array:21 [
  "pii" => "X2013251413002485"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
  "estado" => "S300"
  "fechaPublicacion" => "2013-01-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2013;33:143-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4093
    "formatos" => array:3 [
      "EPUB" => 350
      "HTML" => 3002
      "PDF" => 741
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699513002488"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
      "estado" => "S300"
      "fechaPublicacion" => "2013-01-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2013;33:143-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8798
        "formatos" => array:3 [
          "EPUB" => 300
          "HTML" => 7850
          "PDF" => 648
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Introducción retrasada de tacrolimus en riñones subóptimos. Estudio de seguimiento a corto plazo en el Hospital Universitario de Salamanca"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "143"
            "paginaFinal" => "144"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Delayed introduction of tacrolimus in sub-optimal kidneys. A short-term follow-up study in the University Hospital of Salamanca"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => 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" => "11779_108_37149_es_11779_t1.jpg"
                "Alto" => 236
                "Ancho" => 600
                "Tamanyo" => 114153
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Comparación de la aparición de complicaciones entre los grupos de estudio"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Consolación Rosado-Rubio, Pilar Fraile-Gómez, Cristina Lucas-Álvarez, José L. Lerma-Márquez, Pedro García-Cosmes"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Consolación"
                "apellidos" => "Rosado-Rubio"
              ]
              1 => array:2 [
                "nombre" => "Pilar"
                "apellidos" => "Fraile-Gómez"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Lucas-Álvarez"
              ]
              3 => array:2 [
                "nombre" => "José L."
                "apellidos" => "Lerma-Márquez"
              ]
              4 => array:2 [
                "nombre" => "Pedro"
                "apellidos" => "García-Cosmes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251413002485"
          "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
          "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/X2013251413002485?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513002488?idApp=UINPBA000064"
      "url" => "/02116995/0000003300000001/v0_201502091331/X0211699513002488/v0_201502091334/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251413002477"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11469"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2013;33:144-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5348
      "formatos" => array:3 [
        "EPUB" => 381
        "HTML" => 4318
        "PDF" => 649
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Terminal chronic kidney disease in Gambia. A one-year study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "144"
          "paginaFinal" => "146"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad renal crónica terminal en Gambia. Estudio de un año"
        ]
      ]
      "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" => "11469_16025_42299_en_t111469.jpg"
              "Alto" => 943
              "Ancho" => 1424
              "Tamanyo" => 167446
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patients' characteristics"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mauro Cuba de la Cruz, Osmani Rojas Téllez, Odalys Pérez Caloto"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Mauro"
              "apellidos" => "Cuba de la Cruz"
            ]
            1 => array:2 [
              "nombre" => "Osmani"
              "apellidos" => "Rojas Téllez"
            ]
            2 => array:2 [
              "nombre" => "Odalys"
              "apellidos" => "Pérez Caloto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951300247X"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11469"
        "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/X021169951300247X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002477?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002477/v0_201502091556/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251413002493"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11534"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2013;33:142-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4653
      "formatos" => array:3 [
        "EPUB" => 356
        "HTML" => 3668
        "PDF" => 629
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Law on advance directives in Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "142"
          "paginaFinal" => "143"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ley de la voluntad anticipada en México"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Guillermo Cantú, Josefina Alberú"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Guillermo"
              "apellidos" => "Cantú"
