The effect of replacing aluminium hydroxide with calcium acetate/magnesium carbonate on serum phosphorus control in haemodialysis patients
Efecto en el control del fósforo sérico tras la sustitución de hidróxido de aluminio por acetato cálcico/carbonato magnésico en pacientes en hemodiálisis
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López-Gómez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "David" "apellidos" => "Arroyo" "email" => array:1 [ 0 => "dvdrry@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Nayara" "apellidos" => "Panizo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Soraya" "apellidos" => "Abad" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Almudena" "apellidos" => "Vega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Ana" "apellidos" => "Pérez-de José" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Juan M." "apellidos" => "López-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto en el control del fósforo sérico tras la sustitución de hidróxido de aluminio por acetato cálcico/carbonato magnésico en pacientes en hemodiálisis" ] ] "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" => "12145_16025_55977_en_t17.12145i.jpg" "Alto" => 1113 "Ancho" => 1084 "Tamanyo" => 285897 ] ] "descripcion" => array:1 [ "en" => "Patient baseline characteristics." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Cardiovascular disease is the main cause of mortality in haemodialysis patients.<span class="elsevierStyleSup">1 </span>Mineral metabolism disorders, and specifically hyperphosphataemia, are one of the factors directly involved through vascular calcification.<span class="elsevierStyleSup">2-5 </span>As such, control of hyperphosphataemia and secondary hyperparathyroidism (SHPT) is one of the cornerstones of treatment in haemodialysis patients. Dietary restriction of phosphorus and appropriate dialysis are the first steps, but they are often insufficient and the prescription of phosphate binders is usually required.</p><p class="elsevierStylePara">Although the ideal binder has not yet been found, there are currently various drugs that are effective in terms of their main objective. However, there are differences in their pleiotropic and adverse effects and cost, and as such, the choice of binder must be rationalised and individualised for each patient.<span class="elsevierStyleSup">5-8</span></p><p class="elsevierStylePara">Aluminium hydroxide [Al(OH)<span class="elsevierStyleInf">3</span>] has always been one of the most powerful binders. Its use has classically been restricted due to potential toxic effects, but there is no clear scientific evidence of these effects.<span class="elsevierStyleSup">9,10 </span>We have used it regularly in our unit and have not observed higher serum aluminium levels than those recommended or related adverse events. Nevertheless, this binder has not been manufactured in recent years for commercial reasons.</p><p class="elsevierStylePara">One of the therapeutic options emerging in the market is the combination of calcium acetate with magnesium carbonate (MgCO<span class="elsevierStyleInf">3</span>). Its advantages include a lower calcium intake than other calcium binder monotherapies and a lower cost than new non-calcium binders, with the same efficacy, as well as the potential benefits of additional magnesium intake.<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">The objective of this study was to assess tolerance and efficacy in hyperphosphataemia control when we replaced Al(OH)<span class="elsevierStyleInf">3</span> (Pepsamar<span class="elsevierStyleSup">®</span>) with MgCO<span class="elsevierStyleInf">3</span> (Osvaren<span class="elsevierStyleSup">®</span>) in a cohort of haemodialysis patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Between October and December 2012, we selected patients from our haemodialysis unit who had an adequate control of phosphataemia (serum phosphorus <5mg/dl), on treatment with Al(OH)<span class="elsevierStyleInf">3</span> binder monotherapy who required continuation of this treatment. We followed the indications on dietary restriction of phosphorus rich foods regularly and without variation, in accordance with the unit’s standard protocol. Twenty-one patients (66.7% male, aged 56.7±16.4 years) met the inclusion criteria. They all underwent dialysis in three four-hour weekly sessions; 6 received high-flux haemodialysis and 15 received online haemodiafiltration. Both the regimen and dialysate remained unchanged throughout the study, with there being a constant magnesium concentration of 0.5mmol/l. The dialysate calcium concentration did not change and was 1.25mmol/l in eight patients and 1.5mmol/l in the remaining 13. Patient baseline characteristics are displayed in Table 1. The conversion to MgCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup"> </span>was carried out without changing the number of pills or the time at which they were taken, which were indicated during or immediately after meals. The maintenance dose was adjusted to clinical criteria in accordance with monthly serum phosphorus levels.