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and it has 2 vector components&#58; resistance and reactance&#46; The first determines the tissue hydration status&#44; as water is an excellent conductor&#44; such that the higher the water content&#44; the less the resistance&#46; Therefore&#44; tissues with plenty of water &#40;e&#46;g&#46;&#44; muscle&#41; can be discriminated from those containing small quantities of water &#40;e&#46;g&#46;&#44; fat and bone&#41;&#46; The second component is reactance or capacitance&#44; which determines the amount of energy that can be accumulated in tissue&#44; as tissue cells behave as true capacitors&#46; The vector sum of both components is the impedance and the angle it forms is called the phase angle&#46; This variable has been related to the nutritional status of patients on HD&#46;<span class="elsevierStyleSup">3&#44;6</span></p><p class="elsevierStylePara">The aim of this study was to analyse the relationship between the phase angle determined at 50kHz with various nutritional parameters&#44; and study its value as a predictor of long-term mortality in a sample of patients on dialysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS</span></p><p class="elsevierStylePara">A prospective observational study&#44; with a 6-year follow-up&#44; of 164 patients on dialysis&#44; including 127 on HD and 37 on peritoneal dialysis&#46; The mean patient age was 61&#46;1&#177;14&#46;5 years&#44; of whom 99 were male &#40;60&#46;3&#37;&#41;&#46; The etiology of chronic kidney disease included 23&#46;2&#37; diabetes mellitus&#44; 27&#46;9&#37; glomerulonephritis&#44; 17&#46;0&#37; tubulointerstitial nephritis&#44; 7&#46;0&#37; vascular nephritis&#44; 7&#46;0&#37; of unknown etiology and 10&#46;0&#37; from other causes&#46; The prevalence of diabetes mellitus in all patients was 32&#46;2&#37; and 54 patients had undergone a previous kidney transplant&#46; The comorbidity of the patients was determined by the age-adjusted Charlson index&#46;</p><p class="elsevierStylePara">At baseline&#44; a multi-frequency BIA was conducted in all cases using a Bioscan system &#40;Biol&#243;gica&#44; Tecnolog&#237;a M&#233;dica S&#46;L&#46;&#44; La Garriga&#44; Spain&#41; between January 2002 and October 2003&#44; with the study being terminated in December 2009&#46; The measurement was performed before a HD session in the middle of the week&#44; after spending 10 minutes supine&#44; with 4 conventional electrodes placed 2-by-2 in the hand and foot contralateral to vascular access&#46; The bioimpedance analyser determined the resistance&#44; reactance and phase angle at 10 different AC frequencies&#44; ranging from 5 to 500kHz&#46;</p><p class="elsevierStylePara">When performing the bioimpedance analysis&#44; all patients were on conventional HD&#44; lasting between 3&#46;5 and 4 hours&#46; Throughout the study&#44; there were technical changes&#44; including on-line progressive haemodiafiltration and increases in the session times&#46; Patients on peritoneal dialysis were examined with the stomach empty and the same time in supine position&#46; The data collected were resistance&#44; reactance and phase angle at 50kHz &#40;PA50&#41;&#44; as it was the maximum phase angle frequency for most patients&#46; This was the only frequency used to analyse the rest of the parameters&#46; The total body water &#40;TBW&#41;&#44; intracellular water &#40;ICW&#41;&#44; extracellular water &#40;ECW&#41;&#44; fat mass &#40;FM&#41; and fat-free mass &#40;FFM&#41; were calculated by the system software&#46; These parameters were adjusted on a percentage basis to estimated body weight of each patient&#46; Also personal data&#44; analytical data were collected according to conventional techniques and anthropometric parameters&#46; For patients on HD&#44; the interdialytic weight gain was calculated as the average of 3 weekly sessions&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis </span></p><p class="elsevierStylePara">Quantitative variables were expressed as mean and standard deviation and qualitative variables as percentages&#46; The comparisons between means were performed using Student&#39;s t-test or the analysis of variance&#46; Comparisons between quantitative variables were performed using the chi-squared analysis&#46; Bivariate correlations were performed by calculating the Pearson or Spearman coefficient according to the type of variable&#46; The Kolmogorov-Smirnov test was used to analyse for normal distribution of a variable&#46; Survival analysis was performed using