            ]
            1 => array:2 [
              "nombre" => "Josefina"
              "apellidos" => "Alberú"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513002496"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11534"
        "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/X0211699513002496?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002493?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002493/v0_201502091556/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Delayed introduction of tacrolimus in sub-optimal kidneys. A short-term follow-up study in the University Hospital of Salamanca"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "143"
        "paginaFinal" => "144"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Consolación Rosado-Rubio, Pilar Fraile-Gómez, Cristina Lucas-Álvarez, José L. Lerma-Márquez, Pedro García-Cosmes"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Consolación"
            "apellidos" => "Rosado-Rubio"
            "email" => array:1 [
              0 => "crosadorubio@hotmail.com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pilar"
            "apellidos" => "Fraile-G&#243;mez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Lucas-&#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jos&#233; L&#46;"
            "apellidos" => "Lerma-M&#225;rquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Pedro"
            "apellidos" => "Garc&#237;a-Cosmes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario de Salamanca,    "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Introducci&#243;n retrasada de tacrolimus en ri&#241;ones sub&#243;ptimos&#46; Estudio de seguimiento a corto plazo en el Hospital Universitario de Salamanca"
      ]
    ]
    "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" => "11779_16025_42310_en_t111779.jpg"
            "Alto" => 563
            "Ancho" => 1435
            "Tamanyo" => 109914
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the appearance of complications between the two study groups"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In an attempt to satisfy the growing demand for kidney grafts&#44; several hospitals have gradually expanded their criteria for accepting marginal and sub-optimal kidneys &#40;generally derived from elderly donors or those with a risk for a potential reduction in nephron mass&#41;&#44; which currently constitute 50&#37; of all grafts&#46;<span class="elsevierStyleSup">1</span> These organs are associated with a greater incidence of acute ischaemic renal failure&#44; acute tubular necrosis &#40;ATN&#41;&#44; greater plasma creatinine levels&#44; and delayed graft function&#44; which can all contribute to increasing the rates of acute rejection&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Calcineurin inhibitors &#40;cyclosporine A and tacrolimus&#41; are essential medications for maintenance immunosuppression therapy&#46; The mechanism of action of these drugs is to block interleukin &#40;IL&#41; 2&#44; IL-2 and IL-4 receptors&#44; and gamma interferon&#46; The most characteristic side effect of these drugs is nephrotoxicity&#44; due to the increased expression of transforming growth factor beta &#40;TGF-&#223;&#41;&#44; which contributes to interstitial fibrosis and the synthesis of nitric oxide and endothelin&#44; which have vasomotor properties&#46;<span class="elsevierStyleSup">3</span> This effect is increased in marginal kidneys&#44; which often present interstitial fibrosis&#44; vascular involvement&#44; and glomerulosclerosis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup">&#160;</span></p><p class="elsevierStylePara">In order to minimise the nephrotoxicity of these drugs in sub-optimal grafts&#44; several different strategies have been tested&#44; such as reducing doses or delaying introduction of treatment&#46; The latter has produced positive long-term results&#44; with low rates of acute rejection and acceptable levels of renal function&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup">&#160;</span></p><p class="elsevierStylePara">We examined the short-term influence of delayed introduction of calcineurin inhibitors among patients who received kidney transplants from marginal donors at the University Hospital of Salamanca&#44; comparing the effects of the drug in these patients with another group of recipients of young kidney transplants who received treatment from the start&#46; We performed an observational&#44; descriptive&#44; cohort study of all transplants carried out at our hospital between 2008 and 2011&#46; Patients were divided into two groups&#58; recipients of standard kidneys&#44; who received tacrolimus treatment starting before the transplant was performed&#44; and sub-optimal kidney recipients &#40;donor and recipient older than 55 years of age&#44; cold ischaemia time greater than 1 day&#44; cardiovascular death&#44; serum creatinine greater than 2mg&#47;dl&#44; and non-heart beating donors&#41;&#44; in which the medication was introduced on the fourth day&#46; All other immunosuppression was maintained in both groups&#58; basiliximab&#44; steroids&#44; and mycophenolate mofetil&#44; as well as anti-infection