A successful treatment in patients suffering from therapy resistant congestive heart failure. Adv Perit Dial 1991;7:97-101. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1680467" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stegmayr BG, Banga R, Lundberg L, et al. PD treatment for severe congestive heart failure. Perit Dial Int 1996;16(Suppl 1):S231-S235. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8728198" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ryckelynck JP, Lobbedez T, Valette B, et al. Peritoneal ultrafiltration and treatment-resistant heart failure. Nephrol Dial Transplant 1998;13(Suppl 4): 56-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9614668" 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" => "Elhalel-Dranitsky M, Rubinger D, Moscovici A, et al. CAPD to improve quality of life in patients with refractory heart failure. Nephrol Dial Transplant 1998;13:3041-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9870463" 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" => "Kagan A, Rapoport J. The role of peritoneal dialysis in the treatment of refractory heart failure: Nephrol Dial Transplant 2005;20(Suppl 7):S28-S31." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gotloib L, Fudin R, Yakubovich M, et al. Peritoneal dialysis in refractory end-stage congestive heart failure: a challenge facing a no-win situation. Nephrol Dial Transplant\u{A0} 2005;20(Suppl. 7):S28-S31." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ryckelynck JP, Lobbedez T, Valette B, et al. Peritoneal ultrafiltration and refractory congestive heart failure. Adv Perit Dial 1997;13:93-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9360658" 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" => "Bertoli SV, Ciurlino D, Maccario M, et al. Home peritoneal ultrafiltration in patients with severe congestive HeART failure without end stage renal disease. Adv Perit Dial 2005;21:123-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16686301" 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" => "Díez B, Suárez C, Vidau P, et al. Papel de la diálisis peritoneal en el tratamiento de la insuficiencia cardiaca. Experiencia en nuestro centro. Nefrologia 2007;27:605-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18045037" 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" => "Basile C, Chimienti D, Bruno A, et al. Efficacy of peritoneal dialysis with icodextrin in the long-term treatment of refractory congestive heart failure. Perit Dial Int 2009;29:116-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19164263" 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" => "Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation 2005;112:e154-e235. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16160202" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000001/v0_201502091608/X2013251410033851/v0_201502091608/en/main.assets" "Apartado" => array:4 [ "identificador" => "35445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short Reviews" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000001/v0_201502091608/X2013251410033851/v0_201502091608/en/P1-E43-S1790-A10204-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410033851?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 7 | 10 |
| 2024 October | 55 | 45 | 100 |
| 2024 September | 55 | 29 | 84 |
| 2024 August | 49 | 57 | 106 |
| 2024 July | 50 | 17 | 67 |
| 2024 June | 62 | 43 | 105 |