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Variables</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We recorded the patients’ demographic and clinical characteristics. Before the conversion and over the following four months, we collected the data related to SHPT treatment each month, as well as laboratory parameters related to phosphorus and calcium metabolism: total and free calcium, phosphorus, 25-OH-vitamin D<span class="elsevierStyleInf">3</span>, parathyroid hormone (PTH) and serum magnesium. Serum aluminium was measured at baseline and after four months. Patients were regularly questioned about their adherence to the treatment with phosphate binders.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">All statistical analyses were performed using the SPSS version 17.0 software (SPSS Inc, Chicago, IL). The variables were recorded as percentages or as a mean ± standard deviation. Qualitative variables were compared using McNemar's test and quantitative data were analysed using the Wilcoxon signed-rank test for related non-parametric variables. We considered relationships with a <span class="elsevierStyleItalic">P</span> value <.05 to be significant.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We observed a statistically significant decrease in serum phosphorus levels four months after the conversion to MgCO<span class="elsevierStyleInf">3</span> (4.52±0.99 versus 4.02±1.07mg/dl, <span class="elsevierStyleItalic">p</span>=.027), and in calcium-phosphorus product levels (40.20±10.44 versus 35.16±11.06mg<span class="elsevierStyleSup">2</span>/dl<span class="elsevierStyleSup">2</span>, <span class="elsevierStyleItalic">p</span>=.037). Despite the additional intake of oral calcium, the change in serum calcium was not significant (8.85±0.65 versus 8.66±0.81mg/dl). No significant changes were observed in PTH or vitamin D levels. Changes in laboratory results throughout follow-up are summarised in Table 2.</p><p class="elsevierStylePara">The improvement in phosphataemia control was achieved by decreasing the number of MgCO<span class="elsevierStyleInf">3 </span>pills (from 3.33±2.29 to 2.15±2.21 pills per day, <span class="elsevierStyleItalic">P</span>=.020). There were no significant changes in the rest of the drugs used to treat SHPT (Table 3).</p><p class="elsevierStylePara">We discontinued treatment with MgCO<span class="elsevierStyleInf">3</span> in six patients (30%), in five due to hypophosphataemia and in one due to digestive intolerance. We observed a significant increase in magnesaemia from the first month (2.21±0.24 versus 2.43±0.39mg/dl, <span class="elsevierStyleItalic">P</span>=.001), which remained stable for four months. We recorded just one case of hypermagnesaemia (>3mg/dl), which was suitably resolved by reducing the dose.</p><p class="elsevierStylePara">Likewise, we found a decrease in serum aluminium levels from 14.91±8.55 to 8.47±3.98µg/l (<span class="elsevierStyleItalic">p</span>=.004), with levels being within the recommended range (<40µg/l) in all patients.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The conversion from Al(OH)<span class="elsevierStyleInf">3</span> to MgCO<span class="elsevierStyleInf">3</span> allowed phosphorus to be controlled adequately in this haemodialysis patient cohort. Although we were not able to demonstrate clearly that a decrease in serum phosphorus results in reduced mortality, the obvious pathophysiological role that it plays has led to clear indications in national and international guidelines.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">There are currently a wide variety of binders available, all of which are effective in reducing hyperphosphataemia, but with differences in other aspects that force doctors to make a decision about which binder to prescribe.<span class="elsevierStyleSup">13-15</span> Until recently, aluminium salts were considered the most powerful binder, with a very low cost/benefit ratio.<span class="elsevierStyleSup">11 </span>However, the potential toxicity of aluminium had restricted its use in the literature to settings with fewer economic resources.<span class="elsevierStyleSup">16-18 </span>There has even been a certain concern about aluminium intake from other drugs, both in terms of hidden intake and alongside other indications, especially antacids.<span class="elsevierStyleSup">19 </span>Improvement in the treatment of dialysis water, with the resulting lower aluminium concentration, and its low cost in this period of adjustments has challenged these limitations. Various recent studies in which no long term toxicity was observed have reopened the debate on the potential use of aluminium salts.<span class="elsevierStyleSup">9,10,20,21</span></p><p class="elsevierStylePara">In our study, we found that suppressing aluminium salt-based binders effectively decreases serum levels of this element, although no patient had levels higher than 40µg/l at any given time. For now and until there is more evidence on the use of aluminium salts with the current water controls, the guidelines continue to advise against them. Furthermore, the manufacture and distribution of the aluminium binder available in our setting was recently interrupted, forcing us to seek other therapeutic options.</p><p class="elsevierStylePara">The purpose of our study was to assess the replacement of Al(OH)<span class="elsevierStyleInf">3 </span>with MgCO<span class="elsevierStyleInf">3</span>. The first studies in this line were carried out in the nineteen eighties, in different conditions to the current situation.<span class="elsevierStyleSup">22 </span>Since then, many studies have used magnesium salts as phosphate binders.<span class="elsevierStyleSup">23 </span>Of the many drugs available, MgCO<span class="elsevierStyleInf">3 </span>has advantages in terms of safety and tolerance, with an efficacy that is comparable to that of other more modern binders.<span class="elsevierStyleSup">24</span> In our study, we found a significant reduction in the number of pills, which allowed an improvement in adherence and therefore in hyperphosphataemia control.<span class="elsevierStyleSup">25</span> It also has a lower cost than other non-calcium binders, which is important in the current situation.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">Another advantage of using MgCO<span class="elsevierStyleInf">3</span> is the benefits of magnesium intake, an element that is increasingly important.<span class="elsevierStyleSup">26</span> There is growing evidence of the relationship between lower levels of magnesium in the general population and the occurrence or poor control of diseases such as diabetes, high blood pressure or cardiovascular disease.<span class="elsevierStyleSup">27-31 In chronic kidney disease patients, reduced levels of magnesium have been associated with greater mortality, a worsening of mineral and bone disorder and an increase in vascular calcifications.32-35 </span>An interventional study demonstrated delayed arterial calcification with a reduction in intima-media thickness in relation to magnesium supplements.<span class="elsevierStyleSup">36 </span>At present, there are few studies on the effects of different dialysate concentrations.<span class="elsevierStyleSup">37,38 </span>It seems that there could be certain advantages to using dialysate with a higher magnesium content, such as better haemodynamic tolerance.<span class="elsevierStyleSup">39 </span>It is not clear what levels of serum magnesium are suitable, although there seems to be an increasingly greater consensus that somewhat higher levels could be beneficial for patients on dialysis. Intervention trials, which assess the medium and long term effects of increasing magnesium, whether through oral intake or higher dialysate concentrations, are necessary.</p><p class="elsevierStylePara">In our study, we observed a slight increase in magnesium levels, which, as in the CALMAG study, occurred at the start of treatment and subsequently remained stable.<span class="elsevierStyleSup">24 </span>Only one case of asymptomatic hypermagnesaemia was recorded, which returned to levels below 3mg/dl after dose reduction. Likewise, we only found one case of digestive intolerance due to diarrhoea, which forced us to discontinue treatment.</p><p class="elsevierStylePara">Our study has various limitations: it is a non-controlled observational study, with a small patient sample and without strict control of adherence to a low phosphorus diet and binders. It is possible that due to the “study effect” patients will improve their level of adherence. Nevertheless, the changes observed in serum aluminium and magnesium suggest that there was at least partial adherence to treatment.