treatment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The variables analysed included&#58; creatinine at the time of patient discharge and the presence of ATN&#44; acute rejection&#44; and infections within three months after transplantation&#46; We used SPSS<span class="elsevierStyleSup">&#174;</span> statistical software&#44; version 15&#46;0&#44; for all statistical analyses&#44; which involved Student&#8217;s t-tests and chi-square tests&#44; using a significance level of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 and expressing variables as percentages&#44; means&#44; standard deviation&#44; and relative risk&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">During the study period&#44; a total of 160 patients received kidney transplants&#46; Of these&#44; 43&#46;8&#37; received pre-transplant tacrolimus&#44; and 56&#46;3&#37; received tacrolimus starting on the fourth day post-transplant&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Mean creatinine in the early introduction group was 1&#46;9&#43;1&#46;25mg&#47;dl&#44; and this value was 2&#46;64&#43;1&#46;48mg&#47;dl in the late introduction group &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;098&#41;&#46; All other results are expressed in Table 1&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The late introduction of calcineurin inhibitors is safe in the short-term&#44; since&#44; in comparison with grafts from young donors in which recipients received immunosuppression from the start&#44; these patients did not exhibit a significant increase in parameters for renal dysfunction or secondary side effects&#46; In this manner&#44; the differences observed between the two groups may be due simply to the worse condition of marginal kidneys&#44; rather than being due to any negative influence of the late introduction of medication on the immediate post-transplant patient evolution&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of our study&#44; together with the results from previous studies that have established long-term safety&#44; support the use of this immunosuppression regimen for treating recipients of marginal kidney grafts&#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 declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statements collected</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This study has had no source of sponsorship&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11779&#95;16025&#95;42310&#95;en&#95;t111779&#46;jpg" class="elsevierStyleCrossRefs"><img src="11779_16025_42310_en_t111779.jpg" alt="Comparison of the appearance of complications between the two study groups"></img></a></p><p class="elsevierStylePara">Table 1&#46; Comparison of the appearance of complications between the two study groups</p>"
    "pdfFichero" => "P1-E547-S3875-A11779-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => 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" => "11779_16025_42310_en_t111779.jpg"
            "Alto" => 563
            "Ancho" => 1435
            "Tamanyo" => 109914
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the appearance of complications between the two study groups"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002485/v0_201502091556/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35438"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000001/v0_201502091555/X2013251413002485/v0_201502091556/en/P1-E547-S3875-A11779-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002485?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Delayed introduction of tacrolimus in sub-optimal kidneys. A short-term follow-up study in the University Hospital of Salamanca
Introducción retrasada de tacrolimus en riñones subóptimos. Estudio de seguimiento a corto plazo en el Hospital Universitario de Salamanca
Consolación Rosado-Rubioa, Pilar Fraile-Gómeza, Cristina Lucas-Álvareza, José L. Lerma-Márqueza, Pedro García-Cosmesa
a Servicio de Nefrología, Hospital Universitario de Salamanca,
Read
7141
Times
was read the article
2289
Total PDF
4852
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251413002485"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
  "estado" => "S300"
  "fechaPublicacion" => "2013-01-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:143-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4093
    "formatos" => array:3 [
      "EPUB" => 350
      "HTML" => 3002
      "PDF" => 741
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699513002488"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
      "estado" => "S300"
      "fechaPublicacion" => "2013-01-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2013;33:143-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8798
        "formatos" => array:3 [
          "EPUB" => 300
          "HTML" => 7850
          "PDF" => 648
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Introducci&#243;n retrasada de tacrolimus en ri&#241;ones sub&#243;ptimos&#46; Estudio de seguimiento a corto plazo en el Hospital Universitario de Salamanca"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "143"
            "paginaFinal" => "144"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Delayed introduction of tacrolimus in sub-optimal kidneys&#46; A short-term follow-up study in the University Hospital of Salamanca"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => 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" => "11779_108_37149_es_11779_t1.jpg"
                "Alto" => 236
                "Ancho" => 600
                "Tamanyo" => 114153
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Comparaci&#243;n de la aparici&#243;n de complicaciones entre los grupos de estudio"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Consolaci&#243;n Rosado-Rubio, Pilar Fraile-G&#243;mez, Cristina Lucas-&#193;lvarez, Jos&#233; L&#46; Lerma-M&#225;rquez, Pedro Garc&#237;a-Cosmes"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Consolaci&#243;n"
                "apellidos" => "Rosado-Rubio"
              ]
              1 => array:2 [
                "nombre" => "Pilar"
                "apellidos" => "Fraile-G&#243;mez"
              ]
              2 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Lucas-&#193;lvarez"
              ]
              3 => array:2 [
                "nombre" => "Jos&#233; L&#46;"
                "apellidos" => "Lerma-M&#225;rquez"
              ]
              4 => array:2 [
                "nombre" => "Pedro"
                "apellidos" => "Garc&#237;a-Cosmes"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251413002485"
          "doi" => "10.3265/Nefrologia.pre2012.Oct.11779"
          "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/X2013251413002485?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513002488?idApp=UINPBA000064"
      "url" => "/02116995/0000003300000001/v0_201502091331/X0211699513002488/v0_201502091334/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251413002477"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11469"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:144-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5348
      "formatos" => array:3 [
        "EPUB" => 381
        "HTML" => 4318
        "PDF" => 649
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Terminal chronic kidney disease in Gambia&#46; A one-year study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "144"
          "paginaFinal" => "146"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad renal cr&#243;nica terminal en Gambia&#46; Estudio de un a&#241;o"
        ]
      ]
      "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" => "11469_16025_42299_en_t111469.jpg"
              "Alto" => 943
              "Ancho" => 1424
              "Tamanyo" => 167446
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patients&#39; characteristics"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mauro Cuba de la Cruz, Osmani Rojas T&#233;llez, Odalys P&#233;rez Caloto"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Mauro"
              "apellidos" => "Cuba de la Cruz"
            ]
            1 => array:2 [
              "nombre" => "Osmani"
              "apellidos" => "Rojas T&#233;llez"
            ]
            2 => array:2 [
              "nombre" => "Odalys"
              "apellidos" => "P&#233;rez Caloto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951300247X"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11469"
        "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/X021169951300247X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002477?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002477/v0_201502091556/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251413002493"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Jun.11534"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:142-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4653
      "formatos" => array:3 [
        "EPUB" => 356
        "HTML" => 3668
        "PDF" => 629
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Law on advance directives in Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "142"
          "paginaFinal" => "143"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ley de la voluntad anticipada en M&#233;xico"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Guillermo Cant&#250;, Josefina Alber&#250;"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Guillermo"
              "apellidos" => "Cant&#250;"
            ]
            1 => array:2 [
              "nombre" => "Josefina"
              "apellidos" => "Alber&#250;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513002496"
        "doi" => "10.3265/Nefrologia.pre2012.Jun.11534"
        "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/X0211699513002496?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002493?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002493/v0_201502091556/en/main.assets"
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "titulo" => "Delayed introduction of tacrolimus in sub-optimal kidneys&#46; A short-term follow-up study in the University Hospital of Salamanca"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "143"
        "paginaFinal" => "144"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Consolaci&#243;n Rosado-Rubio, Pilar Fraile-G&#243;mez, Cristina Lucas-&#193;lvarez, Jos&#233; L&#46; Lerma-M&#225;rquez, Pedro Garc&#237;a-Cosmes"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Consolaci&#243;n"
