array:21 [
  "pii" => "X2013251414053795"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
  "estado" => "S300"
  "fechaPublicacion" => "2014-03-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2014;34:189-98"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 11075
    "formatos" => array:3 [
      "EPUB" => 322
      "HTML" => 9500
      "PDF" => 1253
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699514053798"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
      "estado" => "S300"
      "fechaPublicacion" => "2014-03-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2014;34:189-98"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 16378
        "formatos" => array:3 [
          "EPUB" => 415
          "HTML" => 14999
          "PDF" => 964
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Prevalencia de anemia y su manejo clínico en la enfermedad renal crónica estadios 3-5 no en diálisis en Cataluña: estudio MICENAS I"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "189"
            "paginaFinal" => "198"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study"
          ]
        ]
        "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" => "12261_19904_50419_es_12261_t1.jpg"
                "Alto" => 673
                "Ancho" => 700
                "Tamanyo" => 303661
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Características de los pacientes incluidos en el estudio."
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => " Investigadores del estudio MICENAS I, Aleix Cases-Amenós, Alberto Martínez-Castelao, Joan Fort-Ros, Jordi Bonal-Bastons, M. Pilar Ruiz, Martí Vallés-Prats, Elisabeth Coll-Piera, Josep M. Galcerán-Gui"
            "autores" => array:9 [
              0 => array:1 [
                "apellidos" => "Investigadores del estudio MICENAS I"
              ]
              1 => array:2 [
                "nombre" => "Aleix"
                "apellidos" => "Cases-Amenós"
              ]
              2 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Martínez-Castelao"
              ]
              3 => array:2 [
                "nombre" => "Joan"
                "apellidos" => "Fort-Ros"
              ]
              4 => array:2 [
                "nombre" => "Jordi"
                "apellidos" => "Bonal-Bastons"
              ]
              5 => array:2 [
                "nombre" => "M. Pilar"
                "apellidos" => "Ruiz"
              ]
              6 => array:2 [
                "nombre" => "Martí"
                "apellidos" => "Vallés-Prats"
              ]
              7 => array:2 [
                "nombre" => "Elisabeth"
                "apellidos" => "Coll-Piera"
              ]
              8 => array:2 [
                "nombre" => "Josep M."
                "apellidos" => "Galcerán-Gui"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251414053795"
          "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
          "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/X2013251414053795?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053798?idApp=UINPBA000064"
      "url" => "/02116995/0000003400000002/v0_201502091349/X0211699514053798/v0_201502091350/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251414053787"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Nov.12145"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2014;34:199-204"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8406
      "formatos" => array:3 [
        "EPUB" => 345
        "HTML" => 7233
        "PDF" => 828
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "The effect of replacing aluminium hydroxide with calcium acetate/magnesium carbonate on serum phosphorus control in haemodialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "199"
          "paginaFinal" => "204"
        ]
      ]
      "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"
        ]
      ]
      "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" => "12145_16025_55977_en_t17.12145i.jpg"
              "Alto" => 1113
              "Ancho" => 1084
              "Tamanyo" => 285897
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient baseline characteristics."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "David Arroyo, Nayara Panizo, Soraya Abad, Almudena Vega, Ana Pérez-de José, Juan M. López-Gómez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "David"
              "apellidos" => "Arroyo"
            ]
            1 => array:2 [
              "nombre" => "Nayara"
              "apellidos" => "Panizo"
            ]
            2 => array:2 [
              "nombre" => "Soraya"
              "apellidos" => "Abad"
            ]
            3 => array:2 [
              "nombre" => "Almudena"
              "apellidos" => "Vega"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Pérez-de José"
            ]
            5 => array:2 [
              "nombre" => "Juan M."
              "apellidos" => "López-Gómez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951405378X"
        "doi" => "10.3265/Nefrologia.pre2013.Nov.12145"
        "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/X021169951405378X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053787?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053787/v0_201502091616/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141405380X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2014;34:175-88"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8074
      "formatos" => array:3 [
        "EPUB" => 331
        "HTML" => 6937
        "PDF" => 806
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Spanish nephrologists and the management of mineral and bone metabolism disorders in chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "175"
          "paginaFinal" => "188"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los nefrólogos españoles y el manejo de las alteraciones del metabolismo óseo-mineral en la enfermedad renal crónica"
        ]
      ]
      "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" => "12280_16025_56452_en_t15.12280_04.jpg"
              "Alto" => 9292
              "Ancho" => 2168
              "Tamanyo" => 4635887
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Statistical results for the 86 statements."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Cannata-Andía, J. Vicente Torregrosa"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Cannata-Andía"
            ]
            1 => array:2 [
              "nombre" => "J. Vicente"
              "apellidos" => "Torregrosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053802"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
        "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/X0211699514053802?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405380X?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X201325141405380X/v0_201502091616/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "189"
        "paginaFinal" => "198"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => " Investigadores del estudio MICENAS I, Aleix Cases-Amenós, Alberto Martínez-Castelao, Joan Fort-Ros, Jordi Bonal-Bastons, M. Pilar Ruiz, Martí Vallés-Prats, Elisabeth Coll-Piera, Josep M. Galcerán-Gui"
        "autores" => array:9 [
          0 => array:1 [
            "apellidos" => "Investigadores del estudio MICENAS I"
          ]
          1 => array:4 [
            "nombre" => "Aleix"
            "apellidos" => "Cases-Amenós"
            "email" => array:1 [
              0 => "acases@clinic.ub.es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Mart&#237;nez-Castelao"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Joan"
            "apellidos" => "Fort-Ros"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Jordi"
            "apellidos" => "Bonal-Bastons"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46; Pilar"
            "apellidos" => "Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mart&#237;"
            "apellidos" => "Vall&#233;s-Prats"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Elisabeth"
            "apellidos" => "Coll-Piera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "affg"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Josep M&#46;"
            "apellidos" => "Galcer&#225;n-Gui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "affh"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:7 [
          0 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Clínic, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          1 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari de Bellvitge, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          2 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          3 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          4 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Josep Trueta, Girona   "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
          5 => array:3 [
            "entidad" => " Servicio de Nefrología, Fundació Puigvert, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">g</span>"
            "identificador" => "affg"
          ]
          6 => array:3 [
            "entidad" => " Servicio de Nefrología, Fundació Althaia Manresa, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">h</span>"
            "identificador" => "affh"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Prevalencia de anemia y su manejo cl&#237;nico en la enfermedad renal cr&#243;nica estadios 3-5 no en di&#225;lisis en Catalu&#241;a&#58; estudio MICENAS I"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56332_en_pginas_desde6.12261_02i.jpg"
            "Alto" => 654
            "Ancho" => 716
            "Tamanyo" => 74456
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the patients included in the study&#46;"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Chronic kidney disease &#40;CKD&#41; affects around 11&#37; of the Spanish adult population&#44; according to data from the EPIRCE study&#44;<span class="elsevierStyleSup">1</span> and is associated with high morbidity and mortality&#44; particularly as a consequence of cardiovascular disease&#46;<span class="elsevierStyleSup">2&#44;3</span> Furthermore&#44; CKD is related to a series of complications&#44; including anaemia&#44;<span class="elsevierStyleSup">4 </span>which has been linked to higher morbidity and mortality and CKD progression&#46;</p><p class="elsevierStylePara">The presence of anaemia is already observed in early stages of CKD &#40;stage 3&#41;&#44; but its prevalence increases as renal failure progresses to more advanced stages&#46;<span class="elsevierStyleSup">5 </span>The main cause of anaemia in CKD patients is an erythropoietin deficiency&#44; although a decrease in the half-life of red blood cells&#44; iron and vitamin deficiency and other factors have also been involved&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Since the introduction of recombinant human erythropoietin&#44; erythropoiesis-stimulating agents &#40;ESA&#41; have become the cornerstone of CKD anaemia treatment and have reduced requirements for transfusion&#44; improved the quality of life and reduced left ventricular hypertrophy and morbidity and mortality in these patients&#46;<span class="elsevierStyleSup">6-10 </span>However&#44; target haemoglobin has been the subject of debate in recent years due to recent randomised studies and meta-analyses that have demonstrated that total anaemia correction with ESA is not associated with better survival or a significant improvement in quality of life&#44; while it is associated with a potential increase in adverse cardiovascular effects&#46;<span class="elsevierStyleSup">11-16</span></p><p class="elsevierStylePara">In light of these results&#44; the 2010 European guidelines recommended target haemoglobin of between 11 and 12g&#47;dl&#44; without intentionally exceeding 13g&#47;dl<span class="elsevierStyleSup">17 </span>and the EMA &#40;European Medicines Agency&#41; advises not exceeding haemoglobin levels of 12g&#47;dl in patients treated with ESA &#40;Ref&#46; EMEA&#47;188068&#47;2007&#41;&#46;<span class="elsevierStyleSup">18</span></p><p class="elsevierStylePara">The objective of this study was to establish the prevalence of anaemia in patients with stages 3&#44; 4 and 5 CKD not on dialysis treated in outpatient Nephrology clinics in Catalonia&#44; and know its therapeutic management &#40;haemoglobin levels achieved&#44; prescription of ESA&#44; iron therapy and other concomitant treatments&#41; in clinical practice&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study design and data collection</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">This is an epidemiological&#44; cross-sectional&#44; multicentre study under routine clinical practice conditions&#46;</p><p class="elsevierStylePara">The study data were collected during 2010&#46; All Nephrology Services in Catalonia were invited to participate and we conducted a feasibility survey on all candidates&#46; Nineteen centres were included in the study &#40;90&#46;47&#37; of those invited&#41;&#44; of which 17 recruited patients &#40;80&#46;95&#37; of those invited&#41;&#46; Two of the centres invited did not participate in the study&#46; Participant centres contributed data from all patients visited consecutively in outpatient Nephrology clinics who met the inclusion and exclusion criteria and who gave their consent to participate in the study over a week&#44; with the aim of including the highest possible number of patients&#46; The data were collected using an electronic data collection log-book &#40;e-DCL&#41;&#44; which was developed specifically for the study&#46; We compiled patients&#8217; demographic data &#40;age&#44; gender&#44; weight&#44; height&#44; CKD stage&#44; CKD diagnosis time&#41; and data corresponding to anaemia &#40;haemoglobin levels&#44; ferritin levels&#44; transferrin saturation index &#91;TSI&#93;&#44; treatment with ESA&#44; iron&#44; folic acid or vitamin B<span class="elsevierStyleSup">12</span>&#41;&#46; We also estimated the glomerular filtration rate &#40;eGFR&#41; using the MDRD-4 formula&#46;</p><p class="elsevierStylePara">The study was approved by the different ethics committees of participating hospitals and patients had to sign their informed consent to allow data to be taken from their clinical history&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient selection</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The study&#8217;s target population was adult patients with CKD and an eGFR of less than 60ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> who were not on dialysis&#46;</p><p class="elsevierStylePara">Inclusion criteria&#58;</p><ul><li>Patients 18 years old or older&#46;</li><li>Patients with an established clinical diagnosis of stage 3&#44; 4 or 5 CKD not on dialysis treated in outpatient Nephrology clinics in Catalonia&#46;</li><li>Patients who gave their informed consent in writing to participate in the study&#46;</li></ul><p class="elsevierStylePara">Exclusion criteria&#58;</p><ul><li>Patients whose clinical history did not include a recent determination of haemoglobin &#40;two months before inclusion&#41;&#46;</li><li>Any patient situation or condition that&#44; in the opinion of the researcher&#44; would make them unsuitable for participating in the study&#46;</li></ul><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Anaemia was defined as haemoglobin levels &#60;13&#46;5g&#47;dl in males and &#60;12g&#47;dl in females or treatment with ESA&#46; We defined iron deficiency as ferritin levels &#60;100ng&#47;ml and&#47;or TSI&#160;&#60;20&#37;&#46;</p><p class="elsevierStylePara">Categorical variables were described using absolute and relative frequencies&#44; including a 95&#37; confidence interval&#46; For the description of the continuous variables&#44; we used means&#44; standard deviation&#44; medians&#44; the minimum and maximum&#44; including the total number of valid values&#46;</p><p class="elsevierStylePara">For quantitative variables&#44; we used parametric tests &#40;Student&#8217;s t-test or Anova&#41; or non-parametric tests &#40;Mann-Whitney or Kruskal-Wallis&#41;&#44; as appropriate&#46; For qualitative variables&#44; we performed the &#967;<span class="elsevierStyleSup">2</span> test&#46;</p><p class="elsevierStylePara">The results were considered to be statistically significant when the <span class="elsevierStyleItalic">P</span> value was less than 0&#46;05&#46;</p><p class="elsevierStylePara">The statistical analyses were carried out using the SAS version 9&#46;1&#46;3 statistical software&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study population</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We recruited a total of 531 patients&#44; of which we excluded 27 because they did not meet the selection criteria or did not have the data necessary for assessing the main variable&#44; leaving 504 patients included in the study&#46;</p><p class="elsevierStylePara">The characteristics of patients included are displayed in Table 1&#46; 61&#46;5&#37; had stage 3 CKD&#44; 30&#46;2&#37; had stage 4 CKD and the remaining 8&#46;3&#37; had stage 5 of the disease&#46; The causes of CKD are displayed in Table 1&#46; We observe that the main aetiologies are vascular and diabetic nephropathy&#44; although the aetiologies of a high percentage of patients were unknown&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Laboratory data on anaemia and iron status</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Data on haemoglobin and iron status are displayed in Table 2&#44; which shows levels of haemoglobin&#44; serum iron&#44; ferritin and TSI according to CKD stage&#46; Anaemia prevalence in the study population was 58&#46;5&#37;&#44; although only 14&#46;9&#37; of patients had haemoglobin levels &#60;11g&#47;dl&#46; The mean haemoglobin of the whole cohort was 12&#46;6&#177;1&#46;6g&#47;dl&#44; although we observed a tendency for haemoglobin levels to decrease as CKD advanced&#46; We observed an inverse correlation between the eGFR and haemoglobin levels &#40;Figure 1&#41;&#46; The mean ferritin of the whole study group was 158&#46;4&#177;135&#46;8ng&#47;ml and the mean TSI was 24&#46;2&#177;11&#46;7&#37;&#44; without significant differences for ferritin or TSI being observed according to the stage of the disease&#46; Among anaemic patients &#40;n&#61;295&#41;&#44; 36&#46;3&#37; &#40;n&#61;107&#41; had an iron deficiency &#40;ferritin &#60;100ng&#47;ml and&#47;or TSI &#60;20&#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Anaemia prevalence according to demographic data</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The patient&#8217;s profile according to the presence or absence of anaemia is displayed in Table 3&#44; without significant differences being found according to sex&#44; but with there being significant differences according to age &#40;higher anaemia amongst older individuals&#41;&#44; CKD aetiology &#40;diabetes and unknown cause are the most prevalent aetiologies in anaemia&#41;&#44; CKD stage &#40;as CKD progresses&#44; a higher presence of anaemia is observed&#41; and eGFR &#40;lower eGFR amongst patients with anaemia&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatments prescribed for anaemia</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">40&#46;5&#37; of all patients were receiving some form of treatment for anaemia at the time of the visit&#46; The data referring to treatment for anaemia are displayed in Tables 4&#44; 5&#44; 6&#44; 7 and 8&#46;</p><p class="elsevierStylePara">The treatments for anaemia are displayed in Table 4 according to the CKD stage&#46; Of the patients treated&#44; 68&#46;0&#37; &#40;n&#61;136&#41; were receiving an ESA&#44; 14&#46;5&#37; were receiving folic acid and 10&#46;0&#37; were receiving vitamin B<span class="elsevierStyleInf">12</span>&#46; 66&#46;0&#37; of all patients with chronic renal failure and anaemia were receiving iron supplements at the time of the visit &#40;61&#37; orally and 5&#37; intravenously&#41;&#46; We can observe how the percentage of patients treated increases as the CKD stage increases &#40;Table 8&#41;&#46; ESA was the most frequent treatment as CKD progressed&#44; while folate and vitamin B<span class="elsevierStyleInf">12 </span>were prescribed more often in earlier stages&#44; but no significant differences were observed with regard to the prescription of iron supplements according to the stages&#46; There were no statistically significant differences with regard to the prescription of oral and intravenous iron according to the CKD stage&#46; In the anaemic patient subgroup we observed similar results to those of the overall population&#44; although they were not significant for vitamin B<span class="elsevierStyleInf">12 </span>and folic acid &#40;Table 5&#41;&#46; The ESA and intervals most frequently prescribed in our population were darbepoetin alfa with a median dose of 40&#956;g&#47;biweekly&#44; followed by C&#46;E&#46;R&#46;A &#40;<span class="elsevierStyleItalic">Continuous Erythropoietin Receptor Activator</span>&#41; with a median dose of 75&#956;g&#47;month&#44; followed by epoetin beta with a median dose of 5000IU&#47;week&#46; The prescription of epoetin alfa to the study population was rare&#46;</p><p class="elsevierStylePara">Table 6 displays treatment with iron supplements in the anaemic&#44; iron-deficient patient subgroup&#59; 53&#46;3&#37; received treatment with iron&#44; 12&#46;1&#37; did not receive iron supplements and in the rest of the patients&#44; it was not specified in the e-DCL&#46; The prescription of iron to anaemic and iron-deficient patients was more common in patients with stage 5 CKD than in earlier stages&#46;</p><p class="elsevierStylePara">Table 7 displays treatment for anaemia according to haemoglobin levels&#44; and we observed that 67&#46;9&#37; of patients with haemoglobin levels &#60;11g&#47;dl received ESA and&#47;or iron therapy and 33&#46;3&#37; received both&#46; Likewise&#44; in patients with haemoglobin &#62;12g&#47;dl&#44; 18&#160;&#37; received ESA&#44; as well as 8&#46;2&#37; of those with haemoglobin &#62;13g&#47;dl&#46; Of those treated with ESA&#44; 43&#46;4&#37; had haemoglobin levels &#62;12g&#47;dl and 12&#46;5&#37; had haemoglobin levels &#62;13g&#47;dl&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">This study shows a high prevalence of anaemia in patients with stages 3-5 CKD not on dialysis and a suitable control of the latter in patients treated in 17 Nephrology Service outpatient clinics in Catalonia&#46;</p><p class="elsevierStylePara">The prevalence of anaemia in this patient population with stages 3-5 CKD not on dialysis was 58&#46;5&#37;&#44; however only 14&#46;9&#37; had haemoglobin of less than 11g&#47;dl&#44; that is&#44; that 85&#46;1&#37; of patients would exceed the low haemoglobin margin established by the European guidelines&#46;<span class="elsevierStyleSup">17 </span>In the MERENA observational multicentre study&#44; conducted on 1129 patients with stages 3 and 4 CKD tested in outpatient Nephrology clinics in Spain&#44; anaemia prevalence was somewhat lower than that of this study &#40;51&#46;3&#37; compared to 58&#46;5&#37;&#41;&#44; although it must be borne in mind that this study did not include patients with stage 5 CKD and it is possible that recently published referral criteria may have resulted in patients who are currently treated in outpatient Nephrology clinics having higher comorbidities&#44; including anaemia&#44; than in previous studies&#44; such as MERENA&#46;<span class="elsevierStyleSup">19 </span>The prevalence of anaemia in 1058 patients with CKD not on dialysis in Italy was 16&#37;&#44; 32&#37; and 51&#37; in stages 3&#44; 4 and 5 respectively&#44; although the definition of anaemia in this study would require lower levels of haemoglobin &#40;haemoglobin &#60;12g&#47;dl in males and &#60;11g&#47;dl in females&#41;&#46;<span class="elsevierStyleSup">20 </span>In a recent Spanish prospective study of 439 non-anaemic patients with CKD&#44; followed up over three years&#44; 35&#37; developed anaemia&#44; and they had a quicker progression of CKD and a higher risk of hospitalisation&#44; cardiovascular events and mortality&#46;<span class="elsevierStyleSup">21</span></p><p class="elsevierStylePara">Demographic factors that influence the presence of anaemia in the study population include CKD stage &#40;greater prevalence of anaemia as the glomerular filtration rate decreases&#41;&#44; age &#40;greater prevalence of anaemia in older patients&#44; probably related to a lower eGFR&#41; and the aetiology of CKD &#40;greater prevalence of anaemia in diabetic nephropathy and lower prevalence in interstitial nephritis&#41;&#46; These results coincide with previous studies that demonstrate that anaemia is more common and severe at any eGFR level in diabetic patients&#44; compared with non-diabetic patients&#46;<span class="elsevierStyleSup">22&#44;23</span></p><p class="elsevierStylePara">Mean haemoglobin of CKD patients was relatively high &#40;12&#46;6g&#47;dl&#41;&#44; bearing in mind that 40&#46;5&#37; of patients were receiving some form of treatment for anaemia&#46; Of the 187 patients treated for anaemia&#44; 72&#46;7&#37; &#40;136 patients&#41; were treated with ESA at the time of the study&#46;</p><p class="elsevierStylePara">In earlier stages of CKD&#44; only 16&#46;7&#37; of patients with stage 3a CKD and 31&#46;3&#37; with stage 3b CKD received some form of treatment for anaemia&#44; with mean haemoglobin levels of 13&#46;6g&#47;dl and 12&#46;9g&#47;dl being observed&#44; respectively&#46; As CKD progressed&#44; the percentage of patients who received some form of treatment for anaemia increased to 85&#46;7&#37; in stage 5 with mean haemoglobin of 11&#46;4g&#47;dl being observed&#46;</p><p class="elsevierStylePara">In the most advanced stages of CKD &#40;4 and 5&#41;&#44; anaemia was controlled by more frequent use of ESA&#44; notably ESA with a longer half-life&#44; which allow them to be administered biweekly or monthly&#46; This facilitates compliance&#44; it is more comfortable for the patient and it improves haemoglobin stability&#46; Furthermore&#44; monthly doses of agents with a longer half-life &#40;darbepoetin or C&#46;E&#46;R&#46;A&#46;&#41; were lower than equivalent doses of erythropoietin&#44; although given the cross-sectional nature of the study&#44; these data should be interpreted with caution&#46; It should also be highlighted from this study that anaemia control is achieved with relatively low doses of ESA &#40;80&#956;g&#47;month darbepoetin&#44; 75&#956;g&#47;month C&#46;E&#46;R&#46;A&#46;&#41; with respect to other studies with darbepoetin or C&#46;E&#46;R&#46;A&#46;<span class="elsevierStyleSup">13&#44;24-26 </span>This is important because high doses of ESA have been associated with higher mortality<span class="elsevierStyleSup">27 </span>and the guidelines advise considering the ESA doses necessary for achieving the haemoglobin levels&#46;<span class="elsevierStyleSup">17</span></p><p class="elsevierStylePara">In our study&#44; 43&#46;4&#37; of anaemic patients who received ESA had haemoglobin &#62;12g&#47;dl and 12&#46;5&#37; had haemoglobin &#62;13g&#47;dl&#44; which suggests overtreatment with ESA in a significant percentage of them&#46; Additionally in our study&#44; we observed that 24 patients &#40;32&#46;0&#37; of whom had haemoglobin &#60;11g&#47;dl&#41; did not receive any treatment for anaemia&#46;</p><p class="elsevierStylePara">Although the mean values of ferritin and TSI of the whole group were above the minimum values advised in the guidelines&#44; 36&#46;3&#37; of anaemic patients had an iron deficiency&#46; With regard to iron therapy&#44; 53&#46;3&#37; of iron-deficient patients received treatment with iron supplements &#40;most as oral iron supplements&#41;&#44; 12&#37; did not receive iron and there was no data available for 34&#46;5&#37;&#46; Assuming that where no data was contributed the patients did not receive iron&#44; this suggests an aspect of improvement in anaemia treatment in these patients&#44; as indicated by recommendations by experts and the new KDIGO &#40;Kidney Disease Improving Global Outcomes&#41; guidelines&#44; which promote iron therapy for optimising erythropoiesis and the response of the ESA treatment&#46;<span class="elsevierStyleSup">28-29</span></p><p class="elsevierStylePara">The main limitation of this study for the interpretation of its results is its cross-sectional nature and that the conclusions are obtained from haemoglobin levels and iron parameters from just one laboratory test&#44; and from the dosage of a treatment at one point in time&#46; Another limitation concerns the difference between the valid definition for all the populations &#40;haemoglobin &#60;13&#46;5g&#47;dl in males and &#60;12g&#47;dl in females&#41; and accepted target haemoglobin levels for good control of anaemia in CKD patients&#44; defined as the result of the latest prospective multicentre studies carried out&#44;<span class="elsevierStyleSup">11-13 </span>which would be between 10 and 12g&#47;dl&#44; both in males and females&#46; Furthermore&#44; this study did not evaluate other parameters that influence haemoglobin levels and ESA dose&#44; such as the presence of inflammation&#44; nutritional parameters&#44; treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists&#44; or intact parathyroid hormone levels&#46; Furthermore&#44; this study cannot be extrapolated to the general CKD patient population&#44; since many are treated in Primary Care&#44; but it can be extrapolated to the patient subgroup treated in outpatient Nephrology clinics&#44; who presumably have more comorbidities&#44; including anaemia&#46;</p><p class="elsevierStylePara">The main conclusion of this study is that patients with stages 3&#44; 4 and 5 CKD not on dialysis followed up in hospital clinics of Catalonia have a high prevalence but&#44; in general&#44; an adequate control of anaemia&#46; This good control is achieved with a combination of moderate doses of ESA &#40;particularly in advanced stages of CKD&#41; and the prescription of iron in more than 50&#37; of those who require it&#46; Nevertheless&#44; we have observed a significant percentage of patients treated with ESA with haemoglobin levels &#62;12g&#47;dl and a certain undertreatment of iron deficiency&#44; which suggests that there are opportunities for improvement in the treatment of anaemia in our patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">MICENAS I study researchers&#46; The following researchers also participated in this study&#58; Arias M&#46; &#40;Hospital Cl&#237;nic&#44; Barcelona&#41;&#44; Perell&#243; M&#46; &#40;Hospital Vall d&#180;Hebron&#44; Barcelona&#41;&#44; Samon R&#46; &#40;Hospital Mollet&#44; Barcelona&#41;&#44; Agraz I&#46; &#40;Hospital Vall d&#180;Hebron&#44; Barcelona&#41;&#44; Bayes B&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Ca&#241;as L&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Castellote E&#46; &#40;Hospital de Vic&#44; Barcelona&#41;&#44; Craver L&#46; &#40;Hospital Arnau de Vilanova&#44; Barcelona&#41;&#44; Garc&#237;a R&#46; &#40;Hospital Palam&#243;s&#44; Girona&#41;&#44; Felip A&#46; &#40;Hospital Matar&#243;&#44; Barcelona&#41;&#44; Lauzurica R&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Pou M&#46; &#40;Hospital Terrassa&#44; Barcelona&#41;&#44; Ballar&#237;n J&#46; &#40;Fundaci&#243; Puigvert&#44; Barcelona&#41;&#44; Puig J&#46;M&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Puig C&#46; &#40;Hospital d&#39;Igualada&#44; Barcelona&#41;&#44; Cao H&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Collado S&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Barbosa F&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Mart&#237;nez-Vea A&#46; &#40;Hospital Universitari Joan XXIII&#44; Tarragona&#41;&#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">This study was sponsored by the Societat Catalana de Nefrologia with financing from Roche Pharma in Spain&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56332&#95;en&#95;pginas&#95;desde6&#46;12261&#95;02i&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56332_en_pginas_desde6.12261_02i.jpg" alt="Characteristics of the patients included in the study&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the patients included in the study&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56333&#95;en&#95;t2&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56333_en_t2_6.12261_02i2.jpg" alt="Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56334&#95;en&#95;t3&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56334_en_t3_6.12261_02i2.jpg" alt="Patient profile according to the presence of anaemia&#46;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Patient profile according to the presence of anaemia&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56335&#95;en&#95;t4&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56335_en_t4_6.12261_02i2.jpg" alt="Treatment of anaemia according to the chronic kidney disease stage&#46;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Treatment of anaemia according to the chronic kidney disease stage&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56336&#95;en&#95;t5&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56336_en_t5_6.12261_02i2.jpg" alt="Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;"></img></a></p><p class="elsevierStylePara">Table 5&#46; Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56338&#95;en&#95;t7&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56338_en_t7_6.12261_02i2.jpg" alt="Treatment for anaemia according to haemoglobin levels&#46;"></img></a></p><p class="elsevierStylePara">Table 7&#46; Treatment for anaemia according to haemoglobin levels&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56339&#95;en&#95;t8&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56339_en_t8_6.12261_02i2.jpg" alt="Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;"></img></a></p><p class="elsevierStylePara">Table 8&#46; Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56340&#95;en&#95;f16&#46;12261&#95;02i&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56340_en_f16.12261_02i.jpg" alt="Correlation between the haemoglobin level and the glomerular filtration rate&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Correlation between the haemoglobin level and the glomerular filtration rate&#46;</p><p class="elsevierStylePara"><a href="12261&#95;19157&#95;56337&#95;en&#95;w47771409412ref&#46;1226127659&#95;12261&#95;19115&#95;54116&#95;es&#95;12261&#95;tabla6&#95;en&#46;docx" class="elsevierStyleCrossRefs">12261&#95;19157&#95;56337&#95;en&#95;w47771409412ref&#46;1226127659&#95;12261&#95;19115&#95;54116&#95;es&#95;12261&#95;tabla6&#95;en&#46;docx</a></p><p class="elsevierStylePara">Table 6&#46; Treatment with iron supplements in anaemic and iron-deficient patients according to the chronic kidney disease stage&#46; </p>"
    "pdfFichero" => "P1-E567-S4547-A12261-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:4 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438667"
          "palabras" => array:1 [
            0 => "Ferropenia"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438669"
          "palabras" => array:1 [
            0 => "Enfermedad renal cr&#243;nica"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438671"
          "palabras" => array:1 [
            0 => "Anemia"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438673"
          "palabras" => array:1 [
            0 => "Agentes estimuladores de la eritropoyesis"
          ]
        ]
      ]
      "en" => array:4 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438668"
          "palabras" => array:1 [
            0 => "IIron deficiency"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438670"
          "palabras" => array:1 [
            0 => "Chronic kidney disease"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438672"
          "palabras" => array:1 [
            0 => "Anaemia"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438674"
          "palabras" => array:1 [
            0 => "Erythropoiesis-stimulating agents"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> La anemia es una complicaci&#243;n frecuente de la enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; El objetivo de este estudio fue conocer la prevalencia de anemia en pacientes con ERC estadios 3-5 no en di&#225;lisis atendidos en consultas externas &#40;CCEE&#41; de Nefrolog&#237;a en Catalu&#241;a y su manejo cl&#237;nico&#46; <span class="elsevierStyleBold">Metodolog&#237;a&#58;</span> Estudio epidemiol&#243;gico&#44; de cohorte transversal&#44; multic&#233;ntrico&#44; en condiciones de pr&#225;ctica cl&#237;nica habitual&#46; Recogida de datos mediante un e-CRD que inclu&#237;a datos de filiaci&#243;n y aquellos relacionados con la anemia &#40;hemoglobina&#44; estatus f&#233;rrico&#44; tratamiento con agentes estimuladores de la eritropoyesis &#91;AEE&#93; y con otros coadyuvantes&#41;&#46; Se defini&#243; anemia como unos niveles de hemoglobina &#60;&#160;13&#44;5&#160;g&#47;dl en varones o &#60;&#160;12&#160;g&#47;dl en mujeres o pacientes que recibieran tratamiento con AEE&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Se incluyeron<span class="elsevierStyleItalic"> </span>504 pacientes &#40;56&#44;4&#160;&#37; varones&#44; edad media de 67&#44;8&#160;&#177;&#160;15&#44;5 a&#241;os&#41;&#58; 61&#44;5&#160;&#37; presentaban ERC estadio 3&#44; 30&#44;2&#160;&#37; estadio 4 y 8&#44;3&#160;&#37; estadio 5&#46; Las principales causas de ERC fueron la vascular y la nefropat&#237;a diab&#233;tica&#46; La prevalencia de anemia fue del 58&#44;5&#160;&#37; &#40;n&#160;&#61;&#160;295&#41;&#59; sin embargo&#44; solo un 14&#44;9&#160;&#37; de los pacientes ten&#237;an niveles de hemoglobina &#60;&#160;11&#160;g&#47;dl&#46; Los niveles medios de hemoglobina disminu&#237;an y el tratamiento con AEE era m&#225;s frecuente a medida que progresaba la ERC&#44; pero no se observaron diferencias significativas respecto a la prescripci&#243;n de hierro&#44; seg&#250;n estadios&#46; Los AEE e intervalos m&#225;s frecuentemente prescritos fueron darbepoetina alfa con una dosis mediana de 40 &#956;g&#47;bisemanal&#44; seguida por C&#46;E&#46;R&#46;A&#46;&#44; con una dosis mediana de 75 &#956;g&#47;mensual y epoetina beta con una dosis mediana de 5000 UI&#47;semanal&#46; De los pacientes con anemia &#40;n&#160;&#61;&#160;295&#41;&#44; un 36&#44;3&#160;&#37; &#40;n&#160;&#61;&#160;107&#41; presentaban ferropenia y de ellos solo un 53&#44;3&#160;&#37; recib&#237;a tratamiento con suplementos de hierro&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span><span class="elsevierStyleItalic"> </span>Este estudio demuestra la alta prevalencia de anemia&#44; la cual aumenta a medida que progresa la enfermedad&#44; as&#237; como el buen control de la misma en la poblaci&#243;n de pacientes con ERC atendidos en CCEE de Nefrolog&#237;a en Catalu&#241;a&#46; Este control se consigue con dosis moderadas de AEE y prescripci&#243;n de suplementos de hierro en m&#225;s del 50&#160;&#37; de los pacientes an&#233;micos&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Anaemia is a common complication of chronic kidney disease &#40;CKD&#41;&#46; The aim of this study was to determine the prevalence and clinical management of anaemia in patients with stages 3-5 CKD not on dialysis treated in outpatient Nephrology clinics &#40;OC&#41; in Catalonia&#46; <span class="elsevierStyleBold">Methods&#58;</span> Epidemiological&#44; cross-sectional cohort&#44; multicentre study under routine clinical practice conditions&#46; Data collection by electronic data collection log-book &#40;e-DCL&#41; including personal information and data related to anaemia &#40;haemoglobin&#44; iron status&#44; treatment with erythropoiesis-stimulating agents &#91;ESA&#93; and other anaemia treatments&#41;&#46; Anaemia was defined as haemoglobin levels &#60;13&#46;5g&#47;dL in males or &#60;12g&#47;dL in females or patients who receive treatment with ESA&#46; <span class="elsevierStyleBold">Results&#58;</span> We included 504 patients &#40;56&#46;4&#37; male&#44; mean age of 67&#46;8&#177;15&#46;5 years&#41;&#58; 61&#46;5&#37; had stage 3 CKD&#44; 30&#46;2&#37; stage 4 and 8&#46;3&#37; stage 5&#46; The main causes of CKD were vascular and diabetic nephropathy&#46; The prevalence of anaemia was 58&#46;5&#37; &#40;n&#61;295&#41;&#44; however&#44; only 14&#46;9&#37; of patients had haemoglobin levels &#60;11g&#47;dL&#46; Mean haemoglobin levels decreased and ESA treatment was more common as CKD progressed&#44; but no significant differences were observed regarding the prescription of iron&#44; according to CKD stages&#46; ESA and intervals most frequently prescribed were darbepoetin alfa with a median dose of 40&#956;g&#47;biweekly&#44; followed by C&#46;E&#46;R&#46;A&#46; with a median dose of 75&#956;g&#47;month and epoetin beta with a median dose of 5&#44;000IU&#47;week&#46; Among the patients with anaemia &#40;n&#61;295&#41;&#44; 36&#46;3&#37; &#40;n&#61;107&#41; had iron deficiency and only 53&#46;3&#37; of these patients were treated with iron supplements&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> This study demonstrates the high prevalence of anaemia&#44; which increases as the disease progresses and its good control in a CKD patient population treated in Nephrology outpatient clinics in Catalonia&#46; This control is achieved with moderate doses of ESA and iron supplements prescribed in more than 50&#37; of anaemic CKD patients&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56332_en_pginas_desde6.12261_02i.jpg"
            "Alto" => 654
            "Ancho" => 716
            "Tamanyo" => 74456
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the patients included in the study&#46;"
        ]
      ]
      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" => "12261_16025_56333_en_t2_6.12261_02i2.jpg"
            "Alto" => 1254
            "Ancho" => 2165
            "Tamanyo" => 376763
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;"
        ]
      ]
      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" => "12261_16025_56334_en_t3_6.12261_02i2.jpg"
            "Alto" => 1166
            "Ancho" => 2160
            "Tamanyo" => 391329
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Patient profile according to the presence of anaemia&#46;"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56335_en_t4_6.12261_02i2.jpg"
            "Alto" => 519
            "Ancho" => 2174
            "Tamanyo" => 284057
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment of anaemia according to the chronic kidney disease stage&#46;"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56336_en_t5_6.12261_02i2.jpg"
            "Alto" => 523
            "Ancho" => 2143
            "Tamanyo" => 272915
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Tab.  7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56338_en_t7_6.12261_02i2.jpg"
            "Alto" => 376
            "Ancho" => 2179
            "Tamanyo" => 179832
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment for anaemia according to haemoglobin levels&#46;"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Tab.  8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56339_en_t8_6.12261_02i2.jpg"
            "Alto" => 385
            "Ancho" => 2179
            "Tamanyo" => 211942
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig8"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56340_en_f16.12261_02i.jpg"
            "Alto" => 1321
            "Ancho" => 2111
            "Tamanyo" => 643824
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Correlation between the haemoglobin level and the glomerular filtration rate&#46;"
        ]
      ]
      8 => array:8 [
        "identificador" => "mmc1"
        "etiqueta" => "Tab. 6"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "Ecomponente" => array:2 [
          "fichero" => "12261_19157_56337_en_w47771409412ref.1226127659_12261_19115_54116_es_12261_tabla6_en.docx"
          "ficheroTamanyo" => 12835
        ]
        "descripcion" => array:1 [
          "en" => "Treatment with iron supplements in anaemic and iron-deficient patients according to the chronic kidney disease stage. "
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Otero A, Gayoso P, Garcia F, de Francisco AL; EPIRCE study group. Epidemiology of chronic renal disease in the Galician Population: results of the pilot Spanish Epirce study. Kidney Int Suppl 2005;(99):S16-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16612395" 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" => "US Renal Data System: USRDS 2009 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rucker D, Tonelli M. Cardiovascular risk and management in chronic kidney disease. Nat Rev Nephrol 2009;5:287-96. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19384330" 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" => "Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 2001;38:803-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11576884" 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" => "Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia. The Third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2002;162:1401-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Obrador GT, Roberts T, St Peter WL, Frazier E, Pereira BJG, Collins AJ. Trends in anemia at initiation of dialysis in the United States. Kidney Int 2001;60:1875-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11703606" 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" => "Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomiopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 1996;28:53-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8712222" 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" => "Moreno F, Sanz-Guajardo D, Lopez-Gomez JM, Jofre R, Valderrabano F. Increasing the hematocrit has beneficial effect on quality of life and is safe in selected haemodialysis patients. Spanish Cooperative Renal Patients Quality of life Study Group of the Spanish Society of Nephrology. J Am Soc Nephrol 2000;11:335-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10665941" 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" => "Cody J, Daly C, Campbell M, Donaldson C, Khan I, Rabindranath K, et al. Recombinant human erythropoietin for chronic renal failure anemia in pre-dialysis patients. Cochrane Database Syst Rev 2005;(3):CD003266."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "De Nicola L, Chiodini P, Zoccali C, Borrelli S, Cianciaruso B, Di Iorio B, et al.; SIN-TABLE CKD Study Group. Prognosis of CKD patients receiving outpatient nephrology care in Italy. Clin J Am Soc Nephrol 2011;6:2421-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21817127" 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" => "Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al.; CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085-98."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al.; CREATE investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17108342" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, et al.; TREAT investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361:2019-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19880844" 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" => "Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, et al. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med 2010;153:23-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20439566" 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" => "Clement FM, Klarenbach S, Tonelli M, Johnson JA, Manns BJ. The impact of selecting a high hemoglobin target level on health-related quality of life for patients with chronic kidney disease: a systematic review and meta-analysis. Arch Intern Med 2009;169:1104-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19546410" 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" => "Parfrey PS, Lauve M, Latremouille-Viau D, Lefebvre P. Erythropoietin therapy and left ventricular mass index in CKD and ESRD patients: a meta-analysis. Clin J Am Soc Nephrol 2009;4:755-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19339417" 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" => "Locatelli F, Aljama P, Canaud B, Covic A, De Francisco, Macdougall IC, et al.; Anemia Working group of European Best Practice (ERBP). Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) study. Nephrol Dial Transplant 2010;25:2846-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20591813" 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" => "Ref.EMEA/188068/2007 European Medicines Agency starts review of the safety of epoetins. Available at: http://www.halmed.hr/upl/novosti/18806807en.pdf."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martínez-Castelao A, Górriz JL, Portolés JM, De Alvaro F, Cases A, Luño J, et al. Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in Spain: the MERENA observational cohort study. BMC Nephrol 2011;12:53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21970625" 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" => "De Nicola L, Minutolo R, Chiodini P, Zoccali C, Castellino P, Donadio C, et al.; Target Blood Pressure LEvels in Chronic Kidney Disease (TABLE in CKD) Study Group. Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention. Kidney Int 2006;69:538-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16395261" 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" => "Portolés J, Gorriz JL, Rubio E, de Alvaro F, García F, Alvarez-Chivas V, et al.; NADIR-3 Study Group. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease. BMC Nephrol 2013;14:2."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dikow R, Schwenger V, Schomig M, Ritz E. How should we manage anemia in patients with diabetes? Nephrol Dial Transplant 2001;17:67-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11812916" 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" => "Bosman DR, Winker AS, Marseden JT, MacDougall IC, Watkins PJ. Anaemia with erythropoietin deficiency occurs early in diabetic nephropaty. Diabetes Care 2001;24:495-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11289474" 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" => "Agarwal AK, Silver MR, Reed JE, Dhingra RK, Liu W, Varma N, et al. An open-label study of darbepoetin alfa administered once monthly for the maintenance of haemoglobin concentrations in patients with chronic kidney disease not receiving dialysis. J Intern Med 2006;260:577-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17116009" 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" => "Minutolo R, Zamboli P, Chiodini P, Mascia S, Vitiello S, Stanzione G, et al. Conversion of darbepoetin to low doses of CERA maintains hemoglobin levels in non-dialysis chronic kidney disease patients. Blood Purif 2010;30:186-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20924174" 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" => "Frimat L, Mariat C, Landais P, Koné S, Commenges B, Choukroun G. Anaemia management with C.E.R.A. in routine clinical practice: OCEANE (Cohorte Mircera patients non-dialyses), a national, multicenter, longitudinal, observational prospective study, in patients with chronic kidney disease not on dialysis. BMJ Open 2013;3(3):e001888. pii: e001888. doi: 10.1136/bmjopen-2012-001888."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cuevas X, García F, Martín-Malo A, Fort J, Lladós F, Lozano J, et al. Risk factors associated with cardiovascular morbidity and mortality in Spanish incident hemodialysis patients: two-year results from the ANSWER Study. Blood Purif 2011;33(1-3):21-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22134224" 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" => "Besarab A, Coyne DW. Iron supplementation to treat anemia in patients with chronic kidney disease. Nat Rev Nephrol 2010;6:699-710. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20956992" 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" => "KDIGO. Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:279-335."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053795/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/X2013251414053795/v0_201502091616/en/P1-E567-S4547-A12261-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053795?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study
Prevalencia de anemia y su manejo clínico en la enfermedad renal crónica estadios 3-5 no en diálisis en Cataluña: estudio MICENAS I
Investigadores del estudio MICENAS I, Aleix Cases-Amenósb, Alberto Martínez-Castelaoc, Joan Fort-Rosd, Jordi Bonal-Bastonse, M. Pilar Ruize, Martí Vallés-Pratsf, Elisabeth Coll-Pierag, Josep M. Galcerán-Guih
b Servicio de Nefrología, Hospital Clínic, Barcelona,
c Servicio de Nefrología, Hospital Universitari de Bellvitge, Barcelona,
d Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona,
e Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Barcelona,
f Servicio de Nefrología, Hospital Universitari Josep Trueta, Girona
g Servicio de Nefrología, Fundació Puigvert, Barcelona,
h Servicio de Nefrología, Fundació Althaia Manresa, Barcelona,
Read
18213
Times
was read the article
3865
Total PDF
14348
Total HTML
Share statistics
 array:21 [
  "pii" => "X2013251414053795"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
  "estado" => "S300"
  "fechaPublicacion" => "2014-03-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:189-98"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 11075
    "formatos" => array:3 [
      "EPUB" => 322
      "HTML" => 9500
      "PDF" => 1253
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699514053798"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
      "estado" => "S300"
      "fechaPublicacion" => "2014-03-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2014;34:189-98"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 16378
        "formatos" => array:3 [
          "EPUB" => 415
          "HTML" => 14999
          "PDF" => 964
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Prevalencia de anemia y su manejo cl&#237;nico en la enfermedad renal cr&#243;nica estadios 3-5 no en di&#225;lisis en Catalu&#241;a&#58; estudio MICENAS I"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "189"
            "paginaFinal" => "198"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia&#58; MICENAS I study"
          ]
        ]
        "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" => "12261_19904_50419_es_12261_t1.jpg"
                "Alto" => 673
                "Ancho" => 700
                "Tamanyo" => 303661
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Caracter&#237;sticas de los pacientes incluidos en el estudio&#46;"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => " Investigadores del estudio MICENAS I, Aleix Cases-Amen&#243;s, Alberto Mart&#237;nez-Castelao, Joan Fort-Ros, Jordi Bonal-Bastons, M&#46; Pilar Ruiz, Mart&#237; Vall&#233;s-Prats, Elisabeth Coll-Piera, Josep M&#46; Galcer&#225;n-Gui"
            "autores" => array:9 [
              0 => array:1 [
                "apellidos" => "Investigadores del estudio MICENAS I"
              ]
              1 => array:2 [
                "nombre" => "Aleix"
                "apellidos" => "Cases-Amen&#243;s"
              ]
              2 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Mart&#237;nez-Castelao"
              ]
              3 => array:2 [
                "nombre" => "Joan"
                "apellidos" => "Fort-Ros"
              ]
              4 => array:2 [
                "nombre" => "Jordi"
                "apellidos" => "Bonal-Bastons"
              ]
              5 => array:2 [
                "nombre" => "M&#46; Pilar"
                "apellidos" => "Ruiz"
              ]
              6 => array:2 [
                "nombre" => "Mart&#237;"
                "apellidos" => "Vall&#233;s-Prats"
              ]
              7 => array:2 [
                "nombre" => "Elisabeth"
                "apellidos" => "Coll-Piera"
              ]
              8 => array:2 [
                "nombre" => "Josep M&#46;"
                "apellidos" => "Galcer&#225;n-Gui"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251414053795"
          "doi" => "10.3265/Nefrologia.pre2013.Dec.12261"
          "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/X2013251414053795?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514053798?idApp=UINPBA000064"
      "url" => "/02116995/0000003400000002/v0_201502091349/X0211699514053798/v0_201502091350/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251414053787"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Nov.12145"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:199-204"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8406
      "formatos" => array:3 [
        "EPUB" => 345
        "HTML" => 7233
        "PDF" => 828
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "The effect of replacing aluminium hydroxide with calcium acetate&#47;magnesium carbonate on serum phosphorus control in haemodialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "199"
          "paginaFinal" => "204"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Efecto en el control del f&#243;sforo s&#233;rico tras la sustituci&#243;n de hidr&#243;xido de aluminio por acetato c&#225;lcico&#47;carbonato magn&#233;sico en pacientes 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" => "12145_16025_55977_en_t17.12145i.jpg"
              "Alto" => 1113
              "Ancho" => 1084
              "Tamanyo" => 285897
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Patient baseline characteristics&#46;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "David Arroyo, Nayara Panizo, Soraya Abad, Almudena Vega, Ana P&#233;rez-de Jos&#233;, Juan M&#46; L&#243;pez-G&#243;mez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "David"
              "apellidos" => "Arroyo"
            ]
            1 => array:2 [
              "nombre" => "Nayara"
              "apellidos" => "Panizo"
            ]
            2 => array:2 [
              "nombre" => "Soraya"
              "apellidos" => "Abad"
            ]
            3 => array:2 [
              "nombre" => "Almudena"
              "apellidos" => "Vega"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "P&#233;rez-de Jos&#233;"
            ]
            5 => array:2 [
              "nombre" => "Juan M&#46;"
              "apellidos" => "L&#243;pez-G&#243;mez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169951405378X"
        "doi" => "10.3265/Nefrologia.pre2013.Nov.12145"
        "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/X021169951405378X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053787?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053787/v0_201502091616/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X201325141405380X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
    "estado" => "S300"
    "fechaPublicacion" => "2014-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:175-88"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8074
      "formatos" => array:3 [
        "EPUB" => 331
        "HTML" => 6937
        "PDF" => 806
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Spanish nephrologists and the management of mineral and bone metabolism disorders in chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "175"
          "paginaFinal" => "188"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Los nefr&#243;logos espa&#241;oles y el manejo de las alteraciones del metabolismo &#243;seo-mineral en la enfermedad renal cr&#243;nica"
        ]
      ]
      "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" => "12280_16025_56452_en_t15.12280_04.jpg"
              "Alto" => 9292
              "Ancho" => 2168
              "Tamanyo" => 4635887
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Statistical results for the 86 statements&#46;"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Cannata-And&#237;a, J&#46; Vicente Torregrosa"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Cannata-And&#237;a"
            ]
            1 => array:2 [
              "nombre" => "J&#46; Vicente"
              "apellidos" => "Torregrosa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514053802"
        "doi" => "10.3265/Nefrologia.pre2014.Jan.12280"
        "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/X0211699514053802?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405380X?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000002/v0_201502091616/X201325141405380X/v0_201502091616/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Prevalence of anaemia and its clinical management in patients with stages 3-5 chronic kidney disease not on dialysis in Catalonia&#58; MICENAS I study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "189"
        "paginaFinal" => "198"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => " Investigadores del estudio MICENAS I, Aleix Cases-Amen&#243;s, Alberto Mart&#237;nez-Castelao, Joan Fort-Ros, Jordi Bonal-Bastons, M&#46; Pilar Ruiz, Mart&#237; Vall&#233;s-Prats, Elisabeth Coll-Piera, Josep M&#46; Galcer&#225;n-Gui"
        "autores" => array:9 [
          0 => array:1 [
            "apellidos" => "Investigadores del estudio MICENAS I"
          ]
          1 => array:4 [
            "nombre" => "Aleix"
            "apellidos" => "Cases-Amen&#243;s"
            "email" => array:1 [
              0 => "acases&#64;clinic&#46;ub&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Mart&#237;nez-Castelao"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Joan"
            "apellidos" => "Fort-Ros"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Jordi"
            "apellidos" => "Bonal-Bastons"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46; Pilar"
            "apellidos" => "Ruiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "affe"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Mart&#237;"
            "apellidos" => "Vall&#233;s-Prats"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "afff"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Elisabeth"
            "apellidos" => "Coll-Piera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "affg"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Josep M&#46;"
            "apellidos" => "Galcer&#225;n-Gui"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "affh"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:7 [
          0 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Clínic, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          1 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari de Bellvitge, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          2 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
          3 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Germans Trias i Pujol, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">e</span>"
            "identificador" => "affe"
          ]
          4 => array:3 [
            "entidad" => " Servicio de Nefrología, Hospital Universitari Josep Trueta, Girona   "
            "etiqueta" => "<span class="elsevierStyleSup">f</span>"
            "identificador" => "afff"
          ]
          5 => array:3 [
            "entidad" => " Servicio de Nefrología, Fundació Puigvert, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">g</span>"
            "identificador" => "affg"
          ]
          6 => array:3 [
            "entidad" => " Servicio de Nefrología, Fundació Althaia Manresa, Barcelona,   "
            "etiqueta" => "<span class="elsevierStyleSup">h</span>"
            "identificador" => "affh"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Prevalencia de anemia y su manejo cl&#237;nico en la enfermedad renal cr&#243;nica estadios 3-5 no en di&#225;lisis en Catalu&#241;a&#58; estudio MICENAS I"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56332_en_pginas_desde6.12261_02i.jpg"
            "Alto" => 654
            "Ancho" => 716
            "Tamanyo" => 74456
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the patients included in the study&#46;"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Chronic kidney disease &#40;CKD&#41; affects around 11&#37; of the Spanish adult population&#44; according to data from the EPIRCE study&#44;<span class="elsevierStyleSup">1</span> and is associated with high morbidity and mortality&#44; particularly as a consequence of cardiovascular disease&#46;<span class="elsevierStyleSup">2&#44;3</span> Furthermore&#44; CKD is related to a series of complications&#44; including anaemia&#44;<span class="elsevierStyleSup">4 </span>which has been linked to higher morbidity and mortality and CKD progression&#46;</p><p class="elsevierStylePara">The presence of anaemia is already observed in early stages of CKD &#40;stage 3&#41;&#44; but its prevalence increases as renal failure progresses to more advanced stages&#46;<span class="elsevierStyleSup">5 </span>The main cause of anaemia in CKD patients is an erythropoietin deficiency&#44; although a decrease in the half-life of red blood cells&#44; iron and vitamin deficiency and other factors have also been involved&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">Since the introduction of recombinant human erythropoietin&#44; erythropoiesis-stimulating agents &#40;ESA&#41; have become the cornerstone of CKD anaemia treatment and have reduced requirements for transfusion&#44; improved the quality of life and reduced left ventricular hypertrophy and morbidity and mortality in these patients&#46;<span class="elsevierStyleSup">6-10 </span>However&#44; target haemoglobin has been the subject of debate in recent years due to recent randomised studies and meta-analyses that have demonstrated that total anaemia correction with ESA is not associated with better survival or a significant improvement in quality of life&#44; while it is associated with a potential increase in adverse cardiovascular effects&#46;<span class="elsevierStyleSup">11-16</span></p><p class="elsevierStylePara">In light of these results&#44; the 2010 European guidelines recommended target haemoglobin of between 11 and 12g&#47;dl&#44; without intentionally exceeding 13g&#47;dl<span class="elsevierStyleSup">17 </span>and the EMA &#40;European Medicines Agency&#41; advises not exceeding haemoglobin levels of 12g&#47;dl in patients treated with ESA &#40;Ref&#46; EMEA&#47;188068&#47;2007&#41;&#46;<span class="elsevierStyleSup">18</span></p><p class="elsevierStylePara">The objective of this study was to establish the prevalence of anaemia in patients with stages 3&#44; 4 and 5 CKD not on dialysis treated in outpatient Nephrology clinics in Catalonia&#44; and know its therapeutic management &#40;haemoglobin levels achieved&#44; prescription of ESA&#44; iron therapy and other concomitant treatments&#41; in clinical practice&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study design and data collection</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">This is an epidemiological&#44; cross-sectional&#44; multicentre study under routine clinical practice conditions&#46;</p><p class="elsevierStylePara">The study data were collected during 2010&#46; All Nephrology Services in Catalonia were invited to participate and we conducted a feasibility survey on all candidates&#46; Nineteen centres were included in the study &#40;90&#46;47&#37; of those invited&#41;&#44; of which 17 recruited patients &#40;80&#46;95&#37; of those invited&#41;&#46; Two of the centres invited did not participate in the study&#46; Participant centres contributed data from all patients visited consecutively in outpatient Nephrology clinics who met the inclusion and exclusion criteria and who gave their consent to participate in the study over a week&#44; with the aim of including the highest possible number of patients&#46; The data were collected using an electronic data collection log-book &#40;e-DCL&#41;&#44; which was developed specifically for the study&#46; We compiled patients&#8217; demographic data &#40;age&#44; gender&#44; weight&#44; height&#44; CKD stage&#44; CKD diagnosis time&#41; and data corresponding to anaemia &#40;haemoglobin levels&#44; ferritin levels&#44; transferrin saturation index &#91;TSI&#93;&#44; treatment with ESA&#44; iron&#44; folic acid or vitamin B<span class="elsevierStyleSup">12</span>&#41;&#46; We also estimated the glomerular filtration rate &#40;eGFR&#41; using the MDRD-4 formula&#46;</p><p class="elsevierStylePara">The study was approved by the different ethics committees of participating hospitals and patients had to sign their informed consent to allow data to be taken from their clinical history&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patient selection</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The study&#8217;s target population was adult patients with CKD and an eGFR of less than 60ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> who were not on dialysis&#46;</p><p class="elsevierStylePara">Inclusion criteria&#58;</p><ul><li>Patients 18 years old or older&#46;</li><li>Patients with an established clinical diagnosis of stage 3&#44; 4 or 5 CKD not on dialysis treated in outpatient Nephrology clinics in Catalonia&#46;</li><li>Patients who gave their informed consent in writing to participate in the study&#46;</li></ul><p class="elsevierStylePara">Exclusion criteria&#58;</p><ul><li>Patients whose clinical history did not include a recent determination of haemoglobin &#40;two months before inclusion&#41;&#46;</li><li>Any patient situation or condition that&#44; in the opinion of the researcher&#44; would make them unsuitable for participating in the study&#46;</li></ul><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Anaemia was defined as haemoglobin levels &#60;13&#46;5g&#47;dl in males and &#60;12g&#47;dl in females or treatment with ESA&#46; We defined iron deficiency as ferritin levels &#60;100ng&#47;ml and&#47;or TSI&#160;&#60;20&#37;&#46;</p><p class="elsevierStylePara">Categorical variables were described using absolute and relative frequencies&#44; including a 95&#37; confidence interval&#46; For the description of the continuous variables&#44; we used means&#44; standard deviation&#44; medians&#44; the minimum and maximum&#44; including the total number of valid values&#46;</p><p class="elsevierStylePara">For quantitative variables&#44; we used parametric tests &#40;Student&#8217;s t-test or Anova&#41; or non-parametric tests &#40;Mann-Whitney or Kruskal-Wallis&#41;&#44; as appropriate&#46; For qualitative variables&#44; we performed the &#967;<span class="elsevierStyleSup">2</span> test&#46;</p><p class="elsevierStylePara">The results were considered to be statistically significant when the <span class="elsevierStyleItalic">P</span> value was less than 0&#46;05&#46;</p><p class="elsevierStylePara">The statistical analyses were carried out using the SAS version 9&#46;1&#46;3 statistical software&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Study population</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We recruited a total of 531 patients&#44; of which we excluded 27 because they did not meet the selection criteria or did not have the data necessary for assessing the main variable&#44; leaving 504 patients included in the study&#46;</p><p class="elsevierStylePara">The characteristics of patients included are displayed in Table 1&#46; 61&#46;5&#37; had stage 3 CKD&#44; 30&#46;2&#37; had stage 4 CKD and the remaining 8&#46;3&#37; had stage 5 of the disease&#46; The causes of CKD are displayed in Table 1&#46; We observe that the main aetiologies are vascular and diabetic nephropathy&#44; although the aetiologies of a high percentage of patients were unknown&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Laboratory data on anaemia and iron status</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Data on haemoglobin and iron status are displayed in Table 2&#44; which shows levels of haemoglobin&#44; serum iron&#44; ferritin and TSI according to CKD stage&#46; Anaemia prevalence in the study population was 58&#46;5&#37;&#44; although only 14&#46;9&#37; of patients had haemoglobin levels &#60;11g&#47;dl&#46; The mean haemoglobin of the whole cohort was 12&#46;6&#177;1&#46;6g&#47;dl&#44; although we observed a tendency for haemoglobin levels to decrease as CKD advanced&#46; We observed an inverse correlation between the eGFR and haemoglobin levels &#40;Figure 1&#41;&#46; The mean ferritin of the whole study group was 158&#46;4&#177;135&#46;8ng&#47;ml and the mean TSI was 24&#46;2&#177;11&#46;7&#37;&#44; without significant differences for ferritin or TSI being observed according to the stage of the disease&#46; Among anaemic patients &#40;n&#61;295&#41;&#44; 36&#46;3&#37; &#40;n&#61;107&#41; had an iron deficiency &#40;ferritin &#60;100ng&#47;ml and&#47;or TSI &#60;20&#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Anaemia prevalence according to demographic data</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The patient&#8217;s profile according to the presence or absence of anaemia is displayed in Table 3&#44; without significant differences being found according to sex&#44; but with there being significant differences according to age &#40;higher anaemia amongst older individuals&#41;&#44; CKD aetiology &#40;diabetes and unknown cause are the most prevalent aetiologies in anaemia&#41;&#44; CKD stage &#40;as CKD progresses&#44; a higher presence of anaemia is observed&#41; and eGFR &#40;lower eGFR amongst patients with anaemia&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Treatments prescribed for anaemia</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">40&#46;5&#37; of all patients were receiving some form of treatment for anaemia at the time of the visit&#46; The data referring to treatment for anaemia are displayed in Tables 4&#44; 5&#44; 6&#44; 7 and 8&#46;</p><p class="elsevierStylePara">The treatments for anaemia are displayed in Table 4 according to the CKD stage&#46; Of the patients treated&#44; 68&#46;0&#37; &#40;n&#61;136&#41; were receiving an ESA&#44; 14&#46;5&#37; were receiving folic acid and 10&#46;0&#37; were receiving vitamin B<span class="elsevierStyleInf">12</span>&#46; 66&#46;0&#37; of all patients with chronic renal failure and anaemia were receiving iron supplements at the time of the visit &#40;61&#37; orally and 5&#37; intravenously&#41;&#46; We can observe how the percentage of patients treated increases as the CKD stage increases &#40;Table 8&#41;&#46; ESA was the most frequent treatment as CKD progressed&#44; while folate and vitamin B<span class="elsevierStyleInf">12 </span>were prescribed more often in earlier stages&#44; but no significant differences were observed with regard to the prescription of iron supplements according to the stages&#46; There were no statistically significant differences with regard to the prescription of oral and intravenous iron according to the CKD stage&#46; In the anaemic patient subgroup we observed similar results to those of the overall population&#44; although they were not significant for vitamin B<span class="elsevierStyleInf">12 </span>and folic acid &#40;Table 5&#41;&#46; The ESA and intervals most frequently prescribed in our population were darbepoetin alfa with a median dose of 40&#956;g&#47;biweekly&#44; followed by C&#46;E&#46;R&#46;A &#40;<span class="elsevierStyleItalic">Continuous Erythropoietin Receptor Activator</span>&#41; with a median dose of 75&#956;g&#47;month&#44; followed by epoetin beta with a median dose of 5000IU&#47;week&#46; The prescription of epoetin alfa to the study population was rare&#46;</p><p class="elsevierStylePara">Table 6 displays treatment with iron supplements in the anaemic&#44; iron-deficient patient subgroup&#59; 53&#46;3&#37; received treatment with iron&#44; 12&#46;1&#37; did not receive iron supplements and in the rest of the patients&#44; it was not specified in the e-DCL&#46; The prescription of iron to anaemic and iron-deficient patients was more common in patients with stage 5 CKD than in earlier stages&#46;</p><p class="elsevierStylePara">Table 7 displays treatment for anaemia according to haemoglobin levels&#44; and we observed that 67&#46;9&#37; of patients with haemoglobin levels &#60;11g&#47;dl received ESA and&#47;or iron therapy and 33&#46;3&#37; received both&#46; Likewise&#44; in patients with haemoglobin &#62;12g&#47;dl&#44; 18&#160;&#37; received ESA&#44; as well as 8&#46;2&#37; of those with haemoglobin &#62;13g&#47;dl&#46; Of those treated with ESA&#44; 43&#46;4&#37; had haemoglobin levels &#62;12g&#47;dl and 12&#46;5&#37; had haemoglobin levels &#62;13g&#47;dl&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">This study shows a high prevalence of anaemia in patients with stages 3-5 CKD not on dialysis and a suitable control of the latter in patients treated in 17 Nephrology Service outpatient clinics in Catalonia&#46;</p><p class="elsevierStylePara">The prevalence of anaemia in this patient population with stages 3-5 CKD not on dialysis was 58&#46;5&#37;&#44; however only 14&#46;9&#37; had haemoglobin of less than 11g&#47;dl&#44; that is&#44; that 85&#46;1&#37; of patients would exceed the low haemoglobin margin established by the European guidelines&#46;<span class="elsevierStyleSup">17 </span>In the MERENA observational multicentre study&#44; conducted on 1129 patients with stages 3 and 4 CKD tested in outpatient Nephrology clinics in Spain&#44; anaemia prevalence was somewhat lower than that of this study &#40;51&#46;3&#37; compared to 58&#46;5&#37;&#41;&#44; although it must be borne in mind that this study did not include patients with stage 5 CKD and it is possible that recently published referral criteria may have resulted in patients who are currently treated in outpatient Nephrology clinics having higher comorbidities&#44; including anaemia&#44; than in previous studies&#44; such as MERENA&#46;<span class="elsevierStyleSup">19 </span>The prevalence of anaemia in 1058 patients with CKD not on dialysis in Italy was 16&#37;&#44; 32&#37; and 51&#37; in stages 3&#44; 4 and 5 respectively&#44; although the definition of anaemia in this study would require lower levels of haemoglobin &#40;haemoglobin &#60;12g&#47;dl in males and &#60;11g&#47;dl in females&#41;&#46;<span class="elsevierStyleSup">20 </span>In a recent Spanish prospective study of 439 non-anaemic patients with CKD&#44; followed up over three years&#44; 35&#37; developed anaemia&#44; and they had a quicker progression of CKD and a higher risk of hospitalisation&#44; cardiovascular events and mortality&#46;<span class="elsevierStyleSup">21</span></p><p class="elsevierStylePara">Demographic factors that influence the presence of anaemia in the study population include CKD stage &#40;greater prevalence of anaemia as the glomerular filtration rate decreases&#41;&#44; age &#40;greater prevalence of anaemia in older patients&#44; probably related to a lower eGFR&#41; and the aetiology of CKD &#40;greater prevalence of anaemia in diabetic nephropathy and lower prevalence in interstitial nephritis&#41;&#46; These results coincide with previous studies that demonstrate that anaemia is more common and severe at any eGFR level in diabetic patients&#44; compared with non-diabetic patients&#46;<span class="elsevierStyleSup">22&#44;23</span></p><p class="elsevierStylePara">Mean haemoglobin of CKD patients was relatively high &#40;12&#46;6g&#47;dl&#41;&#44; bearing in mind that 40&#46;5&#37; of patients were receiving some form of treatment for anaemia&#46; Of the 187 patients treated for anaemia&#44; 72&#46;7&#37; &#40;136 patients&#41; were treated with ESA at the time of the study&#46;</p><p class="elsevierStylePara">In earlier stages of CKD&#44; only 16&#46;7&#37; of patients with stage 3a CKD and 31&#46;3&#37; with stage 3b CKD received some form of treatment for anaemia&#44; with mean haemoglobin levels of 13&#46;6g&#47;dl and 12&#46;9g&#47;dl being observed&#44; respectively&#46; As CKD progressed&#44; the percentage of patients who received some form of treatment for anaemia increased to 85&#46;7&#37; in stage 5 with mean haemoglobin of 11&#46;4g&#47;dl being observed&#46;</p><p class="elsevierStylePara">In the most advanced stages of CKD &#40;4 and 5&#41;&#44; anaemia was controlled by more frequent use of ESA&#44; notably ESA with a longer half-life&#44; which allow them to be administered biweekly or monthly&#46; This facilitates compliance&#44; it is more comfortable for the patient and it improves haemoglobin stability&#46; Furthermore&#44; monthly doses of agents with a longer half-life &#40;darbepoetin or C&#46;E&#46;R&#46;A&#46;&#41; were lower than equivalent doses of erythropoietin&#44; although given the cross-sectional nature of the study&#44; these data should be interpreted with caution&#46; It should also be highlighted from this study that anaemia control is achieved with relatively low doses of ESA &#40;80&#956;g&#47;month darbepoetin&#44; 75&#956;g&#47;month C&#46;E&#46;R&#46;A&#46;&#41; with respect to other studies with darbepoetin or C&#46;E&#46;R&#46;A&#46;<span class="elsevierStyleSup">13&#44;24-26 </span>This is important because high doses of ESA have been associated with higher mortality<span class="elsevierStyleSup">27 </span>and the guidelines advise considering the ESA doses necessary for achieving the haemoglobin levels&#46;<span class="elsevierStyleSup">17</span></p><p class="elsevierStylePara">In our study&#44; 43&#46;4&#37; of anaemic patients who received ESA had haemoglobin &#62;12g&#47;dl and 12&#46;5&#37; had haemoglobin &#62;13g&#47;dl&#44; which suggests overtreatment with ESA in a significant percentage of them&#46; Additionally in our study&#44; we observed that 24 patients &#40;32&#46;0&#37; of whom had haemoglobin &#60;11g&#47;dl&#41; did not receive any treatment for anaemia&#46;</p><p class="elsevierStylePara">Although the mean values of ferritin and TSI of the whole group were above the minimum values advised in the guidelines&#44; 36&#46;3&#37; of anaemic patients had an iron deficiency&#46; With regard to iron therapy&#44; 53&#46;3&#37; of iron-deficient patients received treatment with iron supplements &#40;most as oral iron supplements&#41;&#44; 12&#37; did not receive iron and there was no data available for 34&#46;5&#37;&#46; Assuming that where no data was contributed the patients did not receive iron&#44; this suggests an aspect of improvement in anaemia treatment in these patients&#44; as indicated by recommendations by experts and the new KDIGO &#40;Kidney Disease Improving Global Outcomes&#41; guidelines&#44; which promote iron therapy for optimising erythropoiesis and the response of the ESA treatment&#46;<span class="elsevierStyleSup">28-29</span></p><p class="elsevierStylePara">The main limitation of this study for the interpretation of its results is its cross-sectional nature and that the conclusions are obtained from haemoglobin levels and iron parameters from just one laboratory test&#44; and from the dosage of a treatment at one point in time&#46; Another limitation concerns the difference between the valid definition for all the populations &#40;haemoglobin &#60;13&#46;5g&#47;dl in males and &#60;12g&#47;dl in females&#41; and accepted target haemoglobin levels for good control of anaemia in CKD patients&#44; defined as the result of the latest prospective multicentre studies carried out&#44;<span class="elsevierStyleSup">11-13 </span>which would be between 10 and 12g&#47;dl&#44; both in males and females&#46; Furthermore&#44; this study did not evaluate other parameters that influence haemoglobin levels and ESA dose&#44; such as the presence of inflammation&#44; nutritional parameters&#44; treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists&#44; or intact parathyroid hormone levels&#46; Furthermore&#44; this study cannot be extrapolated to the general CKD patient population&#44; since many are treated in Primary Care&#44; but it can be extrapolated to the patient subgroup treated in outpatient Nephrology clinics&#44; who presumably have more comorbidities&#44; including anaemia&#46;</p><p class="elsevierStylePara">The main conclusion of this study is that patients with stages 3&#44; 4 and 5 CKD not on dialysis followed up in hospital clinics of Catalonia have a high prevalence but&#44; in general&#44; an adequate control of anaemia&#46; This good control is achieved with a combination of moderate doses of ESA &#40;particularly in advanced stages of CKD&#41; and the prescription of iron in more than 50&#37; of those who require it&#46; Nevertheless&#44; we have observed a significant percentage of patients treated with ESA with haemoglobin levels &#62;12g&#47;dl and a certain undertreatment of iron deficiency&#44; which suggests that there are opportunities for improvement in the treatment of anaemia in our patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">MICENAS I study researchers&#46; The following researchers also participated in this study&#58; Arias M&#46; &#40;Hospital Cl&#237;nic&#44; Barcelona&#41;&#44; Perell&#243; M&#46; &#40;Hospital Vall d&#180;Hebron&#44; Barcelona&#41;&#44; Samon R&#46; &#40;Hospital Mollet&#44; Barcelona&#41;&#44; Agraz I&#46; &#40;Hospital Vall d&#180;Hebron&#44; Barcelona&#41;&#44; Bayes B&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Ca&#241;as L&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Castellote E&#46; &#40;Hospital de Vic&#44; Barcelona&#41;&#44; Craver L&#46; &#40;Hospital Arnau de Vilanova&#44; Barcelona&#41;&#44; Garc&#237;a R&#46; &#40;Hospital Palam&#243;s&#44; Girona&#41;&#44; Felip A&#46; &#40;Hospital Matar&#243;&#44; Barcelona&#41;&#44; Lauzurica R&#46; &#40;Hospital Germans Trias i Pujol&#44; Barcelona&#41;&#44; Pou M&#46; &#40;Hospital Terrassa&#44; Barcelona&#41;&#44; Ballar&#237;n J&#46; &#40;Fundaci&#243; Puigvert&#44; Barcelona&#41;&#44; Puig J&#46;M&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Puig C&#46; &#40;Hospital d&#39;Igualada&#44; Barcelona&#41;&#44; Cao H&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Collado S&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Barbosa F&#46; &#40;Hospital del Mar&#44; Barcelona&#41;&#44; Mart&#237;nez-Vea A&#46; &#40;Hospital Universitari Joan XXIII&#44; Tarragona&#41;&#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">This study was sponsored by the Societat Catalana de Nefrologia with financing from Roche Pharma in Spain&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56332&#95;en&#95;pginas&#95;desde6&#46;12261&#95;02i&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56332_en_pginas_desde6.12261_02i.jpg" alt="Characteristics of the patients included in the study&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Characteristics of the patients included in the study&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56333&#95;en&#95;t2&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56333_en_t2_6.12261_02i2.jpg" alt="Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56334&#95;en&#95;t3&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56334_en_t3_6.12261_02i2.jpg" alt="Patient profile according to the presence of anaemia&#46;"></img></a></p><p class="elsevierStylePara">Table 3&#46; Patient profile according to the presence of anaemia&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56335&#95;en&#95;t4&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56335_en_t4_6.12261_02i2.jpg" alt="Treatment of anaemia according to the chronic kidney disease stage&#46;"></img></a></p><p class="elsevierStylePara">Table 4&#46; Treatment of anaemia according to the chronic kidney disease stage&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56336&#95;en&#95;t5&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56336_en_t5_6.12261_02i2.jpg" alt="Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;"></img></a></p><p class="elsevierStylePara">Table 5&#46; Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56338&#95;en&#95;t7&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56338_en_t7_6.12261_02i2.jpg" alt="Treatment for anaemia according to haemoglobin levels&#46;"></img></a></p><p class="elsevierStylePara">Table 7&#46; Treatment for anaemia according to haemoglobin levels&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56339&#95;en&#95;t8&#95;6&#46;12261&#95;02i2&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56339_en_t8_6.12261_02i2.jpg" alt="Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;"></img></a></p><p class="elsevierStylePara">Table 8&#46; Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12261&#95;16025&#95;56340&#95;en&#95;f16&#46;12261&#95;02i&#46;jpg" class="elsevierStyleCrossRefs"><img src="12261_16025_56340_en_f16.12261_02i.jpg" alt="Correlation between the haemoglobin level and the glomerular filtration rate&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Correlation between the haemoglobin level and the glomerular filtration rate&#46;</p><p class="elsevierStylePara"><a href="12261&#95;19157&#95;56337&#95;en&#95;w47771409412ref&#46;1226127659&#95;12261&#95;19115&#95;54116&#95;es&#95;12261&#95;tabla6&#95;en&#46;docx" class="elsevierStyleCrossRefs">12261&#95;19157&#95;56337&#95;en&#95;w47771409412ref&#46;1226127659&#95;12261&#95;19115&#95;54116&#95;es&#95;12261&#95;tabla6&#95;en&#46;docx</a></p><p class="elsevierStylePara">Table 6&#46; Treatment with iron supplements in anaemic and iron-deficient patients according to the chronic kidney disease stage&#46; </p>"
    "pdfFichero" => "P1-E567-S4547-A12261-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:4 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438667"
          "palabras" => array:1 [
            0 => "Ferropenia"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438669"
          "palabras" => array:1 [
            0 => "Enfermedad renal cr&#243;nica"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438671"
          "palabras" => array:1 [
            0 => "Anemia"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec438673"
          "palabras" => array:1 [
            0 => "Agentes estimuladores de la eritropoyesis"
          ]
        ]
      ]
      "en" => array:4 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438668"
          "palabras" => array:1 [
            0 => "IIron deficiency"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438670"
          "palabras" => array:1 [
            0 => "Chronic kidney disease"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438672"
          "palabras" => array:1 [
            0 => "Anaemia"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec438674"
          "palabras" => array:1 [
            0 => "Erythropoiesis-stimulating agents"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> La anemia es una complicaci&#243;n frecuente de la enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; El objetivo de este estudio fue conocer la prevalencia de anemia en pacientes con ERC estadios 3-5 no en di&#225;lisis atendidos en consultas externas &#40;CCEE&#41; de Nefrolog&#237;a en Catalu&#241;a y su manejo cl&#237;nico&#46; <span class="elsevierStyleBold">Metodolog&#237;a&#58;</span> Estudio epidemiol&#243;gico&#44; de cohorte transversal&#44; multic&#233;ntrico&#44; en condiciones de pr&#225;ctica cl&#237;nica habitual&#46; Recogida de datos mediante un e-CRD que inclu&#237;a datos de filiaci&#243;n y aquellos relacionados con la anemia &#40;hemoglobina&#44; estatus f&#233;rrico&#44; tratamiento con agentes estimuladores de la eritropoyesis &#91;AEE&#93; y con otros coadyuvantes&#41;&#46; Se defini&#243; anemia como unos niveles de hemoglobina &#60;&#160;13&#44;5&#160;g&#47;dl en varones o &#60;&#160;12&#160;g&#47;dl en mujeres o pacientes que recibieran tratamiento con AEE&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Se incluyeron<span class="elsevierStyleItalic"> </span>504 pacientes &#40;56&#44;4&#160;&#37; varones&#44; edad media de 67&#44;8&#160;&#177;&#160;15&#44;5 a&#241;os&#41;&#58; 61&#44;5&#160;&#37; presentaban ERC estadio 3&#44; 30&#44;2&#160;&#37; estadio 4 y 8&#44;3&#160;&#37; estadio 5&#46; Las principales causas de ERC fueron la vascular y la nefropat&#237;a diab&#233;tica&#46; La prevalencia de anemia fue del 58&#44;5&#160;&#37; &#40;n&#160;&#61;&#160;295&#41;&#59; sin embargo&#44; solo un 14&#44;9&#160;&#37; de los pacientes ten&#237;an niveles de hemoglobina &#60;&#160;11&#160;g&#47;dl&#46; Los niveles medios de hemoglobina disminu&#237;an y el tratamiento con AEE era m&#225;s frecuente a medida que progresaba la ERC&#44; pero no se observaron diferencias significativas respecto a la prescripci&#243;n de hierro&#44; seg&#250;n estadios&#46; Los AEE e intervalos m&#225;s frecuentemente prescritos fueron darbepoetina alfa con una dosis mediana de 40 &#956;g&#47;bisemanal&#44; seguida por C&#46;E&#46;R&#46;A&#46;&#44; con una dosis mediana de 75 &#956;g&#47;mensual y epoetina beta con una dosis mediana de 5000 UI&#47;semanal&#46; De los pacientes con anemia &#40;n&#160;&#61;&#160;295&#41;&#44; un 36&#44;3&#160;&#37; &#40;n&#160;&#61;&#160;107&#41; presentaban ferropenia y de ellos solo un 53&#44;3&#160;&#37; recib&#237;a tratamiento con suplementos de hierro&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span><span class="elsevierStyleItalic"> </span>Este estudio demuestra la alta prevalencia de anemia&#44; la cual aumenta a medida que progresa la enfermedad&#44; as&#237; como el buen control de la misma en la poblaci&#243;n de pacientes con ERC atendidos en CCEE de Nefrolog&#237;a en Catalu&#241;a&#46; Este control se consigue con dosis moderadas de AEE y prescripci&#243;n de suplementos de hierro en m&#225;s del 50&#160;&#37; de los pacientes an&#233;micos&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Anaemia is a common complication of chronic kidney disease &#40;CKD&#41;&#46; The aim of this study was to determine the prevalence and clinical management of anaemia in patients with stages 3-5 CKD not on dialysis treated in outpatient Nephrology clinics &#40;OC&#41; in Catalonia&#46; <span class="elsevierStyleBold">Methods&#58;</span> Epidemiological&#44; cross-sectional cohort&#44; multicentre study under routine clinical practice conditions&#46; Data collection by electronic data collection log-book &#40;e-DCL&#41; including personal information and data related to anaemia &#40;haemoglobin&#44; iron status&#44; treatment with erythropoiesis-stimulating agents &#91;ESA&#93; and other anaemia treatments&#41;&#46; Anaemia was defined as haemoglobin levels &#60;13&#46;5g&#47;dL in males or &#60;12g&#47;dL in females or patients who receive treatment with ESA&#46; <span class="elsevierStyleBold">Results&#58;</span> We included 504 patients &#40;56&#46;4&#37; male&#44; mean age of 67&#46;8&#177;15&#46;5 years&#41;&#58; 61&#46;5&#37; had stage 3 CKD&#44; 30&#46;2&#37; stage 4 and 8&#46;3&#37; stage 5&#46; The main causes of CKD were vascular and diabetic nephropathy&#46; The prevalence of anaemia was 58&#46;5&#37; &#40;n&#61;295&#41;&#44; however&#44; only 14&#46;9&#37; of patients had haemoglobin levels &#60;11g&#47;dL&#46; Mean haemoglobin levels decreased and ESA treatment was more common as CKD progressed&#44; but no significant differences were observed regarding the prescription of iron&#44; according to CKD stages&#46; ESA and intervals most frequently prescribed were darbepoetin alfa with a median dose of 40&#956;g&#47;biweekly&#44; followed by C&#46;E&#46;R&#46;A&#46; with a median dose of 75&#956;g&#47;month and epoetin beta with a median dose of 5&#44;000IU&#47;week&#46; Among the patients with anaemia &#40;n&#61;295&#41;&#44; 36&#46;3&#37; &#40;n&#61;107&#41; had iron deficiency and only 53&#46;3&#37; of these patients were treated with iron supplements&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> This study demonstrates the high prevalence of anaemia&#44; which increases as the disease progresses and its good control in a CKD patient population treated in Nephrology outpatient clinics in Catalonia&#46; This control is achieved with moderate doses of ESA and iron supplements prescribed in more than 50&#37; of anaemic CKD patients&#46;</p>"
      ]
    ]
    "multimedia" => array:9 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56332_en_pginas_desde6.12261_02i.jpg"
            "Alto" => 654
            "Ancho" => 716
            "Tamanyo" => 74456
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Characteristics of the patients included in the study&#46;"
        ]
      ]
      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" => "12261_16025_56333_en_t2_6.12261_02i2.jpg"
            "Alto" => 1254
            "Ancho" => 2165
            "Tamanyo" => 376763
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Laboratory data on anaemia &#40;according to the different stages of chronic kidney disease&#41;&#46;"
        ]
      ]
      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" => "12261_16025_56334_en_t3_6.12261_02i2.jpg"
            "Alto" => 1166
            "Ancho" => 2160
            "Tamanyo" => 391329
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Patient profile according to the presence of anaemia&#46;"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Tab.  4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56335_en_t4_6.12261_02i2.jpg"
            "Alto" => 519
            "Ancho" => 2174
            "Tamanyo" => 284057
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment of anaemia according to the chronic kidney disease stage&#46;"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Tab.  5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56336_en_t5_6.12261_02i2.jpg"
            "Alto" => 523
            "Ancho" => 2143
            "Tamanyo" => 272915
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment of anaemia according to the chronic kidney disease stage in anaemic patients&#46;"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Tab.  7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56338_en_t7_6.12261_02i2.jpg"
            "Alto" => 376
            "Ancho" => 2179
            "Tamanyo" => 179832
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Treatment for anaemia according to haemoglobin levels&#46;"
        ]
      ]
      6 => array:8 [
        "identificador" => "fig7"
        "etiqueta" => "Tab.  8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56339_en_t8_6.12261_02i2.jpg"
            "Alto" => 385
            "Ancho" => 2179
            "Tamanyo" => 211942
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Patients on treatment with oral iron and intravenous iron according to the chronic kidney disease stage&#46;"
        ]
      ]
      7 => array:8 [
        "identificador" => "fig8"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12261_16025_56340_en_f16.12261_02i.jpg"
            "Alto" => 1321
            "Ancho" => 2111
            "Tamanyo" => 643824
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Correlation between the haemoglobin level and the glomerular filtration rate&#46;"
        ]
      ]
      8 => array:8 [
        "identificador" => "mmc1"
        "etiqueta" => "Tab. 6"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "Ecomponente" => array:2 [
          "fichero" => "12261_19157_56337_en_w47771409412ref.1226127659_12261_19115_54116_es_12261_tabla6_en.docx"
          "ficheroTamanyo" => 12835
        ]
        "descripcion" => array:1 [
          "en" => "Treatment with iron supplements in anaemic and iron-deficient patients according to the chronic kidney disease stage. "
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:29 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Otero A, Gayoso P, Garcia F, de Francisco AL; EPIRCE study group. Epidemiology of chronic renal disease in the Galician Population: results of the pilot Spanish Epirce study. Kidney Int Suppl 2005;(99):S16-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16612395" 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" => "US Renal Data System: USRDS 2009 Annual Data Report. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rucker D, Tonelli M. Cardiovascular risk and management in chronic kidney disease. Nat Rev Nephrol 2009;5:287-96. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19384330" 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" => "Kazmi WH, Kausz AT, Khan S, Abichandani R, Ruthazer R, Obrador GT, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 2001;38:803-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11576884" 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" => "Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia. The Third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2002;162:1401-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Obrador GT, Roberts T, St Peter WL, Frazier E, Pereira BJG, Collins AJ. Trends in anemia at initiation of dialysis in the United States. Kidney Int 2001;60:1875-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11703606" 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" => "Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomiopathy, morbidity, and mortality in end-stage renal disease. Am J Kidney Dis 1996;28:53-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8712222" 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" => "Moreno F, Sanz-Guajardo D, Lopez-Gomez JM, Jofre R, Valderrabano F. Increasing the hematocrit has beneficial effect on quality of life and is safe in selected haemodialysis patients. Spanish Cooperative Renal Patients Quality of life Study Group of the Spanish Society of Nephrology. J Am Soc Nephrol 2000;11:335-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10665941" 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" => "Cody J, Daly C, Campbell M, Donaldson C, Khan I, Rabindranath K, et al. Recombinant human erythropoietin for chronic renal failure anemia in pre-dialysis patients. Cochrane Database Syst Rev 2005;(3):CD003266."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "De Nicola L, Chiodini P, Zoccali C, Borrelli S, Cianciaruso B, Di Iorio B, et al.; SIN-TABLE CKD Study Group. Prognosis of CKD patients receiving outpatient nephrology care in Italy. Clin J Am Soc Nephrol 2011;6:2421-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21817127" 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" => "Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al.; CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085-98."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Drüeke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al.; CREATE investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17108342" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, et al.; TREAT investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361:2019-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19880844" 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" => "Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, et al. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med 2010;153:23-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20439566" 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" => "Clement FM, Klarenbach S, Tonelli M, Johnson JA, Manns BJ. The impact of selecting a high hemoglobin target level on health-related quality of life for patients with chronic kidney disease: a systematic review and meta-analysis. Arch Intern Med 2009;169:1104-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19546410" 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" => "Parfrey PS, Lauve M, Latremouille-Viau D, Lefebvre P. Erythropoietin therapy and left ventricular mass index in CKD and ESRD patients: a meta-analysis. Clin J Am Soc Nephrol 2009;4:755-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19339417" 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" => "Locatelli F, Aljama P, Canaud B, Covic A, De Francisco, Macdougall IC, et al.; Anemia Working group of European Best Practice (ERBP). Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) study. Nephrol Dial Transplant 2010;25:2846-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20591813" 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" => "Ref.EMEA/188068/2007 European Medicines Agency starts review of the safety of epoetins. Available at: http://www.halmed.hr/upl/novosti/18806807en.pdf."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martínez-Castelao A, Górriz JL, Portolés JM, De Alvaro F, Cases A, Luño J, et al. Baseline characteristics of patients with chronic kidney disease stage 3 and stage 4 in Spain: the MERENA observational cohort study. BMC Nephrol 2011;12:53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21970625" 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" => "De Nicola L, Minutolo R, Chiodini P, Zoccali C, Castellino P, Donadio C, et al.; Target Blood Pressure LEvels in Chronic Kidney Disease (TABLE in CKD) Study Group. Global approach to cardiovascular risk in chronic kidney disease: reality and opportunities for intervention. Kidney Int 2006;69:538-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16395261" 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" => "Portolés J, Gorriz JL, Rubio E, de Alvaro F, García F, Alvarez-Chivas V, et al.; NADIR-3 Study Group. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease. BMC Nephrol 2013;14:2."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dikow R, Schwenger V, Schomig M, Ritz E. How should we manage anemia in patients with diabetes? Nephrol Dial Transplant 2001;17:67-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11812916" 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" => "Bosman DR, Winker AS, Marseden JT, MacDougall IC, Watkins PJ. Anaemia with erythropoietin deficiency occurs early in diabetic nephropaty. Diabetes Care 2001;24:495-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11289474" 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" => "Agarwal AK, Silver MR, Reed JE, Dhingra RK, Liu W, Varma N, et al. An open-label study of darbepoetin alfa administered once monthly for the maintenance of haemoglobin concentrations in patients with chronic kidney disease not receiving dialysis. J Intern Med 2006;260:577-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17116009" 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" => "Minutolo R, Zamboli P, Chiodini P, Mascia S, Vitiello S, Stanzione G, et al. Conversion of darbepoetin to low doses of CERA maintains hemoglobin levels in non-dialysis chronic kidney disease patients. Blood Purif 2010;30:186-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20924174" 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" => "Frimat L, Mariat C, Landais P, Koné S, Commenges B, Choukroun G. Anaemia management with C.E.R.A. in routine clinical practice: OCEANE (Cohorte Mircera patients non-dialyses), a national, multicenter, longitudinal, observational prospective study, in patients with chronic kidney disease not on dialysis. BMJ Open 2013;3(3):e001888. pii: e001888. doi: 10.1136/bmjopen-2012-001888."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cuevas X, García F, Martín-Malo A, Fort J, Lladós F, Lozano J, et al. Risk factors associated with cardiovascular morbidity and mortality in Spanish incident hemodialysis patients: two-year results from the ANSWER Study. Blood Purif 2011;33(1-3):21-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22134224" 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" => "Besarab A, Coyne DW. Iron supplementation to treat anemia in patients with chronic kidney disease. Nat Rev Nephrol 2010;6:699-710. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20956992" 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" => "KDIGO. Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:279-335."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003400000002/v0_201502091616/X2013251414053795/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/X2013251414053795/v0_201502091616/en/P1-E567-S4547-A12261-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053795?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 11 6 17
2024 October 69 60 129
2024 September 63 58 121
2024 August 86 79 165
2024 July 70 34 104
2024 June 75 69 144
2024 May 78 57 135
2024 April 92 51 143
2024 March 72 33 105
2024 February 66 40 106
2024 January 63 32 95
2023 December 50 35 85
2023 November 83 42 125
2023 October 45 32 77
2023 September 57 41 98
2023 August 43 27 70
2023 July 80 52 132
2023 June 65 26 91
2023 May 59 44 103
2023 April 57 24 81
2023 March 102 36 138
2023 February 72 57 129
2023 January 78 40 118
2022 December 111 54 165
2022 November 103 60 163
2022 October 115 61 176
2022 September 93 49 142
2022 August 94 75 169
2022 July 63 70 133
2022 June 89 63 152
2022 May 63 63 126
2022 April 97 66 163
2022 March 83 70 153
2022 February 87 65 152
2022 January 131 56 187
2021 December 92 64 156
2021 November 71 44 115
2021 October 107 58 165
2021 September 68 49 117
2021 August 62 47 109
2021 July 99 42 141
2021 June 122 33 155
2021 May 116 49 165
2021 April 178 118 296
2021 March 137 53 190
2021 February 157 30 187
2021 January 166 30 196
2020 December 65 20 85
2020 November 68 24 92
2020 October 52 31 83
2020 September 50 23 73
2020 August 76 18 94
2020 July 87 28 115
2020 June 116 33 149
2020 May 100 28 128
2020 April 76 30 106
2020 March 85 18 103
2020 February 65 30 95
2020 January 89 30 119
2019 December 99 30 129
2019 November 86 33 119
2019 October 40 40 80
2019 September 89 43 132
2019 August 100 38 138
2019 July 77 42 119
2019 June 127 36 163
2019 May 132 40 172
2019 April 223 43 266
2019 March 141 57 198
2019 February 114 46 160
2019 January 80 36 116
2018 December 315 83 398
2018 November 261 47 308
2018 October 234 35 269
2018 September 304 32 336
2018 August 260 34 294
2018 July 213 33 246
2018 June 187 26 213
2018 May 168 30 198
2018 April 207 21 228
2018 March 169 22 191
2018 February 120 15 135
2018 January 145 11 156
2017 December 133 16 149
2017 November 159 24 183
2017 October 110 20 130
2017 September 122 21 143
2017 August 109 28 137
2017 July 111 18 129
2017 June 148 21 169
2017 May 182 18 200
2017 April 98 18 116
2017 March 121 18 139
2017 February 218 21 239
2017 January 110 28 138
2016 December 127 10 137
2016 November 230 19 249
2016 October 236 18 254
2016 September 395 9 404
2016 August 500 13 513
2016 July 334 15 349
2016 June 205 0 205
2016 May 197 0 197
2016 April 180 0 180
2016 March 143 0 143
2016 February 135 0 135
2016 January 182 0 182
2015 December 171 0 171
2015 November 150 0 150
2015 October 141 0 141
2015 September 134 0 134
2015 August 101 0 101
2015 July 149 0 149
2015 June 69 0 69
2015 May 73 0 73
2015 April 15 0 15
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)
es en

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

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