the Kaplan-Meier test and statistical significance calculated by the log-rank test&#46; The Cox test was used with different models for the multivariate analysis which included significant variables in the univariate analysis&#46; A <span class="elsevierStyleItalic">P</span>&#60;&#46;05 value was considered significant&#46; The package SPSS version 18&#46;0 &#40;SPSS&#44; Chicago&#44; Illinois&#44; USA&#41; was used for the statistical analysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">The initial clinical and analytical features of patients are shown in Table 1&#46; Table 2 shows the results of the baseline parameters calculated by BIA at 50kHz&#46; A bivariate correlation analysis was conducted between PA50 and the continuous variables analysed&#44; with the results shown in Table 3&#46; The significant relationship between nutritional parameters determined by BIA and serum albumin is worth noting&#44; as well as the direct relationship between the intracellular and extracellular water content adjusted to the dry weight of the patient&#46; However&#44; there was no significant relationship between PA50 and some inflammation parameters&#44; such as C-reactive protein&#44; serum fibrinogen or serum ferritin&#46;</p><p class="elsevierStylePara">The mean PA50 was 7&#46;8&#177;1&#46;2&#176; &#40;range&#44; 5-14&#176;&#41;&#46; The patients were divided into 3 groups according to the PA50&#58; a&#41; 19 patients with PA50 of 5-6&#176;&#44; b&#41; 106 patients with PA50 7-8&#176;&#44; and c&#41; 39 patients with PA50&#62;8&#176;&#46; The mean values were 5&#46;7&#177;0&#46;4&#176;&#44; 7&#46;5&#177;0&#46;5&#176; and 9&#46;5&#177;1&#46;1&#176;&#44; respectively &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; After 6 years&#44; the mean follow-up was 3&#46;1&#177;2&#46;0 years&#58; 100 patients &#40;61&#37;&#41; had died&#44; 22 &#40;13&#46;4&#37;&#41; had undergone transplantation&#44; 4 &#40;2&#46;4&#37;&#41; were removed due to transfer to another centre&#44; 36 &#40;22&#37;&#41; remained on HD and 2 &#40;1&#46;2&#37;&#41; were on peritoneal dialysis&#46; The Kaplan-Meier survival analysis showed that the group with the highest PA50 had significantly better survival than the remaining 2 &#40;log-rank 14&#46;9&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; which is shown in Figure 1&#46; The percentage AEC&#44; FFM ICW&#44; TBW and MG parameters among the 3 groups obtained from PA50 measurements were compared&#46; The group with the greatest PA50 was the youngest and had a significantly higher FFM&#44; ICW and TBW content&#44; but lower MG &#40;Table 4&#41;&#46;</p><p class="elsevierStylePara">The BIA variables related to mortality in the univariate analysis showed that the percentage MG was associated with an increased risk of mortality &#40;<span class="elsevierStyleItalic">P&#61;</span>&#46;003&#41;&#44; while the percentage FFM &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;003&#41;&#44; percentage ICW &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;044&#41; and PA50&#62;8&#176; &#40;<span class="elsevierStyleItalic">P&#61;</span>&#46;005&#41; were associated with lower risk&#46; The Cox multivariate analysis &#40;Table 5&#41; was performed with a model that included the above variables and body composition and&#44; when adjusted for comorbidity by the Charlson index including age&#44; the only independent risk factors for mortality were PA50&#60;8&#176; &#40;<span class="elsevierStyleItalic">P&#61;</span>&#46;003&#41; and comorbidity itself &#40;<span class="elsevierStyleItalic">P&#60;</span>&#46;001&#41;&#46;</p><p class="elsevierStylePara">Table 6 shows the data analysed according to the dialysis modality of patients at the time of the study&#46; It is notable that peritoneal dialysis patients were younger &#40;<span class="elsevierStyleItalic">P&#60;</span>&#46;001&#41;&#44; had increased extracellular hydration status &#40;<span class="elsevierStyleItalic">P&#61;</span>&#46;036&#41;&#44; a greater PA50 &#40;<span class="elsevierStyleItalic">P&#61;</span>&#46;004&#41;&#44; a higher proportion of lean tissue &#40;<span class="elsevierStyleItalic">P&#60;</span>&#46;001&#41; and a lower proportion of fat &#40;<span class="elsevierStyleItalic">P&#60;</span>&#46;001&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Our study prospectively confirms that the BIA phase angle measured at 50kHz is associated with nutritional status&#44; as described by other authors&#44;<span class="elsevierStyleSup">11&#44;12</span> and is also an independent risk