            "apellidos" => "Rosado-Rubio"
            "email" => array:1 [
              0 => "crosadorubio&#64;hotmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pilar"
            "apellidos" => "Fraile-G&#243;mez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Lucas-&#193;lvarez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jos&#233; L&#46;"
            "apellidos" => "Lerma-M&#225;rquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Pedro"
            "apellidos" => "Garc&#237;a-Cosmes"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario de Salamanca,    "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Introducci&#243;n retrasada de tacrolimus en ri&#241;ones sub&#243;ptimos&#46; Estudio de seguimiento a corto plazo en el Hospital Universitario de Salamanca"
      ]
    ]
    "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" => "11779_16025_42310_en_t111779.jpg"
            "Alto" => 563
            "Ancho" => 1435
            "Tamanyo" => 109914
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the appearance of complications between the two study groups"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In an attempt to satisfy the growing demand for kidney grafts&#44; several hospitals have gradually expanded their criteria for accepting marginal and sub-optimal kidneys &#40;generally derived from elderly donors or those with a risk for a potential reduction in nephron mass&#41;&#44; which currently constitute 50&#37; of all grafts&#46;<span class="elsevierStyleSup">1</span> These organs are associated with a greater incidence of acute ischaemic renal failure&#44; acute tubular necrosis &#40;ATN&#41;&#44; greater plasma creatinine levels&#44; and delayed graft function&#44; which can all contribute to increasing the rates of acute rejection&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Calcineurin inhibitors &#40;cyclosporine A and tacrolimus&#41; are essential medications for maintenance immunosuppression therapy&#46; The mechanism of action of these drugs is to block interleukin &#40;IL&#41; 2&#44; IL-2 and IL-4 receptors&#44; and gamma interferon&#46; The most characteristic side effect of these drugs is nephrotoxicity&#44; due to the increased expression of transforming growth factor beta &#40;TGF-&#223;&#41;&#44; which contributes to interstitial fibrosis and the synthesis of nitric oxide and endothelin&#44; which have vasomotor properties&#46;<span class="elsevierStyleSup">3</span> This effect is increased in marginal kidneys&#44; which often present interstitial fibrosis&#44; vascular involvement&#44; and glomerulosclerosis&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup">&#160;</span></p><p class="elsevierStylePara">In order to minimise the nephrotoxicity of these drugs in sub-optimal grafts&#44; several different strategies have been tested&#44; such as reducing doses or delaying introduction of treatment&#46; The latter has produced positive long-term results&#44; with low rates of acute rejection and acceptable levels of renal function&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup">&#160;</span></p><p class="elsevierStylePara">We examined the short-term influence of delayed introduction of calcineurin inhibitors among patients who received kidney transplants from marginal donors at the University Hospital of Salamanca&#44; comparing the effects of the drug in these patients with another group of recipients of young kidney transplants who received treatment from the start&#46; We performed an observational&#44; descriptive&#44; cohort study of all transplants carried out at our hospital between 2008 and 2011&#46; Patients were divided into two groups&#58; recipients of standard kidneys&#44; who received tacrolimus treatment starting before the transplant was performed&#44; and sub-optimal kidney recipients &#40;donor and recipient older than 55 years of age&#44; cold ischaemia time greater than 1 day&#44; cardiovascular death&#44; serum creatinine greater than 2mg&#47;dl&#44; and non-heart beating donors&#41;&#44; in which the medication was introduced on the fourth day&#46; All other immunosuppression was maintained in both groups&#58; basiliximab&#44; steroids&#44; and mycophenolate mofetil&#44; as well as anti-infection treatment&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The variables analysed included&#58; creatinine at the time of patient discharge and the presence of ATN&#44; acute rejection&#44; and infections within three months after transplantation&#46; We used SPSS<span class="elsevierStyleSup">&#174;</span> statistical software&#44; version 15&#46;0&#44; for all statistical analyses&#44; which involved Student&#8217;s t-tests and chi-square tests&#44; using a significance level of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 and expressing variables as percentages&#44; means&#44; standard deviation&#44; and relative risk&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">During the study period&#44; a total of 160 patients received kidney transplants&#46; Of these&#44; 43&#46;8&#37; received pre-transplant tacrolimus&#44; and 56&#46;3&#37; received tacrolimus starting on the fourth day post-transplant&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Mean creatinine in the early introduction group was 1&#46;9&#43;1&#46;25mg&#47;dl&#44; and this value was 2&#46;64&#43;1&#46;48mg&#47;dl in the late introduction group &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;098&#41;&#46; All other results are expressed in Table 1&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The late introduction of calcineurin inhibitors is safe in the short-term&#44; since&#44; in comparison with grafts from young donors in which recipients received immunosuppression from the start&#44; these patients did not exhibit a significant increase in parameters for renal dysfunction or secondary side effects&#46; In this manner&#44; the differences observed between the two groups may be due simply to the worse condition of marginal kidneys&#44; rather than being due to any negative influence of the late introduction of medication on the immediate post-transplant patient evolution&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The results of our study&#44; together with the results from previous studies that have established long-term safety&#44; support the use of this immunosuppression regimen for treating recipients of marginal kidney grafts&#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 declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statements collected</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This study has had no source of sponsorship&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11779&#95;16025&#95;42310&#95;en&#95;t111779&#46;jpg" class="elsevierStyleCrossRefs"><img src="11779_16025_42310_en_t111779.jpg" alt="Comparison of the appearance of complications between the two study groups"></img></a></p><p class="elsevierStylePara">Table 1&#46; Comparison of the appearance of complications between the two study groups</p>"
    "pdfFichero" => "P1-E547-S3875-A11779-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => 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" => "11779_16025_42310_en_t111779.jpg"
            "Alto" => 563
            "Ancho" => 1435
            "Tamanyo" => 109914
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of the appearance of complications between the two study groups"
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002485/v0_201502091556/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35438"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000001/v0_201502091555/X2013251413002485/v0_201502091556/en/P1-E547-S3875-A11779-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002485?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 10 15
2024 October 46 27 73
2024 September 48 32 80
2024 August 56 58 114
2024 July 39 28 67
2024 June 56 36 92
2024 May 59 35 94
2024 April 40 33 73
2024 March 29 24 53
2024 February 26 35 61
2024 January 27 24 51
2023 December 19 23 42
2023 November 25 25 50
2023 October 22 35 57
2023 September 31 31 62
2023 August 30 15 45
2023 July 32 21 53
2023 June 40 22 62
2023 May 37 33 70
2023 April 15 15 30
2023 March 25 17 42
2023 February 25 18 43
2023 January 23 22 45
2022 December 32 12 44
2022 November 28 36 64
2022 October 38 38 76
2022 September 31 26 57
2022 August 34 40 74
2022 July 21 47 68
2022 June 35 25 60
2022 May 37 36 73
2022 April 30 52 82
2022 March 32 55 87
2022 February 27 43 70
2022 January 33 37 70
2021 December 37 39 76
2021 November 30 35 65
2021 October 53 40 93
2021 September 41 33 74
2021 August 31 43 74
2021 July 42 36 78
2021 June 32 19 51
2021 May 56 29 85
2021 April 51 31 82
2021 March 32 27 59
2021 February 46 15 61
2021 January 40 16 56
2020 December 25 15 40
2020 November 18 9 27
2020 October 13 11 24
2020 September 21 4 25
2020 August 23 8 31
2020 July 24 10 34
2020 June 23 13 36
2020 May 27 14 41
2020 April 18 15 33
2020 March 26 13 39
2020 February 21 19 40
2020 January 30 16 46
2019 December 29 22 51
2019 November 20 12 32
2019 October 5 7 12
2019 September 9 14 23
2019 August 10 8 18
2019 July 16 16 32
2019 June 24 16 40
2019 May 17 14 31
2019 April 42 25 67
2019 March 31 16 47
2019 February 25 19 44
2019 January 19 18 37
2018 December 75 36 111
2018 November 83 18 101
2018 October 53 17 70
2018 September 61 14 75
2018 August 38 30 68
2018 July 42 21 63
2018 June 55 15 70
2018 May 43 19 62
2018 April 59 6 65
2018 March 45 12 57
2018 February 44 7 51
2018 January 60 13 73
2017 December 54 9 63
2017 November 44 22 66
2017 October 31 12 43
2017 September 42 12 54
2017 August 39 42 81
2017 July 27 26 53
2017 June 38 21 59
2017 May 33 22 55
2017 April 32 26 58
2017 March 11 17 28
2017 February 30 36 66
2017 January 19 25 44
2016 December 26 9 35
2016 November 38 8 46
2016 October 54 12 66
2016 September 73 4 77
2016 August 110 4 114
2016 July 119 11 130
2016 June 110 0 110
2016 May 126 0 126
2016 April 77 0 77
2016 March 66 0 66
2016 February 118 0 118
2016 January 117 0 117
2015 December 120 0 120
2015 November 111 0 111
2015 October 110 0 110
2015 September 55 0 55
2015 August 60 0 60
2015 July 71 0 71
2015 June 43 0 43
2015 May 45 0 45
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

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

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