Determination of peritoneal phosphate transport as a tool for controlling serum phosphorus

array:21 ["pii" => "X201325141405461X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2014.Jun.12281" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2014;34:584-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5873 "formatos" => array:3 [ "EPUB" => 294 "HTML" => 4847 "PDF" => 732 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699514054612" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2014.Jun.12281" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2014;34:584-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8911 "formatos" => array:3 [ "EPUB" => 309 "HTML" => 7885 "PDF" => 717 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Determinación del transporte peritoneal de fósforo como herramienta para el control del fósforo sérico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "590" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Determination of peritoneal phosphate transport as a tool for controlling serum phosphorus" ] ] "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" => "12281_19904_50802_en_12281_t1_copy1.jpg" "Alto" => 438 "Ancho" => 700 "Tamanyo" => 238392 ] ] "descripcion" => array:1 [ "es" => "Características de la población: manejo médico y dialítico" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo A. López-Guerra, Víctor H. Rodríguez-García, Francisco E. Rodríguez-Castellanos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Eduardo A." "apellidos" => "López-Guerra" ] 1 => array:2 [ "nombre" => "Eduardo A." "apellidos" => "López-Guerra" ] 2 => array:2 [ "nombre" => "Víctor H." "apellidos" => "Rodríguez-García" ] 3 => array:2 [ "nombre" => "Francisco E." "apellidos" => "Rodríguez-Castellanos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X201325141405461X" "doi" => "10.3265/Nefrologia.pre2014.Jun.12281" "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/X201325141405461X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514054612?idApp=UINPBA000064" "url" => "/02116995/0000003400000005/v0_201502091337/X0211699514054612/v0_201502091337/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251414054601" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2014.Jun.12538" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2014;34:591-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8650 "formatos" => array:3 [ "EPUB" => 318 "HTML" => 7536 "PDF" => 796 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Performance of MDRD-IDMS and CKD-EPI equations in Mexican individuals with normal renal function" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "591" "paginaFinal" => "598" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Funcionamiento de las fórmulas MDRD-IDMS y CKD-EPI, en individuos mexicanos con función renal normal" ] ] "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" => "12538_16025_61172_en_t112538i.jpg" "Alto" => 673 "Ancho" => 1043 "Tamanyo" => 181156 ] ] "descripcion" => array:1 [ "en" => "General characteristics of the study population" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José M. Arreola-Guerra, Rodolfo Rincón-Pedrero, Cristino Cruz-Rivera, Teresa Belmont-Pérez, Ricardo Correa-Rotter, José A. Niño-Cruz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José M." "apellidos" => "Arreola-Guerra" ] 1 => array:2 [ "nombre" => "Rodolfo" "apellidos" => "Rincón-Pedrero" ] 2 => array:2 [ "nombre" => "Cristino" "apellidos" => "Cruz-Rivera" ] 3 => array:2 [ "nombre" => "Teresa" "apellidos" => "Belmont-Pérez" ] 4 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Correa-Rotter" ] 5 => array:2 [ "nombre" => "José A." "apellidos" => "Niño-Cruz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699514054604" "doi" => "10.3265/Nefrologia.pre2014.Jun.12538" "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/X0211699514054604?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054601?idApp=UINPBA000064" "url" => "/20132514/0000003400000005/v0_201502091605/X2013251414054601/v0_201502091605/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251414054628" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2014.Jun.12422" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2014;34:579-83" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6136 "formatos" => array:3 [ "EPUB" => 301 "HTML" => 4924 "PDF" => 911 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Study on overhydration in dialysis patients and its association with inflammation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "579" "paginaFinal" => "583" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de sobrehidratación en los pacientes en diálisis y su relación con la inflamación" ] ] "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" => "12422_16025_61167_en_t112422i.jpg" "Alto" => 1723 "Ancho" => 1074 "Tamanyo" => 249080 ] ] "descripcion" => array:1 [ "en" => "Descriptive baseline characteristics" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Almudena Vega, Borja Quiroga, Soraya Abad, Caridad Ruiz, Juan M. López-Gómez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Almudena" "apellidos" => "Vega" ] 1 => array:2 [ "nombre" => "Borja" "apellidos" => "Quiroga" ] 2 => array:2 [ "nombre" => "Soraya" "apellidos" => "Abad" ] 3 => array:2 [ "nombre" => "Caridad" "apellidos" => "Ruiz" ] 4 => array:2 [ "nombre" => "Juan M." "apellidos" => "López-Gómez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699514054620" "doi" => "10.3265/Nefrologia.pre2014.Jun.12422" "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/X0211699514054620?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054628?idApp=UINPBA000064" "url" => "/20132514/0000003400000005/v0_201502091605/X2013251414054628/v0_201502091605/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Determination of peritoneal phosphate transport as a tool for controlling serum phosphorus" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "584" "paginaFinal" => "590" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Eduardo A. López-Guerra, Víctor H. Rodríguez-García, Francisco E. Rodríguez-Castellanos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Eduardo A." "apellidos" => "López-Guerra" "email" => array:1 [ 0 => "drelopezg@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Eduardo A." "apellidos" => "López-Guerra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Víctor H." "apellidos" => "Rodríguez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] 3 => array:3 [ "nombre" => "Francisco E." "apellidos" => "Rodríguez-Castellanos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México, Distrito Federal, México, " "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chavez Ciudad de México, Distrito Federal, México, " "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Determinación del transporte peritoneal de fósforo como herramienta para el control del fósforo sérico" ] ] "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" => "12281_16025_61888_en_t112281.jpg" "Alto" => 1345 "Ancho" => 2145 "Tamanyo" => 381952 ] ] "descripcion" => array:1 [ "en" => "Population characteristics: medical and dialysis management" ] ] ] "textoCompleto" => "  INTRODUCTION Cardiovascular disease is the main cause of mortality in population with advanced renal disease, and hyperphosphatemia (serum phosphate > 5.5 mg/dl) is an independent risk factor that can range from 30 to 40% of the population subjected to renal replacement therapy, resulting amongst other complications, calcification of the tunica media of blood vessels, particularly in coronary arteries, which precipitates acute cardiovascular events, with fatal consequences1-10. For these reasons, controlling serum phosphorus is imperative in the management of chronic kidney disease patients.There is little information with respect to weekly phosphorus clearance (PCl) and dialysate/plasma phosphorus (D/P P). Sedlacek et al. found a high correlation between dialysate/plasma creatinine (D/P Cr) and D/P P, as well as their respective clearances, concluding that the clearance of both solutes is closely linked, and as such, the main determinant for weekly creatinine clearance (CrCl) and PCl is D/P Cr11. In a study of paediatric patients on automated peritoneal dialysis, they found a good correlation between both D/P, but PCl was related better to D/P P than to D/P Cr, with the conclusion that the former is a better predictor12. Bernardo et al. classified phosphorus transport by its D/P based on Twardowski’s creatinine transport classification13 and they observed that the distribution of patients based on D/P P in the different categories was different to that presented for D/P Cr, suggesting that, despite there being a correlation between D/P P and D/P Cr, the latter measure is not adequate enough to classify patients in accordance with the transport of phosphorus14. This study evaluates concordance between D/P Cr and D/P P, and between CrCl and PCl, using the Bland and Altman method15, with the objective of finding out how much one test may differ from the other and thus determine whether D/P Cr and CrCl can continue to be reliable replacements of peritoneal phosphorus transport. Furthermore, we evaluated peritoneal phosphorus transport in a dialysis population with the aim of highlighting its role in phosphataemia control beyond dietary restriction and the use of phosphate binders. MATERIALs AND METHODs We carried out a