factor for long-term mortality&#46; Recently&#44; Segall et al&#46; reported that a PA50&#60;6&#176; has a relative risk of mortality per year of 4&#46;1 compared to those who have a higher PA50&#46;<span class="elsevierStyleSup">3</span> Our data demonstrate that this predictor effect remains at 6 years of follow-up&#44; although with a slightly higher cut-off value&#46;</p><p class="elsevierStylePara">BIA has been used in assessing the nutritional status of patients on dialysis for more than two decades&#46;<span class="elsevierStyleSup">7&#44;13&#44;14</span> One of its most important components is the phase angle&#44; which is the resultant vector of resistance and reactance&#46; The former mainly reflects the patient&#39;s hydration status&#58; such that the higher the water content&#44; the lower the resistance&#59; and&#44; in the same individual&#44; the greater the water loss&#44; the greater the increase in resistance&#46; Thus&#44; the length of the vector&#44; which is mainly due to the resistance&#44; has been used as a procedure to assess ultrafiltration needs in HD&#46;<span class="elsevierStyleSup">15&#44;16</span> The reactance represents the ability of tissues to accumulate energy&#44; since the cells have a similar electrical behaviour to a capacitor&#44; such that the greater the number of cells&#44; the greater the reactance&#46;</p><p class="elsevierStylePara">Multi-frequency BI analysers can determine the 3 components&#58; resistance&#44; reactance and phase angle over a wide range of frequencies&#44; which vary according to the manufacturer between 1 and 1000kHz&#46; Typically&#44; the single-frequency systems are set to make a single measurement at 50kHz&#44; due to the phase angle being the maximum at this frequency&#46;<span class="elsevierStyleSup">17</span> As a result&#44; this frequency only was chosen for this study&#44; without considering any others&#46;</p><p class="elsevierStylePara">The water content in the body depends physiologically on the amount of fatty tissue it contains&#46;<span class="elsevierStyleSup">18</span> Therefore&#44; it is usually necessary to have reference values for a similar population to the one analysed&#46; Fat content varies physiologically with sex &#40;women have more fat and less water&#41;&#44; age &#40;older people have more fat and less water&#41;<span class="elsevierStyleSup">14 </span>and nutritional status &#40;the fatter the person&#44; the lower the water content&#41;&#46; In general&#44; bioimpedance analysers come with software which is based on validated formulas to calculate hydration and body composition parameters&#46; These data are individualised on the basis of sex&#44;<span class="elsevierStyleSup">16&#44;17</span> but theoretically should also be based on age&#44; nutritional status or even race&#46;<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara">To avoid bias due to body composition&#44; in this study we used the raw impedance data as a primary variable&#44; with special emphasis on the phase angle as a combined result of resistance and reactance&#46; Thus&#44; it was not necessary to consider normal reference parameters&#46; However&#44; we also analysed parameters provided by the software system as secondary variables&#46;</p><p class="elsevierStylePara">It is worth noting that the determination of the phase angle varies from one series to another&#44; probably because of the type of BI analyser used&#46; The mean obtained in our study is higher than that found by other authors&#44; although our results also confirm that there is a strong relationship between nutritional status and phase angle&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Numerous studies show a strong relationship between nutritional status assessed by bioelectrical impedance techniques and inflammation status&#44; as well as its effect on survival for patients on dialysis&#46;<span class="elsevierStyleSup">20-22</span> However&#44; other authors report that the state of malnutrition may be a risk factor for mortality independent of inflammation&#46;<span class="elsevierStyleSup">23</span> Our results show that PA50 has a strong correlation with nutritional parameters&#59; however&#44; it is not associated with inflammation parameters such as ferritin or fibrinogen&#44; and has only a weakly significant relationship with the logarithm of C-reactive protein&#46;</p><p class="elsevierStylePara">Although many authors evaluate nutritional status using body mass index &#40;BMI&#41;&#44; our study shows that it is necessary