| 2024 May | 62 | 35 | 97 |
| 2024 April | 48 | 29 | 77 |
| 2024 March | 27 | 22 | 49 |
| 2024 February | 44 | 33 | 77 |
| 2024 January | 29 | 19 | 48 |
| 2023 December | 27 | 22 | 49 |
| 2023 November | 37 | 33 | 70 |
| 2023 October | 29 | 24 | 53 |
| 2023 September | 30 | 24 | 54 |
| 2023 August | 41 | 21 | 62 |
| 2023 July | 27 | 40 | 67 |
| 2023 June | 43 | 25 | 68 |
| 2023 May | 47 | 30 | 77 |
| 2023 April | 18 | 16 | 34 |
| 2023 March | 37 | 15 | 52 |
| 2023 February | 30 | 20 | 50 |
| 2023 January | 27 | 24 | 51 |
| 2022 December | 53 | 40 | 93 |
| 2022 November | 41 | 34 | 75 |
| 2022 October | 48 | 32 | 80 |
| 2022 September | 42 | 46 | 88 |
| 2022 August | 45 | 36 | 81 |
| 2022 July | 42 | 46 | 88 |
| 2022 June | 48 | 29 | 77 |
| 2022 May | 54 | 41 | 95 |
| 2022 April | 46 | 49 | 95 |
| 2022 March | 56 | 53 | 109 |
| 2022 February | 48 | 32 | 80 |
| 2022 January | 33 | 26 | 59 |
| 2021 December | 59 | 44 | 103 |
| 2021 November | 52 | 30 | 82 |
| 2021 October | 65 | 41 | 106 |
| 2021 September | 35 | 34 | 69 |
| 2021 August | 70 | 37 | 107 |
| 2021 July | 55 | 32 | 87 |
| 2021 June | 43 | 29 | 72 |
| 2021 May | 63 | 29 | 92 |
| 2021 April | 132 | 66 | 198 |
| 2021 March | 97 | 29 | 126 |
| 2021 February | 70 | 17 | 87 |
| 2021 January | 44 | 12 | 56 |
| 2020 December | 30 | 14 | 44 |
| 2020 November | 30 | 12 | 42 |
| 2020 October | 26 | 14 | 40 |
| 2020 September | 23 | 11 | 34 |
| 2020 August | 42 | 8 | 50 |
| 2020 July | 38 | 7 | 45 |
| 2020 June | 33 | 10 | 43 |
| 2020 May | 49 | 11 | 60 |
| 2020 April | 37 | 10 | 47 |
| 2020 March | 36 | 10 | 46 |
| 2020 February | 50 | 18 | 68 |
| 2020 January | 66 | 18 | 84 |
| 2019 December | 75 | 26 | 101 |
| 2019 November | 65 | 26 | 91 |
| 2019 October | 48 | 8 | 56 |
| 2019 September | 51 | 14 | 65 |
| 2019 August | 35 | 15 | 50 |
| 2019 July | 44 | 21 | 65 |
| 2019 June | 34 | 11 | 45 |
| 2019 May | 28 | 18 | 46 |
| 2019 April | 90 | 27 | 117 |
| 2019 March | 52 | 17 | 69 |
| 2019 February | 22 | 18 | 40 |
| 2019 January | 36 | 18 | 54 |
| 2018 December | 96 | 30 | 126 |
| 2018 November | 64 | 10 | 74 |
| 2018 October | 59 | 15 | 74 |
| 2018 September | 72 | 8 | 80 |
| 2018 August | 42 | 15 | 57 |
| 2018 July | 42 | 14 | 56 |
| 2018 June | 38 | 13 | 51 |
| 2018 May | 52 | 20 | 72 |
| 2018 April | 51 | 7 | 58 |
| 2018 March | 52 | 11 | 63 |
| 2018 February | 42 | 8 | 50 |
| 2018 January | 37 | 4 | 41 |
| 2017 December | 35 | 10 | 45 |
| 2017 November | 35 | 4 | 39 |
| 2017 October | 27 | 10 | 37 |
| 2017 September | 20 | 7 | 27 |
| 2017 August | 30 | 12 | 42 |
| 2017 July | 21 | 6 | 27 |
| 2017 June | 29 | 9 | 38 |
| 2017 May | 29 | 10 | 39 |
| 2017 April | 15 | 6 | 21 |
| 2017 March | 18 | 13 | 31 |
| 2017 February | 18 | 12 | 30 |
| 2017 January | 8 | 6 | 14 |
| 2016 December | 92 | 8 | 100 |
| 2016 November | 83 | 9 | 92 |
| 2016 October | 88 | 25 | 113 |
| 2016 September | 127 | 7 | 134 |
| 2016 August | 180 | 5 | 185 |
| 2016 July | 167 | 7 | 174 |
| 2016 June | 110 | 0 | 110 |
| 2016 May | 137 | 0 | 137 |
| 2016 April | 109 | 0 | 109 |
| 2016 March | 86 | 0 | 86 |
| 2016 February | 109 | 0 | 109 |
| 2016 January | 111 | 0 | 111 |
| 2015 December | 103 | 0 | 103 |
| 2015 November | 89 | 0 | 89 |
| 2015 October | 70 | 0 | 70 |
| 2015 September | 82 | 0 | 82 |
| 2015 August | 73 | 0 | 73 |
| 2015 July | 47 | 0 | 47 |
| 2015 June | 32 | 0 | 32 |
| 2015 May | 55 | 0 | 55 |
| 2015 April | 5 | 0 | 5 |
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