cross-sectional, observational and comparative study in which we included 60 patients of the peritoneal dialysis outpatient clinic. Inclusion criteria: patients older than 16 years of age who were on renal replacement therapy for at least one month through continuous ambulatory peritoneal dialysis or nocturnal automated peritoneal dialysis (NAPD). Exclusion criteria: having presented with peritonitis at the time of the study, with this being considered to be the presence of 100 or more leukocytes per field in the cytological study of dialysate, who completed antibiotic treatment within the two previous months or patients who presented or had presented in the previous month with an incapacitating medical condition. For the peritoneal equilibration test (PET), we included as exclusion criteria ultrafiltration failure, defined as lower than 400ml after the application of a 4.25% 2000ml bag after 4 hours in the peritoneal cavity, catheter mechanical problems, defined as a fluid entry time greater than 10 minutes and an exit time greater than 30 minutes or having greater D/P P than the unit. The following were counted as exclusion criteria in solute clearance measurement: NAPD mode (reasons unrelated to the interests of this study), peritonitis, the 24-hour dialysate effluent volume being lower than the infused volume and a lack of adherence to the dialysis prescription, confirmed subjectively by the patient.We performed a PET on all patients using a 4.25% solution to determine D/P P and D/P Cr. We carried out a cytology of the dialysate in order to rule out an active infectious condition. We calculated weekly the Kt/V of urea and weekly PCl and CrCl expressed in litres per week adjusted to body surface area (l/week/1.73m2 BSA), all in their renal, peritoneal and total forms using standard methods16, as well as the normalized protein nitrogen appearance using the Randerson formula17. The urine samples were only collected for those with diuresis equal to or greater than 200ml/day; if this was not the case, they were considered anuric. The Department of Nutrition, though the food frequency questionnaire of the Nutritional Habits and Nutrient Consumption Evaluation System18 determined the average daily phosphorus intake. STATISTICAL ANALYSIS The results were expressed as means and standard deviations in the case of numeric variables or as proportions for categorical variables. The comparison of means between the two groups was carried out with Student’s t-test for independent groups or with its non-parametric alternative (U-Mann-Whitney), in accordance with the distribution of each variable. The comparison of proportions was carried out using the χ2 test. Variables were associated using Spearman’s correlation coefficient.We carried out a concordance analysis between two tests (D/P Cr and D/P P; CrCl and PCl) using the Bland and Altman method. We created a graph showing the difference between the two methods against their average. 95% of differences are found in this graph between two limits that define the confidence interval (CI). The concordance limits are displayed with their respective 95% CI.To compare more than two means, we carried out a one-way ANOVA test with the Bonferroni test. In order to divide up the database in the best way possible with regard to the D/P P variable, we used a classification tree, taking the CHAID (Chi Squared Automatic Interaction Detector) method as the form of growth.Values of P<.05 were considered to be statistically significant. The statistical package SPSS version 15 for Windows was used. RESULTS We included 60 patients, of which 4 PET were excluded due to having a greater D/P P than the unit and we eliminated 10 solute clearance measurements due to the following: one due to inadequate sample collection, one due to not requiring dialysis after recovery from acute renal damage, four due to a 24-hour ultrafiltration volume lower than the infused volume, two due to being in NAPD mode and two due to not having a stable dialysis dose because of poor adherence to their prescription.The population characteristics and the biochemical and treatment parameters can be observed in Table 1. Phosphorus Mean serum phosphorus in our population was 5.3±1.7mg/dl (2.6-9.7mg/dl), with 21 (31.3%) cases of hyperphosphataemia, with there being a low inverse correlation between phosphorus levels and D/P P, r=−0.273, p=.04 and a statistically significant difference in D/P P in those with normal phosphataemia when we compared them with hyperphosphataemic patients, 0.61±0.13mg/dl versus 0.54±0.10mg/dl (p=.035). Daily estimated mean phosphorus intake was 1290±472mg/day (522-2794mg/day). We found that those who consumed a quantity lower than or equal to 1000mg/day (n=18, 32%) had significantly lower serum phosphorus when we compared them with those who consumed more than 1000mg/day (4.8±1.6mg/dl versus 5.6±1.7mg/dl, p=.039). Dialysate/plasma phosphorus and creatinine ratios The mean D/P Cr for our population was 0.70±0.10 (0.51-0.92) and the mean D/P P was 0.58±0.12 (0.28-0.85), and we observed an adequate correlation between the two, with r=0.90, p<.05 (Figure 1). However, we observed a poor concordance between the two methods with upper and lower limits of D/P Cr with respect to D/P P of −0.17 (−0.21 to −0.13 95% CI) and 0.47 (0.35-0.59 95% CI), respectively (Figure 2). Phosphorus clearance, creatinine clearance and Kt/V of urea We observed a low correlation between PCl and D/P P (r=0.33, p=.02), and between PCl and D/P Cr (r=0.30, p=.03). However, when we carried out a subanalysis that only included those with a Kt/V of urea ≥1.7, we found a correlation between PCl and D/P P (r=0.384, p=.04), but not between PCl and D/P Cr (r=0.348, p=.06). We also explored this association in anuric patients, where we similarly observed that PCl was significantly related to D/P P (r=0.392, p=.04), but not to D/P Cr (r=0.358, p=.52).We attempted to find an association between the Kt/V of urea, CrCl and PCl in their total, peritoneal and renal measurements and we found the following: Kt/V of urea had significant correlations with CrCl in its total, peritoneal and renal measurements (r=0.68, p<.05; r=0.78, p<.05; r=0.47, p=.03, respectively); PCl showed significant correlations with CrCl in its total, peritoneal and renal measurements (r=0.45, p<.05, r=0.59, p<.05 and r=0.67, p<.05, respectively). However, the concordance analysis showed that it is poor, with lower and upper concordance limits of −13.54l/week/1.73m2 BSA (95% CI −21.68 to −5.4) and of 58.98l/week/1.73m2 BSA (95% CI 50.84-67.12), respectively, of total CrCl with respect to total PCl (Figure 3). Moreover, renal PCl showed an almost significant association with Kt/V of renal urea (r=0.43, p=.05), while total and peritoneal PCl did not display a significant association with Kt/V of total and peritoneal urea (r=0.18, p=.31 for both). Phosphorus clearance, serum phosphorus levels and residual renal function When we divided patients in accordance with diuresis and subdivided each group into normal phosphataemia and hyperphosphataemia (Table 2), we could observe that mean serum phosphorus for anuric patients with hyperphosphataemia was significantly higher than those with hyperphosphataemia who maintained diuresis (7.4±1.4mg/dl versus 6.3±0.8mg/dl, p=.03). D/P P was significantly lower in anuric patients with hyperphosphataemia, compared with those who had normal serum phosphorus levels (0.51±0.8 versus 0.62±0.14, p=.006). Although total PCl was higher in patients with diuresis compared with the anuric patient subgroup (40.2±10.4l/week/1.73m2 BSA vs. 35.6±9.6l/week/1.73m2 BSA, p=.12), it was not significantly different. However, peritoneal PCl in anuric patients was significantly higher when we compared it with patients who maintained diuresis (35.5±9.8l/week/1.73m2 BSA vs. 28.3±10.25l/week/1.73m2 BSA, p=.01). Residual renal function was significantly lower in patients with hyperphosphataemia compared with those with normal phosphataemia (3.2±1.2ml/min vs. 4.8±2.0ml/min, p=.048). Phosphorus excretion We also evaluated the potential association between total and peritoneal phosphorus excretion with total and peritoneal CrCl and PCl, and we found the following: total phosphorus excretion showed a better correlation with total PCl (r=0.62, p<.05) than with total CrCl (r=0.360, p<.05). Peritoneal phosphorus excretion also had a better correlation with peritoneal PCl (r=0.687, p<.05) in comparison with peritoneal CrCl (r=0.466, p<.05). Lastly, in patients with a Kt/V of urea ≥1.7 the correlation between total PCl and total phosphorus excretion was significant (r=0.643, p<.05), but was not between total CrCl and total phosphorus excretion (r=0.222, p=.23). Categorization of phosphorus transport On the basis of D/P P distribution using the CHAID method, we created a classification tree and obtained the following nodes with their respective ranges: node 1: ≤0.5, node 2: 0.51-0.55, node 3: 0.56-0.66, node 4: 0.67-0.76, node 5: >0.76, and we found statistically significant differences between nodes in terms of serum phosphorus levels, total and peritoneal PCl, and Kt/V of urea (Table 3). DISCUSSION Phosphorus clearance is the result of the complex interaction between diffusion, convection, osmotic and chemical factors, electrical gradients, and active transmembrane phosphorus transporters19,20. It has been demonstrated that absorption by lymphatic convection has no impact and that