to differentiate between those with a high index of fat-free mass and those with a very low fat-free mass&#44; even if they have a high BMI&#46; The first group is associated with a high PA50 and has significantly better survival than the latter&#46; These data have similar results to those described recently by Kalantar-Zadeh et al&#46;&#44; who established the need to differentiate the various components of body composition to assess any prognostic effect&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Table 4 shows how the subgroup of patients with the highest PA50 also has higher ICW and TBW percentages&#44; as well as a higher content of fat-free mass&#46; Therefore&#44; these data show that patients with the highest PA50 have more muscle tissue and ICW&#44; while the fat contains very little ICW&#46; Therefore&#44; the assessment of TBW has little meaning without knowing the total body composition&#46;<span class="elsevierStyleSup">18</span></p><p class="elsevierStylePara">We recorded the interdialytic weight gain in the patients studied as the mean of 3 weekly sessions&#44; and found a good correlation with nutritional status and age&#46; These data corroborate previous findings&#44; which found that this parameter is associated with greater survival&#44; confirming the importance of nutrition in dialysis patients&#46;<span class="elsevierStyleSup">24</span></p><p class="elsevierStylePara">The study included patients with 2 dialysis modalities&#46; Although it was not a primary aim to compare the characteristics of patients in both techniques&#44; Table 6 shows the characteristics of both groups&#46; It is worth noting that the peritoneal dialysis patients have better nutritional status with higher levels of lean mass and less fat&#46; They also have a significantly lower Charlson index comorbidity&#44; but with a greater extracellular hydration status&#44; as has been noted before&#46;<span class="elsevierStyleSup">25</span> However&#44; the most noticeable finding is the age difference between both groups&#44; as usually happens&#44; which largely determines nutrition&#44; comorbidity&#44; and body composition&#44; and detracts from the comparison between both techniques&#46;</p><p class="elsevierStylePara">In conclusion&#44; our study shows that the gross parameters obtained by BIA at a frequency of 50kHz correlate well with nutritional parameters&#44; with PA50 especially being a good marker of survival in dialysis patients&#46; However&#44; intervention studies are needed to demonstrate if improvement in BIA parameters is associated with greater survival&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25122&#95;en&#95;t1&#95;10999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25122_en_t1_10999i.jpg" alt="Clinical and analytical features of patients"></img></a></p><p class="elsevierStylePara">Table 1&#46; Clinical and analytical features of patients</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25123&#95;en&#95;t2&#95;10999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25123_en_t2_10999i.jpg" alt="Parameters determined by bioelectrical impedance at 50kHz"></img></a></p><p class="elsevierStylePara">Table 2&#46; Parameters determined by bioelectrical impedance at 50kHz</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25124&#95;en&#95;t3&#95;10999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25124_en_t3_10999i.jpg" alt="Analysis of bivariate correlation between the phase angle measured at 50kHz and analytical nutrition&#44; anthropometric and bioimpedance parameters"></img></a></p><p class="elsevierStylePara">Table 3&#46; Analysis of bivariate correlation between the phase angle measured at 50kHz and analytical nutrition&#44; anthropometric and bioimpedance parameters</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25125&#95;en&#95;t410999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25125_en_t410999i.jpg" alt="Group features according to the phase angle at 50kHz"></img></a></p><p class="elsevierStylePara">Table 4&#46; Group features according to the phase angle at 50kHz</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25126&#95;en&#95;t510999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25126_en_t510999i.jpg" alt="Multivariate analysis of the mortality risk factors"></img></a></p><p class="elsevierStylePara">Table 5&#46; Multivariate analysis of the mortality risk factors</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25127&#95;en&#95;t610999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25127_en_t610999i.jpg" alt="Clinical