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">After the conversion from Al(OH)<span class="elsevierStyleInf">3</span> to MgCO<span class="elsevierStyleInf">3</span>, there was adequate control of serum phosphorus and patients required a lower number of pills. We observed a slight increase in magnesaemia within the normal limits, whose long term clinical significance is as yet unknown. Prospective studies with a longer follow-up period are required for an accurate assessment of the long term effect of high levels of serum magnesium in patients on dialysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12145_16025_55977_en_t17.12145i.jpg" class="elsevierStyleCrossRefs"><img src="12145_16025_55977_en_t17.12145i.jpg" alt="Patient baseline characteristics."></img></a></p><p class="elsevierStylePara">Table 1. Patient baseline characteristics.</p><p class="elsevierStylePara"><a href="grande/12145_16025_55978_en_t27.12145i.jpg" class="elsevierStyleCrossRefs"><img src="12145_16025_55978_en_t27.12145i.jpg" alt="Change in laboratory parameters after replacing aluminium hydroxide with calcium acetate/magnesium carbonate."></img></a></p><p class="elsevierStylePara">Table 2. Change in laboratory parameters after replacing aluminium hydroxide with calcium acetate/magnesium carbonate.</p><p class="elsevierStylePara"><a href="grande/12145_16025_55979_en_t37.12145i.jpg" class="elsevierStyleCrossRefs"><img src="12145_16025_55979_en_t37.12145i.jpg" alt="Other treatments used for phosphorus-calcium metabolism disorders."></img></a></p><p class="elsevierStylePara">Table 3. Other treatments used for phosphorus-calcium metabolism disorders.</p>" "pdfFichero" => "P1-E567-S4547-A12145-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438693" "palabras" => array:1 [ 0 => "Hidróxido de aluminio" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438695" "palabras" => array:1 [ 0 => "Carbonato de magnesio" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438697" "palabras" => array:1 [ 0 => "Quelantes de fósforo" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438699" "palabras" => array:1 [ 0 => "Hiperfosfatemia" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec438701" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438694" "palabras" => array:1 [ 0 => "Aluminum hydroxide" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438696" "palabras" => array:1 [ 0 => "Magnesium carbonate" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438698" "palabras" => array:1 [ 0 => "Phosphate binders" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438700" "palabras" => array:1 [ 0 => "Hyperphosphatemia" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec438702" "palabras" => array:1 [ 0 => "Haemodialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción: </span>El acetato cálcico/carbonato magnésico (MgCO<span class="elsevierStyleInf">3</span>) es un quelante de fósforo con ventajas en cuanto a coste, seguridad y tolerancia, con similar eficacia a la de otros fármacos. El objetivo del estudio es evaluar los efectos sobre el metabolismo fosfocálcico al sustituir hidróxido de aluminio [Al(OH<span class="elsevierStyleInf">3</span>)] por MgCO<span class="elsevierStyleInf">3</span> en una cohorte de pacientes en hemodiálisis. <span class="elsevierStyleBold">Material y métodos: </span>Se incluyen 21 pacientes con fósforo < 5 mg/dl, con Al(OH<span class="elsevierStyleInf">3</span>) como único quelante. La conversión a MgCO<span class="elsevierStyleInf">3</span> se realizó sin variar el número de comprimidos. Se registraron características clínico-demográficas, tratamiento para hiperparatiroidismo secundario y parámetros analíticos antes de la conversión, y mensualmente durante cuatro meses. <span class="elsevierStyleBold">Resultados: </span>La fosforemia disminuyó de 4,52 ± 0,99 a 4,02 ± 1,07 mg/dl (p = 0,027), con una reducción del producto calcio-fósforo de 40,20 ± 10,44 a 35,16 ± 11,06 mg<span class="elsevierStyleSup">2</span>/dl<span class="elsevierStyleSup">2</span> (p = 0,037). No encontramos variaciones significativas en los niveles de calcio, hormona paratiroidea o 25-OH-vitamina D<span class="elsevierStyleInf">3</span>. El número prescrito de comprimidos diarios se redujo de 3,33 ± 2,29 a 2,15 ± 2,21 (p = 0,020). Los tratamientos concomitantes no variaron. Observamos un aumento significativo inicial de la magnesemia de 2,21 ± 0,24 a 2,43 ± 0,39 mg/dl (p = 0,001), que posteriormente se mantuvo estable. Encontramos una disminución del aluminio sérico de 14,91 ± 8,55 a 8,47 ± 3,98 µg/l (p = 0,004), con niveles en rango recomendado en todos los pacientes. <span class="elsevierStyleBold">Conclusiones: </span>El MgCO<span class="elsevierStyleInf">3</span> permite un buen control del fósforo sérico en pacientes en hemodiálisis previamente bien controlados con Al(OH)<span class="elsevierStyleInf">3</span>, con menos comprimidos diarios. Se produce un ligero aumento en el magnesio sérico, sin significado clínico a corto plazo. Desconocemos los efectos de este aumento a más largo plazo.