solutions with a higher concentration remove a higher quantity of phosphorus and are attributed to the convection factor. However, it was not possible to establish for certain whether ultrafiltration influences clearance21. Messa et al. demonstrated in 35 patients that glucose concentration was one of the predictors of phosphorus clearance and this was independent of the ultrafiltration volume22, while Granja et al. calculated that 11% of the phosphorus eliminated was due to ultrafiltration23.In our population, we found that the frequency of hyperphosphataemia was 31.3%, which is similar to that reported in the literature7. In previous studies, an adequate correlation was found between D/P Cr and D/P P, and between CrCl and PCl, suggesting equivalence between them12,13. In this study, we demonstrated that although, D/P Cr and D/P P displayed adequate correlation, the concordance was poor, since the concordance limits were very broad. With such great variability of D/P Cr or CrCl with respect to the phosphorus parameters, there would be a very significant impact on clearance, excretion and therefore serum phosphorus levels, and as such, these measurements could not be considered equivalents. For example, a patient with a D/P P of 0.4 may have a D/P Cr from 0.16 to 0.94, values that are very different from the value of D/P P. Likewise, a patient with PCl of 35l/week/1.73m2 BSA could have CrCl from 13.32l/week/1.73m2 BSA to 102.12l/week/1.73m2 BSA. Given the poor concordance that exists between the values studied and that they cannot be taken as replacements, we proposed a phosphorus transport classification tree with five nodes based on its D/P P, amongst which we identified statistically significant differences between groups for total and peritoneal PCl.Our results confirm the role of diuresis in maintaining phosphorus levels at low values compared to anuria. In anuric patients, in whom the peritoneum has an exclusive role in phosphorus clearance, the determination of phosphorus transport indicators is particularly important for two factors: 1) D/P P is significantly lower in hyperphosphataemic patients; 2) Peritoneal PCl is significantly higher compared with those who maintain diuresis (Table 2).The current recommendations for the prescription of peritoneal dialysis in accordance with the 2006 K/DOQI clinical guidelines24, based on the results of three major studies25-27, set a Kt/V of urea target of ≥1.7, which has not managed to reduce mortality in this population. As such, the search for new markers of targets is vitally important. The current recommendations are to maintain the phosphorus level within the normal limits28, although this is an arduous challenge for patients and physicians, since beyond dietary restriction and the adequate use of binders, the doctor must know the role that dialysis exercises on PCl. This study demonstrates the independence of phosphorus transport with respect to urea and creatinine and it leads to a series of questions such as the PCl dose necessary for helping patients achieve the serum phosphorus targets, whether this value is different in patients with diuresis and anuric patients, whether the dialysis adjustment to achieve an established PCl target improves mortality compared with the current Kt/V of urea targets or whether a low D/P P is associated with greater mortality, amongst others. As such, studies must be carried out to determine the benefits of the adjustment of peritoneal dialysis based on D/P P with different PCl doses, establish the mid- and long-term morbidity and mortality, and thus compare them with the current recommendations on dialysis. CONCLUSIONS This study shows that D/P P and PCl measurements are not concordant with those of D/P Cr and CrCl, respectively, despite having an adequate correlation. As such, given the current lack of knowledge about phosphorus transport in peritoneal dialysis in clinical practice, in a group of patients in whom phosphataemia control is imperative, it is necessary to give continuity to the research of these indicators, since they are useful tools for physicians and may guide dialysis prescription in search for a better control of serum phosphorus. Conflicts of interest The authors declare that they have no conflicts of interest related to the contents of this article.<a href="grande/12281_16025_61888_en_t112281.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61888_en_t112281.jpg" alt="Population characteristics: medical and dialysis management "></img></a>Table 1. Population characteristics: medical and dialysis management <a href="grande/12281_16025_61889_en_t212281.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61889_en_t212281.jpg" alt="Transport of solutes, dialysis dose and phosphataemia in accordance with residual uresis"></img></a>Table 2. Transport of solutes, dialysis dose and phosphataemia in accordance with residual uresis<a href="grande/12281_16025_61890_en_t312281.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61890_en_t312281.jpg" alt="Phosphorus and clearance characteristics between transport nodes "></img></a>Table 3. Phosphorus and clearance characteristics between transport nodes <a href="grande/12281_16025_61892_en_f112281.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61892_en_f112281.jpg" alt="Correlation between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio."></img></a>Figure 1. Correlation between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio.<a href="grande/12281_16025_61893_en_f2122813.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61893_en_f2122813.jpg" alt="Concordance between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio."></img></a>Figure 2. Concordance between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio.<a href="grande/12281_16025_61894_en_f3122813.jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61894_en_f3122813.jpg" alt="Concordance between creatinine clearance and phosphorus clearance."></img></a>Figure 3. Concordance between creatinine clearance and phosphorus clearance." "pdfFichero" => "P1-E574-S4691-A12281-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437331" "palabras" => array:1 [ 0 => "Aclaramiento de creatinina" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437333" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437335" "palabras" => array:1 [ 0 => "Hiperfosfatemia" ] ] ] "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437332" "palabras" => array:1 [ 0 => "Creatinine clearance" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437334" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437336" "palabras" => array:1 [ 0 => "Hyperphosphatemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Introducción: La hiperfosfatemia (fósforo sérico ≥ 5,5 mg/dl) es un factor independiente de mortalidad en la población en diálisis. Comparamos el transporte peritoneal de fósforo, creatinina y urea para demostrar diferencias y señalar la relevancia de estos parámetros en el control del fósforo sérico. Material y métodos: Se incluyeron 60 pacientes en diálisis peritoneal y se determinó el índice dializante/plasma de fósforo (D/P P) y creatinina (D/P Cr), el aclaramiento semanal de fósforo (AclP) y creatinina (AclCr), Kt/V de urea semanal y la excreción peritoneal de fósforo (ExP). Resultados: El D/P P fue superior en pacientes con normofosfatemia, comparados con los que presentaron hiperfosfatemia, 0,61 ± 0,13 frente a 0,54 ± 0,10 (p = 0,035). Se observó una adecuada correlación entre el D/P P y el D/P Cr, r = 0,90, p < 0,05, pero una pobre concordancia entre ambos, con un límite inferior de −0,17 (−0,24 a −0,09 IC 95 %) y límite superior de 0,47 (0,39-0,54 IC 95 %) para el D/P Cr respecto al D/P P. El AclP tuvo una adecuada correlación con el D/P P en pacientes con Kt/V ≥ 1,7 (r = 0,384, p = 0,04) y en anúricos (r = 0,392, p = 0,04), pero no con el D/P Cr. Hubo una pobre concordancia del AclCr respecto al AclP con límite inferior de −13,54 l/sem/1,73 m2 SC (−21,68 a −5,4 IC 95 %) y límite superior de 58,98 l/sem/1,73 m2 SC (50,84-67,12 IC 95 %). La ExP total se relacionó con el AclP (r = 0,643, p < 0,05), mientras que no lo hizo con el AclCr (r = 0,222, p = 0,23). Mediante el método CHAID se realizó un árbol de clasificación del transporte de fósforo con base en su D/P, obteniendo 5 nodos (≤ 0,5, 0,51-0,55, 0,56-0,66, 0,67-0,76, > 0,76), mostrando diferencias estadísticamente significativas entre nodos para niveles séricos de fósforo, AclP total y peritoneal, así como Kt/V de urea semanal. Conclusiones: Las mediciones de D/P P y AclP no concuerdan con las mediciones de D/P Cr y AclCr, respectivamente, por lo que su determinación es una herramienta clínica para el control del nivel de fósforo sérico." ] "en" => array:1 [ "resumen" => "Background: Hyperphosphataemia (serum phosphorus ≥5.5mg/dl) is an independent mortality factor for the dialysis population. We compared phosphorus, creatinine and urea peritoneal transport to demonstrate differences and indicate the relevance of these parameters in the control of serum phosphorus. Material and method: We included 60 patients on peritoneal dialysis and determined the dialysate/plasma phosphorus (D/P P) and creatinine (D/P Cr) ratios, weekly creatinine clearance (CrCl) and phosphorus clearance (PCl), weekly Kt/V of urea, and peritoneal phosphorus excretion (PEx). Results: D/P P was higher in patients with normal phosphataemia, compared with those who were hyperphosphataemic 0.61±0.13 versus 0.54±0.10 (p=.035). We observed an adequate correlation between D/P P and D/P Cr, r=0.90, p<.05, but poor concordance between both, with a lower limit of −0.17 (−0.24 to −0.09 95% CI) and an upper limit of 0.47 (0.39-0.54 95% CI) for D/P Cr with respect to D/P P. PCl had an adequate correlation with D/P P in patients with a Kt/V ≥1.7 (r=0.384, p=.04) and in anuric patients (r=0.392, p=.04), but not with D/P Cr. There was poor concordance of the CrCl with respect to PCl with a lower limit of −13.54l/week/1.73m2 BSA (−21.68 to −5.4 95% CI) and an upper limit of 58.98l/week/1.73m2 BSA (50.84-67.12 95% CI). Total PEx was related to PCl (r=0.643, p<.05), while it was not related to CrCl (r=0.222, p=.23). Using the CHAID method, we created a classification tree for phosphorus transport based on its D/P, obtaining 5 nodes (≤0.5, 0.51-0.55, 0.56-0.66, 0.67-0.76, >0.76), with statistically significant differences between nodes for serum phosphorus, total and peritoneal PCl and weekly Kt/V of urea. Conclusions: D/P P and PCl are not concordant with D/P Cr and CrCl respectively and therefore their determination is a clinical tool to control serum phosphorus levels." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61888_en_t112281.jpg" "Alto" => 1345 "Ancho" => 2145 "Tamanyo" => 381952 ] ] "descripcion" => array:1 [ "en" => "Population characteristics: medical and dialysis management" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61889_en_t212281.jpg" "Alto" => 1233 "Ancho" => 2150 "Tamanyo" => 564291 ] ] "descripcion" => array:1 [ "en" => "Transport of solutes, dialysis dose and phosphataemia in accordance with residual uresis" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61890_en_t312281.jpg" "Alto" => 371 "Ancho" => 2164 "Tamanyo" => 190059 ] ] "descripcion" => array:1 [ "en" => "Phosphorus and clearance characteristics between transport nodes" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61892_en_f112281.jpg" "Alto" => 913 "Ancho" => 1015 "Tamanyo" => 112256 ] ] "descripcion" => array:1 [ "en" => "Correlation between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio." ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61893_en_f2122813.jpg" "Alto" => 902 "Ancho" => 1015 "Tamanyo" => 134616 ] ] "descripcion" => array:1 [ "en" => "Concordance between the dialysate/plasma creatinine ratio and the dialysate/plasma phosphorus ratio." ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12281_16025_61894_en_f3122813.jpg" "Alto" => 927 "Ancho" => 1014 "Tamanyo" => 155794 ] ] "descripcion" => array:1 [ "en" => "Concordance between creatinine clearance and phosphorus clearance." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15385656" 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" => "Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:S112-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9820470" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Brenner BM. Brenner and Rector`s The Kidney. 8th edition. Philadelphia, PA: Saunders Elsevier; 2008. pp. 1784-807." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Murer H, Hernando N, Forster I, Biber J. Regulation of Na/Pi transporter in the proximal tubule. Annu Rev Physiol 2003;65:531-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12517995" 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" => "Levin A, Barkris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:31-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gutierrez O, Isakova T, Rhee E, Shah A, Holmes J, Collerone G, et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol 2005;16:2205-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15917335" 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" => "Hruska KA, Mathew S, Lund R, Qiu P, Pratt R. Hyperphosphatemia of chronic kidney disease. Kidney Int 2008;74:148-57. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18449174" 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" => "London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal diseases: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003;18:1731-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12937218" 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" => "Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007;71:438-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17200680" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zheng CM, Lu KC, Wu CC, Hsu YH, Lin YF. Association of serum phosphate and related factors in ESRD-related vascular calcification. Int J Nephrol 2011;2011:939613." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sedlacek M, Dimaano F, Uribarri J. Relationship between phosphorus and creatinine clearance in peritoneal dialysis: clinical implications. Am J Kidney Dis 2000;36(5):1020-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11054360" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schmitt CP, Borzych D, Nau B, Wühl E, Zurowska A, Schaefer F. Dialytic phosphate removal: a modifiable measure of dialysis efficacy in automated peritoneal dialysis. Perit Dial Int 2009;29(4):465-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19602613" 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" => "Twardowski ZJ, Nolph KD, Khanna R, Prowant BF, Ryan LP, Moore HL, et al. Peritoneal equilibration test. Perit Dial Bull 1987;7:138-47." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bernardo AP, Contesse SA, Bajo MA, Rodrigues A, Del Peso G, Ossorio M, et al. Peritoneal membrane phosphate transport status: a cornerstone in phosphate handling in peritoneal dialysis. Clin J Am Soc Nephrol 2011;6(3):591-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21115631" 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" => "Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2868172" 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" => "Nolph KD, Moore HL, Twardowski ZJ, Khanna R, Prowant B, Meyer M, et al. Cross-sectional assessment of weekly urea and creatinine clearances in patients on continuous ambulatory peritoneal dialysis. ASAIO J 1992;38:M139-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1457833" 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" => "Randerson DH, Chapman GV, Farrell PC. Amino acid and dietary status in CAPD patients. In: Atkins RC, Farrell PC, Thomson N, eds. Peritoneal Dialysis. Edinburgh, Scotland: Churchill-Livingstone; 1981. pp. 180-91." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hernández-Ávila JE, González-Avilés L, Rosales-Mendoza E. Manual de usuario. SNUT Sistema de Evaluación de Hábitos Nutricionales y Consumo de Nutrimentos. México: Instituto Nacional de Salud Pública; 2003." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Graff J, Fugleberg S, Brahm J, Fogh-Andersen N. The transport of phosphate between the plasma and dialysate compartments in peritoneal dialysis is influenced by an electric potential difference. Clin Physiol 1996;16:291-300. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8736715" 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" => "Rippe B, Venturoli D, Simonsen O, de Arteaga J. Fluid an electrolyte transport across the peritoneal membrane during CAPD according to the three-pore model. Perit Dial Int 2004;24:10-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Delmez JA, Slatopolsky E, Martin KJ, Gearing BN, Harter HR. Minerals, vitamin D, and parathyroid hormone in continuous ambulatory peritoneal dialysis. Kidney Int 1982;21:862-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6897087" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Messa P, Gropuzzo M, Cleva M, Boscutti G, Mioni G, Cruciatti A, et al. Behaviour of phosphate removal with different dialysis schedules. Nephron Dial Transplant 1998;13 Suppl 6:43-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861014001844" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Granja CA, Juerguensen P, Finkelstein FO. Phosphate balance in peritoneal dialysis patients: Role of ultrafiltration. Contrib Nephrol 2009;163:198-205. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19494614" 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" => "K/DOQI 2006 Updates Clinical Practice Guidelines and Recomendations for Peritoneal Dialysis Adequacy. National Kidney Foundation; 2006." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Churchill DN, Taylor DW, Keshaviah PR, Thorpe KE, Beecroft ML. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7:198-207. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8785388" 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" => "Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002;13:1307-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961019" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lo WK, Ho YW, Li CS, Wong KS, Chan TM. Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study. Kidney Int 2003;64:649-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12846762" 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" => "Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009;(113):S1-130." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003400000005/v0_201502091605/X201325141405461X/v0_201502091605/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/20132514/0000003400000005/v0_201502091605/X201325141405461X/v0_201502091605/en/P1-E574-S4691-A12281-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405461X?idApp=UINPBA000064"]