and bioelectrical impedance features of patients on haemodialysis and peritoneal dialysis"></img></a></p><p class="elsevierStylePara">Table 6&#46; Clinical and bioelectrical impedance features of patients on haemodialysis and peritoneal dialysis</p><p class="elsevierStylePara"><a href="grande&#47;10999&#95;108&#95;25128&#95;en&#95;f1&#95;10999i&#46;jpg" class="elsevierStyleCrossRefs"><img src="10999_108_25128_en_f1_10999i.jpg" alt="Phase angle"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Phase angle</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58; </span>La malnutrici&#243;n cal&#243;rico-proteica es un factor de riesgo de mortalidad en pacientes en di&#225;lisis&#44; sin embargo&#44; su valoraci&#243;n cl&#237;nica no ha sido bien definida&#46; La bioimpedancia el&#233;ctrica &#40;BIE&#41; es un procedimiento no invasivo y objetivo&#44; cada vez m&#225;s empleado en su valoraci&#243;n&#46; <span class="elsevierStyleBold">Objetivo&#58; </span>El objetivo de este estudio es analizar la relaci&#243;n entre el &#225;ngulo de fase determinado por BIE a una frecuencia de 50 kHz &#40;AF50&#41; con otros par&#225;metros de nutrici&#243;n y valorar prospectivamente su capacidad como marcador pron&#243;stico de mortalidad a largo plazo&#46; <span class="elsevierStyleBold">Pacientes y m&#233;todos&#58; </span>Incluimos a 164 pacientes&#44; 127 en hemodi&#225;lisis y 37 en di&#225;lisis peritoneal&#44; a los que se les realiza un an&#225;lisis de BIE al tiempo que se solicitan par&#225;metros de inflamaci&#243;n y nutrici&#243;n y se calcula el &#237;ndice de comorbilidad de Charlson&#46; <span class="elsevierStyleBold">Resultados&#58; </span>En el an&#225;lisis de correlaci&#243;n lineal&#44; encontramos que el AF50 tiene una asociaci&#243;n directa con la masa magra&#44; con el agua intracelular&#44; con el agua extracelular y con la ganancia de peso interdi&#225;lisis&#44; mientras que se asocia de forma inversa con la edad&#44; con la masa grasa y con el log PCR&#46; Los pacientes con AF50 &#62;8&#186; presentan un mejor estado nutricional&#44; son m&#225;s j&#243;venes y tienen una supervivencia significativamente mejor a los seis a&#241;os de seguimiento&#46; Entre los pacientes estudiados&#44; tanto el AF50 como el resto de los par&#225;metros de composici&#243;n corporal son mejores en di&#225;lisis peritoneal que en hemodi&#225;lisis&#44; pero estas diferencias pueden ser atribuidas a que los primeros son m&#225;s j&#243;venes&#46; En el an&#225;lisis multivariable&#44; s&#243;lo el AF50 &#60;8&#186; y la comorbilidad ajustada para la edad persisten como factores de riesgo independientes de mortalidad&#46;<span class="elsevierStyleBold"> Conclusiones&#58;</span> Concluimos que el AF50 tiene una buena correlaci&#243;n con los par&#225;metros de nutrici&#243;n y que es un buen marcador de supervivencia en pacientes en di&#225;lisis&#46; No obstante&#44; son necesarios estudios de intervenci&#243;n en los que se demuestre si la mejor&#237;a de los par&#225;metros de BIE se acompa&#241;a de una mayor supervivencia&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58; </span>Protein-energy malnutrition is a risk factor for mortality in dialysis patients&#59; however&#44; its clinical assessment has not been well defined&#46; Electrical bioimpedance &#40;EBI&#41; is a non-invasive and objective procedure&#44; which is increasingly being used for this assessment&#46;<span class="elsevierStyleBold"> Objective&#58; </span>The aim of this study is to analyse the relationship between the phase angle determined by EBI at a frequency of 50kHz &#40;AF50&#41; and other nutritional parameters&#44; and prospectively evaluate its ability as a marker for long-term mortality&#46; <span class="elsevierStyleBold">Patients and methods&#58; </span>We included 164 patients &#40;127 on haemodialysis and 37 on peritoneal dialysis&#41; who underwent an EBI analysis while simultaneously determining inflammation and nutrition parameters&#46; The Charlson comorbidity index was then calculated&#46; <span class="elsevierStyleBold">Results&#58; </span>In the linear correlation analysis&#44; we found that the AF50 had a direct association with lean mass&#44; intracellular water&#44; extracellular water and interdialytic weight gain&#44; while having an inverse association with age and fat mass&#46; Patients with AF50 &#62;8&#186; had a better nutritional status&#44; were younger and had significantly longer survival at the six-year follow-up&#46; Among the patients studied&#44; both the AF50 and the other body composition parameters were better in peritoneal dialysis than in haemodialysis&#44; but these differences may be attributable to the fact that the first patients were younger&#46; In the multivariate analysis&#44; only the AF50 &#60;8&#186; and comorbidity adjusted for age persisted as independent risk factors for mortality&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> We conclude that AF50 has a good correlation with nutritional parameters and is a good marker of survival in dialysis patients&#46; Nevertheless&#44; intervention studies are needed to demonstrate if the improvement in EBI parameters is associated with better survival&#46;</p>"
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                0 => array:3 [
                  "referenciaCompleta" => "Acchiardo SR, Moore LW, Latour PA. Malnutrition as the main factor in morbidity and mortality of hemodialysis patients. Kidney Int 1983;24(Suppl 16):199-203."
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Lowrie EG, Lew LN. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2333868" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Segall L, Mardare NG, Ungureanu S, Busuioc M, Nistor I, Enache R, et al.\u{A0}Nutritional status evaluation and survival in haemodialysis patients in one centre from Romania. Nephrol Dial Transplant 2009;24(8):2536-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19297358" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Enia G, Sicuso C, Alati G. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993;8:1094-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8272222" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
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                0 => array:3 [
                  "referenciaCompleta" => "Kalantar-Zadeh K, Streja E, Kovesdy CP, Oreopoulos A, Noori N, Jing J, et al.\u{A0}The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc 2010;85(11):991-1001. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21037042" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Beberashvili I, Sinuani I, Azar A, Yasur H, Feldman L, Efrati S, et al.\u{A0}Nutritional and inflammatory status of hemodialysis patients in relation to their body mass index. J Ren Nutr 2009;19(3):238-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19243974" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "etiqueta" => "7"
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                0 => array:3 [
                  "referenciaCompleta" => "De Lorenzo A, Barra PFA, Sasso GF. Body impedance measurements during dialysis. Eur J Clin Nutr 1991;45:231-5."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kamimura MA, Avesani CM, Cendoroglo M. Comparison of skinfold thicknesses and bioelectrical impedance analysis with dual energy X-ray absorptiometry for the assessment of body fat in patients on long-term haemodialysis therapy. Nephrol Dial Transplant 2003;18:101-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12480966" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Chertow GM, Lowrie EG, Wilmore DW. Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. Am Soc Nephrol 1995;6:75-81."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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                0 => array:3 [
                  "referenciaCompleta" => "Bellizzi V, Scalfi L, Terracciano V, De Nicola L, Minutolo R, Marra M, et al.\u{A0}Early changes in bioelectrical estimates of body composition in chronic kidney disease. J Am Soc Nephrol 2006;17(5):1481-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16611719" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Oliveira CM, Kubrusly M, Mota RS, Silva CA, Choukroun G, Oliveira VN. The phase angle and mass body cell as markers of nutritional status in hemodialysis patients. J Ren Nutr 2010;20(5):314-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20303790" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            ]
            11 => array:3 [
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              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cupisti A, Capitanini A, Betti G, D'Alessandro C, Barsotti G. Assessment of habitual physical activity and energy expenditure in dialysis patients and relationships to nutritional parameters. Clin Nephrol 2011;75(3):218-25. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21329632" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
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                0 => array:3 [
                  "referenciaCompleta" => "Scanferla F, Landini S, Fracasso A, Morachiello P, Righetto F, Toffoletto PP, et al.\u{A0}On-line bioelectric impedance during haemodialysis: monitoring of body fluids and cell membrane status. Nephrol Dial Transplant 1990;5(Suppl 1):167-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2129453" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Biasioli S, Foroni R, Petrosino L, Cavallini L, Zambello A, Cavalcanti G, et al.\u{A0}Effect of aging on the body composition of dialyzed subjects. Comparison with normal subjects. ASAIO J 1993;39(3):M596-601. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8268607" 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" => "Pillon L, Piccoli A, Lowrie EG, Lazarus JM, Chertow GM. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis. Kidney Int 2004;66(3):1266-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15327426" 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" => "Piccoli A, Rossi B, Pillon L, Bucciante G. A new method for monitoring body fluid variation by bioimpedance analysis: The RXc graph. Kidney Int 1994;46:534-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7967368" 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" => "Piccoli A, Rossi B, Pillon L. Is 50 kHz the optimal frequency in routine estimation of body water by bio-electrical impedance analysis? Am J Clin Nutr 1992;56:1069. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1442661" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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              ]
            ]
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              "etiqueta" => "18"
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                0 => array:3 [
                  "referenciaCompleta" => "Chamney PW, Wabel P, Moissl UM, Müller MJ, Bosy-Westphal A, Korth O, et al.\u{A0}A whole-body model to distinguish excess fluid from the hydration of major body tissues. Am J Clin Nutr 2007;85:80-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17209181" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
                    0 => null
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            ]
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              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jha V, Jairam A, Sharma MC, Sakhuja V, Piccoli A, Parthasarathy S. Body composition analysis with bioelectric impedance in adult Indians with ESRD: comparison with healthy population. Kidney Int 2006;69(9):1649-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16598204" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
                    0 => null
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            ]
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              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mushnick R, Fein PA, Mittman N, Goel N, Chattopadhyay J, Avram MM. Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients. Kidney Int Suppl 2003;87:S53-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14531774" 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" => "Chertow GM, Johansen KL, Lew N, Lazarus JM, Lowrie EG. Vintage, nutritional status, and survival in hemodialysis patients. Kidney Int 2000;57(3):1176-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10720970" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maggiore Q, Nigrelli S, Ciccarelli C, Grimaldi C, Rossi GA, Michelassi C. Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients. Kidney Int 1996;50(6):2103-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8943496" 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" => "Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int 2004;66(5):2054-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15496179" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "López¿Gómez JM, Villaverde M, Jofre R, Rodríguez-Benítez P, Pérez-García R. Interdialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodialysis patients. Kidney Int 2005;67:S63-S68."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Devolder I, Verleysen A, Vijt D, Vanholder R, Van Biesen W. Body composition, hydration, and related parameters in hemodialysis versus peritoneal dialysis patients. Perit Dial Int 2010;30(2):208-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20081049" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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