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction: </span>Calcium acetate/magnesium carbonate (MgCO<span class="elsevierStyleInf">3</span>) is a phosphorus binder with advantages in terms of cost, safety and tolerance and it has a similar efficacy to other drugs. The objective of the study is to assess the effects of replacing aluminium hydroxide [Al(OH<span class="elsevierStyleInf">3</span>)] with MgCO<span class="elsevierStyleInf">3 </span>on<span class="elsevierStyleInf"> </span>phosphorus and calcium metabolism in a cohort of haemodialysis patients. <span class="elsevierStyleBold">Materials and methods:</span> We included 21 patients with phosphorus <5mg/dl, with Al(OH<span class="elsevierStyleInf">3</span>) as the only binder. The conversion to MgCO<span class="elsevierStyleInf">3 </span>was carried out without changing the number of pills. We recorded clinical-demographic characteristics, treatment for secondary hyperparathyroidism and laboratory parameters before conversion and every month for four months. <span class="elsevierStyleBold">Results: </span>Phosphataemia decreased from 4.52±0.99 to 4.02±1.07mg/dl (<span class="elsevierStyleItalic">p</span>=.027), and there was a decrease in the calcium-phosphorus product from 40.20±10.44 to 35.16±11.06mg<span class="elsevierStyleSup">2</span>/dl<span class="elsevierStyleSup">2</span> (<span class="elsevierStyleItalic">p</span>=.037). We did not observe significant changes in levels of calcium, parathyroid hormone or 25-OH-vitamin D<span class="elsevierStyleInf">3</span>. The daily number of pills prescribed was reduced from 3.33±2.29 to 2.15±2.21 (<span class="elsevierStyleItalic">p</span>=.020). Concomitant treatments were not altered. We observed an initial significant increase in magnesaemia from 2.21±0.24 to 2.43±0.39mg/dl (<span class="elsevierStyleItalic">p</span>=.001), which subsequently remained stable. We found a decrease in serum aluminium from 14.91±8.55 to 8.47±3.98µg/l (<span class="elsevierStyleItalic">p</span>=.004), with levels within the recommended range in all patients. <span class="elsevierStyleBold">Conclusions:</span> MgCO<span class="elsevierStyleInf">3 </span>allowed good control of serum phosphorus in haemodialysis patients who were previously well controlled with Al(OH)<span class="elsevierStyleInf">3</span>, using fewer daily pills. There was a slight increase in serum magnesium, without short-term clinical significance. We do not know the effects of this increase in the longer term.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12145_16025_55977_en_t17.12145i.jpg" "Alto" => 1113 "Ancho" => 1084 "Tamanyo" => 285897 ] ] "descripcion" => array:1 [ "en" => "Patient baseline characteristics." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12145_16025_55978_en_t27.12145i.jpg" "Alto" => 642 "Ancho" => 2163 "Tamanyo" => 477976 ] ] "descripcion" => array:1 [ "en" => "Change in laboratory parameters after replacing aluminium hydroxide with calcium acetate/magnesium carbonate." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12145_16025_55979_en_t37.12145i.jpg" "Alto" => 880 "Ancho" => 2169 "Tamanyo" => 411934 ] ] "descripcion" => array:1 [ "en" => "Other treatments used for phosphorus-calcium metabolism disorders." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:39 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Collins AJ, Li S, Ma JZ, Herzog C. Cardiovascular disease in end-stage renal disease patients. Am J Kidney Dis 2001;38(4 Suppl 1):S26-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11576917" 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" => "Wald R, Sarnak MJ, Tighiouart H, Cheung AK, Levey AS, Eknoyan G, et al. Disordered mineral metabolism in hemodialysis patients: an analysis of cumulative effects in the Hemodialysis (HEMO) Study. Am J Kidney Dis 2008;52(3):531-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18657891" 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" => "Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2008;52(3):519-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18514987" 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" => "Lezaic V, Tirmenstajn-Jankovic B, Bukvic D, Vujisic B, Perovic M, Novakovic N, et al. Efficacy of hyperphosphatemia control in the progression of chronic renal failure and the prevalence of cardiovascular calcification. Clin Nephrol 2009;71(1):21-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19203546" 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" => "Covic A, Kothawala P, Bernal M, Robbins S, Chalian A, Goldsmith D. Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease. Nephrol Dial Transplant 2009;24(5):1506-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19001560" 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" => "Navaneethan SD, Palmer SC, Craig JC, Elder GJ, Strippoli GF. Benefits and harms of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis 2009;54(4):619-37. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19692157" 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" => "Plagemann T, Prenzler A, Mittendorf T. Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia. Health Econ Rev 2011;1(1):1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22828213" 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" => "de Francisco AL. Captores de fósforo. ¿El precio determina la elección? Sí. Nefrologia 2012;32(2):235-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Arenas MD, Malek T, Gil MT, Moledous A, Núñez C, Álvarez-Ude F. Uso de captores alumínicos en hemodiálisis en la era del agua ultrapura. Nefrologia 2008;28(2):168-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18454706" 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" => "Mudge DW, Johnson DW, Hawley CM, Campbell SB, Isbel NM, van Eps CL, et al. Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice? BMC Nephrol 2011;12:20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21569446" 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" => "Daugirdas JT, Finn WF, Emmett M, Chertow GM; Frequent Hemodialysis Network Trial Group. The phosphate binder equivalent dose. Semin Dial 2011;24(1):41-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21338393" 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" => "Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009;(113):S1-130." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hutchinson AJ. Oral phosphate binder. Kidney Int 2009;75(9):906-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19279554" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Frazão JM, Adragão T. Non-calcium-containing phosphate binders: comparing efficacy, safety, and other clinical effects. Nephron Clin Pract 2012;120(2):c108-19. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22555359" 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" => "Malberti F. Hyperphosphataemia: treatment options. Drugs 2013;73(7):673-88. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23625273" 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" => "Sandhu G, Djebali D, Bansal A, Chan G, Smith SD. Serum concentrations of aluminum in hemodialysis patients. Am J Kidney Dis 2011;57(3):523-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21257246" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Guo CH, Wang CL. Plasma aluminum is a risk factor for oxidative stress and inflammation status in hemodialysis patients. Clin Biochem 2011;44(16):1309-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21893052" 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" => "Janssen MJ, van der Kuy A, ter Wee PM, van Boven WP. Aluminum hydroxide, calcium carbonate and calcium acetate in chronic intermittent hemodialysis patients. Clin Nephrol 1996;45(2):111-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8846523" 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" => "Da Silva E, Jakubovic R, Pejovic-Milic A, Heyd DV. Aluminium and strontium in calcium supplements and antacids: a concern to haemodialysis patients? Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2010;27(10):1405-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20640960" 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" => "Pepper R, Campbell N, Yagoob MM, Roberts NB, Fan SL. Do oral aluminium phosphate binders cause accumulation of aluminium to toxic levels? BMC Nephrol 2011;12:55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21992770" 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" => "Jimenez PM, Douthat W, Orías M. Can aluminum-based binders be used safely? Semin Dial 2011;24(4):430-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21801208" 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" => "Wheeler DC, Smith B, Walls J. Substitution of aluminium salts by magnesium salts in control of dialysis hyperphosphataemia. Lancet 1986;1(8494):1380. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2884488" 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" => "Tzanakis IP, Papadaki AN, Wei M, Kagia S, Spadidakis VV, Kallivretakis NE, et al. Magnesium carbonate for phosphate control in patients on hemodialysis. A randomized controlled trial. Int Urol Nephrol 2008;40(1):193-201. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18193489" 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" => "de Francisco AL, Leidig M, Covic AC, Ketteler M, Benedyk-Lorens E, Mircescu GM, et al. Evaluation of calcium acetate/magnesium carbonate as a phosphate binder compared with sevelamer hydrochloride in haemodialysis patients: a controlled randomized study (CALMAG study) assessing efficacy and tolerability. Nephrol Dial Transplant 2010;25(11):3707-17. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20530499" 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" => "Arenas MD, Pérez-García R, Bennouna M, Blanco A, Mauricio O, Prados MD, et al. Mejoría del cumplimiento terapéutico en pacientes en hemodiálisis con mal control del fósforo y mala adherencia al tratamiento con captores: Estudio COMQUELFOS. Nefrologia 2013;33(2):196-203." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "de Francisco AL, Rodríguez M. Magnesio y enfermedad renal crónica. Nefrologia 2013;33(3):389-99. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23640095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ma J, Folsom AR, Melnick SL, Eckfeldt JH, Sharrett AR, Nabulsi AA, et al. Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study. J Clin Epidemiol 1995;48(7):927-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7782801" 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" => "Larsson SC, Wolk A. Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med 2007;262(2):208-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17645588" 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" => "Pham PC, Pham PM, Pham PA, Pham SV, Pham HV, Miller JM, et al. Lower serum magnesium levels are associated with more rapid decline of renal function in patients with diabetes mellitus type 2. Clin Nephrol 2005;63(6):429-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15960144" 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" => "Dickinson HO, Nicolson DJ, Campbell F, Cook JV, Beyer FR, Ford GA, et al. Magnesium supplementation for the management of essential hypertension in adults. Cochrane Database Syst Rev 2006;(3):CD004640." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Reffelman T, Itterman T, Dörr M, Völzke H, Reinthaler M, Petersmann A, et al. Low serum magnesium concentrations predict cardiovascular and all-cause mortality. Atherosclerosis 2011;219(1):280-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21703623" 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" => "Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y. Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients. Magnes Res 2007;20(4):237-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18271493" 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" => "Navarro JF, Mora C, Jiménez A, Torres A, Macía M, García J. Relationship between serum magnesium and parathyroid hormone levels in hemodialysis patients. Am J Kidney Dis 1999;34(1):43-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10401014" 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" => "Tzanakis I, Pras A, Kounali D, Mamali V, Kartsonakis V, Mayopoulou-Symvoulidou D, et al. Mitral annular calcifications in haemodialysis patients: a possible protective role of magnesium. Nephrol Dial Transplant 1997;12(9):2036-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9306378" 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" => "Tzanakis I, Virvidakis K, Tsomi A, Mantakas E, Girousis N, Karefyllakis N, et al. Intra- and extracellular magnesium levels and atheromatosis in haemodialysis patients. Magnes Res 2004;17(2):102-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15319142" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Turgut F, Kanbay M, Metin MR, Uz E, Akcay A, Covic A. Magnesium supplementation helps to improve carotid intima media thickness in patients on hemodialysis. Int Urol Nephrol 2008;40(4):1075-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18568412" 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" => "Nilsson P, Johansson SG, Danielson BG. Magnesium studies in hemodialysis patients before and after treatment with low dialysate magnesium. Nephron 1984;37(1):25-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6717701" 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" => "Kelber J, Slatopolsky E, Delmez JA. Acute effects of different concentrations of dialysate magnesium during high-efficiency dialysis. Am J Kidney Dis 1994;24(3):453-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8079970" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kyriazis J, Kalogeropoulou K, Bilirakis L, Smirnioudis N, Pikounis V, Stamatiadis D, et al. Dialysate magnesium level and blood pressure. Kidney Int 2004;66(3):1221-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15327421" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053787/v0_201502091616/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/20132514/0000003400000002/v0_201502091616/X2013251414053787/v0_201502091616/en/P1-E567-S4547-A12145-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053787?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 10 | 17 |
| 2024 October | 51 | 67 | 118 |
| 2024 September | 103 | 66 | 169 |
| 2024 August | 103 | 84 | 187 |
| 2024 July | 78 | 40 | 118 |
| 2024 June | 83 | 49 | 132 |
| 2024 May | 78 | 44 | 122 |
| 2024 April | 79 | 44 | 123 |
| 2024 March | 68 | 30 | 98 |
| 2024 February | 49 | 41 | 90 |
| 2024 January | 66 | 37 | 103 |
| 2023 December | 53 | 29 | 82 |
| 2023 November | 75 | 36 | 111 |
| 2023 October | 62 | 30 | 92 |
| 2023 September | 77 | 44 | 121 |
| 2023 August | 61 | 41 | 102 |
| 2023 July | 67 | 43 | 110 |
| 2023 June | 57 | 33 | 90 |
| 2023 May | 72 | 32 | 104 |
| 2023 April | 55 | 21 | 76 |
| 2023 March | 65 | 24 | 89 |
| 2023 February | 74 | 23 | 97 |
| 2023 January | 72 | 36 | 108 |
| 2022 December | 76 | 47 | 123 |
| 2022 November | 94 | 57 | 151 |
| 2022 October | 65 | 68 | 133 |
| 2022 September | 61 | 52 | 113 |
| 2022 August | 70 | 63 | 133 |
| 2022 July | 59 | 75 | 134 |
| 2022 June | 45 | 52 | 97 |
| 2022 May | 89 | 47 | 136 |
| 2022 April | 64 | 65 | 129 |
| 2022 March | 58 | 66 | 124 |
| 2022 February | 49 | 51 | 100 |
| 2022 January | 80 | 34 | 114 |
| 2021 December | 92 | 49 | 141 |
| 2021 November | 96 | 40 | 136 |
| 2021 October | 152 | 42 | 194 |
| 2021 September | 94 | 41 | 135 |
| 2021 August | 64 | 41 | 105 |
| 2021 July | 85 | 31 | 116 |
| 2021 June | 68 | 29 | 97 |
| 2021 May | 63 | 46 | 109 |
| 2021 April | 140 | 93 | 233 |
| 2021 March | 110 | 35 | 145 |
| 2021 February | 105 | 24 | 129 |
| 2021 January | 66 | 16 | 82 |
| 2020 December | 71 | 19 | 90 |
| 2020 November | 85 | 16 | 101 |
| 2020 October | 56 | 22 | 78 |
| 2020 September | 54 | 8 | 62 |
| 2020 August | 66 | 17 | 83 |
| 2020 July | 56 | 10 | 66 |
| 2020 June | 62 | 17 | 79 |
| 2020 May | 74 | 10 | 84 |
| 2020 April | 74 | 20 | 94 |
| 2020 March | 78 | 15 | 93 |
| 2020 February | 88 | 20 | 108 |
| 2020 January | 103 | 23 | 126 |
| 2019 December | 94 | 22 | 116 |
| 2019 November | 95 | 25 | 120 |
| 2019 October | 128 | 20 | 148 |
| 2019 September | 126 | 16 | 142 |
| 2019 August | 70 | 13 | 83 |
| 2019 July | 69 | 25 | 94 |
| 2019 June | 76 | 31 | 107 |
| 2019 May | 101 | 17 | 118 |
| 2019 April | 101 | 41 | 142 |
| 2019 March | 73 | 31 | 104 |
| 2019 February | 51 | 19 | 70 |
| 2019 January | 82 | 31 | 113 |
| 2018 December | 126 | 54 | 180 |
| 2018 November | 123 | 31 | 154 |
| 2018 October | 121 | 32 | 153 |
| 2018 September | 209 | 22 | 231 |
| 2018 August | 114 | 32 | 146 |
| 2018 July | 137 | 21 | 158 |
| 2018 June | 145 | 19 | 164 |
| 2018 May | 129 | 19 | 148 |
| 2018 April | 113 | 8 | 121 |
| 2018 March | 70 | 11 | 81 |
| 2018 February | 92 | 13 | 105 |
| 2018 January | 86 | 6 | 92 |
| 2017 December | 88 | 15 | 103 |
| 2017 November | 88 | 18 | 106 |
| 2017 October | 65 | 15 | 80 |
| 2017 September | 98 | 17 | 115 |
| 2017 August | 92 | 6 | 98 |
| 2017 July | 117 | 25 | 142 |
| 2017 June | 78 | 13 | 91 |
| 2017 May | 95 | 12 | 107 |
| 2017 April | 65 | 11 | 76 |
| 2017 March | 95 | 15 | 110 |
| 2017 February | 120 | 17 | 137 |
| 2017 January | 62 | 14 | 76 |
| 2016 December | 119 | 8 | 127 |
| 2016 November | 157 | 7 | 164 |
| 2016 October | 202 | 12 | 214 |
| 2016 September | 329 | 6 | 335 |
| 2016 August | 408 | 6 | 414 |
| 2016 July | 318 | 16 | 334 |
| 2016 June | 216 | 0 | 216 |
| 2016 May | 174 | 0 | 174 |
| 2016 April | 180 | 0 | 180 |
| 2016 March | 140 | 0 | 140 |
| 2016 February | 160 | 0 | 160 |
| 2016 January | 151 | 0 | 151 |
| 2015 December | 162 | 0 | 162 |
| 2015 November | 137 | 0 | 137 |
| 2015 October | 143 | 0 | 143 |
| 2015 September | 111 | 0 | 111 |
| 2015 August | 91 | 0 | 91 |
| 2015 July | 125 | 0 | 125 |
| 2015 June | 73 | 0 | 73 |
| 2015 May | 87 | 0 | 87 |
| 2015 April | 9 | 0 | 9 |
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