Diagnostic and interventional nephrology: an opportunity for Spanish nephrologists
Nefrología diagnóstica e intervencionista: una oportunidad para los nefrólogos españoles
Read
10160
Timeswas read the article
2773
Total PDF
7387
Total HTML
Share statistics
array:21 [ "pii" => "X2013251411051743" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Feb.10825" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:131-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5102 "formatos" => array:3 [ "EPUB" => 272 "HTML" => 4098 "PDF" => 732 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699511051746" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.Feb.10825" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2011;31:131-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 13193 "formatos" => array:3 [ "EPUB" => 331 "HTML" => 11824 "PDF" => 1038 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Nefrología diagnóstica e intervencionista: una oportunidad para los nefrólogos españoles" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "133" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnostic and interventional nephrology: an opportunity for Spanish nephrologists" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Rivera, C. Quereda" "autores" => array:3 [ 0 => null 1 => array:2 [ "Iniciales" => "M." "apellidos" => "Rivera" ] 2 => array:2 [ "Iniciales" => "C." "apellidos" => "Quereda" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251411051743" "doi" => "10.3265/Nefrologia.pre2011.Feb.10825" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051743?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051746?idApp=UINPBA000064" "url" => "/02116995/0000003100000002/v0_201502091417/X0211699511051746/v0_201502091417/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251411051735" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Jan.10773" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:134-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4426 "formatos" => array:3 [ "EPUB" => 268 "HTML" => 3603 "PDF" => 555 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Autosomal dominant polycystic kidney disease and sickle cell trait" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "134" "paginaFinal" => "136" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Poliquistosis renal autosómica dominante y hemoglobina con rasgo falciforme" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Peces, C. Peces" "autores" => array:3 [ 0 => null 1 => array:2 [ "Iniciales" => "R." "apellidos" => "Peces" ] 2 => array:2 [ "Iniciales" => "C." "apellidos" => "Peces" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511051738" "doi" => "10.3265/Nefrologia.pre2011.Jan.10773" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051738?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051735?idApp=UINPBA000064" "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051735/v0_201502091641/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251411051751" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Feb.10842" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:129-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3838 "formatos" => array:3 [ "EPUB" => 306 "HTML" => 2997 "PDF" => 535 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "How can we make nephrology more appealing to junior doctors?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "130" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué podemos hacer para que la nefrología sea una especialidad más atractiva para los residentes?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Ortega Suárez" "autores" => array:2 [ 0 => null 1 => array:2 [ "Iniciales" => "F." "apellidos" => "Ortega Suárez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511051754" "doi" => "10.3265/Nefrologia.pre2011.Feb.10842" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051754?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051751?idApp=UINPBA000064" "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051751/v0_201502091641/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Diagnostic and interventional nephrology: an opportunity for Spanish nephrologists" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "133" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Rivera, C. Quereda" "autores" => array:3 [ 0 => null 1 => array:4 [ "Iniciales" => "M." "apellidos" => "Rivera" "email" => array:1 [ 0 => "mriverag.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "C." "apellidos" => "Quereda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Ramón y Cajal. IRYCIS, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nefrología diagnóstica e intervencionista: una oportunidad para los nefrólogos españoles" ] ] "textoCompleto" => "<p class="elsevierStylePara">Half-way through the 20th century, nephrologists were responsible for numerous milestones, leading us to modern nephrology as we know it today. Nephrologists have designed and developed instruments that are fundamental for our speciality, such as renal biopsy,<span class="elsevierStyleSup">1</span> the first haemodialysis shunt,<span class="elsevierStyleSup">2</span> double lumen catheters,<span class="elsevierStyleSup">3</span> the first arteriovenous fistula for haemodialysis,<span class="elsevierStyleSup">4</span> the first tunnelled catheter for peritoneal dialysis,<span class="elsevierStyleSup">5</span> and laparoscopic catheter placing.<span class="elsevierStyleSup">6</span> Furthermore, Dr J Holmes, considered the father of diagnostic ultrasound,<span class="elsevierStyleSup">7</span> was also a nephrologist.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">However, as dialysis treatment progressed, nephrologists stopped performing interventions on their patients, to the advantage of other specialities (surgeons and radiologists, mainly) yet to the detriment of overall patient care. A clear example is the significant increase in the number of patients that received dialysis through a permanent catheter or a synthetic bypass, compared with those that have received an arteriovenous fistula, during recent decades.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Kidney patient care was therefore fragmented, being placed into the hands of other specialists, who did not fully understand the reality of kidney diseases. Furthermore, as reported by O’Neill,<span class="elsevierStyleSup">9</span> we nephrologists started to spend more time on the telephone, asking for tests, than solving our patients’ problems.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In 2000, a group of American nephrologists, aware of this controversial situation, decided to create the American Society of Diagnostic and Interventional Nephrology (ASDIN)<span class="elsevierStyleSup">10</span> so as to defeat the apathy that had developed. Its objective was for nephrologists to regain leadership, promoting the appropriate application of their techniques, that they themselves had developed, and to improve nephrology patients’ care. This Society strives to promote interventional nephrology within nephrology services and has presented an annual congress since 2005. It also has a section in the journal <span class="elsevierStyleItalic">Seminars in Dialysis</span>, where its original articles are published. Since 2004, the International Society of Nephrology created the Interventional Nephrology Committee with the aim of promoting and addressing issues related with this new discipline, such as healthcare provision and training.<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">INTERVENTIONAL NEPHROLOGY IN THE WORLD</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Diagnostic and interventional nephrology is expanding is the United States. This discipline is being included more frequently as a permanent feature of courses and congresses, such as the Annual Scientific Meeting of the American Society of Nephrology, which has been taking place since 2000.<span class="elsevierStyleSup">12</span> Hospitals offering training under this subspeciality have also increased notably in North America. However, according to a recent survey published on this matter,<span class="elsevierStyleSup">13</span> there still are not enough hospitals and even fewer are ASDIN-accredited.<span class="elsevierStyleSup">14-16</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Interest is also growing in Latin America. Countries such as Puerto Rico, Peru, Brazil, Mexico, Colombia, Argentina and Venezuela have been incorporating interventional nephrology into their daily healthcare and in scientific meetings.<span class="elsevierStyleSup">17,18</span> The Latin American Society of Nephrology and Hypertension considers interventional nephrology as a discipline in itself and has its own interventional nephrology advisory committee.<span class="elsevierStyleSup">19</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Europe, on the other hand, is more interested in diagnosis than intervention, i.e. introducing ultrasound to nephrology. We can assume this fact because ultrasound has featured occasionally in European Dialysis and Transplant Association pre-congress courses. However, very few studies conducted by nephrologists are presented in congresses or published in the <span class="elsevierStyleItalic">Nephrology Dialysis and Transplantation</span> journal.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">INTERVENTIONAL NEPHROLOGY IN SPAIN</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">This subspeciality has hardly been developed in Spain. Although we are aware that there are numerous interventional nephrologists in Spain and that several departments boast an ultrasound machine, very few have published their experiences on performing fistula for haemodialysis,<span class="elsevierStyleSup">20</span> placing tunnelled catheters,<span class="elsevierStyleSup">21,22</span> ultrasound-guided renal biopsy,<span class="elsevierStyleSup">23</span> or peritoneal dialysis catheters.<span class="elsevierStyleSup">24,25</span> However, there are brilliant, consolidated initiatives for diagnostic ultrasound for vascular access.<span class="elsevierStyleSup">26</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Lastly, in recent years we have learnt that kidney disease is an independent cardiovascular risk factor, and if attended to at early stages, nephrologists may have more treatment variables available, crucially influencing patient survival and quality of life. Therefore, kidney patients’ diagnosis and follow-up should not only involve examining renal anatomy, but also evaluate the cardiovascular risk, by measuring the carotid intima-media thickness, for example.<span class="elsevierStyleSup">27-30</span> This aspect is being actively researched in an important Spanish multi-centre study, which is supported by the Spanish Society of Nephrology (S.E.N.).<span class="elsevierStyleSup">31</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We have had a diagnostic and interventional ultrasound unit at the <span class="elsevierStyleItalic">Servicio de Nefrología</span> (Nephrology Department) of the Ramón y Cajal Hospital since 1991.<span class="elsevierStyleSup">22-35</span> From this moment onwards, we have been able to examine our patients (those suffering from kidney diseases and transplant recipients) using conventional ultrasound, later implementing Doppler imaging. Our initial idea was to recover the renal biopsy technique, but, in our experience, incorporating these diagnostic procedures in the nephrology department’s daily routine has been extremely useful. It is an important tool for diagnosing and monitoring patients suffering from clinical kidney diseases, high blood pressure, or receiving kidney transplants.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Since 1995, we have been surgically implanting catheters for peritoneal dialysis. Since 2010, we have been evaluating the vascular access using ultrasound (pre- and post-surgery) and placing transitory central catheters using real-time ultrasound. Lastly, in our department, we also perform minor surgery, such as removing Schon tunnelled catheters (which was previously performed by vascular surgeons), repairing peritoneal catheters and draining abscesses.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Interest with regards diagnostic and interventional nephrology is growing in Spain, something which is reflected in the number of courses taking place.<span class="elsevierStyleSup">36,37</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISADVANTAGES AND OBSTACLES</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Our first obstacle is that we must overcome the assumption that we are stepping into other specialist’s fields,which is not the case, as we are relieving other specialities of numerous examinations and interventions, which may be of the utmost importance to us, but are less of a priority for them. In either case, there should be consensus with regard to interventional nephrology throughout the hospital so that it benefits the patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Another disadvantage, in our opinion, is that more focus is given to interventional nephrology than other areas. In our hospital there is a nephrologist who organises the <span class="elsevierStyleItalic">Unidad de Nefrología Diagnóstica e Intervencionista</span> (diagnostic and interventional nephrology unit), which is integrated by other nephrologists from the department. Each one is not only responsible for a given nephrology area, but also performs interventions. Given that they are continuously in contact with their patients, techniques are performed more swiftly. We have standardised each and every one of the activities performed in our department to avoid outcome variability.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Lastly, excessive workload is one of the main reasons for diagnostic ultrasound and interventional techniques being included as part of our routine. This has therefore improved the situation for other specialities (e.g. cardiology) by increasing staff.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Diagnostic and interventional nephrologists provide complete, rapid treatment to resolve problems associated with kidney diseases. We are able to recover diagnostic and treatment techniques from other specialists. If nobody is able to imagine a cardiologist living without an ultrasound machine or a cath lab, then maybe it would not be so difficult to envisage a “new type of nephrologist”, who would be a master of ultrasound, perform renal ultrasounds and vascular mapping of the upper extremity to gain vascular access, perform ultrasound-guided biopsy and provide early diagnosis for vascular access complications. Nephrologists would also be responsible for starting dialysis programmes, as it would be them who place tunnelled catheters for haemodialysis and the peritoneal catheter or perform arteriovenous fistula surgery. Furthermore, they would be capable of evaluating chronic kidney patients’ cardiovascular risk, adapting treatments to these parameters throughout the disease’s development.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">To achieve these goals, nephrologists must complete training in experienced centres and scientific societies must create training programmes and establish the minimum accreditation requirements. In this respect, we recognise the S.E.N.’s interest in promoting this type of programme. In Spain, the national commission for this speciality should assess whether these skills should be included in the nephrologists training programme. This new approach to nephrology may make this discipline more attractive to future resident junior doctors.</p>" "pdfFichero" => "P1-E518-S2891-A10825-EN.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441228" "palabras" => array:1 [ 0 => "Interventional nephrology" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441230" "palabras" => array:1 [ 0 => "Diagnostic nephrology" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Iversen P, Brun C. Aspiration biopsy of the kidney. Am J Med 1951;11:324-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14877837" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Quinton WE, Dillard DH, Cole JJ, Scribner BH. Eight months' experience with silastic-teflon bypass cannulas. Trans Am Soc Artif Int Organs 1962:8:236-45." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Uldall PR, Dyck RF, Woods F, Merchant N, Martin GS, Cardella CJ, et al.\u{A0}A subclavian cannula for temporary vascular access for haemodialysis and plasmapheresis. Dial Transplant 1979;8:963-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and surgically created arteriovenous fistula. N Engl J Med 1966;275:1089-92. \u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/5923023" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tenckhoff H, Schechter H. A bacteriologically safe peritoneal access device. Trans Am Soc Artif Int Organs 1968;14:181-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ash SR. Bedside peritoneoscopic peritoneal catheter placement of Tenckhoff and newer peritoneal catheters. Adv Peritoneal Dial 1998;14:75-9. \u{A0}" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Holmes JH. Early diagnostic ultrasonography. J Ultrasound Med 1983;2:33-43. \u{A0}" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from\u{A0}the dialysis outcomes and practice patterns study. Nephrol Dial Transplant 2008;23:3219-26. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511606" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "O'Neill C. The new Nephrologist. Am J Kidney Dis 2000;35:978-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "www.asding.org" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "http://www.isn-online.org/isn/society/about/isn_20016.html" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "http://www.asn-online.org/education_and_meetings/renal_week/archives/" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Berns JS, O¿NeilL WC. Performance of Procedures by Nephrologists and Nephrology Fellows at U.S. Nephrology Training Programs. Clin J Am Soc Nephrol 2008;3:941-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Niyyar VD, Work J. Interventional Nephrology: Core Curriculum 2009. Am J Kidney Dis 2009;54:169-82." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "O'Neill WC, Ash SR, Work J, Saad TF. Guidelines for Training,\u{A0}Certification, and Accreditation for Hemodialysis Vascular Access and Endovascular Procedures.\u{A0}Semin\u{A0}Dial 2003;16:173-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12641883" 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" => "Teitelbaum I, Burkar J. Core Curriculum in Nephrology Peritoneal Dialysis. Am J Kidney Dis 2003;42:1082-96. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14582053" 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" => "Nascimento MM, Chula D, Campos R,\u{A0}Nascimento D, Riella MC.\u{A0}Interventional Nephrology in Brazil: Current and Future Status. Semin Dial 2006;19:172-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16551298" 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" => "Torre León F, Rivera Bermúdez C, Hernández V, Silva J, Santiago Delpín E. Interventional Nephrology in Puerto Rico. Semi Dial 2006;19:176-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "http://www.slanh.org" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García-Trío G, Alonso M, Saavedra J, Cigarrán S, Lamas JM.\u{A0}>Gestión integral del acceso vascular por los nefrólogos. Resultados de tres años de trabajo. Nefrologia 2007;27:335-9.\u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/17725453" 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" => "Royo P, García-Testal A, Soldevila A, Panadero J, Cruz JM. Catéteres tunelizados. Complicaciones en su inserción. Nefrología 2008;28:543-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18816214" 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" => "Ibrik O,\u{A0}Samon R,\u{A0}Roca R, Viladoms J, Mora J. Catéteres tunelizados para hemodiálisis tipo «sistema Tesio de catéteres gemelos» mediante técnica ecodirigida. Análisis retrospectivo de 210 catéteres. Nefrologia 2006;26:719-25." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Toledo K, Pérez MJ, Espinosa M, Gómez J, López M, Redondo D, et al.\u{A0}Complicaciones asociadas a la biopsia renal percutánea. Experiencia en España 50 años después. Nefrologia 2010;30:539-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20882092" 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" => "Lanuza M, Minguela JI, Rodado R, Muriel J, Ruiz-de-Gauna R. Our nine-year experience with the self-locating catheter: comparison of malfunction rate with other Tenckhoff catheter variants. Int J Artif Organs 2006;26:138-41." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "De\u{A0}Álvaro F, Selgas R,\u{A0}Bajo MA, Serrano P, Fernández-Reyes MJ, Del Peso G, et al.\u{A0}Adv Perit Dial 1994;10:199-202. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7999827" 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" => "Ibeas J, Vallespín J, Rodríguez-Jornet A,\u{A0}Branera J, Fortuño JR, Bermúdez P, et al.\u{A0}Portable Doppler-ultrasound used by the nephrologist in the hemodialysis Unit for the immediate detection of fistula pathology and ultrasound guided cannulation: consolidation of a technique incide a protocolized interdisciplinary team with vascular surgeons, interventional radiologists and infirmary. A 4 years experience. J Am Soc Nephrol 2008;19:254A." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Junyent M, Martínez M, Borrás M, Betriu A, Coll B, Craver L, et al.\u{A0}Utilidad de las técnicas de imagen y biomarcadores en la predicción del riesgo cardiovascular en pacientes con enfermedad renal crónica en España: Proyecto NEFRONA. Nefrologia 2010;30:119-26." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al.\u{A0}Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003;108:2154-69." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Go A, Chertow GM, Fan D, McCullough CE, Hsu CY. Chronic Kidney disease and the risks of death, cardiovascular events and hospitalization. N Engl J Med 2004;351;1296-1305. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15385656" 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" => "Weiner DE, Tighiouart H, Amin MG, Stark PC, McLeod B, Griffith JL, et al.\u{A0}Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15100371" 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" => "Fernández E, Martínez-Castelao A. Proyecto NEFRONA: banco de datos de libre utilización. Nefrologia 2011;31:5-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21270907" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rivera M, Merino JL, Puig-Hooper C, Marcen-Letosa R, Rodríguez JR, Liaño F, et al.\u{A0}Interventional Nephrology: A One-Center Experience for 15 Years. J Am Soc Nephrol 2006;17." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rivera M. Incorporación de la ecografía a la práctica rutinaria del nefrólogo: nuestra experiencia. Nefrologia 1995;15:104-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rivera M, Ortuño J. Ultrasonography in Nephrology. Am J\u{A0}Kidney Dis 1998;32:703. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9774138" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rivera M, Quereda C. La ecografía realizada por el nefrólogo: nuestra experiencia. NefroPlus 2009;2:9-16." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "http://www.seacv.es/congresos/V_CURSO_ECO_V8.pdf" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "category&layout=blog&id=18&">www.nefrosur.com/index.php?option=com_content&view=category&layout=blog&id=18&" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109707036790" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051743/v0_201502091641/en/main.assets" "Apartado" => array:4 [ "identificador" => "35429" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorials" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000002/v0_201502091641/X2013251411051743/v0_201502091641/en/P1-E518-S2891-A10825-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051743?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 7 | 13 |
| 2024 October | 42 | 39 | 81 |
| 2024 September | 50 | 54 | 104 |
| 2024 August | 62 | 87 | 149 |
| 2024 July | 50 | 42 | 92 |
| 2024 June | 47 | 50 | 97 |
| 2024 May | 69 | 41 | 110 |
| 2024 April | 52 | 34 | 86 |
| 2024 March | 39 | 33 | 72 |
| 2024 February | 44 | 42 | 86 |
| 2024 January | 39 | 26 | 65 |
| 2023 December | 40 | 33 | 73 |
| 2023 November | 57 | 33 | 90 |
| 2023 October | 53 | 42 | 95 |
| 2023 September | 74 | 33 | 107 |
| 2023 August | 78 | 30 | 108 |
| 2023 July | 56 | 43 | 99 |
| 2023 June | 42 | 31 | 73 |
| 2023 May | 43 | 38 | 81 |
| 2023 April | 31 | 20 | 51 |
| 2023 March | 49 | 30 | 79 |
| 2023 February | 39 | 39 | 78 |
| 2023 January | 58 | 20 | 78 |
| 2022 December | 53 | 41 | 94 |
| 2022 November | 49 | 33 | 82 |
| 2022 October | 53 | 40 | 93 |
| 2022 September | 57 | 53 | 110 |
| 2022 August | 56 | 54 | 110 |
| 2022 July | 58 | 51 | 109 |
| 2022 June | 65 | 30 | 95 |
| 2022 May | 53 | 49 | 102 |
| 2022 April | 74 | 69 | 143 |
| 2022 March | 79 | 58 | 137 |
| 2022 February | 46 | 45 | 91 |
| 2022 January | 60 | 44 | 104 |
| 2021 December | 48 | 49 | 97 |
| 2021 November | 59 | 37 | 96 |
| 2021 October | 79 | 53 | 132 |
| 2021 September | 71 | 42 | 113 |
| 2021 August | 48 | 46 | 94 |
| 2021 July | 48 | 36 | 84 |
| 2021 June | 48 | 29 | 77 |
| 2021 May | 51 | 43 | 94 |
| 2021 April | 110 | 51 | 161 |
| 2021 March | 106 | 38 | 144 |
| 2021 February | 101 | 9 | 110 |
| 2021 January | 53 | 22 | 75 |
| 2020 December | 70 | 16 | 86 |
| 2020 November | 68 | 22 | 90 |
| 2020 October | 37 | 15 | 52 |
| 2020 September | 54 | 10 | 64 |
| 2020 August | 59 | 22 | 81 |
| 2020 July | 75 | 15 | 90 |
| 2020 June | 66 | 12 | 78 |
| 2020 May | 81 | 16 | 97 |
| 2020 April | 48 | 20 | 68 |
| 2020 March | 63 | 16 | 79 |
| 2020 February | 61 | 20 | 81 |
| 2020 January | 60 | 27 | 87 |
| 2019 December | 64 | 16 | 80 |
| 2019 November | 80 | 23 | 103 |
| 2019 October | 41 | 8 | 49 |
| 2019 September | 58 | 22 | 80 |
| 2019 August | 46 | 14 | 60 |
| 2019 July | 69 | 29 | 98 |
| 2019 June | 37 | 24 | 61 |
| 2019 May | 52 | 22 | 74 |
| 2019 April | 76 | 35 | 111 |
| 2019 March | 50 | 14 | 64 |
| 2019 February | 24 | 17 | 41 |
| 2019 January | 35 | 16 | 51 |
| 2018 December | 68 | 36 | 104 |
| 2018 November | 84 | 21 | 105 |
| 2018 October | 81 | 29 | 110 |
| 2018 September | 62 | 19 | 81 |
| 2018 August | 43 | 17 | 60 |
| 2018 July | 40 | 11 | 51 |
| 2018 June | 36 | 12 | 48 |
| 2018 May | 43 | 13 | 56 |
| 2018 April | 50 | 9 | 59 |
| 2018 March | 40 | 7 | 47 |
| 2018 February | 55 | 7 | 62 |
| 2018 January | 64 | 8 | 72 |
| 2017 December | 69 | 8 | 77 |
| 2017 November | 47 | 12 | 59 |
| 2017 October | 55 | 11 | 66 |
| 2017 September | 53 | 19 | 72 |
| 2017 August | 50 | 11 | 61 |
| 2017 July | 71 | 15 | 86 |
| 2017 June | 44 | 15 | 59 |
| 2017 May | 74 | 18 | 92 |
| 2017 April | 31 | 11 | 42 |
| 2017 March | 24 | 20 | 44 |
| 2017 February | 23 | 9 | 32 |
| 2017 January | 30 | 13 | 43 |
| 2016 December | 82 | 35 | 117 |
| 2016 November | 80 | 12 | 92 |
| 2016 October | 100 | 19 | 119 |
| 2016 September | 148 | 16 | 164 |
| 2016 August | 205 | 8 | 213 |
| 2016 July | 180 | 12 | 192 |
| 2016 June | 138 | 0 | 138 |
| 2016 May | 147 | 0 | 147 |
| 2016 April | 111 | 0 | 111 |
| 2016 March | 97 | 0 | 97 |
| 2016 February | 103 | 0 | 103 |
| 2016 January | 109 | 0 | 109 |
| 2015 December | 118 | 0 | 118 |
| 2015 November | 83 | 0 | 83 |
| 2015 October | 89 | 0 | 89 |
| 2015 September | 82 | 0 | 82 |
| 2015 August | 80 | 0 | 80 |
| 2015 July | 67 | 0 | 67 |
| 2015 June | 45 | 0 | 45 |
| 2015 May | 57 | 0 | 57 |
| 2015 April | 10 | 0 | 10 |
Show all