Statistics

Determinación del transporte peritoneal de fósforo como herramienta para el control del fósforo sérico

Eduardo A. López-Guerraa, Eduardo A. López-Guerraa, Víctor H. Rodríguez-Garcíab, Francisco E. Rodríguez-Castellanosb

a Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México, Distrito Federal, México,

b Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chavez Ciudad de México, Distrito Federal, México,

Read

10889

Times
was read the article

2585

Total PDF

8304

Total HTML

Share statistics

 array:21 [
  "pii" => "X201325141405461X"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2014.Jun.12281"
  "estado" => "S300"
  "fechaPublicacion" => "2014-09-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:584-90"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5873
    "formatos" => array:3 [
      "EPUB" => 294
      "HTML" => 4847
      "PDF" => 732
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699514054612"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2014.Jun.12281"
      "estado" => "S300"
      "fechaPublicacion" => "2014-09-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2014;34:584-90"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8911
        "formatos" => array:3 [
          "EPUB" => 309
          "HTML" => 7885
          "PDF" => 717
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "titulo" => "Determinaci&#243;n del transporte peritoneal de f&#243;sforo como herramienta para el control del f&#243;sforo s&#233;rico"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "584"
            "paginaFinal" => "590"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Determination of peritoneal phosphate transport as a tool for controlling serum phosphorus"
          ]
        ]
        "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" => "12281_19904_50802_en_12281_t1_copy1.jpg"
                "Alto" => 438
                "Ancho" => 700
                "Tamanyo" => 238392
              ]
            ]
            "descripcion" => array:1 [
              "es" => "Caracter&#237;sticas de la poblaci&#243;n&#58; manejo m&#233;dico y dial&#237;tico"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Eduardo A&#46; L&#243;pez-Guerra, V&#237;ctor H&#46; Rodr&#237;guez-Garc&#237;a, Francisco E&#46; Rodr&#237;guez-Castellanos"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Eduardo A&#46;"
                "apellidos" => "L&#243;pez-Guerra"
              ]
              1 => array:2 [
                "nombre" => "Eduardo A&#46;"
                "apellidos" => "L&#243;pez-Guerra"
              ]
              2 => array:2 [
                "nombre" => "V&#237;ctor H&#46;"
                "apellidos" => "Rodr&#237;guez-Garc&#237;a"
              ]
              3 => array:2 [
                "nombre" => "Francisco E&#46;"
                "apellidos" => "Rodr&#237;guez-Castellanos"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X201325141405461X"
          "doi" => "10.3265/Nefrologia.pre2014.Jun.12281"
          "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/X201325141405461X?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699514054612?idApp=UINPBA000064"
      "url" => "/02116995/0000003400000005/v0_201502091337/X0211699514054612/v0_201502091337/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251414054601"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jun.12538"
    "estado" => "S300"
    "fechaPublicacion" => "2014-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:591-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 8650
      "formatos" => array:3 [
        "EPUB" => 318
        "HTML" => 7536
        "PDF" => 796
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Performance of MDRD-IDMS and CKD-EPI equations in Mexican individuals with normal renal function"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "591"
          "paginaFinal" => "598"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Funcionamiento de las f&#243;rmulas MDRD-IDMS y CKD-EPI&#44; en individuos mexicanos con funci&#243;n renal normal"
        ]
      ]
      "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" => "12538_16025_61172_en_t112538i.jpg"
              "Alto" => 673
              "Ancho" => 1043
              "Tamanyo" => 181156
            ]
          ]
          "descripcion" => array:1 [
            "en" => "General characteristics of the study population"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; M&#46; Arreola-Guerra, Rodolfo Rinc&#243;n-Pedrero, Cristino Cruz-Rivera, Teresa Belmont-P&#233;rez, Ricardo Correa-Rotter, Jos&#233; A&#46; Ni&#241;o-Cruz"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Jos&#233; M&#46;"
              "apellidos" => "Arreola-Guerra"
            ]
            1 => array:2 [
              "nombre" => "Rodolfo"
              "apellidos" => "Rinc&#243;n-Pedrero"
            ]
            2 => array:2 [
              "nombre" => "Cristino"
              "apellidos" => "Cruz-Rivera"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Belmont-P&#233;rez"
            ]
            4 => array:2 [
              "nombre" => "Ricardo"
              "apellidos" => "Correa-Rotter"
            ]
            5 => array:2 [
              "nombre" => "Jos&#233; A&#46;"
              "apellidos" => "Ni&#241;o-Cruz"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514054604"
        "doi" => "10.3265/Nefrologia.pre2014.Jun.12538"
        "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/X0211699514054604?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054601?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000005/v0_201502091605/X2013251414054601/v0_201502091605/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251414054628"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2014.Jun.12422"
    "estado" => "S300"
    "fechaPublicacion" => "2014-09-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2014;34:579-83"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6136
      "formatos" => array:3 [
        "EPUB" => 301
        "HTML" => 4924
        "PDF" => 911
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Study on overhydration in dialysis patients and its association with inflammation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "579"
          "paginaFinal" => "583"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estudio de sobrehidrataci&#243;n en los pacientes en di&#225;lisis y su relaci&#243;n con la inflamaci&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "12422_16025_61167_en_t112422i.jpg"
              "Alto" => 1723
              "Ancho" => 1074
              "Tamanyo" => 249080
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Descriptive baseline characteristics"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Almudena Vega, Borja Quiroga, Soraya Abad, Caridad Ruiz, Juan M&#46; L&#243;pez-G&#243;mez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Almudena"
              "apellidos" => "Vega"
            ]
            1 => array:2 [
              "nombre" => "Borja"
              "apellidos" => "Quiroga"
            ]
            2 => array:2 [
              "nombre" => "Soraya"
              "apellidos" => "Abad"
            ]
            3 => array:2 [
              "nombre" => "Caridad"
              "apellidos" => "Ruiz"
            ]
            4 => array:2 [
              "nombre" => "Juan M&#46;"
              "apellidos" => "L&#243;pez-G&#243;mez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699514054620"
        "doi" => "10.3265/Nefrologia.pre2014.Jun.12422"
        "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/X0211699514054620?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414054628?idApp=UINPBA000064"
    "url" => "/20132514/0000003400000005/v0_201502091605/X2013251414054628/v0_201502091605/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Determination of peritoneal phosphate transport as a tool for controlling serum phosphorus"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "584"
        "paginaFinal" => "590"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Eduardo A&#46; L&#243;pez-Guerra, V&#237;ctor H&#46; Rodr&#237;guez-Garc&#237;a, Francisco E&#46; Rodr&#237;guez-Castellanos"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Eduardo A&#46;"
            "apellidos" => "L&#243;pez-Guerra"
            "email" => array:1 [
              0 => "drelopezg&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Eduardo A&#46;"
            "apellidos" => "L&#243;pez-Guerra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "V&#237;ctor H&#46;"
            "apellidos" => "Rodr&#237;guez-Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Francisco E&#46;"
            "apellidos" => "Rodr&#237;guez-Castellanos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México, Distrito Federal, México, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Nefrología, Instituto Nacional de Cardiología Ignacio Chavez Ciudad de México, Distrito Federal, México, "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Determinaci&#243;n del transporte peritoneal de f&#243;sforo como herramienta para el control del f&#243;sforo s&#233;rico"
      ]
    ]
    "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" => "12281_16025_61888_en_t112281.jpg"
            "Alto" => 1345
            "Ancho" => 2145
            "Tamanyo" => 381952
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics&#58; medical and dialysis management"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Cardiovascular disease is the main cause of mortality in population with advanced renal disease&#44; and hyperphosphatemia &#40;serum phosphate &#62; 5&#46;5 mg&#47;dl&#41; is an independent risk factor that can range from 30 to 40&#37; of the population subjected to renal replacement therapy&#44; resulting amongst other complications&#44; calcification of the tunica media of blood vessels&#44; particularly in coronary arteries&#44; which precipitates acute cardiovascular events&#44; with fatal consequences<span class="elsevierStyleSup">1-10</span>&#46; For these reasons&#44; controlling serum phosphorus is imperative in the management of chronic kidney disease patients&#46;</p><p class="elsevierStylePara">There is little information with respect to weekly phosphorus clearance &#40;PCl&#41; and dialysate&#47;plasma phosphorus &#40;D&#47;P P&#41;&#46; Sedlacek et al&#46; found a high correlation between dialysate&#47;plasma creatinine &#40;D&#47;P Cr&#41; and D&#47;P P&#44; as well as their respective clearances&#44; concluding that the clearance of both solutes is closely linked&#44; and as such&#44; the main determinant for weekly creatinine clearance &#40;CrCl&#41; and PCl is D&#47;P Cr<span class="elsevierStyleSup">11</span>&#46; In a study of paediatric patients on automated peritoneal dialysis&#44; they found a good correlation between both D&#47;P&#44; but PCl was related better to D&#47;P P than to D&#47;P Cr&#44; with the conclusion that the former is a better predictor<span class="elsevierStyleSup">12</span>&#46; Bernardo et al&#46; classified phosphorus transport by its D&#47;P based on Twardowski&#8217;s creatinine transport classification<span class="elsevierStyleSup">13 </span>and they observed that the distribution of patients based on D&#47;P P in the different categories was different to that presented for D&#47;P Cr&#44; suggesting that&#44; despite there being a correlation between D&#47;P P and D&#47;P Cr&#44; the latter measure is not adequate enough to classify patients in accordance with the transport of phosphorus<span class="elsevierStyleSup">14</span>&#46; This study evaluates concordance between D&#47;P Cr and D&#47;P P&#44; and between CrCl and PCl&#44; using the Bland and Altman method<span class="elsevierStyleSup">15</span>&#44; with the objective of finding out how much one test may differ from the other and thus determine whether D&#47;P Cr and CrCl can continue to be reliable replacements of peritoneal phosphorus transport&#46; Furthermore&#44; we evaluated peritoneal phosphorus transport in a dialysis population with the aim of highlighting its role in phosphataemia control beyond dietary restriction and the use of phosphate binders&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIALs AND METHODs</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We carried out a cross-sectional&#44; observational and comparative study in which we included 60 patients of the peritoneal dialysis outpatient clinic&#46; Inclusion criteria&#58; patients older than 16 years of age who were on renal replacement therapy for at least one month through continuous ambulatory peritoneal dialysis or nocturnal automated peritoneal dialysis &#40;NAPD&#41;&#46; Exclusion criteria&#58; having presented with peritonitis at the time of the study&#44; with this being considered to be the presence of 100 or more leukocytes per field in the cytological study of dialysate&#44; who completed antibiotic treatment within the two previous months or patients who presented or had presented in the previous month with an incapacitating medical condition&#46; For the peritoneal equilibration test &#40;PET&#41;&#44; we included as exclusion criteria ultrafiltration failure&#44; defined as lower than 400ml after the application of a 4&#46;25&#37; 2000ml bag after 4 hours in the peritoneal cavity&#44; catheter mechanical problems&#44; defined as a fluid entry time greater than 10 minutes and an exit time greater than 30 minutes or having greater D&#47;P P than the unit&#46; The following were counted as exclusion criteria in solute clearance measurement&#58; NAPD mode &#40;reasons unrelated to the interests of this study&#41;&#44; peritonitis&#44; the 24-hour dialysate effluent volume being lower than the infused volume and a lack of adherence to the dialysis prescription&#44; confirmed subjectively by the patient&#46;</p><p class="elsevierStylePara">We performed a PET on all patients using a 4&#46;25&#37; solution to determine D&#47;P P and D&#47;P Cr&#46; We carried out a cytology of the dialysate in order to rule out an active infectious condition&#46; We calculated weekly the Kt&#47;V of urea and weekly PCl and CrCl expressed in litres per week adjusted to body surface area &#40;l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA&#41;&#44; all in their renal&#44; peritoneal and total forms using standard methods<span class="elsevierStyleSup">16</span>&#44; as well as the normalized protein nitrogen appearance using the Randerson formula<span class="elsevierStyleSup">17</span>&#46; The urine samples were only collected for those with diuresis equal to or greater than 200ml&#47;day&#59; if this was not the case&#44; they were considered anuric&#46; The Department of Nutrition&#44; though the food frequency questionnaire of the Nutritional Habits and Nutrient Consumption Evaluation System<span class="elsevierStyleSup">18</span> determined the average daily phosphorus intake&#46;</p><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">The results were expressed as means and standard deviations in the case of numeric variables or as proportions for categorical variables&#46; The comparison of means between the two groups was carried out with Student&#8217;s t-test for independent groups or with its non-parametric alternative &#40;U-Mann-Whitney&#41;&#44; in accordance with the distribution of each variable&#46; The comparison of proportions was carried out using the &#967;<span class="elsevierStyleSup">2 </span>test&#46; Variables were associated using Spearman&#8217;s correlation coefficient&#46;</p><p class="elsevierStylePara">We carried out a concordance analysis between two tests &#40;D&#47;P Cr and D&#47;P P&#59; CrCl and PCl&#41; using the Bland and Altman method&#46; We created a graph showing the difference between the two methods against their average&#46; 95&#37; of differences are found in this graph between two limits that define the confidence interval &#40;CI&#41;&#46; The concordance limits are displayed with their respective 95&#37; CI&#46;</p><p class="elsevierStylePara">To compare more than two means&#44; we carried out a one-way ANOVA test with the Bonferroni test&#46; In order to divide up the database in the best way possible with regard to the D&#47;P P variable&#44; we used a classification tree&#44; taking the CHAID &#40;<span class="elsevierStyleItalic">Chi Squared Automatic Interaction Detector</span>&#41; method as the form of growth&#46;</p><p class="elsevierStylePara">Values of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 were considered to be statistically significant&#46; The statistical package SPSS version 15 for Windows was used&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We included 60 patients&#44; of which 4 PET were excluded due to having a greater D&#47;P P than the unit and we eliminated 10 solute clearance measurements due to the following&#58; one due to inadequate sample collection&#44; one due to not requiring dialysis after recovery from acute renal damage&#44; four due to a 24-hour ultrafiltration volume lower than the infused volume&#44; two due to being in NAPD mode and two due to not having a stable dialysis dose because of poor adherence to their prescription&#46;</p><p class="elsevierStylePara">The population characteristics and the biochemical and treatment parameters can be observed in Table 1&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Phosphorus</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">Mean serum phosphorus in our population was 5&#46;3&#177;1&#46;7mg&#47;dl &#40;2&#46;6-9&#46;7mg&#47;dl&#41;&#44; with 21 &#40;31&#46;3&#37;&#41; cases of hyperphosphataemia&#44; with there being a low inverse correlation between phosphorus levels and D&#47;P P&#44; r&#61;&#8722;0&#46;273&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;04 and a statistically significant difference in D&#47;P P in those with normal phosphataemia when we compared them with hyperphosphataemic patients&#44; 0&#46;61&#177;0&#46;13mg&#47;dl versus 0&#46;54&#177;0&#46;10mg&#47;dl &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;035&#41;&#46; Daily estimated mean phosphorus intake was 1290&#177;472mg&#47;day &#40;522-2794mg&#47;day&#41;&#46; We found that those who consumed a quantity lower than or equal to 1000mg&#47;day &#40;n&#61;18&#44; 32&#37;&#41; had significantly lower serum phosphorus when we compared them with those who consumed more than 1000mg&#47;day &#40;4&#46;8&#177;1&#46;6mg&#47;dl versus 5&#46;6&#177;1&#46;7mg&#47;dl&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;039&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Dialysate&#47;plasma phosphorus and creatinine ratios</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The mean D&#47;P Cr for our population was 0&#46;70&#177;0&#46;10 &#40;0&#46;51-0&#46;92&#41; and the mean D&#47;P P was 0&#46;58&#177;0&#46;12 &#40;0&#46;28-0&#46;85&#41;&#44; and we observed an adequate correlation between the two&#44; with r&#61;0&#46;90&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05 &#40;Figure 1&#41;&#46; However&#44; we observed a poor concordance between the two methods with upper and lower limits of D&#47;P Cr with respect to D&#47;P P of &#8722;0&#46;17 &#40;&#8722;0&#46;21 to &#8722;0&#46;13 95&#37; CI&#41; and 0&#46;47 &#40;0&#46;35-0&#46;59 95&#37; CI&#41;&#44; respectively &#40;Figure 2&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Phosphorus clearance&#44; creatinine clearance and Kt&#47;V of urea</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We observed a low correlation between PCl and D&#47;P P &#40;r&#61;0&#46;33&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;02&#41;&#44; and between PCl and D&#47;P Cr &#40;r&#61;0&#46;30&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;03&#41;&#46; However&#44; when we carried out a subanalysis that only included those with a Kt&#47;V of urea &#8805;1&#46;7&#44; we found a correlation between PCl and D&#47;P P &#40;r&#61;0&#46;384&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;04&#41;&#44; but not between PCl and D&#47;P Cr &#40;r&#61;0&#46;348&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;06&#41;&#46; We also explored this association in anuric patients&#44; where we similarly observed that PCl was significantly related to D&#47;P P &#40;r&#61;0&#46;392&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;04&#41;&#44; but not to D&#47;P Cr &#40;r&#61;0&#46;358&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;52&#41;&#46;</p><p class="elsevierStylePara">We attempted to find an association between the Kt&#47;V of urea&#44; CrCl and PCl in their total&#44; peritoneal and renal measurements and we found the following&#58; Kt&#47;V of urea had significant correlations with CrCl in its total&#44; peritoneal and renal measurements &#40;r&#61;0&#46;68&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#59; r&#61;0&#46;78&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#59; r&#61;0&#46;47&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;03&#44; respectively&#41;&#59; PCl showed significant correlations with CrCl in its total&#44; peritoneal and renal measurements &#40;r&#61;0&#46;45&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#44; r&#61;0&#46;59&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05 and r&#61;0&#46;67&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#44; respectively&#41;&#46; However&#44; the concordance analysis showed that it is poor&#44; with lower and upper concordance limits of &#8722;13&#46;54l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA &#40;95&#37; CI &#8722;21&#46;68 to &#8722;5&#46;4&#41; and of 58&#46;98l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA &#40;95&#37; CI 50&#46;84-67&#46;12&#41;&#44; respectively&#44; of total CrCl with respect to total PCl &#40;Figure 3&#41;&#46; Moreover&#44; renal PCl showed an almost significant association with Kt&#47;V of renal urea &#40;r&#61;0&#46;43&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;05&#41;&#44; while total and peritoneal PCl did not display a significant association with Kt&#47;V of total and peritoneal urea &#40;r&#61;0&#46;18&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;31 for both&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Phosphorus clearance&#44; serum phosphorus levels and residual renal function</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">When we divided patients in accordance with diuresis and subdivided each group into normal phosphataemia and hyperphosphataemia &#40;Table 2&#41;&#44; we could observe that mean serum phosphorus for anuric patients with hyperphosphataemia was significantly higher than those with hyperphosphataemia who maintained diuresis &#40;7&#46;4&#177;1&#46;4mg&#47;dl versus 6&#46;3&#177;0&#46;8mg&#47;dl&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;03&#41;&#46; D&#47;P P was significantly lower in anuric patients with hyperphosphataemia&#44; compared with those who had normal serum phosphorus levels &#40;0&#46;51&#177;0&#46;8 versus 0&#46;62&#177;0&#46;14&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;006&#41;&#46; Although total PCl was higher in patients with diuresis compared with the anuric patient subgroup &#40;40&#46;2&#177;10&#46;4l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA vs&#46; 35&#46;6&#177;9&#46;6l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;12&#41;&#44; it was not significantly different&#46; However&#44; peritoneal PCl in anuric patients was significantly higher when we compared it with patients who maintained diuresis &#40;35&#46;5&#177;9&#46;8l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA vs&#46; 28&#46;3&#177;10&#46;25l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;01&#41;&#46; Residual renal function was significantly lower in patients with hyperphosphataemia compared with those with normal phosphataemia &#40;3&#46;2&#177;1&#46;2ml&#47;min vs&#46; 4&#46;8&#177;2&#46;0ml&#47;min&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;048&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Phosphorus excretion</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">We also evaluated the potential association between total and peritoneal phosphorus excretion with total and peritoneal CrCl and PCl&#44; and we found the following&#58; total phosphorus excretion showed a better correlation with total PCl &#40;r&#61;0&#46;62&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41; than with total CrCl &#40;r&#61;0&#46;360&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41;&#46; Peritoneal phosphorus excretion also had a better correlation with peritoneal PCl &#40;r&#61;0&#46;687&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41; in comparison with peritoneal CrCl &#40;r&#61;0&#46;466&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41;&#46; Lastly&#44; in patients with a Kt&#47;V of urea &#8805;1&#46;7 the correlation between total PCl and total phosphorus excretion was significant &#40;r&#61;0&#46;643&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41;&#44; but was not between total CrCl and total phosphorus excretion &#40;r&#61;0&#46;222&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;23&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Categorization of phosphorus transport</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">On the basis of D&#47;P P distribution using the CHAID method&#44; we created a classification tree and obtained the following nodes with their respective ranges&#58; node 1&#58; &#8804;0&#46;5&#44; node 2&#58; 0&#46;51-0&#46;55&#44; node 3&#58; 0&#46;56-0&#46;66&#44; node 4&#58; 0&#46;67-0&#46;76&#44; node 5&#58; &#62;0&#46;76&#44; and we found statistically significant differences between nodes in terms of serum phosphorus levels&#44; total and peritoneal PCl&#44; and Kt&#47;V of urea &#40;Table 3&#41;&#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">Phosphorus clearance is the result of the complex interaction between diffusion&#44; convection&#44; osmotic and chemical factors&#44; electrical gradients&#44; and active transmembrane phosphorus transporters<span class="elsevierStyleSup">19&#44;20</span>&#46; It has been demonstrated that absorption by lymphatic convection has no impact and that solutions with a higher concentration remove a higher quantity of phosphorus and are attributed to the convection factor&#46; However&#44; it was not possible to establish for certain whether ultrafiltration influences clearance<span class="elsevierStyleSup">21</span>&#46; Messa et al&#46; demonstrated in 35 patients that glucose concentration was one of the predictors of phosphorus clearance and this was independent of the ultrafiltration volume<span class="elsevierStyleSup">22</span>&#44; while Granja et al&#46; calculated that 11&#37; of the phosphorus eliminated was due to ultrafiltration<span class="elsevierStyleSup">23</span>&#46;</p><p class="elsevierStylePara">In our population&#44; we found that the frequency of hyperphosphataemia was 31&#46;3&#37;&#44; which is similar to that reported in the literature<span class="elsevierStyleSup">7</span>&#46; In previous studies&#44; an adequate correlation was found between D&#47;P Cr and D&#47;P P&#44; and between CrCl and PCl&#44; suggesting equivalence between them<span class="elsevierStyleSup">12&#44;13</span>&#46; In this study&#44; we demonstrated that although&#44; D&#47;P Cr and D&#47;P P displayed adequate correlation&#44; the concordance was poor&#44; since the concordance limits were very broad&#46; With such great variability of D&#47;P Cr or CrCl with respect to the phosphorus parameters&#44; there would be a very significant impact on clearance&#44; excretion and therefore serum phosphorus levels&#44; and as such&#44; these measurements could not be considered equivalents&#46; For example&#44; a patient with a D&#47;P P of 0&#46;4 may have a D&#47;P Cr from 0&#46;16 to 0&#46;94&#44; values that are very different from the value of D&#47;P P&#46; Likewise&#44; a patient with PCl of 35l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA could have CrCl from 13&#46;32l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA to 102&#46;12l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA&#46; Given the poor concordance that exists between the values studied and that they cannot be taken as replacements&#44; we proposed a phosphorus transport classification tree with five nodes based on its D&#47;P P&#44; amongst which we identified statistically significant differences between groups for total and peritoneal PCl&#46;</p><p class="elsevierStylePara">Our results confirm the role of diuresis in maintaining phosphorus levels at low values compared to anuria&#46; In anuric patients&#44; in whom the peritoneum has an exclusive role in phosphorus clearance&#44; the determination of phosphorus transport indicators is particularly important for two factors&#58; 1&#41; D&#47;P P is significantly lower in hyperphosphataemic patients&#59; 2&#41; Peritoneal PCl is significantly higher compared with those who maintain diuresis &#40;Table 2&#41;&#46;</p><p class="elsevierStylePara">The current recommendations for the prescription of peritoneal dialysis in accordance with the 2006 K&#47;DOQI clinical guidelines<span class="elsevierStyleSup">24</span>&#44; based on the results of three major studies<span class="elsevierStyleSup">25-27</span>&#44; set a Kt&#47;V of urea target of &#8805;1&#46;7&#44; which has not managed to reduce mortality in this population&#46; As such&#44; the search for new markers of targets is vitally important&#46; The current recommendations are to maintain the phosphorus level within the normal limits<span class="elsevierStyleSup">28</span>&#44; although this is an arduous challenge for patients and physicians&#44; since beyond dietary restriction and the adequate use of binders&#44; the doctor must know the role that dialysis exercises on PCl&#46; This study demonstrates the independence of phosphorus transport with respect to urea and creatinine and it leads to a series of questions such as the PCl dose necessary for helping patients achieve the serum phosphorus targets&#44; whether this value is different in patients with diuresis and anuric patients&#44; whether the dialysis adjustment to achieve an established PCl target improves mortality compared with the current Kt&#47;V of urea targets or whether a low D&#47;P P is associated with greater mortality&#44; amongst others&#46; As such&#44; studies must be carried out to determine the benefits of the adjustment of peritoneal dialysis based on D&#47;P P with different PCl doses&#44; establish the mid- and long-term morbidity and mortality&#44; and thus compare them with the current recommendations on dialysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">This study shows that D&#47;P P and PCl measurements are not concordant with those of D&#47;P Cr and CrCl&#44; respectively&#44; despite having an adequate correlation&#46; As such&#44; given the current lack of knowledge about phosphorus transport in peritoneal dialysis in clinical practice&#44; in a group of patients in whom phosphataemia control is imperative&#44; it is necessary to give continuity to the research of these indicators&#44; since they are useful tools for physicians and may guide dialysis prescription in search for a better control of serum phosphorus&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61888&#95;en&#95;t112281&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61888_en_t112281.jpg" alt="Population characteristics&#58; medical and dialysis management "></img></a></p><p class="elsevierStylePara">Table 1&#46; Population characteristics&#58; medical and dialysis management </p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61889&#95;en&#95;t212281&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61889_en_t212281.jpg" alt="Transport of solutes&#44; dialysis dose and phosphataemia in accordance with residual uresis"></img></a></p><p class="elsevierStylePara">Table 2&#46; Transport of solutes&#44; dialysis dose and phosphataemia in accordance with residual uresis</p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61890&#95;en&#95;t312281&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61890_en_t312281.jpg" alt="Phosphorus and clearance characteristics between transport nodes "></img></a></p><p class="elsevierStylePara">Table 3&#46; Phosphorus and clearance characteristics between transport nodes </p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61892&#95;en&#95;f112281&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61892_en_f112281.jpg" alt="Correlation between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Correlation between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61893&#95;en&#95;f2122813&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61893_en_f2122813.jpg" alt="Concordance between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Concordance between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12281&#95;16025&#95;61894&#95;en&#95;f3122813&#46;jpg" class="elsevierStyleCrossRefs"><img src="12281_16025_61894_en_f3122813.jpg" alt="Concordance between creatinine clearance and phosphorus clearance&#46;"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Concordance between creatinine clearance and phosphorus clearance&#46;</p>"
    "pdfFichero" => "P1-E574-S4691-A12281-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437331"
          "palabras" => array:1 [
            0 => "Aclaramiento de creatinina"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437333"
          "palabras" => array:1 [
            0 => "Di&#225;lisis peritoneal"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec437335"
          "palabras" => array:1 [
            0 => "Hiperfosfatemia"
          ]
        ]
      ]
      "en" => array:3 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437332"
          "palabras" => array:1 [
            0 => "Creatinine clearance"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437334"
          "palabras" => array:1 [
            0 => "Peritoneal dialysis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec437336"
          "palabras" => array:1 [
            0 => "Hyperphosphatemia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducci&#243;n&#58;</span> La hiperfosfatemia &#40;f&#243;sforo s&#233;rico &#8805;&#160;5&#44;5&#160;mg&#47;dl&#41; es un factor independiente de mortalidad en la poblaci&#243;n en di&#225;lisis&#46; Comparamos el transporte peritoneal de f&#243;sforo&#44; creatinina y urea para demostrar diferencias y se&#241;alar la relevancia de estos par&#225;metros en el control del f&#243;sforo s&#233;rico&#46; <span class="elsevierStyleBold">Material y m&#233;todos&#58;</span> Se incluyeron 60 pacientes en di&#225;lisis peritoneal y se determin&#243; el &#237;ndice dializante&#47;plasma de f&#243;sforo &#40;D&#47;P P&#41; y creatinina &#40;D&#47;P Cr&#41;&#44; el aclaramiento semanal de f&#243;sforo &#40;AclP&#41; y creatinina &#40;AclCr&#41;&#44; Kt&#47;V de urea semanal y la excreci&#243;n peritoneal de f&#243;sforo &#40;ExP&#41;&#46; <span class="elsevierStyleBold">Resultados&#58;</span> El D&#47;P P fue superior en pacientes con normofosfatemia&#44; comparados con los que presentaron hiperfosfatemia&#44; 0&#44;61&#160;&#177;&#160;0&#44;13 frente a 0&#44;54&#160;&#177;&#160;0&#44;10 &#40;<span class="elsevierStyleItalic">p&#160;</span>&#61;&#160;0&#44;035&#41;&#46; Se observ&#243; una adecuada correlaci&#243;n entre el D&#47;P P y el D&#47;P Cr&#44; r&#160;&#61;&#160;0&#44;90&#44; p&#160;&#60;&#160;0&#44;05&#44; pero una pobre concordancia entre ambos&#44; con un l&#237;mite inferior de &#8722;0&#44;17 &#40;&#8722;0&#44;24 a &#8722;0&#44;09 IC 95&#160;&#37;&#41; y l&#237;mite superior de 0&#44;47 &#40;0&#44;39-0&#44;54 IC 95&#160;&#37;&#41; para el D&#47;P Cr respecto al D&#47;P P&#46; El AclP tuvo una adecuada correlaci&#243;n con el D&#47;P P en pacientes con Kt&#47;V &#8805;&#160;1&#44;7 &#40;r&#160;&#61;&#160;0&#44;384&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;04&#41; y en an&#250;ricos &#40;r&#160;&#61;&#160;0&#44;392&#44; p&#160;&#61;&#160;0&#44;04&#41;&#44; pero no con el D&#47;P Cr&#46; Hubo una pobre concordancia del AclCr respecto al AclP con l&#237;mite inferior de &#8722;13&#44;54&#160;l&#47;sem&#47;1&#44;73&#160;m<span class="elsevierStyleSup">2</span> SC &#40;&#8722;21&#44;68 a &#8722;5&#44;4 IC 95&#160;&#37;&#41; y l&#237;mite superior de 58&#44;98&#160;l&#47;sem&#47;1&#44;73&#160;m<span class="elsevierStyleSup">2</span> SC &#40;50&#44;84-67&#44;12 IC 95&#160;&#37;&#41;&#46; La ExP total se relacion&#243; con el AclP &#40;r&#160;&#61;&#160;0&#44;643&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#44;05&#41;&#44; mientras que no lo hizo con el AclCr &#40;r&#160;&#61;&#160;0&#44;222&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;23&#41;&#46; Mediante el m&#233;todo CHAID se realiz&#243; un &#225;rbol de clasificaci&#243;n del transporte de f&#243;sforo con base en su D&#47;P&#44; obteniendo 5 nodos &#40;&#8804;&#160;0&#44;5&#44; 0&#44;51-0&#44;55&#44; 0&#44;56-0&#44;66&#44; 0&#44;67-0&#44;76&#44; &#62;&#160;0&#44;76&#41;&#44; mostrando diferencias estad&#237;sticamente significativas entre nodos para niveles s&#233;ricos de f&#243;sforo&#44; AclP total y peritoneal&#44; as&#237; como Kt&#47;V de urea semanal&#46; <span class="elsevierStyleBold">Conclusiones&#58;</span> Las mediciones de D&#47;P P y AclP no concuerdan con las mediciones de D&#47;P Cr y AclCr&#44; respectivamente&#44; por lo que su determinaci&#243;n es una herramienta cl&#237;nica para el control del nivel de f&#243;sforo s&#233;rico&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Hyperphosphataemia &#40;serum phosphorus &#8805;5&#46;5mg&#47;dl&#41; is an independent mortality factor for the dialysis population&#46; We compared phosphorus&#44; creatinine and urea peritoneal transport to demonstrate differences and indicate the relevance of these parameters in the control of serum phosphorus&#46; <span class="elsevierStyleBold">Material and method&#58;</span> We included 60 patients on peritoneal dialysis and determined the dialysate&#47;plasma phosphorus &#40;D&#47;P P&#41; and creatinine &#40;D&#47;P Cr&#41; ratios&#44; weekly creatinine clearance &#40;CrCl&#41; and phosphorus clearance &#40;PCl&#41;&#44; weekly Kt&#47;V of urea&#44; and peritoneal phosphorus excretion &#40;PEx&#41;&#46; <span class="elsevierStyleBold">Results&#58;</span> D&#47;P P was higher in patients with normal phosphataemia&#44; compared with those who were hyperphosphataemic 0&#46;61&#177;0&#46;13 versus 0&#46;54&#177;0&#46;10 &#40;<span class="elsevierStyleItalic">p</span>&#61;&#46;035&#41;&#46; We observed an adequate correlation between D&#47;P P and D&#47;P Cr&#44; r&#61;0&#46;90&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#44; but poor concordance between both&#44; with a lower limit of &#8722;0&#46;17 &#40;&#8722;0&#46;24 to &#8722;0&#46;09 95&#37; CI&#41; and an upper limit of 0&#46;47 &#40;0&#46;39-0&#46;54 95&#37; CI&#41; for D&#47;P Cr with respect to D&#47;P P&#46; PCl had an adequate correlation with D&#47;P P in patients with a Kt&#47;V &#8805;1&#46;7 &#40;r&#61;0&#46;384&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;04&#41; and in anuric patients &#40;r&#61;0&#46;392&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;04&#41;&#44; but not with D&#47;P Cr&#46; There was poor concordance of the CrCl with respect to PCl with a lower limit of &#8722;13&#46;54l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA &#40;&#8722;21&#46;68 to &#8722;5&#46;4 95&#37; CI&#41; and an upper limit of 58&#46;98l&#47;week&#47;1&#46;73m<span class="elsevierStyleSup">2</span> BSA &#40;50&#46;84-67&#46;12 95&#37; CI&#41;&#46; Total PEx was related to PCl &#40;r&#61;0&#46;643&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;05&#41;&#44; while it was not related to CrCl &#40;r&#61;0&#46;222&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;23&#41;&#46; Using the CHAID method&#44; we created a classification tree for phosphorus transport based on its D&#47;P&#44; obtaining 5 nodes &#40;&#8804;0&#46;5&#44; 0&#46;51-0&#46;55&#44; 0&#46;56-0&#46;66&#44; 0&#46;67-0&#46;76&#44; &#62;0&#46;76&#41;&#44; with statistically significant differences between nodes for serum phosphorus&#44; total and peritoneal PCl and weekly Kt&#47;V of urea&#46; <span class="elsevierStyleBold">Conclusions&#58;</span> D&#47;P P and PCl are not concordant with D&#47;P Cr and CrCl respectively and therefore their determination is a clinical tool to control serum phosphorus levels&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12281_16025_61888_en_t112281.jpg"
            "Alto" => 1345
            "Ancho" => 2145
            "Tamanyo" => 381952
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Population characteristics&#58; medical and dialysis management"
        ]
      ]
      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" => "12281_16025_61889_en_t212281.jpg"
            "Alto" => 1233
            "Ancho" => 2150
            "Tamanyo" => 564291
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Transport of solutes&#44; dialysis dose and phosphataemia in accordance with residual uresis"
        ]
      ]
      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" => "12281_16025_61890_en_t312281.jpg"
            "Alto" => 371
            "Ancho" => 2164
            "Tamanyo" => 190059
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Phosphorus and clearance characteristics between transport nodes"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig4"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12281_16025_61892_en_f112281.jpg"
            "Alto" => 913
            "Ancho" => 1015
            "Tamanyo" => 112256
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Correlation between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig5"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12281_16025_61893_en_f2122813.jpg"
            "Alto" => 902
            "Ancho" => 1015
            "Tamanyo" => 134616
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Concordance between the dialysate&#47;plasma creatinine ratio and the dialysate&#47;plasma phosphorus ratio&#46;"
        ]
      ]
      5 => array:8 [
        "identificador" => "fig6"
        "etiqueta" => "Fig. 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "12281_16025_61894_en_f3122813.jpg"
            "Alto" => 927
            "Ancho" => 1014
            "Tamanyo" => 155794
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Concordance between creatinine clearance and phosphorus clearance&#46;"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15385656" 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" => "Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:S112-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9820470" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Brenner BM. Brenner and Rector`s The Kidney. 8th edition. Philadelphia, PA: Saunders Elsevier; 2008. pp. 1784-807."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Murer H, Hernando N, Forster I, Biber J. Regulation of Na/Pi transporter in the proximal tubule. Annu Rev Physiol 2003;65:531-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12517995" 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" => "Levin A, Barkris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 2007;71:31-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gutierrez O, Isakova T, Rhee E, Shah A, Holmes J, Collerone G, et al. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. J Am Soc Nephrol 2005;16:2205-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15917335" 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" => "Hruska KA, Mathew S, Lund R, Qiu P, Pratt R. Hyperphosphatemia of chronic kidney disease. Kidney Int 2008;74:148-57. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18449174" 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" => "London GM, Guérin AP, Marchais SJ, Métivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal diseases: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003;18:1731-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12937218" 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" => "Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM. Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 2007;71:438-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17200680" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zheng CM, Lu KC, Wu CC, Hsu YH, Lin YF. Association of serum phosphate and related factors in ESRD-related vascular calcification. Int J Nephrol 2011;2011:939613."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sedlacek M, Dimaano F, Uribarri J. Relationship between phosphorus and creatinine clearance in peritoneal dialysis: clinical implications. Am J Kidney Dis 2000;36(5):1020-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11054360" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schmitt CP, Borzych D, Nau B, Wühl E, Zurowska A, Schaefer F. Dialytic phosphate removal: a modifiable measure of dialysis efficacy in automated peritoneal dialysis. Perit Dial Int 2009;29(4):465-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19602613" 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" => "Twardowski ZJ, Nolph KD, Khanna R, Prowant BF, Ryan LP, Moore HL, et al. Peritoneal equilibration test. Perit Dial Bull 1987;7:138-47."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bernardo AP, Contesse SA, Bajo MA, Rodrigues A, Del Peso G, Ossorio M, et al. Peritoneal membrane phosphate transport status: a cornerstone in phosphate handling in peritoneal dialysis. