Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality

array:21 ["pii" => "X2013251413002630" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Nov.11430" "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;33:85-92" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8320 "formatos" => array:3 [ "EPUB" => 319 "HTML" => 7254 "PDF" => 747 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699513002633" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2012.Nov.11430" "estado" => "S300" "fechaPublicacion" => "2013-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2013;33:85-92" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 11901 "formatos" => array:3 [ "EPUB" => 328 "HTML" => 10901 "PDF" => 672 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Análisis repetido de la resistencia insulínica estimada mediante índice HOMAIR en pacientes no diabéticos en diálisis peritoneal y su relación con la enfermedad cardiovascular y mortalidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "85" "paginaFinal" => "92" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality" ] ] "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" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11430_108_31956_es_11430_t1.jpg" "Alto" => 250 "Ancho" => 600 "Tamanyo" => 172483 ] ] "descripcion" => array:1 [ "es" => "Características basales de los pacientes en diálisis peritoneal incidentes y prevalentes" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "del Instituto de Salud Carlos III) y del IRSIN Grupo de Estudios Peritoneales de Madrid de REDinREN (Red Renal de investigación de la RETICS 06/0016, del Instituto de Salud Carlos III) y del IRSIN, Rafael Sánchez-Villanueva, Patricia Estrada, Gloria del Peso, Cristina Grande, Juan J. Díez, Pedro Iglesias, Elena González, Ana Aguilar-Rodríguez, Rafael Selgas, M. Auxiliadora Bajo" "autores" => array:11 [ 0 => array:2 [ "nombre" => "del Instituto de Salud Carlos III) y del IRSIN" "apellidos" => "Grupo de Estudios Peritoneales de Madrid de REDinREN (Red Renal de investigación de la RETICS 06/0016, del Instituto de Salud Carlos III) y del IRSIN" ] 1 => array:2 [ "nombre" => "Rafael" "apellidos" => "Sánchez-Villanueva" ] 2 => array:2 [ "nombre" => "Patricia" "apellidos" => "Estrada" ] 3 => array:2 [ "nombre" => "Gloria" "apellidos" => "del Peso" ] 4 => array:2 [ "nombre" => "Cristina" "apellidos" => "Grande" ] 5 => array:2 [ "nombre" => "Juan J." "apellidos" => "Díez" ] 6 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iglesias" ] 7 => array:2 [ "nombre" => "Elena" "apellidos" => "González" ] 8 => array:2 [ "nombre" => "Ana" "apellidos" => "Aguilar-Rodríguez" ] 9 => array:2 [ "nombre" => "Rafael" "apellidos" => "Selgas" ] 10 => array:2 [ "nombre" => "M. Auxiliadora" "apellidos" => "Bajo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251413002630" "doi" => "10.3265/Nefrologia.pre2012.Nov.11430" "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/X2013251413002630?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513002633?idApp=UINPBA000064" "url" => "/02116995/0000003300000001/v0_201502091331/X0211699513002633/v0_201502091333/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251413002622" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Oct.11560" "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;33:93-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4780 "formatos" => array:3 [ "EPUB" => 317 "HTML" => 3751 "PDF" => 712 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Advancing in the management of chronic kidney disease: the results of implementing a quick resolution consultation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "93" "paginaFinal" => "98" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Avanzando en el manejo de la enfermedad renal crónica: resultados de la implantación de una consulta de rápida resolución" ] ] "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" => "11560_16025_42072_en_t111560i.jpg" "Alto" => 822 "Ancho" => 1071 "Tamanyo" => 235608 ] ] "descripcion" => array:1 [ "en" => "Summary results" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isidro Torregrosa Maicas, Isidro Torregrosa-Maicas, Isabel Juan García, Isabel Juan-García, Miguel Ángel Solís Salguero, Miguel Á. Solís-Salguero, Carmen Ramos Tomás, Carmen Ramos-Tomás, María Jesús Puchades Montsa, M. Jesús Puchades-Montesa, Miguel González Rico, Miguel González-Rico, Patricia Tomás Simó, Patricia Tomás-Simó, José Ribés Cruz, José Ribés-Cruz, Sandra Tejedor Alonso, Sandra Tejedor-Alonso, Amelia Abarca González, Amelia Abarca-González, Alfonso Miguel Carrasco, Alfonso Miguel-Carrasco" "autores" => array:22 [ 0 => array:2 [ "nombre" => "Isidro" "apellidos" => "Torregrosa Maicas" ] 1 => array:2 [ "nombre" => "Isidro" "apellidos" => "Torregrosa-Maicas" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "Juan García" ] 3 => array:2 [ "nombre" => "Isabel" "apellidos" => "Juan-García" ] 4 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "Solís Salguero" ] 5 => array:2 [ "nombre" => "Miguel Á." "apellidos" => "Solís-Salguero" ] 6 => array:2 [ "nombre" => "Carmen" "apellidos" => "Ramos Tomás" ] 7 => array:2 [ "nombre" => "Carmen" "apellidos" => "Ramos-Tomás" ] 8 => array:2 [ "nombre" => "María Jesús" "apellidos" => "Puchades Montsa" ] 9 => array:2 [ "nombre" => "M. Jesús" "apellidos" => "Puchades-Montesa" ] 10 => array:2 [ "nombre" => "Miguel" "apellidos" => "González Rico" ] 11 => array:2 [ "nombre" => "Miguel" "apellidos" => "González-Rico" ] 12 => array:2 [ "nombre" => "Patricia" "apellidos" => "Tomás Simó" ] 13 => array:2 [ "nombre" => "Patricia" "apellidos" => "Tomás-Simó" ] 14 => array:2 [ "nombre" => "José" "apellidos" => "Ribés Cruz" ] 15 => array:2 [ "nombre" => "José" "apellidos" => "Ribés-Cruz" ] 16 => array:2 [ "nombre" => "Sandra" "apellidos" => "Tejedor Alonso" ] 17 => array:2 [ "nombre" => "Sandra" "apellidos" => "Tejedor-Alonso" ] 18 => array:2 [ "nombre" => "Amelia" "apellidos" => "Abarca González" ] 19 => array:2 [ "nombre" => "Amelia" "apellidos" => "Abarca-González" ] 20 => array:2 [ "nombre" => "Alfonso" "apellidos" => "Miguel Carrasco" ] 21 => array:2 [ "nombre" => "Alfonso" "apellidos" => "Miguel-Carrasco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699513002625" "doi" => "10.3265/Nefrologia.pre2012.Oct.11560" "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/X0211699513002625?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002622?idApp=UINPBA000064" "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002622/v0_201502091556/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251413002649" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Sep.11533" "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;33:77-84" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5146 "formatos" => array:3 [ "EPUB" => 306 "HTML" => 4053 "PDF" => 787 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Double treatment with paricalcitol-associated calcifediol and cardiovascular risk biomarkers in haemodialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "77" "paginaFinal" => "84" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento doble con calcifediol asociado a paricalcitol y biomarcadores de riesgo cardiovascular en hemodiálisis" ] ] "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" => "11533_16025_41491_en_t111533.jpg" "Alto" => 1014 "Ancho" => 2193 "Tamanyo" => 847164 ] ] "descripcion" => array:1 [ "en" => "Modification of the different study variables in both treatment groups over the course of the study" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Celestino Piñera-Haces, María J. Izquierdo-Ortiz, Ángel L. Martín-de Francisco, M. Teresa Garcia-Unzueta, M. Teresa García-Unzueta, Marcos López-Hoyos, Carmen Toyos, Natalia Allende, Estrella Quintela, Manuel Arias" "autores" => array:15 [ 0 => array:2 [ "nombre" => "Celestino" "apellidos" => "Piñera-Haces" ] 1 => array:2 [ "nombre" => "María J." "apellidos" => "Izquierdo-Ortiz" ] 2 => array:2 [ "nombre" => "Ángel L." "apellidos" => "Martín-de Francisco" ] 3 => array:2 [ "nombre" => "Ángel L." "apellidos" => "Martín-de Francisco" ] 4 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "Garcia-Unzueta" ] 5 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "García-Unzueta" ] 6 => array:2 [ "nombre" => "Marcos" "apellidos" => "López-Hoyos" ] 7 => array:2 [ "nombre" => "Marcos" "apellidos" => "López-Hoyos" ] 8 => array:2 [ "nombre" => "Carmen" "apellidos" => "Toyos" ] 9 => array:2 [ "nombre" => "Natalia" "apellidos" => "Allende" ] 10 => array:2 [ "nombre" => "Natalia" "apellidos" => "Allende" ] 11 => array:2 [ "nombre" => "Estrella" "apellidos" => "Quintela" ] 12 => array:2 [ "nombre" => "Estrella" "apellidos" => "Quintela" ] 13 => array:2 [ "nombre" => "Manuel" "apellidos" => "Arias" ] 14 => array:2 [ "nombre" => "Manuel" "apellidos" => "Arias" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699513002641" "doi" => "10.3265/Nefrologia.pre2012.Sep.11533" "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/X0211699513002641?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002649?idApp=UINPBA000064" "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002649/v0_201502091556/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "85" "paginaFinal" => "92" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "del Instituto de Salud Carlos III) y del IRSIN Grupo de Estudios Peritoneales de Madrid de REDinREN (Red Renal de investigación de la RETICS 06/0016, del Instituto de Salud Carlos III) y del IRSIN, Rafael Sánchez-Villanueva, Patricia Estrada, Gloria del Peso, Cristina Grande, Juan J. Díez, Pedro Iglesias, Elena González, Ana Aguilar-Rodríguez, Rafael Selgas, M. Auxiliadora Bajo" "autores" => array:11 [ 0 => array:2 [ "nombre" => "del Instituto de Salud Carlos III) y del IRSIN" "apellidos" => "Grupo de Estudios Peritoneales de Madrid de REDinREN (Red Renal de investigación de la RETICS 06/0016, del Instituto de Salud Carlos III) y del IRSIN" ] 1 => array:4 [ "nombre" => "Rafael" "apellidos" => "Sánchez-Villanueva" "email" => array:1 [ 0 => "rjsanchez.hulp@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "Patricia" "apellidos" => "Estrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 3 => array:3 [ "nombre" => "Gloria" "apellidos" => "del Peso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 4 => array:3 [ "nombre" => "Cristina" "apellidos" => "Grande" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "affc" ] ] ] 5 => array:3 [ "nombre" => "Juan J." "apellidos" => "Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "affd" ] ] ] 6 => array:3 [ "nombre" => "Pedro" "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "affd" ] ] ] 7 => array:3 [ "nombre" => "Elena" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 8 => array:3 [ "nombre" => "Ana" "apellidos" => "Aguilar-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 9 => array:3 [ "nombre" => "Rafael" "apellidos" => "Selgas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 10 => array:3 [ "nombre" => "M. Auxiliadora" "apellidos" => "Bajo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario La Paz, Madrid, " "etiqueta" => "b" "identificador" => "affb" ] 1 => array:3 [ "entidad" => "Servicio de Bioquímica, Hospital Universitario La Paz, Madrid, " "etiqueta" => "c" "identificador" => "affc" ] 2 => array:3 [ "entidad" => "Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, " "etiqueta" => "d" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis repetido de la resistencia insulínica estimada mediante índice HOMAIR en pacientes no diabéticos en diálisis peritoneal y su relación con la enfermedad cardiovascular y mortalidad" ] ] "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" => "11430_16025_42460_en_t1.11430.jpg" "Alto" => 891 "Ancho" => 2169 "Tamanyo" => 344708 ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of incident and prevalent patients on peritoneal dialysis" ] ] ] "textoCompleto" => "Cardiovascular disease (CVD) is the primary cause of death in patients on dialysis.1,2 The association between peripheral insulin resistance index (IR), hyperinsulinism, and CVD has been explored through numerous cross-sectional and prospective studies.1-4 In fact, hyperinsulinism is considered to be a good marker for IR in patients with significant hyperglycaemia. In addition, IR is associated with several risk factors for CVD, such as dyslipidaemia,2 arterial hypertension,5 and hypercoagulability.2 Patients with end-stage chronic kidney disease (CKD) develop early IR, characterised by altered carbohydrate metabolism with hyperinsulinemia, which is generally associated with dyslipidaemia and a pro-inflammatory pattern with altered serum levels of adipocytokines.6 Several studies have demonstrated that IR is possibly associated with a silent and systemic inflammatory process and a micro-inflammatory process characterised by the activation of peripheral cells such as polymorphonuclear cells and monocytes.7 The final consequence is an elevated rate of atherosclerosis and a high rate of morbidity/mortality due to CVD.8 Our working hypothesis was based on the possibility that glucose in peritoneal dialysis (PD) solutions could increase IR through an adipocytokine-mediated effect, and contribute to accelerating the process of atherosclerosis in uraemic patients. With this in mind, the objectives of our study included: <li>Evaluate IR in incident and prevalent nondiabetic patients treated with PD.</li><li>Analyse the evolution of IR indices after 1 year of PD treatment.</li><li>Evaluate the effect of IR on subsequent CV morbidity-mortality.</li> PATIENTS AND METHOD Patients Ours was a prospective and observational study involving a cohort of incident and prevalent patients treated with PD. A total of 69 nondiabetic patients on PD were included, 35 of which were incident (≤3 months on PD) and 34 of which were prevalent (>3 months on PD). In addition, 58% were treated with automated peritoneal dialysis, and 42% with continuous ambulatory peritoneal dialysis, with 2 measurements of insulin resistance taken 12 months apart using the homeostasis model assessment insulin resistance (HOMAIR). The purpose of this combined evaluation was to test the reproducibility, potential changes derived from PD, and the influence of these parameters on the appearance of CV events and mortality. We excluded patients with active forms of cancer, acute infections, uncontrolled or systemic chronic inflammatory disease, or an initial glycaemia value >140mg/dl. The causes of kidney disease were glomerulonephritis in 21 patients (30.4%), nephroangiosclerosis/vascular in 8 patients (11.6%), other causes in 8 patients (11.6%), polycystic kidney disease in 7 patients (10.1%), systemic disease in 7 patients (10.1%), unknown in 7 patients (10.1%), chronic pyelonephritis in 5 patients (7.2%), interstitial nephropathy in 5 patients (7.2%), and hereditary in 1 patient (1.4%). At the time of the first measurement of IR, we considered baseline and start of follow-up times for the survival analysis. Comorbidity was evaluated using the Charlson index as modified by Beddhu.9 LABORATORY PROCEDURES Laboratory parameters were measured at baseline values and after 1 year of evolution, always following 12 hours of fast and maintaining normal regimens of PD treatment. We also compiled dialysis parameters, such as Kt/V from weekly urine samples and normalised protein nitrogen appearance (nPNA). Insulin was measured using a double enzyme immunometric assay method with an AIA 360 auto-analyser (Tosoh Bioscience). The inter and intra-trial coefficients of variation were 1.7% and 3.3%, respectively. The sensitivity of the analysis was 1µU/ml. The normal range for insulin levels in our laboratory was 2-17µU/ml. Based on baseline insulinemia and glycaemia values, we calculated HOMAIR index scores based on the formula by Matthews et al.10: HOMAIR = glucose (mmol/l) x insulin (µU/ml)/22.5. We also calculated the quantitative insulin sensitivity check index based on the protocol by Hrebicek et al.11: QUICKI = 1/[log fasting insulin level (mU/l) – log fasting glycaemia (mg/dl)]. Definitions Coronary disease: a history of angina, myocardial infarction, coronary angiography evidence, percutaneous intervention, or coronary bypass. Congestive heart failure: New York Heart Association (NYHA) classification12:- Functional class I: normal activity with no symptoms. No limitations to physical activity.- Functional class II: the patient tolerates normal activity, but physical activity is slightly limited due to dyspnoea that appears during intense exercise.- Functional class III: the patient’s capacity for physical activity is lower than normal, with notable limitations due to dyspnoea.- Functional class IV: the patient suffers dyspnoea upon the slightest effort or even at rest, and is incapable of performing virtually any physical activityPeripheral arterial disease: patients with intermittent claudication, arterial bypass, amputation, gangrene, acute arterial insufficiency, or unrepaired aneurysms of the thoracic or abdominal arteries greater than 5cm. Cerebral vascular disease: patients with a history of cerebrovascular accidents or transitory ischaemic accidents (with mild or zero sequelae). Dyslipidemia: one or more of the following criteria13: 1) LDL (low-density lipoprotein) cholesterol ≥100mg/dl; 2) non-HDL (non-high-density lipoprotein) cholesterol ≥130mg/dl; 3) triglycerides ≥150mg/dl; 4) HDL cholesterol ≤40mg/dl; and 5) the use of one or more lipid-lowering drugs. Hypertension: blood pressure (BP) was measured using a digital monitor (HEM-907) with cuffs adapted to the circumference of each patient’s arm, once the patient had been laying at rest for at least 5 minutes. Hypertension was diagnosed when the patient fulfilled one or more of the following criteria14: 1) systolic BP≥135mm Hg; 2) diastolic BP≥85mm Hg; and 3) the use of one or more anti-hypertensive drugs. STATISTICAL ANALYSIS Values were expressed as means (± standard deviation) and percentages. Proportions were compared using chi-square tests, and means were compared using Student’s t-tests for variables with a normal distribution, and Mann-Whitney or Wilcoxon tests were used for non-parametric quantitative variables. We performed a linear regression analysis using Pearson and Spearman correlation coefficients. We used the Kaplan-Meier method for the survival analysis, and compared curves using the log-rank method. A P-value <.05 was considered to be statistically significant for all cases. RESULTS Table 1 summarises the baseline clinical characteristics for the two patient groups, classified based on prior time on PD (incident and prevalent patients). We did not observe significant differences between the two groups. The mean time on PD was 32.1±16.0 months (range: 11-87 months). Table 2 displays the mean dialysis parameters, laboratory values, and insulin resistance indices (HOMAIR and QUICKI) at initial evaluations and after 12 months of follow-up. We only observed statistically significant differences between the two groups in the fields of residual renal function, total cholesterol, and LDL cholesterol. At the start of treatment, 60% of incident patients were on treatment with icodextrin, as compared to 57.1% after 12 months. In prevalent patients, the rate of use of icodextrin was 73.5% at both evaluations. HOMAIR and initial insulin levels When patients were classified based on median initial HOMAIR score (HOMAIR: 1.7; range: 6.29), we observed that incident patients with higher HOMAIR scores had significantly higher levels of total calcium and ionised calcium as compared to patients with lower HOMAIR scores. In prevalent patients, we did not observe significant differences for this parameter (Table 3). Upon classifying patients based on median insulinemia (7.0; range: 2-25), the findings were similar. We did not observe differences in HOMAIR or QUICKI scores based on the different concentrations of glucose in peritoneal dialysate solutions, both at the start of the study and after 1 year (data not shown). Comorbidity analysis When we analysed patients based on the median value for baseline HOMAIR score, we did not observe statistically significant differences for CV comorbidity, ischaemic heart disease, heart failure, or cerebral/peripheral vascular comorbidity. We encountered the same result when separating patients based on the median value for initial insulin. We did not observe a significant difference between patients with HOMAIR scores above and below the median value in terms of Charlson comorbidity score (with age excluded) (3.2±1.6 vs. 3.4±1.3). The presence of CVD did not significantly affect HOMAIR scores. Survival analysis Eighteen patients (26%) died during the follow-up period, with death of vascular origin being the most common source of mortality (n=5; 27.8%), followed by cardiac causes (n=4; 22.2%), infectious causes (n=4; 22.2%), deterioration (n=2; 11.1%), tumours (n=1.5; 6%) and other (n=2; 11.1%). Survival analysis revealed that patients who died were mostly male (11 vs 7; P=.001), elderly (63.6±12.3 vs 45.7±16.8 years of age; P=.000), and a higher Charlson index score (with age excluded) (4.5±1.1 vs 2.9±1.3; P=.000). We did not observe statistically significant differences in terms of IR index values (data not shown). The global Kaplan-Meier survival analysis did not reveal significant differences in terms of mortality between patients with HOMAIR index scores above and below the median value (Figure). In a similar manner, we did not observe differences in terms of CV mortality and fatal/non-fatal CV events during the study (data not shown). DISCUSSION In this study, we analysed the effects of PD on parameters of insulin resistance (HOMAIR and QUICKI) and the influence of these scores on the appearance of CV events and mortality in a group of nondiabetic PD patients. IR is very common among uraemic patients, occurring even in early phases.15 Several different hypotheses have been proposed in an attempt to explain IR: 1) hyper-production of endogenous proinflammatory factors such as homocysteine,16 oxidative stress,17 and elevated lipoprotein (a) levels,18 and exogenous proinflammatory factors such as chronic infections (sometimes silent) by Helicobacter pylori,19 infected vascular prostheses, or intravenous iron administration, among others20; and 2) increased adipose tissue21 due to excess caloric intake, which leads to a vicious circle with increased production of adipocytokines (leptin, resistin) and other proinflammatory mediators such as nuclear factor kappa beta, tumour necrosis factor alpha, and interleukin 6.22 These chemokines act as chemotactic proteins for monocytes and macrophages (MCP-1),23,24 thus perpetuating IR. In patients on PD, the development of IR is attributed to the excessive amount of glucose absorbed through dialysate fluids, which contributes to other metabolic disorders such as central obesity, hypertriglyceridemia, and de novo diabetes.25 This process also induces hyper-secretion of adipocytokines, which perpetuate hyperinsulinism and its deleterious metabolic and systemic effects. According to the study by Fortes et al.,26 patients on PD have higher fasting glucose levels, HbA1c, and HOMAIR index scores than patients on haemodialysis. Also, patients who receive dialysis with glucose-free dialysate exhibit a lower absorption of glucose, lower weight gain and fat accumulation, reduced levels of plasma leptin and increased levels of plasma adiponectin, and improved IR and dyslipidemia.27,28 In our study, mean glucose, insulin, and IR (as measured by HOMAIR and QUICKI indices) levels were similar between initial measurements and after 1 year in both incident and prevalent patients. Bonora et al.29 examined a large sample of patients with type 2 diabetes, and showed that IR (as estimated using the HOMAIR index) was a strong predictor for CVD, both at the start of the study and during follow-up. This correlation was independent of traditional CV factors and variables closely related to IR, such as body mass index. Also, despite the fact that several studies have shown that hyperinsulinemia is capable of predicting CVD,4,30 others, in contrast, have not found a significant association between plasma insulin levels and CVD.31 In our study, we did not observe significant differences in terms of CV comorbidity, ischaemic heart disease, heart failure, or cerebral vascular comorbidity based on HOMAIR index scores or insulin levels. The Charlson index score (without the factor of age included) was also similar among all patients. Nor did we observe a relationship between the presence of prior CVD and HOMAIR scores. Glucose in PD solutions may have an effect on abdominal adipocytes, which, through an increase in the secretion of adipocytokines, may increase IR, thus favouring the development of metabolic syndromes and accelerating the process of atherosclerosis in uremic patients. Upon analysis of our results, we did not observe significant differences in HOMAIR or QUICKI index scores based on the concentrations of glucose used in PD solutions.In the general population, IR is considered to be a factor for CV risk and mortality,32,33 whereas this factor appears to have a different significance in studies carried out with CKD patients. A study by Shinohara et al.34 demonstrated that HOMAIR scores predicted mortality in nondiabetic patients with CKD. However, other studies have not observed this relationship.35 In our survival analysis, we did not observe statistically significant differences in terms of IR scores or when classifying patients based on median HOMAIR values in a Kaplan-Meier analysis. It may be that other characteristics of these patients, such as age or comorbidity, may play a greater role in determining survival than insulin resistance. In addition, the HOMAIR scores recorded in our study fell within normal limits, which would also impede the possibility of significant differences in terms of survival. Bonora et al.36 observed mean HOMAIR values of 2.06±0.14 in a population of 62 healthy individuals using a double-antibody radioimmunoassay for measuring plasma insulin. In a study involving 490 nondiabetic volunteers, 77% of which were Caucasian, of both sexes, aged 19-79 years, and with a body mass index of 18-42.2, the researchers observed a mean HOMAIR score of 2.7±.1.37 The mean HOMAIR value in normal individuals (with no glucose metabolism disorders) from a study prior to ours was 2.22±0.26.38 The HOMAIR values recorded in our study, both in incident and prevalent patients, placed between the 50th and 75th percentile of the values recorded for the general population in Spain according to a recent study.39 Caravaca et al.40 observed higher mean HOMAIR values than ours (mean: 4.28±2.07) in a population of nondiabetic patients with CKD. These data support the results obtained in nondiabetic patients on PD, indicating that HOMAIR scores are not significantly elevated in these individuals as compared to the general population, and that this result does not vary over time on dialysis, at least within a period of one year. We recognise that our study involves the limitation of only including patients with an initial glycaemia >140mg/dl instead of the cut-off value for diagnosing diabetes in the general population of ≥126mg/dl, but since our study involved patients on PD with a continuous glucose input, we intended to assess a cohort of patients with a baseline glucose level close to normal values, although with the exclusion of diabetic patients. It is possible that, through the use of this more permissive threshold, we may have included patients with less severe disorders of glucose metabolism, such as carbohydrate intolerance, but it was our intention to only exclude patients with clear cases of diabetes. The fact that, in order to be included in our study, all patients needed to have at least one year on PD also implies a bias in our survival analysis. In addition, this study is limited by the small number of patients evaluated, but it does offer a double approach assessing patients at different stages of PD treatment (initial and late), with consistent results across both groups. The prospective approach used also considerably bolsters the results obtained. To conclude, nondiabetic patients on PD do not have significantly elevated HOMAIR scores, or modifications to these values after one year of treatment on PF, which suggests that PD is not the cause of increased risk of IR. The fact that IR indices were not associated with CV morbidity/mortality rates appears to suggest that this factor holds little sway in the field of PD. Conflicts of interest The authors declare that they have no conflicts of interest related to the contents of this article.<a href="grande/11430_16025_42460_en_t1.11430.jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42460_en_t1.11430.jpg" alt="Baseline characteristics of incident and prevalent patients on peritoneal dialysis"></img></a>Table 1. Baseline characteristics of incident and prevalent patients on peritoneal dialysis<a href="grande/11430_16025_42461_en_t2.11430.jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42461_en_t2.11430.jpg" alt="Dialysis parameters, laboratory values, and peripheral insulin resistance indices in patients on peritoneal dialysis; baseline and after 1 year of follow-up"></img></a>Table 2. Dialysis parameters, laboratory values, and peripheral insulin resistance indices in patients on peritoneal dialysis; baseline and after 1 year of follow-up<a href="grande/11430_16025_42462_en_t3.11430.jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42462_en_t3.11430.jpg" alt="Comparison of baseline values for laboratory parameters based on median HOMAIR values (median: 1.7; range: 6-29)"></img></a>Table 3. Comparison of baseline values for laboratory parameters based on median HOMAIR values (median: 1.7; range: 6-29)<a href="grande/11430_16025_42463_en_f19.114304.jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42463_en_f19.114304.jpg" alt="Kaplan-Meier curves, median HOMAIR vs patient death"></img></a>Figure 1. Kaplan-Meier curves, median HOMAIR vs patient death" "pdfFichero" => "P1-E547-S3850-A11430-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436851" "palabras" => array:1 [ 0 => "Mortalidad" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436853" "palabras" => array:1 [ 0 => "Índice QUIKI" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436855" "palabras" => array:1 [ 0 => "Índice HOMA" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436857" "palabras" => array:1 [ 0 => "Enfermedad cardiovascular" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436859" "palabras" => array:1 [ 0 => "Resistencia a la insulina" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436861" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436863" "palabras" => array:1 [ 0 => "Enfermedad renal crónica" ] ] ] "en" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436852" "palabras" => array:1 [ 0 => "Mortality" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436854" "palabras" => array:1 [ 0 => "QUIKI Index" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436856" "palabras" => array:1 [ 0 => "HOMAIR Index" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436858" "palabras" => array:1 [ 0 => "Cardiovascular disease" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436860" "palabras" => array:1 [ 0 => "Insulin resistance" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436862" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436864" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Los pacientes con enfermedad renal crónica terminal muestran precozmente resistencia insulínica (RI), caracterizada por alteraciones en el metabolismo hidrocarbonado e hiperinsulinemia generalmente asociada a dislipemia y a un patrón pro inflamatorio. La enfermedad cardiovascular (CV) constituye la principal causa de mortalidad en los pacientes en diálisis. Existe una fuerte asociación entre RI, hiperinsulinismo y enfermedad CV. El objetivo del presente estudio fue evaluar el efecto de la diálisis peritoneal (DP) sobre la RI y sus efectos sobre la morbimortalidad CV subsiguiente en pacientes urémicos no diabéticos. Se incluyeron 69 pacientes no diabéticos en DP, 35 incidentes (≤ 3 meses en DP) y 34 prevalentes (> 3 meses en DP), con 2 mediciones de resistencia insulínica estimada mediante el índice de resistencia a la insulina (HOMAIR), separadas entre sí por 12 meses. El valor medio de HOMAIR en pacientes incidentes fue 1,8 ± 1,3 y 2,2 ± 2,1 en situación basal y a los 12 meses, respectivamente (no significativa [ns]). En pacientes prevalentes estos valores fueron 2,3 ± 1,3 y 2,5 ± 2,2 (ns). En nuestro estudio, las concentraciones medias de glucosa, insulina y RI medida por el HOMAIR y QUICKI (índice cuantitativo de control de la sensibilidad a la insulina) fueron similares en situación basal y al año de seguimiento, tanto en incidentes como en prevalentes. No objetivamos diferencias significativas en relación con la comorbilidad CV, cardiopatía isquémica, insuficiencia cardíaca o comorbilidad vascular cerebral o periférica, ni en función del índice HOMAIR, ni en el de los niveles de insulina. En conclusión, los pacientes no diabéticos en DP no presentan elevación significativa de los niveles de HOMAIR, ni se modifica con paso del tiempo en diálisis, lo que sugiere que la DP no es un factor de riesgo de RI. El hecho de que los índices de RI no se asocien a morbilidad o mortalidad CV parece sugerir el menor peso de este factor en el ámbito de la DP." ] "en" => array:1 [ "resumen" => "End-stage renal disease patients show early insulin resistance (IR), characterised by alterations in the carbohydrate metabolism and hyperinsulinaemia generally associated with dyslipidaemia and a proinflammatory condition. Cardiovascular disease (CVD) is the main cause of mortality in patients on dialysis. There is a strong association between IR, hyperinsulinism and CV disease. The objective of this study was to evaluate the effect of peritoneal dialysis (PD) on IR and its effects on the subsequent CVD morbidity and mortality in nondiabetic uraemic patients. It involved 69 nondiabetic patients on PD, 35 incident patients (≤ 3 months on PD) and 34 prevalent patients (> 3 months on PD), with 2 estimated insulin resistance measurements 12 months apart using the insulin resistance index (HOMAIR). The mean HOMAIR value in incident patients was 1.8 ± 1.3 and 2.2 ± 2.1 at baseline situation and at 12 months respectively (not significant [NS]). In prevalent patients these values were 2.3 ± 1.3 and 2.5 ± 2.2 (NS). In our study, the mean glucose, insulin and IR concentrations measured by the HOMAIR and QUICKI indexes (the latter being a quantitative control for insulin sensitivity control) were similar at baseline situation and the following year, in both incident and prevalent patients. We did not find any significant differences in relation to CVD comorbidity, ischaemic heart disease, heart failure or cerebrovascular or peripheral comorbidity neither in the HOMAIR index or insulin levels. To conclude, nondiabetic patients on PD do not display a significant increase in HOMAIR levels and this remains the case over time when on dialysis. This, in turn, suggests that PD is not an IR risk factor. The fact that the IR indexes are not associated with CVD morbidity or mortality seems to suggest that this is a less significant factor in the field of PD." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11430_16025_42460_en_t1.11430.jpg" "Alto" => 891 "Ancho" => 2169 "Tamanyo" => 344708 ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of incident and prevalent patients on peritoneal dialysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11430_16025_42461_en_t2.11430.jpg" "Alto" => 812 "Ancho" => 2185 "Tamanyo" => 304807 ] ] "descripcion" => array:1 [ "en" => "Dialysis parameters, laboratory values, and peripheral insulin resistance indices in patients on peritoneal dialysis; baseline and after 1 year of follow-up" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11430_16025_42462_en_t3.11430.jpg" "Alto" => 601 "Ancho" => 2144 "Tamanyo" => 263090 ] ] "descripcion" => array:1 [ "en" => "Comparison of baseline values for laboratory parameters based on median HOMAIR values (median: 1.7; range: 6-29)" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11430_16025_42463_en_f19.114304.jpg" "Alto" => 876 "Ancho" => 1011 "Tamanyo" => 89722 ] ] "descripcion" => array:1 [ "en" => "Kaplan-Meier curves, median HOMAIR vs patient death" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN. Clinical epidemiology of cardiac disease in dialysis patients: left ventricular hypertrophy, ischemic heart disease, and cardiac failure. Semin Dial 2003;16(2):111-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12641874" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lowrie EG, Lazarus JM, Mocelin AJ, Bailey GL,\u{A0}Hampers CL,\u{A0}Wilson RE,\u{A0}et al. Survival of patients undergoing chronic hemodialysis and renal transplantation. N Engl J Med 1973;288(17):863-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/4571245" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ducimetiere P, Eschwege E, Papoz L, Richard JL, Claude JR, Rosselin G. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia 1980;19(3):205-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6997122" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Welborn TA, Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care 1979;2(2):154-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/520119" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996;334(6):374-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8538710" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kobayashi S, Maesato K, Moriya H, Ohtake T, Ikeda T. Insulin resistance in patients with chronic kidney disease. Am J Kidney Dis 2005;45(2):275-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15685504" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Merino A, Nogueras S, Buendía P, Ojeda R,\u{A0}Carracedo J,\u{A0}Ramirez-Chamond R,\u{A0}et al. Microinflammation and endothelial damage in hemodialysis. Contrib Nephrol 2008;161:83-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18451662" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García-López E, Carrero JJ, Suliman ME, Lindholm B, Stenvinkel P. Risk factors for cardiovascular disease in patients undergoing peritoneal dialysis. Perit Dial Int 2007;27 Suppl 2:S205-S209. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17556305" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108(8):609-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10856407" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7):412-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3899825" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hrebicek J, Janout V, Malincikova J, Horakova D, Cizek L. Detection of insulin resistance by simple quantitative insulin sensitivity check index QUICKI for epidemiological assessment and prevention. J Clin Endocrinol Metab 2002;87(1):144-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11788638" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hurst JW, Morris DC, Alexander RW. The use of the New York Heart Association's classification of cardiovascular disease as part of the patient's complete Problem List. Clin Cardiol 1999;22(6):385-90." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486-97." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997;157(21):2413-46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9385294" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fliser D, Pacini G, Engelleiter R, Kautzky-Willer A,\u{A0}Prager R,\u{A0}Franek E,\u{A0}et al. Insulin resistance and hyperinsulinemia are already present in patients with incipient renal disease. Kidney Int 1998;53(5):1343-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9573550" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gillum R. Distribution of serum total homocysteine and its association with diabetes and cardiovascular risk factors of the insulin resistance syndrome in Mexican American men: the Third National Health and Nutrition Examination Survey. Nutr J 2003;2:6." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rosen P, Nawroth PP, King G, Moller W, Tritschler HJ, Packer L. The role of oxidative stress in the onset and progression of diabetes and its complications: a summary of a Congress Series sponsored by UNESCO-MCBN, the American Diabetes Association and the German Diabetes Society. Diabetes Metab Res Rev 2001;17(3):189-212. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11424232" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Reaven GM, Chen YD, Jeppesen J, Maheux P, Krauss RM. Insulin resistance and hyperinsulinemia in individuals with small, dense low density lipoprotein particles. J Clin Invest 1993;92(1):141-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8325978" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Aguilera A, Gonzalez-Espinoza L, Codoceo R, Jara Mdel C,\u{A0}Pavone M,\u{A0}Bajo MA,\u{A0}et al. Bowel bacterial overgrowth as another cause of malnutrition, inflammation, and atherosclerosis syndrome in peritoneal dialysis patients. Adv Perit Dial 2010;26:130-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21348395" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Amore A, Coppo R. Immunological basis of inflammation in dialysis. Nephrol Dial Transplant 2002;17 Suppl 8:16-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12147772" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U. Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 1983;72(3):1150-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6350364" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shoelson SE, Lee J, Yuan M. Inflammation and the IKK beta/I kappa B/NF-kappa B axis in obesity- and diet-induced insulin resistance. Int J Obes Relat Metab Disord 2003;27 Suppl 3:S49-S52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14704745" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sartipy P, Loskutoff DJ. Monocyte chemoattractant protein 1 in obesity and insulin resistance. Proc Natl Acad Sci U S A 2003;100(12):7265-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12756299" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Takahashi K, Mizuarai S, Araki H, Mashiko S,\u{A0}Ishihara A,\u{A0}Kanatani A,\u{A0}et al. Adiposity elevates plasma MCP-1 levels leading to the increased CD11b-positive monocytes in mice. J Biol Chem 2003;278(47):46654-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13129912" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Szeto CC, Chow KM, Kwan BC, Chung KY, Leung CB, Li PK. New-onset hyperglycemia in nondiabetic chinese patients started on peritoneal dialysis. Am J Kidney Dis 2007;49(4):524-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17386320" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fortes PC, Mendes JG, Riella MC, Pecoits-Filho R.\u{A0}Carbohydrate metabolism disturbances in non-diabetic patients on peritoneal dialysis. Perit Dial Int 2006;26 Suppl 2:Abstract." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Furuya R, Odamaki M, Kumagai H, Hishida A. Beneficial effects of icodextrin on plasma level of adipocytokines in peritoneal dialysis patients. Nephrol Dial Transplant 2006;21(2):494-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16221697" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cho KH, Do JY, Park JW, Yoon KW. Effect of icodextrin dialysis solution on body weight and fat accumulation over time in CAPD patients. Nephrol Dial Transplant 2010;25(2):593-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19767632" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bonora E, Targher G, Alberiche M, Bonadonna RC,\u{A0}Saggiani F,\u{A0}Zenere MB,\u{A0}et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000;23(1):57-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10857969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Després JP, Lamarche B, Mauriège P, Cantin B,\u{A0}Dagenais GR,\u{A0}Moorjani S,\u{A0}et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996;334(15):952-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8596596" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hargreaves AD, Logan RL, Elton RA, Buchanan KD, Oliver MF, Riemersma RA. Glucose tolerance, plasma insulin, HDL cholesterol and obesity: 12-year follow-up and development of coronary heart disease in Edinburgh men. Atherosclerosis 1992;94(1):61-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1632860" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000;106(4):453-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10953019" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001;86(2):713-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11158035" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shinohara K, Shoji T, Emoto M, Tahara H,\u{A0}Koyama H,\u{A0}Ishimura E,\u{A0}et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 2002;13(7):1894-900. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12089386" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Becker B, Kronenberg F, Kielstein JT, Haller H,\u{A0}Morath C,\u{A0}Ritz E,\u{A0}et al. Renal insulin resistance syndrome, adiponectin and cardiovascular events in patients with kidney disease: the mild and moderate kidney disease study. J Am Soc Nephrol 2005;16(4):1091-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15743998" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S152586101000126X" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bonora E, Targher G, Alberiche M, Bonadonna RC,\u{A0}Saggiani F,\u{A0}Zenere MB,\u{A0}et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000;23(1):57-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10857969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000;23(2):171-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10868826" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Díez JJ, Grande C, Méndez J, González-Gancedo P, Iglesias P. Growth hormone and insulin-like growth factor binding protein-1 responses to oral glucose in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2006;65(1):27-34." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, Gude F,\u{A0}Cadarso-Suarez C,\u{A0}García F,\u{A0}et al. Insulin resistance index (HOMA-IR) levels in a general adult population: curves percentile by gender and age. The EPIRCE study. Diabetes Res Clin Pract 2011;94(1):146-55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21824674" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Caravaca F, Cerezo I, Macías R, García de Vinuesa E,\u{A0}Martínez del Viejo C,\u{A0}Villa J,\u{A0}et al. [Insulin resistance in chronic kidney disease: its clinical characteristics and prognosis significance]. Nefrologia 2010;30(6):661-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21113216" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002630/v0_201502091556/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/20132514/0000003300000001/v0_201502091555/X2013251413002630/v0_201502091556/en/P1-E547-S3850-A11430-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002630?idApp=UINPBA000064"]

Statistics

Análisis repetido de la resistencia insulínica estimada mediante índice HOMAIR en pacientes no diabéticos en diálisis peritoneal y su relación con la enfermedad cardiovascular y mortalidad

del Instituto de Salud Carlos III) y del IRSIN Grupo de Estudios Peritoneales de Madrid de REDinREN (Red Renal de investigación de la RETICS 06/0016, del Instituto de Salud Carlos III) y del IRSIN, Rafael Sánchez-Villanuevab, Patricia Estradab, Gloria del Pesob, Cristina Grandec, Juan J. Díezd, Pedro Iglesiasd, Elena Gonzálezb, Ana Aguilar-Rodríguezb, Rafael Selgasb, M. Auxiliadora Bajob

b Servicio de Nefrología, Hospital Universitario La Paz, Madrid,

c Servicio de Bioquímica, Hospital Universitario La Paz, Madrid,

d Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid,

Read

14553

Times
was read the article

2754

Total PDF

11799

Total HTML

Share statistics

 array:21 [
  "pii" => "X2013251413002630"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2012.Nov.11430"
  "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;33:85-92"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 8320
    "formatos" => array:3 [
      "EPUB" => 319
      "HTML" => 7254
      "PDF" => 747
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699513002633"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2012.Nov.11430"
      "estado" => "S300"
      "fechaPublicacion" => "2013-01-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2013;33:85-92"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 11901
        "formatos" => array:3 [
          "EPUB" => 328
          "HTML" => 10901
          "PDF" => 672
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "An&#225;lisis repetido de la resistencia insul&#237;nica estimada mediante &#237;ndice HOMAIR en pacientes no diab&#233;ticos en di&#225;lisis peritoneal y su relaci&#243;n con la enfermedad cardiovascular y mortalidad"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "85"
            "paginaFinal" => "92"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality"
          ]
        ]
        "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" => "Tab.  1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier Espa&#241;a"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "11430_108_31956_es_11430_t1.jpg"
                "Alto" => 250
                "Ancho" => 600
                "Tamanyo" => 172483
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Caracter&#237;sticas basales de los pacientes en di&#225;lisis peritoneal incidentes y prevalentes"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "del Instituto de Salud Carlos III&#41; y del IRSIN Grupo de Estudios Peritoneales de Madrid de REDinREN &#40;Red Renal de investigaci&#243;n de la RETICS 06&#47;0016&#44; del Instituto de Salud Carlos III&#41; y del IRSIN, Rafael S&#225;nchez-Villanueva, Patricia Estrada, Gloria del Peso, Cristina Grande, Juan J&#46; D&#237;ez, Pedro Iglesias, Elena Gonz&#225;lez, Ana Aguilar-Rodr&#237;guez, Rafael Selgas, M&#46; Auxiliadora Bajo"
            "autores" => array:11 [
              0 => array:2 [
                "nombre" => "del Instituto de Salud Carlos III&#41; y del IRSIN"
                "apellidos" => "Grupo de Estudios Peritoneales de Madrid de REDinREN &#40;Red Renal de investigaci&#243;n de la RETICS 06&#47;0016&#44; del Instituto de Salud Carlos III&#41; y del IRSIN"
              ]
              1 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "S&#225;nchez-Villanueva"
              ]
              2 => array:2 [
                "nombre" => "Patricia"
                "apellidos" => "Estrada"
              ]
              3 => array:2 [
                "nombre" => "Gloria"
                "apellidos" => "del Peso"
              ]
              4 => array:2 [
                "nombre" => "Cristina"
                "apellidos" => "Grande"
              ]
              5 => array:2 [
                "nombre" => "Juan J&#46;"
                "apellidos" => "D&#237;ez"
              ]
              6 => array:2 [
                "nombre" => "Pedro"
                "apellidos" => "Iglesias"
              ]
              7 => array:2 [
                "nombre" => "Elena"
                "apellidos" => "Gonz&#225;lez"
              ]
              8 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Aguilar-Rodr&#237;guez"
              ]
              9 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "Selgas"
              ]
              10 => array:2 [
                "nombre" => "M&#46; Auxiliadora"
                "apellidos" => "Bajo"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251413002630"
          "doi" => "10.3265/Nefrologia.pre2012.Nov.11430"
          "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/X2013251413002630?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513002633?idApp=UINPBA000064"
      "url" => "/02116995/0000003300000001/v0_201502091331/X0211699513002633/v0_201502091333/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251413002622"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Oct.11560"
    "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;33:93-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4780
      "formatos" => array:3 [
        "EPUB" => 317
        "HTML" => 3751
        "PDF" => 712
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Advancing in the management of chronic kidney disease&#58; the results of implementing a quick resolution consultation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "93"
          "paginaFinal" => "98"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Avanzando en el manejo de la enfermedad renal cr&#243;nica&#58; resultados de la implantaci&#243;n de una consulta de r&#225;pida resoluci&#243;n"
        ]
      ]
      "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" => "11560_16025_42072_en_t111560i.jpg"
              "Alto" => 822
              "Ancho" => 1071
              "Tamanyo" => 235608
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Summary results"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Isidro Torregrosa Maicas, Isidro Torregrosa-Maicas, Isabel Juan Garc&#237;a, Isabel Juan-Garc&#237;a, Miguel &#193;ngel Sol&#237;s Salguero, Miguel &#193;&#46; Sol&#237;s-Salguero, Carmen Ramos Tom&#225;s, Carmen Ramos-Tom&#225;s, Mar&#237;a Jes&#250;s Puchades Montsa, M&#46; Jes&#250;s Puchades-Montesa, Miguel Gonz&#225;lez Rico, Miguel Gonz&#225;lez-Rico, Patricia Tom&#225;s Sim&#243;, Patricia Tom&#225;s-Sim&#243;, Jos&#233; Rib&#233;s Cruz, Jos&#233; Rib&#233;s-Cruz, Sandra Tejedor Alonso, Sandra Tejedor-Alonso, Amelia Abarca Gonz&#225;lez, Amelia Abarca-Gonz&#225;lez, Alfonso Miguel Carrasco, Alfonso Miguel-Carrasco"
          "autores" => array:22 [
            0 => array:2 [
              "nombre" => "Isidro"
              "apellidos" => "Torregrosa Maicas"
            ]
            1 => array:2 [
              "nombre" => "Isidro"
              "apellidos" => "Torregrosa-Maicas"
            ]
            2 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Juan Garc&#237;a"
            ]
            3 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Juan-Garc&#237;a"
            ]
            4 => array:2 [
              "nombre" => "Miguel &#193;ngel"
              "apellidos" => "Sol&#237;s Salguero"
            ]
            5 => array:2 [
              "nombre" => "Miguel &#193;&#46;"
              "apellidos" => "Sol&#237;s-Salguero"
            ]
            6 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Ramos Tom&#225;s"
            ]
            7 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Ramos-Tom&#225;s"
            ]
            8 => array:2 [
              "nombre" => "Mar&#237;a Jes&#250;s"
              "apellidos" => "Puchades Montsa"
            ]
            9 => array:2 [
              "nombre" => "M&#46; Jes&#250;s"
              "apellidos" => "Puchades-Montesa"
            ]
            10 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Gonz&#225;lez Rico"
            ]
            11 => array:2 [
              "nombre" => "Miguel"
              "apellidos" => "Gonz&#225;lez-Rico"
            ]
            12 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "Tom&#225;s Sim&#243;"
            ]
            13 => array:2 [
              "nombre" => "Patricia"
              "apellidos" => "Tom&#225;s-Sim&#243;"
            ]
            14 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Rib&#233;s Cruz"
            ]
            15 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Rib&#233;s-Cruz"
            ]
            16 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Tejedor Alonso"
            ]
            17 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Tejedor-Alonso"
            ]
            18 => array:2 [
              "nombre" => "Amelia"
              "apellidos" => "Abarca Gonz&#225;lez"
            ]
            19 => array:2 [
              "nombre" => "Amelia"
              "apellidos" => "Abarca-Gonz&#225;lez"
            ]
            20 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Miguel Carrasco"
            ]
            21 => array:2 [
              "nombre" => "Alfonso"
              "apellidos" => "Miguel-Carrasco"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513002625"
        "doi" => "10.3265/Nefrologia.pre2012.Oct.11560"
        "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/X0211699513002625?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002622?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002622/v0_201502091556/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251413002649"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2012.Sep.11533"
    "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;33:77-84"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5146
      "formatos" => array:3 [
        "EPUB" => 306
        "HTML" => 4053
        "PDF" => 787
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Double treatment with paricalcitol-associated calcifediol and cardiovascular risk biomarkers in haemodialysis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "77"
          "paginaFinal" => "84"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Tratamiento doble con calcifediol asociado a paricalcitol y biomarcadores de riesgo cardiovascular en hemodi&#225;lisis"
        ]
      ]
      "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" => "11533_16025_41491_en_t111533.jpg"
              "Alto" => 1014
              "Ancho" => 2193
              "Tamanyo" => 847164
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Modification of the different study variables in both treatment groups over the course of the study"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Celestino Pi&#241;era-Haces, Mar&#237;a J&#46; Izquierdo-Ortiz, &#193;ngel L&#46; Mart&#237;n-de Francisco, M&#46; Teresa Garcia-Unzueta, M&#46; Teresa Garc&#237;a-Unzueta, Marcos L&#243;pez-Hoyos, Carmen Toyos, Natalia Allende, Estrella Quintela, Manuel Arias"
          "autores" => array:15 [
            0 => array:2 [
              "nombre" => "Celestino"
              "apellidos" => "Pi&#241;era-Haces"
            ]
            1 => array:2 [
              "nombre" => "Mar&#237;a J&#46;"
              "apellidos" => "Izquierdo-Ortiz"
            ]
            2 => array:2 [
              "nombre" => "&#193;ngel L&#46;"
              "apellidos" => "Mart&#237;n-de Francisco"
            ]
            3 => array:2 [
              "nombre" => "&#193;ngel L&#46;"
              "apellidos" => "Mart&#237;n-de Francisco"
            ]
            4 => array:2 [
              "nombre" => "M&#46; Teresa"
              "apellidos" => "Garcia-Unzueta"
            ]
            5 => array:2 [
              "nombre" => "M&#46; Teresa"
              "apellidos" => "Garc&#237;a-Unzueta"
            ]
            6 => array:2 [
              "nombre" => "Marcos"
              "apellidos" => "L&#243;pez-Hoyos"
            ]
            7 => array:2 [
              "nombre" => "Marcos"
              "apellidos" => "L&#243;pez-Hoyos"
            ]
            8 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Toyos"
            ]
            9 => array:2 [
              "nombre" => "Natalia"
              "apellidos" => "Allende"
            ]
            10 => array:2 [
              "nombre" => "Natalia"
              "apellidos" => "Allende"
            ]
            11 => array:2 [
              "nombre" => "Estrella"
              "apellidos" => "Quintela"
            ]
            12 => array:2 [
              "nombre" => "Estrella"
              "apellidos" => "Quintela"
            ]
            13 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Arias"
            ]
            14 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Arias"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513002641"
        "doi" => "10.3265/Nefrologia.pre2012.Sep.11533"
        "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/X0211699513002641?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002649?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002649/v0_201502091556/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "85"
        "paginaFinal" => "92"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "del Instituto de Salud Carlos III&#41; y del IRSIN Grupo de Estudios Peritoneales de Madrid de REDinREN &#40;Red Renal de investigaci&#243;n de la RETICS 06&#47;0016&#44; del Instituto de Salud Carlos III&#41; y del IRSIN, Rafael S&#225;nchez-Villanueva, Patricia Estrada, Gloria del Peso, Cristina Grande, Juan J&#46; D&#237;ez, Pedro Iglesias, Elena Gonz&#225;lez, Ana Aguilar-Rodr&#237;guez, Rafael Selgas, M&#46; Auxiliadora Bajo"
        "autores" => array:11 [
          0 => array:2 [
            "nombre" => "del Instituto de Salud Carlos III&#41; y del IRSIN"
            "apellidos" => "Grupo de Estudios Peritoneales de Madrid de REDinREN &#40;Red Renal de investigaci&#243;n de la RETICS 06&#47;0016&#44; del Instituto de Salud Carlos III&#41; y del IRSIN"
          ]
          1 => array:4 [
            "nombre" => "Rafael"
            "apellidos" => "S&#225;nchez-Villanueva"
            "email" => array:1 [
              0 => "rjsanchez&#46;hulp&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Patricia"
            "apellidos" => "Estrada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Gloria"
            "apellidos" => "del Peso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Cristina"
            "apellidos" => "Grande"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Juan J&#46;"
            "apellidos" => "D&#237;ez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Pedro"
            "apellidos" => "Iglesias"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Elena"
            "apellidos" => "Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Aguilar-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Rafael"
            "apellidos" => "Selgas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "M&#46; Auxiliadora"
            "apellidos" => "Bajo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Universitario La Paz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Bioquímica, Hospital Universitario La Paz, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid,   "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "An&#225;lisis repetido de la resistencia insul&#237;nica estimada mediante &#237;ndice HOMAIR en pacientes no diab&#233;ticos en di&#225;lisis peritoneal y su relaci&#243;n con la enfermedad cardiovascular y mortalidad"
      ]
    ]
    "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" => "11430_16025_42460_en_t1.11430.jpg"
            "Alto" => 891
            "Ancho" => 2169
            "Tamanyo" => 344708
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Baseline characteristics of incident and prevalent patients on peritoneal dialysis"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">Cardiovascular disease &#40;CVD&#41; is the primary cause of death in patients on dialysis&#46;<span class="elsevierStyleSup">1&#44;2</span> The association between peripheral insulin resistance index &#40;IR&#41;&#44; hyperinsulinism&#44; and CVD has been explored through numerous cross-sectional and prospective studies&#46;<span class="elsevierStyleSup">1-4 </span>In fact&#44; hyperinsulinism is considered to be a good marker for IR in patients with significant hyperglycaemia&#46; In addition&#44; IR is associated with several risk factors for CVD&#44; such as dyslipidaemia&#44;<span class="elsevierStyleSup">2</span> arterial hypertension&#44;<span class="elsevierStyleSup">5</span> and hypercoagulability&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Patients with end-stage chronic kidney disease &#40;CKD&#41; develop early IR&#44; characterised by altered carbohydrate metabolism with hyperinsulinemia&#44; which is generally associated with dyslipidaemia and a pro-inflammatory pattern with altered serum levels of adipocytokines&#46;<span class="elsevierStyleSup">6</span> Several studies have demonstrated that IR is possibly associated with a silent and systemic inflammatory process and a micro-inflammatory process characterised by the activation of peripheral cells such as polymorphonuclear cells and monocytes&#46;<span class="elsevierStyleSup">7</span> The final consequence is an elevated rate of atherosclerosis and a high rate of morbidity&#47;mortality due to CVD&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup">&#160;</span></p><p class="elsevierStylePara">Our working hypothesis was based on the possibility that glucose in peritoneal dialysis &#40;PD&#41; solutions could increase IR through an adipocytokine-mediated effect&#44; and contribute to accelerating the process of atherosclerosis in uraemic patients&#46; With this in mind&#44; the objectives of our study included&#58;</p><p class="elsevierStylePara">&#160;</p><li>Evaluate IR in incident and prevalent nondiabetic patients treated with PD&#46;</li><li>Analyse the evolution of IR indices after 1 year of PD treatment&#46;</li><li>Evaluate the effect of IR on subsequent CV morbidity-mortality&#46;</li><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Ours was a prospective and observational study involving a cohort of incident and prevalent patients treated with PD&#46; A total of 69 nondiabetic patients on PD were included&#44; 35 of which were incident &#40;&#8804;3 months on PD&#41; and 34 of which were prevalent &#40;&#62;3 months on PD&#41;&#46; In addition&#44; 58&#37; were treated with automated peritoneal dialysis&#44; and 42&#37; with continuous ambulatory peritoneal dialysis&#44; with 2 measurements of insulin resistance taken 12 months apart using the homeostasis model assessment insulin resistance &#40;HOMAIR&#41;&#46; The purpose of this combined evaluation was to test the reproducibility&#44; potential changes derived from PD&#44; and the influence of these parameters on the appearance of CV events and mortality&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We excluded patients with active forms of cancer&#44; acute infections&#44; uncontrolled or systemic chronic inflammatory disease&#44; or an initial glycaemia value &#62;140mg&#47;dl&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The causes of kidney disease were glomerulonephritis in 21 patients &#40;30&#46;4&#37;&#41;&#44; nephroangiosclerosis&#47;vascular in 8 patients &#40;11&#46;6&#37;&#41;&#44; other causes in 8 patients &#40;11&#46;6&#37;&#41;&#44; polycystic kidney disease in 7 patients &#40;10&#46;1&#37;&#41;&#44; systemic disease in 7 patients &#40;10&#46;1&#37;&#41;&#44; unknown in 7 patients &#40;10&#46;1&#37;&#41;&#44; chronic pyelonephritis in 5 patients &#40;7&#46;2&#37;&#41;&#44; interstitial nephropathy in 5 patients &#40;7&#46;2&#37;&#41;&#44; and hereditary in 1 patient &#40;1&#46;4&#37;&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">At the time of the first measurement of IR&#44; we considered baseline and start of follow-up times for the survival analysis&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Comorbidity was evaluated using the Charlson index as modified by Beddhu&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">LABORATORY PROCEDURES</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Laboratory parameters were measured at baseline values and after 1 year of evolution&#44; always following 12 hours of fast and maintaining normal regimens of PD treatment&#46; We also compiled dialysis parameters&#44; such as Kt&#47;V from weekly urine samples and normalised protein nitrogen appearance &#40;nPNA&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Insulin was measured using a double enzyme immunometric assay method with an AIA 360 auto-analyser &#40;Tosoh Bioscience&#41;&#46; The inter and intra-trial coefficients of variation were 1&#46;7&#37; and 3&#46;3&#37;&#44; respectively&#46; The sensitivity of the analysis was 1&#181;U&#47;ml&#46; The normal range for insulin levels in our laboratory was 2-17&#181;U&#47;ml&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Based on baseline insulinemia and glycaemia values&#44; we calculated HOMAIR index scores based on the formula by Matthews et al&#46;<span class="elsevierStyleSup">10</span>&#58; HOMAIR &#61; glucose &#40;mmol&#47;l&#41; x insulin &#40;&#181;U&#47;ml&#41;&#47;22&#46;5&#46; We also calculated the quantitative insulin sensitivity check index based on the protocol by Hrebicek et al&#46;<span class="elsevierStyleSup">11</span>&#58; QUICKI &#61; 1&#47;&#91;log fasting insulin level &#40;mU&#47;l&#41; &#8211; log fasting glycaemia &#40;mg&#47;dl&#41;&#93;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definitions</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Coronary disease&#58;</span> a history of angina&#44; myocardial infarction&#44; coronary angiography evidence&#44; percutaneous intervention&#44; or coronary bypass&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Congestive heart failure&#58;</span>&#160;New York Heart Association &#40;NYHA&#41; classification<span class="elsevierStyleSup">12</span>&#58;</p><p class="elsevierStylePara">- Functional class I&#58; normal activity with no symptoms&#46; No limitations to physical activity&#46;</p><p class="elsevierStylePara">- Functional class II&#58; the patient tolerates normal activity&#44; but physical activity is slightly limited due to dyspnoea that appears during intense exercise&#46;</p><p class="elsevierStylePara">- Functional class III&#58; the patient&#8217;s capacity for physical activity is lower than normal&#44; with notable limitations due to dyspnoea&#46;</p><p class="elsevierStylePara">- Functional class IV&#58; the patient suffers dyspnoea upon the slightest effort or even at rest&#44; and is incapable of performing virtually any physical activity</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Peripheral arterial disease&#58;</span>&#160;patients with intermittent claudication&#44; arterial <span class="elsevierStyleItalic">bypass</span>&#44; amputation&#44; gangrene&#44; acute arterial insufficiency&#44; or unrepaired aneurysms of the thoracic or abdominal arteries greater than 5cm&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cerebral vascular disease&#58;</span>&#160;patients with a history of cerebrovascular accidents or transitory ischaemic accidents &#40;with mild or zero sequelae&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Dyslipidemia&#58;&#160;</span>one or more of the following criteria<span class="elsevierStyleSup">13</span>&#58; 1&#41; LDL &#40;low-density lipoprotein&#41; cholesterol &#8805;100mg&#47;dl&#59; 2&#41; non-HDL &#40;non-high-density lipoprotein&#41; cholesterol &#8805;130mg&#47;dl&#59; 3&#41; triglycerides &#8805;150mg&#47;dl&#59; 4&#41; HDL cholesterol &#8804;40mg&#47;dl&#59; and 5&#41; the use of one or more lipid-lowering drugs&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Hypertension&#58;</span>&#160;blood pressure &#40;BP&#41; was measured using a digital monitor &#40;HEM-907&#41; with cuffs adapted to the circumference of each patient&#8217;s arm&#44; once the patient had been laying at rest for at least 5 minutes&#46; Hypertension was diagnosed when the patient fulfilled one or more of the following criteria<span class="elsevierStyleSup">14</span>&#58; 1&#41; systolic BP&#8805;135mm Hg&#59; 2&#41; diastolic BP&#8805;85mm Hg&#59; and 3&#41; the use of one or more anti-hypertensive drugs&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">STATISTICAL ANALYSIS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Values were expressed as means &#40;&#177; standard deviation&#41; and percentages&#46; Proportions were compared using chi-square tests&#44; and means were compared using Student&#8217;s t-tests for variables with a normal distribution&#44; and Mann-Whitney or Wilcoxon tests were used for non-parametric quantitative variables&#46; We performed a linear regression analysis using Pearson and Spearman correlation coefficients&#46; We used the Kaplan-Meier method for the survival analysis&#44; and compared curves using the log-rank method&#46; A <span class="elsevierStyleItalic">P</span>-value &#60;&#46;05 was considered to be statistically significant for all cases&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Table 1 summarises the baseline clinical characteristics for the two patient groups&#44; classified based on prior time on PD &#40;incident and prevalent patients&#41;&#46; We did not observe significant differences between the two groups&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The mean time on PD was 32&#46;1&#177;16&#46;0 months &#40;range&#58; 11-87 months&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Table 2 displays the mean dialysis parameters&#44; laboratory values&#44; and insulin resistance indices &#40;HOMAIR and QUICKI&#41; at initial evaluations and after 12 months of follow-up&#46; We only observed statistically significant differences between the two groups in the fields of residual renal function&#44; total cholesterol&#44; and LDL cholesterol&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">At the start of treatment&#44; 60&#37; of incident patients were on treatment with icodextrin&#44; as compared to 57&#46;1&#37; after 12 months&#46; In prevalent patients&#44; the rate of use of icodextrin was 73&#46;5&#37; at both evaluations&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">HOMAIR and initial insulin levels</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">When patients were classified based on median initial HOMAIR score &#40;HOMAIR&#58; 1&#46;7&#59; range&#58; 6&#46;29&#41;&#44; we observed that incident patients with higher HOMAIR scores had significantly higher levels of total calcium and ionised calcium as compared to patients with lower HOMAIR scores&#46; In prevalent patients&#44; we did not observe significant differences for this parameter &#40;Table 3&#41;&#46; Upon classifying patients based on median insulinemia &#40;7&#46;0&#59; range&#58; 2-25&#41;&#44; the findings were similar&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We did not observe differences in HOMAIR or QUICKI scores based on the different concentrations of glucose in peritoneal dialysate solutions&#44; both at the start of the study and after 1 year &#40;data not shown&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Comorbidity analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">When we analysed patients based on the median value for baseline HOMAIR score&#44; we did not observe statistically significant differences for CV comorbidity&#44; ischaemic heart disease&#44; heart failure&#44; or cerebral&#47;peripheral vascular comorbidity&#46; We encountered the same result when separating patients based on the median value for initial insulin&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We did not observe a significant difference between patients with HOMAIR scores above and below the median value in terms of Charlson comorbidity score &#40;with age excluded&#41; &#40;3&#46;2&#177;1&#46;6 vs&#46; 3&#46;4&#177;1&#46;3&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The presence of CVD did not significantly affect HOMAIR scores&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Survival analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Eighteen patients &#40;26&#37;&#41; died during the follow-up period&#44; with death of vascular origin being the most common source of mortality &#40;n&#61;5&#59; 27&#46;8&#37;&#41;&#44; followed by cardiac causes &#40;n&#61;4&#59; 22&#46;2&#37;&#41;&#44; infectious causes &#40;n&#61;4&#59; 22&#46;2&#37;&#41;&#44; deterioration &#40;n&#61;2&#59; 11&#46;1&#37;&#41;&#44; tumours &#40;n&#61;1&#46;5&#59; 6&#37;&#41; and other &#40;n&#61;2&#59; 11&#46;1&#37;&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Survival analysis revealed that patients who died were mostly male &#40;11 vs 7&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; elderly &#40;63&#46;6&#177;12&#46;3 vs 45&#46;7&#177;16&#46;8 years of age&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;000&#41;&#44; and a higher Charlson index score &#40;with age excluded&#41; &#40;4&#46;5&#177;1&#46;1 vs 2&#46;9&#177;1&#46;3&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;000&#41;&#46; We did not observe statistically significant differences in terms of IR index values &#40;data not shown&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The global Kaplan-Meier survival analysis did not reveal significant differences in terms of mortality between patients with HOMAIR index scores above and below the median value &#40;Figure&#41;&#46; In a similar manner&#44; we did not observe differences in terms of CV mortality and fatal&#47;non-fatal CV events during the study &#40;data not shown&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In this study&#44; we analysed the effects of PD on parameters of insulin resistance &#40;HOMAIR and QUICKI&#41; and the influence of these scores on the appearance of CV events and mortality in a group of nondiabetic PD patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">IR is very common among uraemic patients&#44; occurring even in early phases&#46;<span class="elsevierStyleSup">15</span> Several different hypotheses have been proposed in an attempt to explain IR&#58; 1&#41; hyper-production of endogenous proinflammatory factors such as homocysteine&#44;<span class="elsevierStyleSup">16</span> oxidative stress&#44;<span class="elsevierStyleSup">17</span> and elevated lipoprotein &#40;a&#41; levels&#44;<span class="elsevierStyleSup">18</span> and exogenous proinflammatory factors such as chronic infections &#40;sometimes silent&#41; by <span class="elsevierStyleItalic">Helicobacter pylori</span>&#44;<span class="elsevierStyleSup">19</span> infected vascular prostheses&#44; or intravenous iron administration&#44; among others<span class="elsevierStyleSup">20</span>&#59; and 2&#41; increased adipose tissue<span class="elsevierStyleSup">21</span> due to excess caloric intake&#44; which leads to a vicious circle with increased production of adipocytokines &#40;leptin&#44; resistin&#41; and other proinflammatory mediators such as nuclear factor kappa beta&#44; tumour necrosis factor alpha&#44; and interleukin 6&#46;<span class="elsevierStyleSup">22</span> These chemokines act as chemotactic proteins for monocytes and macrophages &#40;MCP-1&#41;&#44;<span class="elsevierStyleSup">23&#44;24</span> thus perpetuating IR&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In patients on PD&#44; the development of IR is attributed to the excessive amount of glucose absorbed through dialysate fluids&#44; which contributes to other metabolic disorders such as central obesity&#44; hypertriglyceridemia&#44; and <span class="elsevierStyleItalic">de novo</span> diabetes&#46;<span class="elsevierStyleSup">25</span> This process also induces hyper-secretion of adipocytokines&#44; which perpetuate hyperinsulinism and its deleterious metabolic and systemic effects&#46; According to the study by Fortes et al&#46;&#44;<span class="elsevierStyleSup">26</span> patients on PD have higher fasting glucose levels&#44; HbA<span class="elsevierStyleInf">1c</span>&#44; and HOMAIR index scores than patients on haemodialysis&#46; Also&#44; patients who receive dialysis with glucose-free dialysate exhibit a lower absorption of glucose&#44; lower weight gain and fat accumulation&#44; reduced levels of plasma leptin and increased levels of plasma adiponectin&#44; and improved IR and dyslipidemia&#46;<span class="elsevierStyleSup">27&#44;28</span> In our study&#44; mean glucose&#44; insulin&#44; and IR &#40;as measured by HOMAIR and QUICKI indices&#41; levels were similar between initial measurements and after 1 year in both incident and prevalent patients&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Bonora et al&#46;<span class="elsevierStyleSup">29</span> examined a large sample of patients with type 2 diabetes&#44; and showed that IR &#40;as estimated using the HOMAIR index&#41; was a strong predictor for CVD&#44; both at the start of the study and during follow-up&#46; This correlation was independent of traditional CV factors and variables closely related to IR&#44; such as body mass index&#46; Also&#44; despite the fact that several studies have shown that hyperinsulinemia is capable of predicting CVD&#44;<span class="elsevierStyleSup">4&#44;30</span> others&#44; in contrast&#44; have not found a significant association between plasma insulin levels and CVD&#46;<span class="elsevierStyleSup">31</span> In our study&#44; we did not observe significant differences in terms of CV comorbidity&#44; ischaemic heart disease&#44; heart failure&#44; or cerebral vascular comorbidity based on HOMAIR index scores or insulin levels&#46; The Charlson index score &#40;without the factor of age included&#41; was also similar among all patients&#46; Nor did we observe a relationship between the presence of prior CVD and HOMAIR scores&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Glucose in PD solutions may have an effect on abdominal adipocytes&#44; which&#44; through an increase in the secretion of adipocytokines&#44; may increase IR&#44; thus favouring the development of metabolic syndromes and accelerating the process of atherosclerosis in uremic patients&#46; Upon analysis of our results&#44; we did not observe significant differences in HOMAIR or QUICKI index scores based on the concentrations of glucose used in PD solutions&#46;</p><p class="elsevierStylePara">In the general population&#44; IR is considered to be a factor for CV risk and mortality&#44;<span class="elsevierStyleSup">32&#44;33</span> whereas this factor appears to have a different significance in studies carried out with CKD patients&#46; A study by Shinohara et al&#46;<span class="elsevierStyleSup">34</span> demonstrated that HOMAIR scores predicted mortality in nondiabetic patients with CKD&#46; However&#44; other studies have not observed this relationship&#46;<span class="elsevierStyleSup">35</span> In our survival analysis&#44; we did not observe statistically significant differences in terms of IR scores or when classifying patients based on median HOMAIR values in a Kaplan-Meier analysis&#46; It may be that other characteristics of these patients&#44; such as age or comorbidity&#44; may play a greater role in determining survival than insulin resistance&#46; In addition&#44; the HOMAIR scores recorded in our study fell within normal limits&#44; which would also impede the possibility of significant differences in terms of survival&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Bonora et al&#46;<span class="elsevierStyleSup">36</span>&#160;observed mean HOMAIR values of 2&#46;06&#177;0&#46;14 in a population of 62 healthy individuals using a double-antibody radioimmunoassay for measuring plasma insulin&#46; In a study involving 490 nondiabetic volunteers&#44; 77&#37; of which were Caucasian&#44; of both sexes&#44; aged 19-79 years&#44; and with a body mass index of 18-42&#46;2&#44; the researchers observed a mean HOMAIR score of 2&#46;7&#177;&#46;1&#46;<span class="elsevierStyleSup">37</span> The mean HOMAIR value in normal individuals &#40;with no glucose metabolism disorders&#41; from a study prior to ours was 2&#46;22&#177;0&#46;26&#46;<span class="elsevierStyleSup">38</span> The HOMAIR values recorded in our study&#44; both in incident and prevalent patients&#44; placed between the 50<span class="elsevierStyleSup">th</span> and 75<span class="elsevierStyleSup">th</span> percentile of the values recorded for the general population in Spain according to a recent study&#46;<span class="elsevierStyleSup">39</span> Caravaca et al&#46;<span class="elsevierStyleSup">40</span> observed higher mean HOMAIR values than ours &#40;mean&#58; 4&#46;28&#177;2&#46;07&#41; in a population of nondiabetic patients with CKD&#46; These data support the results obtained in nondiabetic patients on PD&#44; indicating that HOMAIR scores are not significantly elevated in these individuals as compared to the general population&#44; and that this result does not vary over time on dialysis&#44; at least within a period of one year&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We recognise that our study involves the limitation of only including patients with an initial glycaemia &#62;140mg&#47;dl instead of the cut-off value for diagnosing diabetes in the general population of &#8805;126mg&#47;dl&#44; but since our study involved patients on PD with a continuous glucose input&#44; we intended to assess a cohort of patients with a baseline glucose level close to normal values&#44; although with the exclusion of diabetic patients&#46; It is possible that&#44; through the use of this more permissive threshold&#44; we may have included patients with less severe disorders of glucose metabolism&#44; such as carbohydrate intolerance&#44; but it was our intention to only exclude patients with clear cases of diabetes&#46; The fact that&#44; in order to be included in our study&#44; all patients needed to have at least one year on PD also implies a bias in our survival analysis&#46; In addition&#44; this study is limited by the small number of patients evaluated&#44; but it does offer a double approach assessing patients at different stages of PD treatment &#40;initial and late&#41;&#44; with consistent results across both groups&#46; The prospective approach used also considerably bolsters the results obtained&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">To conclude&#44; nondiabetic patients on PD do not have significantly elevated HOMAIR scores&#44; or modifications to these values after one year of treatment on PF&#44; which suggests that PD is not the cause of increased risk of IR&#46; The fact that IR indices were not associated with CV morbidity&#47;mortality rates appears to suggest that this factor holds little sway in the field of PD&#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"><a href="grande&#47;11430&#95;16025&#95;42460&#95;en&#95;t1&#46;11430&#46;jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42460_en_t1.11430.jpg" alt="Baseline characteristics of incident and prevalent patients on peritoneal dialysis"></img></a></p><p class="elsevierStylePara">Table 1&#46; Baseline characteristics of incident and prevalent patients on peritoneal dialysis</p><p class="elsevierStylePara"><a href="grande&#47;11430&#95;16025&#95;42461&#95;en&#95;t2&#46;11430&#46;jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42461_en_t2.11430.jpg" alt="Dialysis parameters&#44; laboratory values&#44; and peripheral insulin resistance indices in patients on peritoneal dialysis&#59; baseline and after 1 year of follow-up"></img></a></p><p class="elsevierStylePara">Table 2&#46; Dialysis parameters&#44; laboratory values&#44; and peripheral insulin resistance indices in patients on peritoneal dialysis&#59; baseline and after 1 year of follow-up</p><p class="elsevierStylePara"><a href="grande&#47;11430&#95;16025&#95;42462&#95;en&#95;t3&#46;11430&#46;jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42462_en_t3.11430.jpg" alt="Comparison of baseline values for laboratory parameters based on median HOMAIR values &#40;median&#58; 1&#46;7&#59; range&#58; 6-29&#41;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Comparison of baseline values for laboratory parameters based on median HOMAIR values &#40;median&#58; 1&#46;7&#59; range&#58; 6-29&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11430&#95;16025&#95;42463&#95;en&#95;f19&#46;114304&#46;jpg" class="elsevierStyleCrossRefs"><img src="11430_16025_42463_en_f19.114304.jpg" alt="Kaplan-Meier curves&#44; median HOMAIR vs patient death"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Kaplan-Meier curves&#44; median HOMAIR vs patient death</p>"
    "pdfFichero" => "P1-E547-S3850-A11430-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:7 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436851"
          "palabras" => array:1 [
            0 => "Mortalidad"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436853"
          "palabras" => array:1 [
            0 => "&#205;ndice QUIKI"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436855"
          "palabras" => array:1 [
            0 => "&#205;ndice HOMA"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436857"
          "palabras" => array:1 [
            0 => "Enfermedad cardiovascular"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436859"
          "palabras" => array:1 [
            0 => "Resistencia a la insulina"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436861"
          "palabras" => array:1 [
            0 => "Di&#225;lisis peritoneal"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec436863"
          "palabras" => array:1 [
            0 => "Enfermedad renal cr&#243;nica"
          ]
        ]
      ]
      "en" => array:7 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436852"
          "palabras" => array:1 [
            0 => "Mortality"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436854"
          "palabras" => array:1 [
            0 => "QUIKI Index"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436856"
          "palabras" => array:1 [
            0 => "HOMAIR Index"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436858"
          "palabras" => array:1 [
            0 => "Cardiovascular disease"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436860"
          "palabras" => array:1 [
            0 => "Insulin resistance"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436862"
          "palabras" => array:1 [
            0 => "Peritoneal dialysis"
          ]
        ]
        6 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec436864"
          "palabras" => array:1 [
            0 => "Chronic kidney disease"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Los pacientes con enfermedad renal cr&#243;nica terminal muestran precozmente resistencia insul&#237;nica &#40;RI&#41;&#44; caracterizada por alteraciones en el metabolismo hidrocarbonado e hiperinsulinemia generalmente asociada a dislipemia y a un patr&#243;n pro inflamatorio&#46; La enfermedad cardiovascular &#40;CV&#41; constituye la principal causa de mortalidad en los pacientes en di&#225;lisis&#46; Existe una fuerte asociaci&#243;n entre RI&#44; hiperinsulinismo y enfermedad CV&#46; El objetivo del presente estudio fue evaluar el efecto de la di&#225;lisis peritoneal &#40;DP&#41; sobre la RI y sus efectos sobre la morbimortalidad CV subsiguiente en pacientes ur&#233;micos no diab&#233;ticos&#46; Se incluyeron 69 pacientes no diab&#233;ticos en DP&#44; 35 incidentes &#40;&#8804; 3 meses en DP&#41; y 34 prevalentes &#40;&#62; 3 meses en DP&#41;&#44; con 2 mediciones de resistencia insul&#237;nica estimada mediante el &#237;ndice de&#160;resistencia&#160;a la&#160;insulina&#160;&#40;HOMAIR&#41;&#44; separadas entre s&#237; por 12 meses&#46; El valor medio de HOMAIR en pacientes incidentes fue 1&#44;8 &#177; 1&#44;3 y 2&#44;2 &#177; 2&#44;1 en situaci&#243;n basal y a los 12 meses&#44; respectivamente &#40;no significativa &#91;ns&#93;&#41;&#46; En pacientes prevalentes estos valores fueron 2&#44;3 &#177; 1&#44;3 y 2&#44;5 &#177; 2&#44;2 &#40;ns&#41;&#46; En nuestro estudio&#44; las concentraciones medias de glucosa&#44; insulina y RI medida por el HOMAIR y QUICKI &#40;&#237;ndice cuantitativo de control de la sensibilidad a la insulina&#41; fueron similares en situaci&#243;n basal y al a&#241;o de seguimiento&#44; tanto en incidentes como en prevalentes&#46; No objetivamos diferencias significativas en relaci&#243;n con la comorbilidad CV&#44; cardiopat&#237;a isqu&#233;mica&#44; insuficiencia card&#237;aca o comorbilidad vascular cerebral o perif&#233;rica&#44; ni en funci&#243;n del &#237;ndice HOMAIR&#44; ni en el de los niveles de insulina&#46; En conclusi&#243;n&#44; los pacientes no diab&#233;ticos en DP no presentan elevaci&#243;n significativa de los niveles de HOMAIR&#44; ni se modifica con paso del tiempo en di&#225;lisis&#44; lo que sugiere que la DP no es un factor de riesgo de RI&#46; El hecho de que los &#237;ndices de RI no se asocien a morbilidad o mortalidad CV parece sugerir el menor peso de este factor en el &#225;mbito de la DP&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">End-stage renal disease patients show early insulin resistance &#40;IR&#41;&#44; characterised by alterations in the carbohydrate metabolism and hyperinsulinaemia generally associated with dyslipidaemia and a proinflammatory condition&#46; Cardiovascular disease &#40;CVD&#41; is the main cause of mortality in patients on dialysis&#46; There is a strong association between IR&#44; hyperinsulinism and CV disease&#46; The objective of this study was to evaluate the effect of peritoneal dialysis &#40;PD&#41; on IR and its effects on the subsequent CVD morbidity and mortality in nondiabetic uraemic patients&#46; It involved 69 nondiabetic patients on PD&#44; 35 incident patients &#40;&#8804; 3 months on PD&#41; and 34 prevalent patients &#40;&#62; 3 months on PD&#41;&#44; with 2 estimated insulin resistance measurements 12 months apart using the insulin resistance index &#40;HOMAIR&#41;&#46; The mean HOMAIR value in incident patients was 1&#46;8 &#177; 1&#46;3 and 2&#46;2 &#177; 2&#46;1 at baseline situation and at 12 months respectively &#40;not significant &#91;NS&#93;&#41;&#46; In prevalent patients these values were 2&#46;3 &#177; 1&#46;3 and 2&#46;5 &#177; 2&#46;2 &#40;NS&#41;&#46; In our study&#44; the mean glucose&#44; insulin and IR concentrations measured by the HOMAIR and QUICKI indexes &#40;the latter being a quantitative control for insulin sensitivity control&#41; were similar at baseline situation and the following year&#44; in both incident and prevalent patients&#46; We did not find any significant differences in relation to CVD comorbidity&#44; ischaemic heart disease&#44; heart failure or cerebrovascular or peripheral comorbidity neither in the HOMAIR index or insulin levels&#46; To conclude&#44; nondiabetic patients on PD do not display a significant increase in HOMAIR levels and this remains the case over time when on dialysis&#46; This&#44; in turn&#44; suggests that PD is not an IR risk factor&#46; The fact that the IR indexes are not associated with CVD morbidity or mortality seems to suggest that this is a less significant factor in the field of PD&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      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" => "11430_16025_42460_en_t1.11430.jpg"
            "Alto" => 891
            "Ancho" => 2169
            "Tamanyo" => 344708
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Baseline characteristics of incident and prevalent patients on peritoneal dialysis"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11430_16025_42461_en_t2.11430.jpg"
            "Alto" => 812
            "Ancho" => 2185
            "Tamanyo" => 304807
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Dialysis parameters&#44; laboratory values&#44; and peripheral insulin resistance indices in patients on peritoneal dialysis&#59; baseline and after 1 year of follow-up"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig3"
        "etiqueta" => "Tab.  3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11430_16025_42462_en_t3.11430.jpg"
            "Alto" => 601
            "Ancho" => 2144
            "Tamanyo" => 263090
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Comparison of baseline values for laboratory parameters based on median HOMAIR values &#40;median&#58; 1&#46;7&#59; range&#58; 6-29&#41;"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11430_16025_42463_en_f19.114304.jpg"
            "Alto" => 876
            "Ancho" => 1011
            "Tamanyo" => 89722
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Kaplan-Meier curves&#44; median HOMAIR vs patient death"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Foley RN. Clinical epidemiology of cardiac disease in dialysis patients: left ventricular hypertrophy, ischemic heart disease, and cardiac failure. Semin Dial 2003;16(2):111-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12641874" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lowrie EG, Lazarus JM, Mocelin AJ, Bailey GL,\u{A0}Hampers CL,\u{A0}Wilson RE,\u{A0}et al. Survival of patients undergoing chronic hemodialysis and renal transplantation. N Engl J Med 1973;288(17):863-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/4571245" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ducimetiere P, Eschwege E, Papoz L, Richard JL, Claude JR, Rosselin G. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease mortality in a middle-aged population. Diabetologia 1980;19(3):205-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6997122" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Welborn TA, Wearne K. Coronary heart disease incidence and cardiovascular mortality in Busselton with reference to glucose and insulin concentrations. Diabetes Care 1979;2(2):154-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/520119" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996;334(6):374-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8538710" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kobayashi S, Maesato K, Moriya H, Ohtake T, Ikeda T. Insulin resistance in patients with chronic kidney disease. Am J Kidney Dis 2005;45(2):275-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15685504" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Merino A, Nogueras S, Buendía P, Ojeda R,\u{A0}Carracedo J,\u{A0}Ramirez-Chamond R,\u{A0}et al. Microinflammation and endothelial damage in hemodialysis. Contrib Nephrol 2008;161:83-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18451662" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "García-López E, Carrero JJ, Suliman ME, Lindholm B, Stenvinkel P. Risk factors for cardiovascular disease in patients undergoing peritoneal dialysis. Perit Dial Int 2007;27 Suppl 2:S205-S209. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17556305" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 2000;108(8):609-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10856407" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7):412-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3899825" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hrebicek J, Janout V, Malincikova J, Horakova D, Cizek L. Detection of insulin resistance by simple quantitative insulin sensitivity check index QUICKI for epidemiological assessment and prevention. J Clin Endocrinol Metab 2002;87(1):144-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11788638" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hurst JW, Morris DC, Alexander RW. The use of the New York Heart Association's classification of cardiovascular disease as part of the patient's complete Problem List. Clin Cardiol 1999;22(6):385-90."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486-97."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997;157(21):2413-46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9385294" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fliser D, Pacini G, Engelleiter R, Kautzky-Willer A,\u{A0}Prager R,\u{A0}Franek E,\u{A0}et al. Insulin resistance and hyperinsulinemia are already present in patients with incipient renal disease. Kidney Int 1998;53(5):1343-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9573550" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gillum R. Distribution of serum total homocysteine and its association with diabetes and cardiovascular risk factors of the insulin resistance syndrome in Mexican American men: the Third National Health and Nutrition Examination Survey. Nutr J 2003;2:6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rosen P, Nawroth PP, King G, Moller W, Tritschler HJ, Packer L. The role of oxidative stress in the onset and progression of diabetes and its complications: a summary of a Congress Series sponsored by UNESCO-MCBN, the American Diabetes Association and the German Diabetes Society. Diabetes Metab Res Rev 2001;17(3):189-212. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11424232" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Reaven GM, Chen YD, Jeppesen J, Maheux P, Krauss RM. Insulin resistance and hyperinsulinemia in individuals with small, dense low density lipoprotein particles. J Clin Invest 1993;92(1):141-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8325978" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Aguilera A, Gonzalez-Espinoza L, Codoceo R, Jara Mdel C,\u{A0}Pavone M,\u{A0}Bajo MA,\u{A0}et al. Bowel bacterial overgrowth as another cause of malnutrition, inflammation, and atherosclerosis syndrome in peritoneal dialysis patients. Adv Perit Dial 2010;26:130-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21348395" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Amore A, Coppo R. Immunological basis of inflammation in dialysis. Nephrol Dial Transplant 2002;17 Suppl 8:16-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12147772" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U. Impact of obesity on metabolism in men and women. Importance of regional adipose tissue distribution. J Clin Invest 1983;72(3):1150-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6350364" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shoelson SE, Lee J, Yuan M. Inflammation and the IKK beta/I kappa B/NF-kappa B axis in obesity- and diet-induced insulin resistance. Int J Obes Relat Metab Disord 2003;27 Suppl 3:S49-S52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14704745" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sartipy P, Loskutoff DJ. Monocyte chemoattractant protein 1 in obesity and insulin resistance. Proc Natl Acad Sci U S A 2003;100(12):7265-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12756299" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Takahashi K, Mizuarai S, Araki H, Mashiko S,\u{A0}Ishihara A,\u{A0}Kanatani A,\u{A0}et al. Adiposity elevates plasma MCP-1 levels leading to the increased CD11b-positive monocytes in mice. J Biol Chem 2003;278(47):46654-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13129912" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Szeto CC, Chow KM, Kwan BC, Chung KY, Leung CB, Li PK. New-onset hyperglycemia in nondiabetic chinese patients started on peritoneal dialysis. Am J Kidney Dis 2007;49(4):524-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17386320" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fortes PC, Mendes JG, Riella MC, Pecoits-Filho R.\u{A0}Carbohydrate metabolism disturbances in non-diabetic patients on peritoneal dialysis. Perit Dial Int 2006;26 Suppl 2:Abstract."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Furuya R, Odamaki M, Kumagai H, Hishida A. Beneficial effects of icodextrin on plasma level of adipocytokines in peritoneal dialysis patients. Nephrol Dial Transplant 2006;21(2):494-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16221697" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cho KH, Do JY, Park JW, Yoon KW. Effect of icodextrin dialysis solution on body weight and fat accumulation over time in CAPD patients. Nephrol Dial Transplant 2010;25(2):593-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19767632" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bonora E, Targher G, Alberiche M, Bonadonna RC,\u{A0}Saggiani F,\u{A0}Zenere MB,\u{A0}et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000;23(1):57-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10857969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Després JP, Lamarche B, Mauriège P, Cantin B,\u{A0}Dagenais GR,\u{A0}Moorjani S,\u{A0}et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996;334(15):952-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8596596" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hargreaves AD, Logan RL, Elton RA, Buchanan KD, Oliver MF, Riemersma RA. Glucose tolerance, plasma insulin, HDL cholesterol and obesity: 12-year follow-up and development of coronary heart disease in Edinburgh men. Atherosclerosis 1992;94(1):61-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1632860" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000;106(4):453-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10953019" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001;86(2):713-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11158035" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shinohara K, Shoji T, Emoto M, Tahara H,\u{A0}Koyama H,\u{A0}Ishimura E,\u{A0}et al. Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 2002;13(7):1894-900. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12089386" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Becker B, Kronenberg F, Kielstein JT, Haller H,\u{A0}Morath C,\u{A0}Ritz E,\u{A0}et al. Renal insulin resistance syndrome, adiponectin and cardiovascular events in patients with kidney disease: the mild and moderate kidney disease study. J Am Soc Nephrol 2005;16(4):1091-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15743998" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S152586101000126X"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bonora E, Targher G, Alberiche M, Bonadonna RC,\u{A0}Saggiani F,\u{A0}Zenere MB,\u{A0}et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000;23(1):57-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10857969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000;23(2):171-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10868826" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Díez JJ, Grande C, Méndez J, González-Gancedo P, Iglesias P. Growth hormone and insulin-like growth factor binding protein-1 responses to oral glucose in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2006;65(1):27-34."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, Gude F,\u{A0}Cadarso-Suarez C,\u{A0}García F,\u{A0}et al. Insulin resistance index (HOMA-IR) levels in a general adult population: curves percentile by gender and age. The EPIRCE study. Diabetes Res Clin Pract 2011;94(1):146-55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21824674" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Caravaca F, Cerezo I, Macías R, García de Vinuesa E,\u{A0}Martínez del Viejo C,\u{A0}Villa J,\u{A0}et al. [Insulin resistance in chronic kidney disease: its clinical characteristics and prognosis significance]. Nefrologia 2010;30(6):661-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21113216" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003300000001/v0_201502091555/X2013251413002630/v0_201502091556/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/20132514/0000003300000001/v0_201502091555/X2013251413002630/v0_201502091556/en/P1-E547-S3850-A11430-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413002630?idApp=UINPBA000064"
]

Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2012.Nov.11430

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	4	13
2024 October	69	44	113
2024 September	74	58	132
2024 August	76	79	155
2024 July	68	69	137
2024 June	82	55	137
2024 May	104	60	164
2024 April	58	31	89
2024 March	55	27	82
2024 February	69	34	103
2024 January	74	20	94
2023 December	78	32	110
2023 November	74	32	106
2023 October	104	45	149
2023 September	83	36	119
2023 August	72	24	96
2023 July	97	43	140
2023 June	59	31	90
2023 May	60	33	93
2023 April	66	27	93
2023 March	68	21	89
2023 February	49	24	73
2023 January	54	31	85
2022 December	86	30	116
2022 November	85	47	132
2022 October	85	69	154
2022 September	67	41	108
2022 August	72	34	106
2022 July	54	53	107
2022 June	70	26	96
2022 May	68	40	108
2022 April	118	48	166
2022 March	113	58	171
2022 February	117	47	164
2022 January	137	52	189
2021 December	96	38	134
2021 November	89	33	122
2021 October	74	54	128
2021 September	78	41	119
2021 August	73	46	119
2021 July	83	31	114
2021 June	55	28	83
2021 May	87	40	127
2021 April	136	33	169
2021 March	89	42	131
2021 February	108	26	134
2021 January	64	26	90
2020 December	84	18	102
2020 November	73	24	97
2020 October	63	16	79
2020 September	49	19	68
2020 August	101	15	116
2020 July	108	14	122
2020 June	99	11	110
2020 May	83	10	93
2020 April	68	19	87
2020 March	87	10	97
2020 February	93	21	114
2020 January	116	15	131
2019 December	149	30	179
2019 November	125	22	147
2019 October	100	9	109
2019 September	125	23	148
2019 August	88	8	96
2019 July	107	24	131
2019 June	92	33	125
2019 May	94	18	112
2019 April	111	27	138
2019 March	66	22	88
2019 February	42	15	57
2019 January	56	17	73
2018 December	193	40	233
2018 November	147	19	166
2018 October	161	21	182
2018 September	276	23	299
2018 August	178	25	203
2018 July	126	26	152
2018 June	117	22	139
2018 May	126	20	146
2018 April	123	12	135
2018 March	78	15	93
2018 February	64	7	71
2018 January	71	11	82
2017 December	88	11	99
2017 November	93	19	112
2017 October	74	8	82
2017 September	61	12	73
2017 August	69	12	81
2017 July	69	10	79
2017 June	85	9	94
2017 May	121	14	135
2017 April	79	11	90
2017 March	99	25	124
2017 February	131	19	150
2017 January	72	16	88
2016 December	77	6	83
2016 November	127	14	141
2016 October	183	14	197
2016 September	315	9	324
2016 August	474	8	482
2016 July	282	13	295
2016 June	198	0	198
2016 May	178	0	178
2016 April	152	0	152
2016 March	125	0	125
2016 February	170	0	170
2016 January	124	0	124
2015 December	158	0	158
2015 November	137	0	137
2015 October	108	0	108
2015 September	73	0	73
2015 August	106	0	106
2015 July	126	0	126
2015 June	53	0	53
2015 May	41	0	41
2015 April	6	0	6

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter