array:21 [
  "pii" => "X201325141200124X"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
  "estado" => "S300"
  "fechaPublicacion" => "2012-05-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2012;32:359-66"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6111
    "formatos" => array:3 [
      "EPUB" => 308
      "HTML" => 5053
      "PDF" => 750
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001242"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
      "estado" => "S300"
      "fechaPublicacion" => "2012-05-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:359-66"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9945
        "formatos" => array:3 [
          "EPUB" => 298
          "HTML" => 9024
          "PDF" => 623
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Factores determinantes de una baja dosis de hemodiálisis establecida por dialisancia iónica en pacientes críticos con insuficiencia renal aguda"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "359"
            "paginaFinal" => "366"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11284_108_24154_es_11284_f1.jpg"
                "Alto" => 399
                "Ancho" => 505
                "Tamanyo" => 101545
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Comparación de hemodiálisis intermitentes frente a extendidas"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Guillermo Rosa Diez, Guillermo Rosa-Diez, Gustavo Greloni, Maria Crucelegui, María Crucelegui, Mariela Bedini Roca, Mariela Bedini-Roca, Agustina Heredia Martínez, Agustina Heredia-Martínez, Maria Luisa Coli, M. Luisa Coli, Sergio Giannasi, Eduardo San Roman, Eduardo San-Román, Rodolfo Pizarro, Cesar Belzitti, César Belzitti, Salomon Algranati, Salomón Algranati, Ricardo Heguilen"
            "autores" => array:20 [
              0 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Rosa Diez"
              ]
              1 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Rosa-Diez"
              ]
              2 => array:2 [
                "nombre" => "Gustavo"
                "apellidos" => "Greloni"
              ]
              3 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "Crucelegui"
              ]
              4 => array:2 [
                "nombre" => "María"
                "apellidos" => "Crucelegui"
              ]
              5 => array:2 [
                "nombre" => "Mariela"
                "apellidos" => "Bedini Roca"
              ]
              6 => array:2 [
                "nombre" => "Mariela"
                "apellidos" => "Bedini-Roca"
              ]
              7 => array:2 [
                "nombre" => "Agustina"
                "apellidos" => "Heredia Martínez"
              ]
              8 => array:2 [
                "nombre" => "Agustina"
                "apellidos" => "Heredia-Martínez"
              ]
              9 => array:2 [
                "nombre" => "Maria Luisa"
                "apellidos" => "Coli"
              ]
              10 => array:2 [
                "nombre" => "M. Luisa"
                "apellidos" => "Coli"
              ]
              11 => array:2 [
                "nombre" => "Sergio"
                "apellidos" => "Giannasi"
              ]
              12 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "San Roman"
              ]
              13 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "San-Román"
              ]
              14 => array:2 [
                "nombre" => "Rodolfo"
                "apellidos" => "Pizarro"
              ]
              15 => array:2 [
                "nombre" => "Cesar"
                "apellidos" => "Belzitti"
              ]
              16 => array:2 [
                "nombre" => "César"
                "apellidos" => "Belzitti"
              ]
              17 => array:2 [
                "nombre" => "Salomon"
                "apellidos" => "Algranati"
              ]
              18 => array:2 [
                "nombre" => "Salomón"
                "apellidos" => "Algranati"
              ]
              19 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Heguilen"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X201325141200124X"
          "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
          "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/X201325141200124X?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001242?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000003/v0_201502091350/X0211699512001242/v0_201502091350/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001231"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jan.11244"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:367-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5620
      "formatos" => array:3 [
        "EPUB" => 312
        "HTML" => 4608
        "PDF" => 700
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Discrepancies among consensus documents, guidelines, clinical practice and the legal framework for the treatment of type 2 diabetes mellitus patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "367"
          "paginaFinal" => "373"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Discrepancias entre documentos de consenso, guías, práctica clínica y normativa legal en el tratamiento de los pacientes con diabetes mellitus tipo 2"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => "11244_16025_29768_en_t1_11244i3.jpg"
              "Alto" => 537
              "Ancho" => 2188
              "Tamanyo" => 371583
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics and differences between the three patient groups according to origin"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "endocrinología y atención primaria de Alcoy Nefrología, endocrinología y atención primaria de Alcoy, Endocrinología y Atención Primaria de Alcoy Nefrología, Endocrinología y Atención Primaria de Alcoy, Carlos Del Pozo Fernández, Carlos Del Pozo-Fernández, Carlos Pardo Ruíz, Carlos Pardo-Ruiz, Concepción Sánchez Botella, Concepción Sánchez-Botella, Vanesa Blanes Castañer, Vanesa Blanes-Castañer, Ramón López-Menchero, Cristina Gisbert Sellés, Cristina Gisbert-Sellés, Carmen Sánchez Jodar, Carmen Sánchez-Jodar, Luis Álvarez Avellan, Luis Álvarez-Avellán"
          "autores" => array:17 [
            0 => array:2 [
              "nombre" => "endocrinología y atención primaria de Alcoy"
              "apellidos" => "Nefrología, endocrinología y atención primaria de Alcoy"
            ]
            1 => array:2 [
              "nombre" => "Endocrinología y Atención Primaria de Alcoy"
              "apellidos" => "Nefrología, Endocrinología y Atención Primaria de Alcoy"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Del Pozo Fernández"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Del Pozo-Fernández"
            ]
            4 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Pardo Ruíz"
            ]
            5 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Pardo-Ruiz"
            ]
            6 => array:2 [
              "nombre" => "Concepción"
              "apellidos" => "Sánchez Botella"
            ]
            7 => array:2 [
              "nombre" => "Concepción"
              "apellidos" => "Sánchez-Botella"
            ]
            8 => array:2 [
              "nombre" => "Vanesa"
              "apellidos" => "Blanes Castañer"
            ]
            9 => array:2 [
              "nombre" => "Vanesa"
              "apellidos" => "Blanes-Castañer"
            ]
            10 => array:2 [
              "nombre" => "Ramón"
              "apellidos" => "López-Menchero"
            ]
            11 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Gisbert Sellés"
            ]
            12 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Gisbert-Sellés"
            ]
            13 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Sánchez Jodar"
            ]
            14 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Sánchez-Jodar"
            ]
            15 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Álvarez Avellan"
            ]
            16 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Álvarez-Avellán"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001234"
        "doi" => "10.3265/Nefrologia.pre2012.Jan.11244"
        "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/X0211699512001234?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001231?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001231/v0_201502091613/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001258"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jan.11295"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2012;32:353-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7020
      "formatos" => array:3 [
        "EPUB" => 329
        "HTML" => 5889
        "PDF" => 802
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Factors associated with early peritoneal dialysis catheter replacement in Veracruz, Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "353"
          "paginaFinal" => "358"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores asociados con el cambio temprano de catéter de diálisis peritoneal en Veracruz, México"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => "11295_16025_29775_en_t111295.jpg"
              "Alto" => 1468
              "Ancho" => 2178
              "Tamanyo" => 896479
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Comparison of patients with peritoneal dialysis catheter dysfunction and those without"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gustavo Martínez-Mier, Marisol Luna-Castillo, Jorge J. Ortiz-Enriquez, Jorge J. Ortiz-Enríquez, Sandro F. Ávila-Pardo, Vicente Fernández, Marco T. Méndez-López, Luis Budar-Fernandez, Luis Budar-Fernández, Felipe González-Velázquez"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Gustavo"
              "apellidos" => "Martínez-Mier"
            ]
            1 => array:2 [
              "nombre" => "Marisol"
              "apellidos" => "Luna-Castillo"
            ]
            2 => array:2 [
              "nombre" => "Jorge J."
              "apellidos" => "Ortiz-Enriquez"
            ]
            3 => array:2 [
              "nombre" => "Jorge J."
              "apellidos" => "Ortiz-Enríquez"
            ]
            4 => array:2 [
              "nombre" => "Sandro F."
              "apellidos" => "Ávila-Pardo"
            ]
            5 => array:2 [
              "nombre" => "Vicente"
              "apellidos" => "Fernández"
            ]
            6 => array:2 [
              "nombre" => "Marco T."
              "apellidos" => "Méndez-López"
            ]
            7 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Budar-Fernandez"
            ]
            8 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Budar-Fernández"
            ]
            9 => array:2 [
              "nombre" => "Felipe"
              "apellidos" => "González-Velázquez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001250"
        "doi" => "10.3265/Nefrologia.pre2012.Jan.11295"
        "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/X0211699512001250?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001258?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001258/v0_201502091613/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "359"
        "paginaFinal" => "366"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Guillermo Rosa Diez, Guillermo Rosa-Diez, Gustavo Greloni, Maria Crucelegui, María Crucelegui, Mariela Bedini Roca, Mariela Bedini-Roca, Agustina Heredia Martínez, Agustina Heredia-Martínez, Maria Luisa Coli, M. Luisa Coli, Sergio Giannasi, Eduardo San Roman, Eduardo San-Román, Rodolfo Pizarro, Cesar Belzitti, César Belzitti, Salomon Algranati, Salomón Algranati, Ricardo Heguilen"
        "autores" => array:20 [
          0 => array:4 [
            "nombre" => "Guillermo"
            "apellidos" => "Rosa Diez"
            "email" => array:1 [
              0 => "guillermo.rosadiez@hospitalitaliano.org.ar"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Guillermo"
            "apellidos" => "Rosa-Diez"
            "email" => array:1 [
              0 => "guillermo&#46;rosadiez&#64;hospitalitaliano&#46;org&#46;ar"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Gustavo"
            "apellidos" => "Greloni"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Crucelegui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Crucelegui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mariela"
            "apellidos" => "Bedini Roca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mariela"
            "apellidos" => "Bedini-Roca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Agustina"
            "apellidos" => "Heredia Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Agustina"
            "apellidos" => "Heredia-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Maria Luisa"
            "apellidos" => "Coli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "M&#46; Luisa"
            "apellidos" => "Coli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Sergio"
            "apellidos" => "Giannasi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "San Roman"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "San-Rom&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Rodolfo"
            "apellidos" => "Pizarro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          15 => array:3 [
            "nombre" => "Cesar"
            "apellidos" => "Belzitti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          16 => array:3 [
            "nombre" => "C&#233;sar"
            "apellidos" => "Belzitti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "affg"
              ]
            ]
          ]
          17 => array:3 [
            "nombre" => "Salomon"
            "apellidos" => "Algranati"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          18 => array:3 [
            "nombre" => "Salom&#243;n"
            "apellidos" => "Algranati"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          19 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Heguilen"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "affh"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Nefrologia, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Terapia Intensiva, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "Terapia Intensiva Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "Cardiologia Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Cardiología Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">g</span>"
            "identificador" => "affg"
          ]
          7 => array:3 [
            "entidad" => "Instituto Universitario, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">h</span>"
            "identificador" => "affh"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Factores determinantes de una baja dosis de hemodi&#225;lisis establecida por dialisancia i&#243;nica en pacientes cr&#237;ticos con insuficiencia renal aguda"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30164_en_f111284.jpg"
            "Alto" => 813
            "Ancho" => 1010
            "Tamanyo" => 124761
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of intermittent and extended haemodialysis regimens"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION&#160;</span></p><p class="elsevierStylePara">Acute kidney injury &#40;AKI&#41; is a highly prevalent entity among patients admitted to intensive care units &#40;ICU&#41;&#46; According to the population at-risk being studied and the definition used&#59; AKI occurs in 5&#37;-15&#37; of these patients<span class="elsevierStyleSup">&#46;1-5</span></p><p class="elsevierStylePara">Although more than 60 years have passed since the first haemodialysis session was successfully carried out in patients with AKI&#44; the mortality rates associated with this condition in critical patients still range between 30&#37; and 60&#37;&#44;<span class="elsevierStyleSup">1-6</span> particularly in patients requiring some type of renal replacement therapy &#40;RRT&#41;&#44;<span class="elsevierStyleSup">1</span> making AKI an independent risk factor for mortality in this group&#46;<span class="elsevierStyleSup">2&#44;3&#44;5&#44;6</span></p><p class="elsevierStylePara">The different types of RRT used in AKI patients can be classified into intermittent &#40;IHD&#41;&#44; extended or hybrid &#40;EHD&#41;&#44; continuous&#44; or peritoneal dialysis&#46;<span class="elsevierStyleSup">7</span> This last technique is not commonly applied in adult patients&#44; and patients treated with continuous methods are rare in Spain&#44; with IHD and EHD being the most common&#44; taking first and second place&#44; respectively&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">While haemodialysis dosage is important for patients on chronic dialysis&#44; threshold doses &#40;TD&#41; for RRT in patients with AKI in the ICU have not been established&#46;<span class="elsevierStyleSup">9-12</span> A study at one hospital showed higher survival and renal recovery rates in patients with daily IHD sessions<span class="elsevierStyleSup">13</span>&#59; however&#44; the dose administered per session was 0&#46;94Kt&#47;V&#44; far below the recommendations for patients with chronic kidney disease &#40;CKD&#41;&#46; A multi-centre study showed that&#44; above a Kt&#47;V of 1&#46;3&#44; no benefits were observed in terms of reduced patient mortality&#46;<span class="elsevierStyleSup">14</span> As such&#44; the TD in patients with AKI is generally considered to be close to the applicable target values in patients with CKD&#44; which entails a Kt&#47;V equal to or greater than 1&#46;2&#44; a percent reduction in urea &#40;PRU&#41; equal to or greater than 65&#37;&#44; or a Kt greater than 45 or 40 in males and females&#44; respectively&#46;<span class="elsevierStyleSup">15-17</span></p><p class="elsevierStylePara">However&#44; in normal clinical practice&#44; in contrast to patients with CKD&#44; the doses administered to AKI patients go uncontrolled&#44; and it is widely estimated that we do not reach the prescribed dose&#46;<span class="elsevierStyleSup">18&#44;19</span> Few studies have evaluated this issue as a primary objective in patients on IHD with an adequate number of patients and treatments&#44; and none has performed such an evaluation in EHD&#46; In this context&#44; critical patients would be at an even greater risk of not receiving the prescribed dose&#46;<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">The most commonly used methods for evaluating the dose administered in patients with AKI have been the Kt&#47;V formula or URR&#46; The Kt&#47;V formula&#44; which is routinely used in CKD patients&#44; has limited applications in critical patients&#44; since this group tends to have a varying and unpredictable urea distribution volume&#46;<span class="elsevierStyleSup">21</span> While determining URR is a simple process&#44; the calculation is made retrospectively&#44; making it impossible to monitor levels during treatment to verify reaching the prescribed dose&#46;<span class="elsevierStyleSup">22</span> Calculating dialysis dose through direct quantification of dialysate would be the most reliable method to use in AKI patients&#44; compared to other options&#46;<span class="elsevierStyleSup">23</span> Measuring Kt through ionic dialysance provides a direct measurement of the dialysis dose being administered without the need for blood or dialysate samples for measuring urea levels&#44; and this method has been validated for patients with both chronic and acute kidney injury&#46;<span class="elsevierStyleSup">24-26</span> It has recently been shown that measuring the dose of dialysis using Kt as determined through ionic dialysance is more sensitive for revealing inadequate treatment than Kt&#47;V<span class="elsevierStyleInf">UREA</span> in critical patients with AKI&#46;<span class="elsevierStyleSup">27</span></p><p class="elsevierStylePara">The difference between the prescribed and the administered dose as well as the factors related to this difference are normally monitored in patients on chronic dialysis treatment&#44; Identifying these factors and understanding and correcting them allows for optimizing the dosage given to these patients&#46;</p><p class="elsevierStylePara">Our objective was to evaluate the differences between prescribed and administered doses in critical patients with AKI and the factors that influence these differences&#44; using Kt measurements through ionic dialysance&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our research team was composed of members of the Nephrology&#44; Cardiology&#44; and Intensive Care departments&#44; and the study took place in the Intensive Care Unit &#40;ICU&#41; and Intensive Coronary Care Unit &#40;ICCU&#41; at the Hospital Italiano de Buenos Aires&#46; The study was conducted according to the regulations established by good clinical practices and the Declaration of Helsinki with the modifications established by the Nuremberg and Tokyo Conventions&#44; and was approved by an Institutional Review Board &#40;IRB&#41; - Comite de Protocolos de Investigaci&#243;n &#40;CEPI&#41; - Hospital Italiano&#46;</p><p class="elsevierStylePara">This was a prospective and observational study involving RRT-requiring adult AKI individuals admitted to the ICU or ICCU&#44; and being treated with intermittent and&#47;or extended haemodialysis&#46; Patients in the ICCU were included due to the extensive cardiological care provided at the Hospital Italiano de Buenos Aires&#46; All baseline characteristics&#44; including sequential organ failure assessment &#40;SOFA&#41;&#44; aetiology and classification of the AKI&#44; and the severity of AKI using the individual severity index &#40;ISI&#41; were recorded&#46;<span class="elsevierStyleSup">28</span> The type and duration of dialysis was not modified for the purposes of the study&#44; and was administered according to the indications by the attending physician and the type of treatment &#40;intermittent or extended dialysis&#41;&#44; registering all of&#160; the different parameters of the prescription&#46; Patients were administered dialysis using Fresenius 4008 S monitors equipped with OCM<span class="elsevierStyleSup">&#174;</span> biosensors &#40;On-line Clearance Monitoring&#44; Fresenius Medical Care AG&#41;&#44; devices that use non-invasive methods to measure effective ionic dialysance with conductivity probes&#46;&#160; Water used for haemodialysis was obtained through a portable reverse osmosis device &#40;FG Ingenieria&#41;&#46; The dialysate flow rates for IHD and extended dialysis were 500ml&#47;min and 300ml&#47;min&#44; respectively&#46; Sterile bicarbonate powder was also used&#46; In all cases&#44; RRT was administered using Fresenius FX<span class="elsevierStyleSup">&#174;</span> 60 dialysers &#40;helixone filters of 1&#46;4m<span class="elsevierStyleSup">2</span>&#44; KoA urea 960ml&#47;min&#41;&#46; In all cases&#44; the vascular access used were non-tunnelled central venous catheters of 11&#46;5Fr&#44; placed using the Seldinger technique in the femoral vein or internal jugular vein&#44; at 19cm or 16cm&#44; respectively&#46; In the absence of any contraindications&#44; patients were administered standard anticoagulation using sodium heparin in a continuous infusion with a loading dose of 1000 units and a maintenance dose of 500 units per hour&#46; Kt was automatically determined through the aforementioned method&#44; and calculated prescribed Kt based on the type of RRT&#44; blood flow&#44; and time prescribed on dialysis along with <span class="elsevierStyleItalic">in vivo </span>dialyser clearance&#44; which was previously determined in a series of CKD patients on stable haemodialysis&#46;<span class="elsevierStyleSup">20&#44;29</span></p><p class="elsevierStylePara">The following parameters were registered throughout each dialysis session&#58; type of RRT&#44; compliance with the duration prescribed&#44; temporary or definitive suspension&#44; ultrafiltration &#40;millilitres&#41;&#44; nominal blood flow&#44; type and location of vascular access&#44; need for catheter line reversal&#44; recirculation of the vascular access&#44; intra-dialysis hypotension &#40;defined as a drop in mean blood pressure of 10mm Hg&#41;&#44; need for hypotension treatment &#40;defined as an increase in inotropic drugs and&#47;or saline solution&#41;&#44; use of heparin&#44; and coagulation of the dialyser or system&#46; Recirculation of the vascular access was measured by determining plasma urea levels in arterial&#44; venous&#44; and peripheral lines using the low-flow method&#46;<span class="elsevierStyleSup">30</span></p><p class="elsevierStylePara">All data are expressed as mean &#177; standard deviation or proportions&#44; unless otherwise indicated&#46; Considering a target Kt of 40 for women and 50 for men&#44; we determined compliance with this target for both the prescribed dose and administered dose in each case&#46; We performed a univariate analysis with the dependent variable of compliance and the independent variables were components of the RRT performed and patient characteristics&#46; A a <span class="elsevierStyleItalic">P</span>-value &#60;&#46;05 was considered statistically significant&#46; All variables that had statistical significance or clinical relevance were included in a multiple logistic regression model&#44; with level of compliance with dosage as the dependent variable&#46; Taking into account the number of variables mentioned&#44; we estimated a minimum number of 200 RRT sessions with Kt measurements&#46; We used STATA software version 8&#46;0 for all statistical analyses&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">A total of 395 RRT sessions were recorded in 105 patients with AKI in the ICU &#40;3&#46;7&#177;3&#46;96 sessions per patient&#41; from June 29&#44; 2010 through&#160; May 24&#44; 2011&#44; Table 1 summarises the characteristics of the study population&#58; mean age&#58; 66&#177;15 years&#44; 37&#37; female&#44; 97&#37; with oliguric AKI&#44; and the most common aetiology was sepsis &#40;70&#37;&#41;&#46; These were critical patients&#44; the majority of which had hypotension and&#47;or requirements for inotropic drugs &#40;71&#37;&#41; and required mechanical ventilation &#40;70&#37;&#41;&#46; The mean ISI was 0&#46;7&#177;0&#46;26&#44; and the mean SOFA score was 12&#177;4&#46; A total of 201 IHD and 193 EHD sessions were performed&#44; and the most commonly used vascular access was the femoral vein &#40;79&#37;&#41;&#46; Serum levels of urea at the start of each haemodialysis session were 101&#177;58mg&#47;dl&#44; and the haematocrit was 24&#177;8 &#37;&#46; Heparin was not administered in 165 sessions &#40;42&#37;&#41;&#44; the treatment duration was 317&#177;102 minutes &#40;extended&#58; 408&#177;73 minutes&#41;&#44; and the blood flow was 223&#177;62ml&#47;min &#40;extended&#58; 186&#177;17ml&#47;min&#41; whereas the total ultrafiltration per session was 1036&#177;684ml &#40;62&#37; above 1000ml&#41;&#46; Vascular access recirculation occurred in 21&#177;19&#37; of cases&#44; with a recirculation of more than 15&#37; in 53&#37; of accesses evaluated&#46; Catheter line reversal was required in 22&#37; of procedures&#44; and recirculation was significantly more common in this instance than when the reversal was not required &#40;recirculation&#58; 25&#177;21 vs 20&#177;18&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; Intra-dialysis hypotension occurred in 20&#37; of RRT sessions&#44; requiring an increased dosage of inotropic drugs in 17&#37; and&#47;or saline solution in 8&#37;&#46; Coagulations occurred in the dialyser in 23 sessions&#44; 11 required temporary suspensions of treatment and then completed the indicated effective time&#44; and 2 required definitive suspension &#40;Table 2&#41;&#46;<span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Mean prescribed Kt was 52&#46;26&#177;13 litres&#44; and 21&#37; of all prescriptions were below the dosage compliance level &#40;lower than 40 litres in women and 45 litres in men&#41;&#46; There were no significant differences between the proportion of men and women with a prescribed Kt below the level of dosage compliance &#40;21&#37; in women vs 23&#37; in men&#41;&#46;</p><p class="elsevierStylePara">As regards the dose of Kt administered with an adequate prescription&#44; 185 sessions &#40;61&#37;&#41; did not comply with the prescribed dose&#44; with mean Kt in this sub-group being 31&#177;8 litres vs 56&#177;12 litres in the sub-group that did reach the compliance level&#46;</p><p class="elsevierStylePara">The Kt obtained in EHD sessions was significantly higher than in IHD&#58; 46&#177;16 litres vs 33&#177;9 litres&#44; respectively &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">In the univariate analysis&#44; an insufficient level of compliance was significantly correlated with age &#40;older than 65 years&#41;&#44; sex &#40;male&#41;&#44; severity of illness&#44; anaemia &#40;haematocrit &#60;25&#41;&#44; failure to achieve the prescribed blood flow&#44; catheter line reversal&#44; and the type of RRT &#40;IHD&#41; &#40;Table 3&#41;&#46;</p><p class="elsevierStylePara">In the multivariate analysis&#44; an insufficient level of compliance was independently correlated with the presence of intra-dialysis hypotension&#44; failure to achieve the prescribed blood flow&#44; catheter line reversal&#44; and intermittent haemodialysis &#40;Table 4&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This study demonstrates that a substantial proportion of RRT sessions in critical patients with AKI are inadequately prescribed&#44; and that an even greater proportion does not reach full compliance with the dose prescribed&#46; This is the first study in which ionic dialysance has been applied in a large number of critical patients with AKI in order to achieve the proposed objectives&#46;</p><p class="elsevierStylePara">As regards our method of measurement for the dosage of dialysis&#44; we believe that it is adequate for this type of patient and treatment&#46; Urea kinetic modelling assumes stability characterised by a neutral nitrogen balance and similar pre-dialysis urea values for each cycle of treatment &#40;haemodialysis&#41;&#46; However&#44; this is not valid for patients with AKI&#44; since the majority of critical patients are hyper-catabolic and have a negative nitrogen balance&#46;<span class="elsevierStyleSup">31</span> Regional blood flow abnormalities&#44; particularly in unstable patients receiving vasoactive drugs&#44; can produce a disequilibrium In the intercompartmental distribution of urea&#44; which would invalidate the normal single-compartment models for urea&#44;<span class="elsevierStyleSup">31</span> over-estimating the dose of dialysis when calculated through blood samples&#46;<span class="elsevierStyleSup">32</span> This disequilibrium would be lower in the case of patients treated with extended dialysis&#44;<span class="elsevierStyleSup">33</span> and so calculating dialysis dosage through urea kinetic modelling could not be used to compare between intermittent and extended therapies&#46; In contrast&#44; ionic dialysance&#44; using the same principle of direct measurements of solute purification in the dialysate&#44; is an applicable&#44; sensible method that allows for comparing doses between IHD and EHD&#46;<span class="elsevierStyleSup">25-27</span></p><p class="elsevierStylePara">In our study&#44; all variables that could be related to an inadequate dialysis dose were taken into account&#59; the fact that none of these were correlated with non-compliance in both univariate and multivariate analyses &#40;for example&#44; not using heparin&#41; does not imply that these are not important&#46; With regard to the severity of the patients&#8217; conditions&#44; while this has been associated with a greater proportion of insufficient dialysis doses&#44;<span class="elsevierStyleSup">20</span> our patients were in severely critical states&#44; since this was part of the primary objective of our study&#44; and this variable is also masked by the type of treatment provided&#44; since the severity of the patient&#8217;s condition at the start of treatment was higher in EHD than IHD &#40;ISI&#58; 0&#46;83&#177;0&#46;16 vs 0&#46;69&#177;0&#46;26&#59; and SOFA&#58; 15&#177;3 vs 7&#177;3&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Age and sex were correlated in the univariate model&#59; a previous study showed that male sex was associated with a higher risk of insufficient dialysis&#44;18 but both variables were not significantly associated in our multivariate model&#46;</p><p class="elsevierStylePara">The vascular access is of fundamental importance&#46; All patients with AKI require temporary catheters&#44; and&#44; as demonstrated by our results&#44; these imply a high rate of recirculation&#44; regardless of the location of insertion&#46;</p><p class="elsevierStylePara">While recirculation was more common in femoral catheters than jugular catheters&#44; this difference was not significant&#44; and recirculation was higher than 15&#37; in both cases &#40;22&#37;&#177;19&#37; vs 19&#37;&#177;19&#37;&#44; respectively&#41;&#46; Line reversal&#44; which is a common practice when we are unable to achieve proper flow rates&#44; was a prevalent cause for inadequate dialysis&#44; with a high rate of recirculation regardless of the site of insertion&#46; These factors&#44; together with an incapacity to achieve the prescribed blood flow rate&#44; makes the vascular access one of the most important factors in considering the dialysis dose to prescribe in critical patients&#46; As such&#44; when faced with an inability to achieve optimal flow rates&#44; we must consider modifying the treatment regimen by increasing the duration of the session<span class="elsevierStyleSup">34</span> and&#47;or the frequency of treatments&#44; or consider using longer catheters &#40;equal to or longer than 20cm for femoral vein insertion&#41; or wider catheters &#40;13Fr&#41;&#46;</p><p class="elsevierStylePara">Independently of other variables&#44; haemodynamic instability during dialysis&#44; which is a common complication in these patients&#44; was another primary cause of inadequate dialysis&#46; This was significantly more common in patients on EHD &#40;23&#37; vs 10&#37; in IHD&#41;&#44; which is probably due to the severity of the patient&#96;s conditions&#44; not to the type of RRT <span class="elsevierStyleItalic">per se&#46;</span></p><p class="elsevierStylePara">Finally&#44; patients on EHD reached a higher level of compliance than those on IHD&#46; A multi-centre study did not observe this difference&#44;<span class="elsevierStyleSup">14</span> but this study had the bias of being a controlled study&#44; since the primary objective was to reach a specific dialysis dosage&#46; Our study attempted to reflect what actually occurs in daily practice&#44; and together with the aforementioned study&#44; supports the arguments set forth by expert opinion&#58; regardless of the controversy surrounding thresholds and methodologies in measuring dialysis dosage&#44; it must indeed be controlled and monitored&#46;<span class="elsevierStyleSup">9&#44;35</span> However&#44; EHD is not without its disadvantages&#59; in a secondary analysis&#44; patients on EHD had a significantly higher proportion of dialyser coagulations &#40;Figure 1&#41;&#46; However&#44; we should point out that the indication for EHD is related to the haemodynamic state and overall severity of the patient&#44; and this type of RRT allows for reaching objective dosage even in critical patients&#44; with the resources normally available in IHD&#46;<span class="elsevierStyleSup">36</span> In our experience&#44; the duration and compliance with time prescriptions for RRT are very important&#46;</p><p class="elsevierStylePara">Our study had certain limitations&#44; most notably the fact that it was carried out at one single hospital&#44; did not incorporate body weight and surface area for the patients analysed&#44; possibly involved a certain level of heterogeneity in the study population&#44; and Kt was considered to be optimal at its lower limit&#59; however&#44; we used an adjusted fit model&#44; and no previous studies exist in the medical literature of this magnitude in which Kt was used as a measurement of the dialysis dose in critical patients with AKI&#46; Prospective studies that include a comparison of the duration of hospital stay and mortality with weekly Kt doses might better respond to the question of limits for Kt dosage in critical patients with AKI&#46;</p><p class="elsevierStylePara">In conclusion&#44; the prescribed dialysis dose in critical patients with AKI should be monitored&#46; Ionic dialysance facilitates such supervision&#44; as well as the estimation of extended treatments based on target doses and TD&#46; In addition to the method used for measuring and controlling dialysis dosage&#44; a better functioning vascular access &#40;ensured optimal blood flow without the need for catheter line reversal&#41; and haemodynamic stability during RRT would be the most important factors for achieving TD and other objectives in critical patients with AKI&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30164&#95;en&#95;f111284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30164_en_f111284.jpg" alt="Comparison of intermittent and extended haemodialysis regimens "></img></a></p><p class="elsevierStylePara">Figure 1&#46; Comparison of intermittent and extended haemodialysis regimens </p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30165&#95;en&#95;t111284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30165_en_t111284.jpg" alt="Characteristics of the study population"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the study population</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30166&#95;en&#95;t211284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30166_en_t211284.jpg" alt="Characteristics of the treatment provided"></img></a></p><p class="elsevierStylePara">Table 2&#46; Characteristics of the treatment provided</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30167&#95;en&#95;t311284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30167_en_t311284.jpg" alt="Univariate analysis of insufficient compliance"></img></a></p><p class="elsevierStylePara">Table 3&#46; Univariate analysis of insufficient compliance</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30168&#95;en&#95;t411284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30168_en_t411284.jpg" alt="Multivariate analysis of insufficient compliance"></img></a></p><p class="elsevierStylePara">Table 4&#46; Multivariate analysis of insufficient compliance</p>"
    "pdfFichero" => "P1-E536-S3491-A11284-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:9 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438403"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis administrada"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438405"
          "palabras" => array:1 [
            0 => "RIFLE"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438407"
          "palabras" => array:1 [
            0 => "Hemodi&#225;lisis extendida"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438409"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis prescrita"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438411"
          "palabras" => array:1 [
            0 => "Hemodi&#225;lisis intermitente"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438413"
          "palabras" => array:1 [
            0 => "Dialisancia i&#243;nica"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438415"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis"
          ]
        ]
        7 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438417"
          "palabras" => array:1 [
            0 => "Lesi&#243;n renal aguda"
          ]
        ]
        8 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438419"
          "palabras" => array:1 [
            0 => "Insuficiencia renal aguda"
          ]
        ]
      ]
      "en" => array:9 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438404"
          "palabras" => array:1 [
            0 => "Delivered dialysis dose"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438406"
          "palabras" => array:1 [
            0 => "RIFLE"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438408"
          "palabras" => array:1 [
            0 => "Extended haemodialysis"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438410"
          "palabras" => array:1 [
            0 => "Prescribed dialysis dose"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438412"
          "palabras" => array:1 [
            0 => "Intermitent haemodialysis"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438414"
          "palabras" => array:1 [
            0 => "Ionic dialysance"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438416"
          "palabras" => array:1 [
            0 => "Dialysis dose"
          ]
        ]
        7 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438418"
          "palabras" => array:1 [
            0 => "Acute renal injury"
          ]
        ]
        8 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438420"
          "palabras" => array:1 [
            0 => "Acute renal failure"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span><span class="elsevierStyleBold">&#160;</span>En la insuficiencia renal aguda &#40;IRA&#41;&#44; la dosis administrada no suele controlarse y se estima que resulta inferior a la prescrita&#46; <span class="elsevierStyleBold">Objetivo&#58;</span>&#160;Evaluar la diferencia entre la dosis prescrita y la dosis administrada en pacientes con IRA en Unidades de Cuidados Intensivos &#40;UCI&#41;&#44; as&#237; como los factores que la determinan&#44; utilizando la determinaci&#243;n del Kt por dialisancia i&#243;nica&#46;&#160;<span class="elsevierStyleBold">Material y m&#233;todo&#58;</span><span class="elsevierStyleBold"> </span>Se incluyeron 394 terapias de reemplazo renal &#40;TRR&#41; en 105 pacientes adultos&#44; con IRA olig&#250;rica ingresados en UCI&#44; con requerimiento de TRR &#44; tratados con hemodi&#225;lisis intermitente &#40;HDI&#41; y&#47;o extendida &#40;HDE&#41;&#46; Las TRR fueron realizadas con un monitor de aclaramiento <span class="elsevierStyleItalic">on line</span> &#40;OCM<span class="elsevierStyleSup">&#174;</span>&#44; Fresenius&#41; para la determinaci&#243;n del Kt&#46; Se registraron las caracter&#237;sticas de los pacientes&#44; la prescripci&#243;n y el desarrollo de TRR&#46; Todas estas variables fueron incluidas en un modelo uni y multivariado&#44; teniendo como variable dependiente la incapacidad de lograr la dosis umbral u objetivo &#40;DU&#41;&#46;&#160;<span class="elsevierStyleBold">Resultados&#58;</span><span class="elsevierStyleBold">&#160;</span>Edad 66 &#177; 15 a&#241;os&#44; 37&#37; del sexo femenino&#44; etiolog&#237;a m&#225;s frecuente&#58; sepsis &#40;70&#37;&#41;&#44; hipotensi&#243;n y&#47;o requerimientos de inotr&#243;picos &#40;71&#37;&#41;&#44; asistencia respiratoria mec&#225;nica &#40;70&#37;&#41;&#59; el &#237;ndice de severidad individualizado promedio fue de 0&#44;7 &#177; 0&#44;26&#46; Se efectuaron 201 HDI y 193 HDE&#44; la v&#237;a de acceso vascular m&#225;s frecuente fue la femoral &#40;79&#37;&#41;&#46; El Kt prescrito fue de 53&#44;5 &#177; 14 litros&#44; y un 21&#37; de las prescripciones estaban por debajo de DU&#46; En el 61&#37; no se logr&#243; el nivel de cumplimiento de la DU &#40;31 &#177; 8 litros&#41;&#44; vs&#46; 56 &#177; 12 litros en el subgrupo que logr&#243; el nivel de cumplimiento&#46; El Kt obtenido por las HDE fue significativamente mayor &#40;46 &#177; 16 litros vs&#46; 33 &#177; 9 litros en HDI&#41;&#46; En el an&#225;lisis univariado&#44; el nivel de cumplimiento insuficiente estuvo relacionado con la edad &#40;&#62; 65 a&#241;os&#41;&#44; el sexo &#40;masculino&#41;&#44; la presencia de hipotensi&#243;n intradi&#225;lisis&#44; no lograr el flujo de sangre prescrito&#44; la inversi&#243;n de las ramas del cat&#233;ter y la HDI&#46; Las mismas variables estuvieron independientemente relacionadas en el modelo multivariado&#44; con excepci&#243;n de la edad y el g&#233;nero&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span>&#160;La dosis de di&#225;lisis administrada fue significativamente inferior a la prescrita&#46; Las HDE exhibieron un Kt m&#225;s cercano a DU y significativamente mayor que las HDI&#46; El funcionamiento adecuado del acceso vascular&#44; sin la necesidad de inversi&#243;n de las ramas del cat&#233;ter&#44; y el hecho de evitar la inestabilidad hemodin&#225;mica durante la TRR constituyen dos de los factores m&#225;s importantes para lograr la DU&#44; particularmente en ancianos y varones&#46; Debe prescribirse y controlarse la dosis de di&#225;lisis en pacientes cr&#237;ticos con IRA&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span>&#160;Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy &#40;RRT&#41; in patients with chronic kidney disease &#40;CKD&#41;&#46; In patients with acute kidney injury &#40;AKI&#41;&#44; this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained&#46; Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments&#44; nor were patients treated with extended therapies&#46; Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that&#44; compared with Kt&#47;V&#44; this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals&#46; The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients&#44; and to evaluate what factors determine this gap using Kt values assessed through ionic dialisance&#46; <span class="elsevierStyleBold">Material and Method&#58;</span> Data from 394 sessions of renal replacement therapy in 105 adult haemodialysis &#40;HD&#41; patients with oliguric acute kidney injury and admitted to ICU were included in this analysis&#46; RRT was carried out with Fresenius 4008E dialysis machines equipped with on-line clearance monitoring &#40;OCM<span class="elsevierStyleSup">&#174;</span> Fresenius&#41;&#44; which use non-invasive techniques to monitor the effective ionic dialysance&#44; equivalent to urea clearance&#46; The baseline characteristics of the study population as well as the prescription and outcome of RRT were analysed&#46; These variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose &#40;TD&#41;&#46; <span class="elsevierStyleBold">Results&#58;</span> The main baseline characteristics of the study population&#47;treatments were&#58; age 66&#177;15 years&#44; 37&#37; female&#44; most frequent cause of AKI&#58; sepsis &#40;70&#37;&#41;&#46; Low BP and&#47;or vasoactive drug requirement &#40;71&#37;&#41;&#44; mechanical ventilation &#40;70&#37;&#41; and average individual severity index&#58; 0&#46;7&#177;0&#46;26&#46; Two hundred and one intermittent HD &#40;IHD&#41; and 193 extended HD &#40;EHD&#41; sessions were performed&#59; the most frequently used temporary vascular access was the femoral vein catheter &#40;79&#37;&#41;&#46; Prescribed Kt was 53&#46;5&#177;14L and 21&#37; of prescriptions fell below the TD&#46; Sixty-one percent of treatments did not fulfill the TD &#40;31&#177;8L&#41; compared with 56&#177;12L obtained in the subgroup that achieved the target&#46; Compared to IHD&#44; EHD provided a significantly larger Kt &#40;46&#177;16L vs 33L&#177;9L&#41;&#46; Univariate analysis showed that inadequate compliance was associated with age &#40;&#62;65y&#41;&#44; male gender&#44; intra-dialytic hypotension&#44; low Qb&#44; catheter line reversal&#44; and IHD&#46; The same variables with the exception of age and gender were independently associated in the multivariate analysis&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>The dialysis dose obtained was significantly lower than that prescribed&#46; EHD achieved values closer to the prescribed KT and significantly higher than in IHD&#46; Ionic Kt measurement facilitates monitoring and allows HD treatments to be extended based upon a previously established TD&#46; Besides the chosen strategy to dispense the dose of dialysis&#44; a well-functioning vascular access allowing for optimal blood flow and other approaches aimed at avoiding hemodynamic instability during RRT are the most important factors to achieve TD&#44; mainly in elderly male patients&#46; The dialysis dose should be prescribed and monitored for all critically ill AKI patients&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30164_en_f111284.jpg"
            "Alto" => 813
            "Ancho" => 1010
            "Tamanyo" => 124761
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of intermittent and extended haemodialysis regimens"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30165_en_t111284.jpg"
            "Alto" => 1622
            "Ancho" => 1081
            "Tamanyo" => 306870
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the study population"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30166_en_t211284.jpg"
            "Alto" => 1343
            "Ancho" => 1059
            "Tamanyo" => 371069
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the treatment provided"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30167_en_t311284.jpg"
            "Alto" => 1101
            "Ancho" => 2165
            "Tamanyo" => 609523
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Univariate analysis of insufficient compliance"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30168_en_t411284.jpg"
            "Alto" => 709
            "Ancho" => 2181
            "Tamanyo" => 384632
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Multivariate analysis of insufficient compliance"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000003/v0_201502091613/X201325141200124X/v0_201502091613/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X201325141200124X/v0_201502091613/en/P1-E536-S3491-A11284-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200124X?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury
Factores determinantes de una baja dosis de hemodiálisis establecida por dialisancia iónica en pacientes críticos con insuficiencia renal aguda
Guillermo Rosa Dieza, Guillermo Rosa-Diezb, Gustavo Grelonib, Maria Cruceleguia, María Cruceleguib, Mariela Bedini Rocaa, Mariela Bedini-Rocab, Agustina Heredia Martíneza, Agustina Heredia-Martínezb, Maria Luisa Colia, M. Luisa Colib, Sergio Giannasic, Eduardo San Romand, Eduardo San-Románc, Rodolfo Pizarroe, Cesar Belzittif, César Belzittig, Salomon Algranatia, Salomón Algranatib, Ricardo Heguilenh
a Nefrologia, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina,
b Servicio de Nefrología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina,
c Servicio de Terapia Intensiva, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina,
d Terapia Intensiva Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina,
e Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina,
f Cardiologia Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina,
g Servicio de Cardiología Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina,
h Instituto Universitario, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina,
Read
10621
Times
was read the article
2506
Total PDF
8115
Total HTML
Share statistics
 array:21 [
  "pii" => "X201325141200124X"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
  "estado" => "S300"
  "fechaPublicacion" => "2012-05-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:359-66"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6111
    "formatos" => array:3 [
      "EPUB" => 308
      "HTML" => 5053
      "PDF" => 750
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699512001242"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
      "estado" => "S300"
      "fechaPublicacion" => "2012-05-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2012;32:359-66"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9945
        "formatos" => array:3 [
          "EPUB" => 298
          "HTML" => 9024
          "PDF" => 623
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Factores determinantes de una baja dosis de hemodi&#225;lisis establecida por dialisancia i&#243;nica en pacientes cr&#237;ticos con insuficiencia renal aguda"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "359"
            "paginaFinal" => "366"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11284_108_24154_es_11284_f1.jpg"
                "Alto" => 399
                "Ancho" => 505
                "Tamanyo" => 101545
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Comparaci&#243;n de hemodi&#225;lisis intermitentes frente a extendidas"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Guillermo Rosa Diez, Guillermo Rosa-Diez, Gustavo Greloni, Maria Crucelegui, Mar&#237;a Crucelegui, Mariela Bedini Roca, Mariela Bedini-Roca, Agustina Heredia Mart&#237;nez, Agustina Heredia-Mart&#237;nez, Maria Luisa Coli, M&#46; Luisa Coli, Sergio Giannasi, Eduardo San Roman, Eduardo San-Rom&#225;n, Rodolfo Pizarro, Cesar Belzitti, C&#233;sar Belzitti, Salomon Algranati, Salom&#243;n Algranati, Ricardo Heguilen"
            "autores" => array:20 [
              0 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Rosa Diez"
              ]
              1 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Rosa-Diez"
              ]
              2 => array:2 [
                "nombre" => "Gustavo"
                "apellidos" => "Greloni"
              ]
              3 => array:2 [
                "nombre" => "Maria"
                "apellidos" => "Crucelegui"
              ]
              4 => array:2 [
                "nombre" => "Mar&#237;a"
                "apellidos" => "Crucelegui"
              ]
              5 => array:2 [
                "nombre" => "Mariela"
                "apellidos" => "Bedini Roca"
              ]
              6 => array:2 [
                "nombre" => "Mariela"
                "apellidos" => "Bedini-Roca"
              ]
              7 => array:2 [
                "nombre" => "Agustina"
                "apellidos" => "Heredia Mart&#237;nez"
              ]
              8 => array:2 [
                "nombre" => "Agustina"
                "apellidos" => "Heredia-Mart&#237;nez"
              ]
              9 => array:2 [
                "nombre" => "Maria Luisa"
                "apellidos" => "Coli"
              ]
              10 => array:2 [
                "nombre" => "M&#46; Luisa"
                "apellidos" => "Coli"
              ]
              11 => array:2 [
                "nombre" => "Sergio"
                "apellidos" => "Giannasi"
              ]
              12 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "San Roman"
              ]
              13 => array:2 [
                "nombre" => "Eduardo"
                "apellidos" => "San-Rom&#225;n"
              ]
              14 => array:2 [
                "nombre" => "Rodolfo"
                "apellidos" => "Pizarro"
              ]
              15 => array:2 [
                "nombre" => "Cesar"
                "apellidos" => "Belzitti"
              ]
              16 => array:2 [
                "nombre" => "C&#233;sar"
                "apellidos" => "Belzitti"
              ]
              17 => array:2 [
                "nombre" => "Salomon"
                "apellidos" => "Algranati"
              ]
              18 => array:2 [
                "nombre" => "Salom&#243;n"
                "apellidos" => "Algranati"
              ]
              19 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Heguilen"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X201325141200124X"
          "doi" => "10.3265/Nefrologia.pre2012.Jan.11284"
          "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/X201325141200124X?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001242?idApp=UINPBA000064"
      "url" => "/02116995/0000003200000003/v0_201502091350/X0211699512001242/v0_201502091350/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251412001231"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jan.11244"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:367-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5620
      "formatos" => array:3 [
        "EPUB" => 312
        "HTML" => 4608
        "PDF" => 700
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Discrepancies among consensus documents&#44; guidelines&#44; clinical practice and the legal framework for the treatment of type 2 diabetes mellitus patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "367"
          "paginaFinal" => "373"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Discrepancias entre documentos de consenso&#44; gu&#237;as&#44; pr&#225;ctica cl&#237;nica y normativa legal en el tratamiento de los pacientes con diabetes mellitus tipo 2"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11244_16025_29768_en_t1_11244i3.jpg"
              "Alto" => 537
              "Ancho" => 2188
              "Tamanyo" => 371583
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Characteristics and differences between the three patient groups according to origin"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "endocrinolog&#237;a y atenci&#243;n primaria de Alcoy Nefrolog&#237;a&#44; endocrinolog&#237;a y atenci&#243;n primaria de Alcoy, Endocrinolog&#237;a y Atenci&#243;n Primaria de Alcoy Nefrolog&#237;a&#44; Endocrinolog&#237;a y Atenci&#243;n Primaria de Alcoy, Carlos Del Pozo Fern&#225;ndez, Carlos Del Pozo-Fern&#225;ndez, Carlos Pardo Ru&#237;z, Carlos Pardo-Ruiz, Concepci&#243;n S&#225;nchez Botella, Concepci&#243;n S&#225;nchez-Botella, Vanesa Blanes Casta&#241;er, Vanesa Blanes-Casta&#241;er, Ram&#243;n L&#243;pez-Menchero, Cristina Gisbert Sell&#233;s, Cristina Gisbert-Sell&#233;s, Carmen S&#225;nchez Jodar, Carmen S&#225;nchez-Jodar, Luis &#193;lvarez Avellan, Luis &#193;lvarez-Avell&#225;n"
          "autores" => array:17 [
            0 => array:2 [
              "nombre" => "endocrinolog&#237;a y atenci&#243;n primaria de Alcoy"
              "apellidos" => "Nefrolog&#237;a&#44; endocrinolog&#237;a y atenci&#243;n primaria de Alcoy"
            ]
            1 => array:2 [
              "nombre" => "Endocrinolog&#237;a y Atenci&#243;n Primaria de Alcoy"
              "apellidos" => "Nefrolog&#237;a&#44; Endocrinolog&#237;a y Atenci&#243;n Primaria de Alcoy"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Del Pozo Fern&#225;ndez"
            ]
            3 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Del Pozo-Fern&#225;ndez"
            ]
            4 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Pardo Ru&#237;z"
            ]
            5 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Pardo-Ruiz"
            ]
            6 => array:2 [
              "nombre" => "Concepci&#243;n"
              "apellidos" => "S&#225;nchez Botella"
            ]
            7 => array:2 [
              "nombre" => "Concepci&#243;n"
              "apellidos" => "S&#225;nchez-Botella"
            ]
            8 => array:2 [
              "nombre" => "Vanesa"
              "apellidos" => "Blanes Casta&#241;er"
            ]
            9 => array:2 [
              "nombre" => "Vanesa"
              "apellidos" => "Blanes-Casta&#241;er"
            ]
            10 => array:2 [
              "nombre" => "Ram&#243;n"
              "apellidos" => "L&#243;pez-Menchero"
            ]
            11 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Gisbert Sell&#233;s"
            ]
            12 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Gisbert-Sell&#233;s"
            ]
            13 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "S&#225;nchez Jodar"
            ]
            14 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "S&#225;nchez-Jodar"
            ]
            15 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "&#193;lvarez Avellan"
            ]
            16 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "&#193;lvarez-Avell&#225;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001234"
        "doi" => "10.3265/Nefrologia.pre2012.Jan.11244"
        "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/X0211699512001234?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001231?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001231/v0_201502091613/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251412001258"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jan.11295"
    "estado" => "S300"
    "fechaPublicacion" => "2012-05-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2012;32:353-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7020
      "formatos" => array:3 [
        "EPUB" => 329
        "HTML" => 5889
        "PDF" => 802
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Factors associated with early peritoneal dialysis catheter replacement in Veracruz&#44; Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "353"
          "paginaFinal" => "358"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Factores asociados con el cambio temprano de cat&#233;ter de di&#225;lisis peritoneal en Veracruz&#44; M&#233;xico"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11295_16025_29775_en_t111295.jpg"
              "Alto" => 1468
              "Ancho" => 2178
              "Tamanyo" => 896479
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Comparison of patients with peritoneal dialysis catheter dysfunction and those without"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Gustavo Mart&#237;nez-Mier, Marisol Luna-Castillo, Jorge J&#46; Ortiz-Enriquez, Jorge J&#46; Ortiz-Enr&#237;quez, Sandro F&#46; &#193;vila-Pardo, Vicente Fern&#225;ndez, Marco T&#46; M&#233;ndez-L&#243;pez, Luis Budar-Fernandez, Luis Budar-Fern&#225;ndez, Felipe Gonz&#225;lez-Vel&#225;zquez"
          "autores" => array:10 [
            0 => array:2 [
              "nombre" => "Gustavo"
              "apellidos" => "Mart&#237;nez-Mier"
            ]
            1 => array:2 [
              "nombre" => "Marisol"
              "apellidos" => "Luna-Castillo"
            ]
            2 => array:2 [
              "nombre" => "Jorge J&#46;"
              "apellidos" => "Ortiz-Enriquez"
            ]
            3 => array:2 [
              "nombre" => "Jorge J&#46;"
              "apellidos" => "Ortiz-Enr&#237;quez"
            ]
            4 => array:2 [
              "nombre" => "Sandro F&#46;"
              "apellidos" => "&#193;vila-Pardo"
            ]
            5 => array:2 [
              "nombre" => "Vicente"
              "apellidos" => "Fern&#225;ndez"
            ]
            6 => array:2 [
              "nombre" => "Marco T&#46;"
              "apellidos" => "M&#233;ndez-L&#243;pez"
            ]
            7 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Budar-Fernandez"
            ]
            8 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Budar-Fern&#225;ndez"
            ]
            9 => array:2 [
              "nombre" => "Felipe"
              "apellidos" => "Gonz&#225;lez-Vel&#225;zquez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699512001250"
        "doi" => "10.3265/Nefrologia.pre2012.Jan.11295"
        "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/X0211699512001250?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001258?idApp=UINPBA000064"
    "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001258/v0_201502091613/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Factors determining a low dose of haemodialysis as measured by ionic dialysance in critical patients with acute kidney injury"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "359"
        "paginaFinal" => "366"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Guillermo Rosa Diez, Guillermo Rosa-Diez, Gustavo Greloni, Maria Crucelegui, Mar&#237;a Crucelegui, Mariela Bedini Roca, Mariela Bedini-Roca, Agustina Heredia Mart&#237;nez, Agustina Heredia-Mart&#237;nez, Maria Luisa Coli, M&#46; Luisa Coli, Sergio Giannasi, Eduardo San Roman, Eduardo San-Rom&#225;n, Rodolfo Pizarro, Cesar Belzitti, C&#233;sar Belzitti, Salomon Algranati, Salom&#243;n Algranati, Ricardo Heguilen"
        "autores" => array:20 [
          0 => array:4 [
            "nombre" => "Guillermo"
            "apellidos" => "Rosa Diez"
            "email" => array:1 [
              0 => "guillermo&#46;rosadiez&#64;hospitalitaliano&#46;org&#46;ar"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Guillermo"
            "apellidos" => "Rosa-Diez"
            "email" => array:1 [
              0 => "guillermo&#46;rosadiez&#64;hospitalitaliano&#46;org&#46;ar"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Gustavo"
            "apellidos" => "Greloni"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Crucelegui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Crucelegui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Mariela"
            "apellidos" => "Bedini Roca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mariela"
            "apellidos" => "Bedini-Roca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Agustina"
            "apellidos" => "Heredia Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Agustina"
            "apellidos" => "Heredia-Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Maria Luisa"
            "apellidos" => "Coli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "M&#46; Luisa"
            "apellidos" => "Coli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Sergio"
            "apellidos" => "Giannasi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          12 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "San Roman"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "Eduardo"
            "apellidos" => "San-Rom&#225;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          14 => array:3 [
            "nombre" => "Rodolfo"
            "apellidos" => "Pizarro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          15 => array:3 [
            "nombre" => "Cesar"
            "apellidos" => "Belzitti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          16 => array:3 [
            "nombre" => "C&#233;sar"
            "apellidos" => "Belzitti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "affg"
              ]
            ]
          ]
          17 => array:3 [
            "nombre" => "Salomon"
            "apellidos" => "Algranati"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          18 => array:3 [
            "nombre" => "Salom&#243;n"
            "apellidos" => "Algranati"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          19 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Heguilen"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "affh"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Nefrologia, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Terapia Intensiva, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "Terapia Intensiva Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Cardiología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          5 => array:3 [
            "entidad" => "Cardiologia Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Cardiología Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">g</span>"
            "identificador" => "affg"
          ]
          7 => array:3 [
            "entidad" => "Instituto Universitario, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires,  Argentina, "
            "etiqueta" => "<span class="elsevierStyleSup">h</span>"
            "identificador" => "affh"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Factores determinantes de una baja dosis de hemodi&#225;lisis establecida por dialisancia i&#243;nica en pacientes cr&#237;ticos con insuficiencia renal aguda"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30164_en_f111284.jpg"
            "Alto" => 813
            "Ancho" => 1010
            "Tamanyo" => 124761
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of intermittent and extended haemodialysis regimens"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION&#160;</span></p><p class="elsevierStylePara">Acute kidney injury &#40;AKI&#41; is a highly prevalent entity among patients admitted to intensive care units &#40;ICU&#41;&#46; According to the population at-risk being studied and the definition used&#59; AKI occurs in 5&#37;-15&#37; of these patients<span class="elsevierStyleSup">&#46;1-5</span></p><p class="elsevierStylePara">Although more than 60 years have passed since the first haemodialysis session was successfully carried out in patients with AKI&#44; the mortality rates associated with this condition in critical patients still range between 30&#37; and 60&#37;&#44;<span class="elsevierStyleSup">1-6</span> particularly in patients requiring some type of renal replacement therapy &#40;RRT&#41;&#44;<span class="elsevierStyleSup">1</span> making AKI an independent risk factor for mortality in this group&#46;<span class="elsevierStyleSup">2&#44;3&#44;5&#44;6</span></p><p class="elsevierStylePara">The different types of RRT used in AKI patients can be classified into intermittent &#40;IHD&#41;&#44; extended or hybrid &#40;EHD&#41;&#44; continuous&#44; or peritoneal dialysis&#46;<span class="elsevierStyleSup">7</span> This last technique is not commonly applied in adult patients&#44; and patients treated with continuous methods are rare in Spain&#44; with IHD and EHD being the most common&#44; taking first and second place&#44; respectively&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">While haemodialysis dosage is important for patients on chronic dialysis&#44; threshold doses &#40;TD&#41; for RRT in patients with AKI in the ICU have not been established&#46;<span class="elsevierStyleSup">9-12</span> A study at one hospital showed higher survival and renal recovery rates in patients with daily IHD sessions<span class="elsevierStyleSup">13</span>&#59; however&#44; the dose administered per session was 0&#46;94Kt&#47;V&#44; far below the recommendations for patients with chronic kidney disease &#40;CKD&#41;&#46; A multi-centre study showed that&#44; above a Kt&#47;V of 1&#46;3&#44; no benefits were observed in terms of reduced patient mortality&#46;<span class="elsevierStyleSup">14</span> As such&#44; the TD in patients with AKI is generally considered to be close to the applicable target values in patients with CKD&#44; which entails a Kt&#47;V equal to or greater than 1&#46;2&#44; a percent reduction in urea &#40;PRU&#41; equal to or greater than 65&#37;&#44; or a Kt greater than 45 or 40 in males and females&#44; respectively&#46;<span class="elsevierStyleSup">15-17</span></p><p class="elsevierStylePara">However&#44; in normal clinical practice&#44; in contrast to patients with CKD&#44; the doses administered to AKI patients go uncontrolled&#44; and it is widely estimated that we do not reach the prescribed dose&#46;<span class="elsevierStyleSup">18&#44;19</span> Few studies have evaluated this issue as a primary objective in patients on IHD with an adequate number of patients and treatments&#44; and none has performed such an evaluation in EHD&#46; In this context&#44; critical patients would be at an even greater risk of not receiving the prescribed dose&#46;<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">The most commonly used methods for evaluating the dose administered in patients with AKI have been the Kt&#47;V formula or URR&#46; The Kt&#47;V formula&#44; which is routinely used in CKD patients&#44; has limited applications in critical patients&#44; since this group tends to have a varying and unpredictable urea distribution volume&#46;<span class="elsevierStyleSup">21</span> While determining URR is a simple process&#44; the calculation is made retrospectively&#44; making it impossible to monitor levels during treatment to verify reaching the prescribed dose&#46;<span class="elsevierStyleSup">22</span> Calculating dialysis dose through direct quantification of dialysate would be the most reliable method to use in AKI patients&#44; compared to other options&#46;<span class="elsevierStyleSup">23</span> Measuring Kt through ionic dialysance provides a direct measurement of the dialysis dose being administered without the need for blood or dialysate samples for measuring urea levels&#44; and this method has been validated for patients with both chronic and acute kidney injury&#46;<span class="elsevierStyleSup">24-26</span> It has recently been shown that measuring the dose of dialysis using Kt as determined through ionic dialysance is more sensitive for revealing inadequate treatment than Kt&#47;V<span class="elsevierStyleInf">UREA</span> in critical patients with AKI&#46;<span class="elsevierStyleSup">27</span></p><p class="elsevierStylePara">The difference between the prescribed and the administered dose as well as the factors related to this difference are normally monitored in patients on chronic dialysis treatment&#44; Identifying these factors and understanding and correcting them allows for optimizing the dosage given to these patients&#46;</p><p class="elsevierStylePara">Our objective was to evaluate the differences between prescribed and administered doses in critical patients with AKI and the factors that influence these differences&#44; using Kt measurements through ionic dialysance&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our research team was composed of members of the Nephrology&#44; Cardiology&#44; and Intensive Care departments&#44; and the study took place in the Intensive Care Unit &#40;ICU&#41; and Intensive Coronary Care Unit &#40;ICCU&#41; at the Hospital Italiano de Buenos Aires&#46; The study was conducted according to the regulations established by good clinical practices and the Declaration of Helsinki with the modifications established by the Nuremberg and Tokyo Conventions&#44; and was approved by an Institutional Review Board &#40;IRB&#41; - Comite de Protocolos de Investigaci&#243;n &#40;CEPI&#41; - Hospital Italiano&#46;</p><p class="elsevierStylePara">This was a prospective and observational study involving RRT-requiring adult AKI individuals admitted to the ICU or ICCU&#44; and being treated with intermittent and&#47;or extended haemodialysis&#46; Patients in the ICCU were included due to the extensive cardiological care provided at the Hospital Italiano de Buenos Aires&#46; All baseline characteristics&#44; including sequential organ failure assessment &#40;SOFA&#41;&#44; aetiology and classification of the AKI&#44; and the severity of AKI using the individual severity index &#40;ISI&#41; were recorded&#46;<span class="elsevierStyleSup">28</span> The type and duration of dialysis was not modified for the purposes of the study&#44; and was administered according to the indications by the attending physician and the type of treatment &#40;intermittent or extended dialysis&#41;&#44; registering all of&#160; the different parameters of the prescription&#46; Patients were administered dialysis using Fresenius 4008 S monitors equipped with OCM<span class="elsevierStyleSup">&#174;</span> biosensors &#40;On-line Clearance Monitoring&#44; Fresenius Medical Care AG&#41;&#44; devices that use non-invasive methods to measure effective ionic dialysance with conductivity probes&#46;&#160; Water used for haemodialysis was obtained through a portable reverse osmosis device &#40;FG Ingenieria&#41;&#46; The dialysate flow rates for IHD and extended dialysis were 500ml&#47;min and 300ml&#47;min&#44; respectively&#46; Sterile bicarbonate powder was also used&#46; In all cases&#44; RRT was administered using Fresenius FX<span class="elsevierStyleSup">&#174;</span> 60 dialysers &#40;helixone filters of 1&#46;4m<span class="elsevierStyleSup">2</span>&#44; KoA urea 960ml&#47;min&#41;&#46; In all cases&#44; the vascular access used were non-tunnelled central venous catheters of 11&#46;5Fr&#44; placed using the Seldinger technique in the femoral vein or internal jugular vein&#44; at 19cm or 16cm&#44; respectively&#46; In the absence of any contraindications&#44; patients were administered standard anticoagulation using sodium heparin in a continuous infusion with a loading dose of 1000 units and a maintenance dose of 500 units per hour&#46; Kt was automatically determined through the aforementioned method&#44; and calculated prescribed Kt based on the type of RRT&#44; blood flow&#44; and time prescribed on dialysis along with <span class="elsevierStyleItalic">in vivo </span>dialyser clearance&#44; which was previously determined in a series of CKD patients on stable haemodialysis&#46;<span class="elsevierStyleSup">20&#44;29</span></p><p class="elsevierStylePara">The following parameters were registered throughout each dialysis session&#58; type of RRT&#44; compliance with the duration prescribed&#44; temporary or definitive suspension&#44; ultrafiltration &#40;millilitres&#41;&#44; nominal blood flow&#44; type and location of vascular access&#44; need for catheter line reversal&#44; recirculation of the vascular access&#44; intra-dialysis hypotension &#40;defined as a drop in mean blood pressure of 10mm Hg&#41;&#44; need for hypotension treatment &#40;defined as an increase in inotropic drugs and&#47;or saline solution&#41;&#44; use of heparin&#44; and coagulation of the dialyser or system&#46; Recirculation of the vascular access was measured by determining plasma urea levels in arterial&#44; venous&#44; and peripheral lines using the low-flow method&#46;<span class="elsevierStyleSup">30</span></p><p class="elsevierStylePara">All data are expressed as mean &#177; standard deviation or proportions&#44; unless otherwise indicated&#46; Considering a target Kt of 40 for women and 50 for men&#44; we determined compliance with this target for both the prescribed dose and administered dose in each case&#46; We performed a univariate analysis with the dependent variable of compliance and the independent variables were components of the RRT performed and patient characteristics&#46; A a <span class="elsevierStyleItalic">P</span>-value &#60;&#46;05 was considered statistically significant&#46; All variables that had statistical significance or clinical relevance were included in a multiple logistic regression model&#44; with level of compliance with dosage as the dependent variable&#46; Taking into account the number of variables mentioned&#44; we estimated a minimum number of 200 RRT sessions with Kt measurements&#46; We used STATA software version 8&#46;0 for all statistical analyses&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">A total of 395 RRT sessions were recorded in 105 patients with AKI in the ICU &#40;3&#46;7&#177;3&#46;96 sessions per patient&#41; from June 29&#44; 2010 through&#160; May 24&#44; 2011&#44; Table 1 summarises the characteristics of the study population&#58; mean age&#58; 66&#177;15 years&#44; 37&#37; female&#44; 97&#37; with oliguric AKI&#44; and the most common aetiology was sepsis &#40;70&#37;&#41;&#46; These were critical patients&#44; the majority of which had hypotension and&#47;or requirements for inotropic drugs &#40;71&#37;&#41; and required mechanical ventilation &#40;70&#37;&#41;&#46; The mean ISI was 0&#46;7&#177;0&#46;26&#44; and the mean SOFA score was 12&#177;4&#46; A total of 201 IHD and 193 EHD sessions were performed&#44; and the most commonly used vascular access was the femoral vein &#40;79&#37;&#41;&#46; Serum levels of urea at the start of each haemodialysis session were 101&#177;58mg&#47;dl&#44; and the haematocrit was 24&#177;8 &#37;&#46; Heparin was not administered in 165 sessions &#40;42&#37;&#41;&#44; the treatment duration was 317&#177;102 minutes &#40;extended&#58; 408&#177;73 minutes&#41;&#44; and the blood flow was 223&#177;62ml&#47;min &#40;extended&#58; 186&#177;17ml&#47;min&#41; whereas the total ultrafiltration per session was 1036&#177;684ml &#40;62&#37; above 1000ml&#41;&#46; Vascular access recirculation occurred in 21&#177;19&#37; of cases&#44; with a recirculation of more than 15&#37; in 53&#37; of accesses evaluated&#46; Catheter line reversal was required in 22&#37; of procedures&#44; and recirculation was significantly more common in this instance than when the reversal was not required &#40;recirculation&#58; 25&#177;21 vs 20&#177;18&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; Intra-dialysis hypotension occurred in 20&#37; of RRT sessions&#44; requiring an increased dosage of inotropic drugs in 17&#37; and&#47;or saline solution in 8&#37;&#46; Coagulations occurred in the dialyser in 23 sessions&#44; 11 required temporary suspensions of treatment and then completed the indicated effective time&#44; and 2 required definitive suspension &#40;Table 2&#41;&#46;<span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Mean prescribed Kt was 52&#46;26&#177;13 litres&#44; and 21&#37; of all prescriptions were below the dosage compliance level &#40;lower than 40 litres in women and 45 litres in men&#41;&#46; There were no significant differences between the proportion of men and women with a prescribed Kt below the level of dosage compliance &#40;21&#37; in women vs 23&#37; in men&#41;&#46;</p><p class="elsevierStylePara">As regards the dose of Kt administered with an adequate prescription&#44; 185 sessions &#40;61&#37;&#41; did not comply with the prescribed dose&#44; with mean Kt in this sub-group being 31&#177;8 litres vs 56&#177;12 litres in the sub-group that did reach the compliance level&#46;</p><p class="elsevierStylePara">The Kt obtained in EHD sessions was significantly higher than in IHD&#58; 46&#177;16 litres vs 33&#177;9 litres&#44; respectively &#40;Figure 1&#41;&#46;</p><p class="elsevierStylePara">In the univariate analysis&#44; an insufficient level of compliance was significantly correlated with age &#40;older than 65 years&#41;&#44; sex &#40;male&#41;&#44; severity of illness&#44; anaemia &#40;haematocrit &#60;25&#41;&#44; failure to achieve the prescribed blood flow&#44; catheter line reversal&#44; and the type of RRT &#40;IHD&#41; &#40;Table 3&#41;&#46;</p><p class="elsevierStylePara">In the multivariate analysis&#44; an insufficient level of compliance was independently correlated with the presence of intra-dialysis hypotension&#44; failure to achieve the prescribed blood flow&#44; catheter line reversal&#44; and intermittent haemodialysis &#40;Table 4&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This study demonstrates that a substantial proportion of RRT sessions in critical patients with AKI are inadequately prescribed&#44; and that an even greater proportion does not reach full compliance with the dose prescribed&#46; This is the first study in which ionic dialysance has been applied in a large number of critical patients with AKI in order to achieve the proposed objectives&#46;</p><p class="elsevierStylePara">As regards our method of measurement for the dosage of dialysis&#44; we believe that it is adequate for this type of patient and treatment&#46; Urea kinetic modelling assumes stability characterised by a neutral nitrogen balance and similar pre-dialysis urea values for each cycle of treatment &#40;haemodialysis&#41;&#46; However&#44; this is not valid for patients with AKI&#44; since the majority of critical patients are hyper-catabolic and have a negative nitrogen balance&#46;<span class="elsevierStyleSup">31</span> Regional blood flow abnormalities&#44; particularly in unstable patients receiving vasoactive drugs&#44; can produce a disequilibrium In the intercompartmental distribution of urea&#44; which would invalidate the normal single-compartment models for urea&#44;<span class="elsevierStyleSup">31</span> over-estimating the dose of dialysis when calculated through blood samples&#46;<span class="elsevierStyleSup">32</span> This disequilibrium would be lower in the case of patients treated with extended dialysis&#44;<span class="elsevierStyleSup">33</span> and so calculating dialysis dosage through urea kinetic modelling could not be used to compare between intermittent and extended therapies&#46; In contrast&#44; ionic dialysance&#44; using the same principle of direct measurements of solute purification in the dialysate&#44; is an applicable&#44; sensible method that allows for comparing doses between IHD and EHD&#46;<span class="elsevierStyleSup">25-27</span></p><p class="elsevierStylePara">In our study&#44; all variables that could be related to an inadequate dialysis dose were taken into account&#59; the fact that none of these were correlated with non-compliance in both univariate and multivariate analyses &#40;for example&#44; not using heparin&#41; does not imply that these are not important&#46; With regard to the severity of the patients&#8217; conditions&#44; while this has been associated with a greater proportion of insufficient dialysis doses&#44;<span class="elsevierStyleSup">20</span> our patients were in severely critical states&#44; since this was part of the primary objective of our study&#44; and this variable is also masked by the type of treatment provided&#44; since the severity of the patient&#8217;s condition at the start of treatment was higher in EHD than IHD &#40;ISI&#58; 0&#46;83&#177;0&#46;16 vs 0&#46;69&#177;0&#46;26&#59; and SOFA&#58; 15&#177;3 vs 7&#177;3&#44; respectively&#41;&#46;</p><p class="elsevierStylePara">Age and sex were correlated in the univariate model&#59; a previous study showed that male sex was associated with a higher risk of insufficient dialysis&#44;18 but both variables were not significantly associated in our multivariate model&#46;</p><p class="elsevierStylePara">The vascular access is of fundamental importance&#46; All patients with AKI require temporary catheters&#44; and&#44; as demonstrated by our results&#44; these imply a high rate of recirculation&#44; regardless of the location of insertion&#46;</p><p class="elsevierStylePara">While recirculation was more common in femoral catheters than jugular catheters&#44; this difference was not significant&#44; and recirculation was higher than 15&#37; in both cases &#40;22&#37;&#177;19&#37; vs 19&#37;&#177;19&#37;&#44; respectively&#41;&#46; Line reversal&#44; which is a common practice when we are unable to achieve proper flow rates&#44; was a prevalent cause for inadequate dialysis&#44; with a high rate of recirculation regardless of the site of insertion&#46; These factors&#44; together with an incapacity to achieve the prescribed blood flow rate&#44; makes the vascular access one of the most important factors in considering the dialysis dose to prescribe in critical patients&#46; As such&#44; when faced with an inability to achieve optimal flow rates&#44; we must consider modifying the treatment regimen by increasing the duration of the session<span class="elsevierStyleSup">34</span> and&#47;or the frequency of treatments&#44; or consider using longer catheters &#40;equal to or longer than 20cm for femoral vein insertion&#41; or wider catheters &#40;13Fr&#41;&#46;</p><p class="elsevierStylePara">Independently of other variables&#44; haemodynamic instability during dialysis&#44; which is a common complication in these patients&#44; was another primary cause of inadequate dialysis&#46; This was significantly more common in patients on EHD &#40;23&#37; vs 10&#37; in IHD&#41;&#44; which is probably due to the severity of the patient&#96;s conditions&#44; not to the type of RRT <span class="elsevierStyleItalic">per se&#46;</span></p><p class="elsevierStylePara">Finally&#44; patients on EHD reached a higher level of compliance than those on IHD&#46; A multi-centre study did not observe this difference&#44;<span class="elsevierStyleSup">14</span> but this study had the bias of being a controlled study&#44; since the primary objective was to reach a specific dialysis dosage&#46; Our study attempted to reflect what actually occurs in daily practice&#44; and together with the aforementioned study&#44; supports the arguments set forth by expert opinion&#58; regardless of the controversy surrounding thresholds and methodologies in measuring dialysis dosage&#44; it must indeed be controlled and monitored&#46;<span class="elsevierStyleSup">9&#44;35</span> However&#44; EHD is not without its disadvantages&#59; in a secondary analysis&#44; patients on EHD had a significantly higher proportion of dialyser coagulations &#40;Figure 1&#41;&#46; However&#44; we should point out that the indication for EHD is related to the haemodynamic state and overall severity of the patient&#44; and this type of RRT allows for reaching objective dosage even in critical patients&#44; with the resources normally available in IHD&#46;<span class="elsevierStyleSup">36</span> In our experience&#44; the duration and compliance with time prescriptions for RRT are very important&#46;</p><p class="elsevierStylePara">Our study had certain limitations&#44; most notably the fact that it was carried out at one single hospital&#44; did not incorporate body weight and surface area for the patients analysed&#44; possibly involved a certain level of heterogeneity in the study population&#44; and Kt was considered to be optimal at its lower limit&#59; however&#44; we used an adjusted fit model&#44; and no previous studies exist in the medical literature of this magnitude in which Kt was used as a measurement of the dialysis dose in critical patients with AKI&#46; Prospective studies that include a comparison of the duration of hospital stay and mortality with weekly Kt doses might better respond to the question of limits for Kt dosage in critical patients with AKI&#46;</p><p class="elsevierStylePara">In conclusion&#44; the prescribed dialysis dose in critical patients with AKI should be monitored&#46; Ionic dialysance facilitates such supervision&#44; as well as the estimation of extended treatments based on target doses and TD&#46; In addition to the method used for measuring and controlling dialysis dosage&#44; a better functioning vascular access &#40;ensured optimal blood flow without the need for catheter line reversal&#41; and haemodynamic stability during RRT would be the most important factors for achieving TD and other objectives in critical patients with AKI&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30164&#95;en&#95;f111284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30164_en_f111284.jpg" alt="Comparison of intermittent and extended haemodialysis regimens "></img></a></p><p class="elsevierStylePara">Figure 1&#46; Comparison of intermittent and extended haemodialysis regimens </p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30165&#95;en&#95;t111284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30165_en_t111284.jpg" alt="Characteristics of the study population"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the study population</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30166&#95;en&#95;t211284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30166_en_t211284.jpg" alt="Characteristics of the treatment provided"></img></a></p><p class="elsevierStylePara">Table 2&#46; Characteristics of the treatment provided</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30167&#95;en&#95;t311284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30167_en_t311284.jpg" alt="Univariate analysis of insufficient compliance"></img></a></p><p class="elsevierStylePara">Table 3&#46; Univariate analysis of insufficient compliance</p><p class="elsevierStylePara"><a href="grande&#47;11284&#95;16025&#95;30168&#95;en&#95;t411284&#46;jpg" class="elsevierStyleCrossRefs"><img src="11284_16025_30168_en_t411284.jpg" alt="Multivariate analysis of insufficient compliance"></img></a></p><p class="elsevierStylePara">Table 4&#46; Multivariate analysis of insufficient compliance</p>"
    "pdfFichero" => "P1-E536-S3491-A11284-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:9 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438403"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis administrada"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438405"
          "palabras" => array:1 [
            0 => "RIFLE"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438407"
          "palabras" => array:1 [
            0 => "Hemodi&#225;lisis extendida"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438409"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis prescrita"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438411"
          "palabras" => array:1 [
            0 => "Hemodi&#225;lisis intermitente"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438413"
          "palabras" => array:1 [
            0 => "Dialisancia i&#243;nica"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438415"
          "palabras" => array:1 [
            0 => "Dosis de di&#225;lisis"
          ]
        ]
        7 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438417"
          "palabras" => array:1 [
            0 => "Lesi&#243;n renal aguda"
          ]
        ]
        8 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438419"
          "palabras" => array:1 [
            0 => "Insuficiencia renal aguda"
          ]
        ]
      ]
      "en" => array:9 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438404"
          "palabras" => array:1 [
            0 => "Delivered dialysis dose"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438406"
          "palabras" => array:1 [
            0 => "RIFLE"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438408"
          "palabras" => array:1 [
            0 => "Extended haemodialysis"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438410"
          "palabras" => array:1 [
            0 => "Prescribed dialysis dose"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438412"
          "palabras" => array:1 [
            0 => "Intermitent haemodialysis"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438414"
          "palabras" => array:1 [
            0 => "Ionic dialysance"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438416"
          "palabras" => array:1 [
            0 => "Dialysis dose"
          ]
        ]
        7 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438418"
          "palabras" => array:1 [
            0 => "Acute renal injury"
          ]
        ]
        8 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438420"
          "palabras" => array:1 [
            0 => "Acute renal failure"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span><span class="elsevierStyleBold">&#160;</span>En la insuficiencia renal aguda &#40;IRA&#41;&#44; la dosis administrada no suele controlarse y se estima que resulta inferior a la prescrita&#46; <span class="elsevierStyleBold">Objetivo&#58;</span>&#160;Evaluar la diferencia entre la dosis prescrita y la dosis administrada en pacientes con IRA en Unidades de Cuidados Intensivos &#40;UCI&#41;&#44; as&#237; como los factores que la determinan&#44; utilizando la determinaci&#243;n del Kt por dialisancia i&#243;nica&#46;&#160;<span class="elsevierStyleBold">Material y m&#233;todo&#58;</span><span class="elsevierStyleBold"> </span>Se incluyeron 394 terapias de reemplazo renal &#40;TRR&#41; en 105 pacientes adultos&#44; con IRA olig&#250;rica ingresados en UCI&#44; con requerimiento de TRR &#44; tratados con hemodi&#225;lisis intermitente &#40;HDI&#41; y&#47;o extendida &#40;HDE&#41;&#46; Las TRR fueron realizadas con un monitor de aclaramiento <span class="elsevierStyleItalic">on line</span> &#40;OCM<span class="elsevierStyleSup">&#174;</span>&#44; Fresenius&#41; para la determinaci&#243;n del Kt&#46; Se registraron las caracter&#237;sticas de los pacientes&#44; la prescripci&#243;n y el desarrollo de TRR&#46; Todas estas variables fueron incluidas en un modelo uni y multivariado&#44; teniendo como variable dependiente la incapacidad de lograr la dosis umbral u objetivo &#40;DU&#41;&#46;&#160;<span class="elsevierStyleBold">Resultados&#58;</span><span class="elsevierStyleBold">&#160;</span>Edad 66 &#177; 15 a&#241;os&#44; 37&#37; del sexo femenino&#44; etiolog&#237;a m&#225;s frecuente&#58; sepsis &#40;70&#37;&#41;&#44; hipotensi&#243;n y&#47;o requerimientos de inotr&#243;picos &#40;71&#37;&#41;&#44; asistencia respiratoria mec&#225;nica &#40;70&#37;&#41;&#59; el &#237;ndice de severidad individualizado promedio fue de 0&#44;7 &#177; 0&#44;26&#46; Se efectuaron 201 HDI y 193 HDE&#44; la v&#237;a de acceso vascular m&#225;s frecuente fue la femoral &#40;79&#37;&#41;&#46; El Kt prescrito fue de 53&#44;5 &#177; 14 litros&#44; y un 21&#37; de las prescripciones estaban por debajo de DU&#46; En el 61&#37; no se logr&#243; el nivel de cumplimiento de la DU &#40;31 &#177; 8 litros&#41;&#44; vs&#46; 56 &#177; 12 litros en el subgrupo que logr&#243; el nivel de cumplimiento&#46; El Kt obtenido por las HDE fue significativamente mayor &#40;46 &#177; 16 litros vs&#46; 33 &#177; 9 litros en HDI&#41;&#46; En el an&#225;lisis univariado&#44; el nivel de cumplimiento insuficiente estuvo relacionado con la edad &#40;&#62; 65 a&#241;os&#41;&#44; el sexo &#40;masculino&#41;&#44; la presencia de hipotensi&#243;n intradi&#225;lisis&#44; no lograr el flujo de sangre prescrito&#44; la inversi&#243;n de las ramas del cat&#233;ter y la HDI&#46; Las mismas variables estuvieron independientemente relacionadas en el modelo multivariado&#44; con excepci&#243;n de la edad y el g&#233;nero&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span>&#160;La dosis de di&#225;lisis administrada fue significativamente inferior a la prescrita&#46; Las HDE exhibieron un Kt m&#225;s cercano a DU y significativamente mayor que las HDI&#46; El funcionamiento adecuado del acceso vascular&#44; sin la necesidad de inversi&#243;n de las ramas del cat&#233;ter&#44; y el hecho de evitar la inestabilidad hemodin&#225;mica durante la TRR constituyen dos de los factores m&#225;s importantes para lograr la DU&#44; particularmente en ancianos y varones&#46; Debe prescribirse y controlarse la dosis de di&#225;lisis en pacientes cr&#237;ticos con IRA&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span>&#160;Estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy &#40;RRT&#41; in patients with chronic kidney disease &#40;CKD&#41;&#46; In patients with acute kidney injury &#40;AKI&#41;&#44; this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained&#46; Reports addressing this issue in AKI individuals are scarce and most have not included an adequate number of patients or treatments&#44; nor were patients treated with extended therapies&#46; Kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that&#44; compared with Kt&#47;V&#44; this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill AKI individuals&#46; The main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill AKI patients&#44; and to evaluate what factors determine this gap using Kt values assessed through ionic dialisance&#46; <span class="elsevierStyleBold">Material and Method&#58;</span> Data from 394 sessions of renal replacement therapy in 105 adult haemodialysis &#40;HD&#41; patients with oliguric acute kidney injury and admitted to ICU were included in this analysis&#46; RRT was carried out with Fresenius 4008E dialysis machines equipped with on-line clearance monitoring &#40;OCM<span class="elsevierStyleSup">&#174;</span> Fresenius&#41;&#44; which use non-invasive techniques to monitor the effective ionic dialysance&#44; equivalent to urea clearance&#46; The baseline characteristics of the study population as well as the prescription and outcome of RRT were analysed&#46; These variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose &#40;TD&#41;&#46; <span class="elsevierStyleBold">Results&#58;</span> The main baseline characteristics of the study population&#47;treatments were&#58; age 66&#177;15 years&#44; 37&#37; female&#44; most frequent cause of AKI&#58; sepsis &#40;70&#37;&#41;&#46; Low BP and&#47;or vasoactive drug requirement &#40;71&#37;&#41;&#44; mechanical ventilation &#40;70&#37;&#41; and average individual severity index&#58; 0&#46;7&#177;0&#46;26&#46; Two hundred and one intermittent HD &#40;IHD&#41; and 193 extended HD &#40;EHD&#41; sessions were performed&#59; the most frequently used temporary vascular access was the femoral vein catheter &#40;79&#37;&#41;&#46; Prescribed Kt was 53&#46;5&#177;14L and 21&#37; of prescriptions fell below the TD&#46; Sixty-one percent of treatments did not fulfill the TD &#40;31&#177;8L&#41; compared with 56&#177;12L obtained in the subgroup that achieved the target&#46; Compared to IHD&#44; EHD provided a significantly larger Kt &#40;46&#177;16L vs 33L&#177;9L&#41;&#46; Univariate analysis showed that inadequate compliance was associated with age &#40;&#62;65y&#41;&#44; male gender&#44; intra-dialytic hypotension&#44; low Qb&#44; catheter line reversal&#44; and IHD&#46; The same variables with the exception of age and gender were independently associated in the multivariate analysis&#46; <span class="elsevierStyleBold">Conclusions&#58; </span>The dialysis dose obtained was significantly lower than that prescribed&#46; EHD achieved values closer to the prescribed KT and significantly higher than in IHD&#46; Ionic Kt measurement facilitates monitoring and allows HD treatments to be extended based upon a previously established TD&#46; Besides the chosen strategy to dispense the dose of dialysis&#44; a well-functioning vascular access allowing for optimal blood flow and other approaches aimed at avoiding hemodynamic instability during RRT are the most important factors to achieve TD&#44; mainly in elderly male patients&#46; The dialysis dose should be prescribed and monitored for all critically ill AKI patients&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30164_en_f111284.jpg"
            "Alto" => 813
            "Ancho" => 1010
            "Tamanyo" => 124761
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of intermittent and extended haemodialysis regimens"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30165_en_t111284.jpg"
            "Alto" => 1622
            "Ancho" => 1081
            "Tamanyo" => 306870
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the study population"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30166_en_t211284.jpg"
            "Alto" => 1343
            "Ancho" => 1059
            "Tamanyo" => 371069
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the treatment provided"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30167_en_t311284.jpg"
            "Alto" => 1101
            "Ancho" => 2165
            "Tamanyo" => 609523
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Univariate analysis of insufficient compliance"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11284_16025_30168_en_t411284.jpg"
            "Alto" => 709
            "Ancho" => 2181
            "Tamanyo" => 384632
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Multivariate analysis of insufficient compliance"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003200000003/v0_201502091613/X201325141200124X/v0_201502091613/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35441"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Originals"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X201325141200124X/v0_201502091613/en/P1-E536-S3491-A11284-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200124X?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 10 17
2024 October 42 39 81
2024 September 51 30 81
2024 August 47 69 116
2024 July 39 48 87
2024 June 53 44 97
2024 May 84 30 114
2024 April 79 46 125
2024 March 60 25 85
2024 February 63 38 101
2024 January 45 21 66
2023 December 46 29 75
2023 November 51 32 83
2023 October 118 23 141
2023 September 297 33 330
2023 August 213 23 236
2023 July 90 19 109
2023 June 95 23 118
2023 May 88 32 120
2023 April 44 17 61
2023 March 61 23 84
2023 February 42 17 59
2023 January 57 26 83
2022 December 57 31 88
2022 November 55 38 93
2022 October 57 45 102
2022 September 43 34 77
2022 August 29 45 74
2022 July 32 53 85
2022 June 36 43 79
2022 May 42 34 76
2022 April 41 58 99
2022 March 54 50 104
2022 February 30 46 76
2022 January 38 41 79
2021 December 36 44 80
2021 November 37 28 65
2021 October 32 39 71
2021 September 31 39 70
2021 August 32 36 68
2021 July 36 28 64
2021 June 27 23 50
2021 May 30 34 64
2021 April 71 36 107
2021 March 39 49 88
2021 February 35 21 56
2021 January 39 19 58
2020 December 44 19 63
2020 November 39 10 49
2020 October 27 18 45
2020 September 27 15 42
2020 August 29 12 41
2020 July 33 6 39
2020 June 25 8 33
2020 May 36 16 52
2020 April 31 19 50
2020 March 25 11 36
2020 February 31 25 56
2020 January 39 22 61
2019 December 39 25 64
2019 November 26 24 50
2019 October 20 14 34
2019 September 17 28 45
2019 August 19 13 32
2019 July 21 19 40
2019 June 31 18 49
2019 May 42 20 62
2019 April 67 37 104
2019 March 28 31 59
2019 February 27 21 48
2019 January 27 17 44
2018 December 127 43 170
2018 November 159 27 186
2018 October 166 20 186
2018 September 90 13 103
2018 August 65 21 86
2018 July 52 17 69
2018 June 64 15 79
2018 May 62 14 76
2018 April 82 7 89
2018 March 100 10 110
2018 February 96 8 104
2018 January 167 8 175
2017 December 154 10 164
2017 November 61 15 76
2017 October 54 15 69
2017 September 55 11 66
2017 August 52 16 68
2017 July 56 14 70
2017 June 58 21 79
2017 May 58 19 77
2017 April 37 18 55
2017 March 41 14 55
2017 February 24 12 36
2017 January 32 9 41
2016 December 68 12 80
2016 November 101 11 112
2016 October 158 14 172
2016 September 153 7 160
2016 August 264 12 276
2016 July 252 14 266
2016 June 184 0 184
2016 May 180 0 180
2016 April 137 0 137
2016 March 118 0 118
2016 February 144 0 144
2016 January 134 0 134
2015 December 167 0 167
2015 November 123 0 123
2015 October 133 0 133
2015 September 96 0 96
2015 August 95 0 95
2015 July 89 0 89
2015 June 51 0 51
2015 May 60 0 60
2015 April 15 0 15
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

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

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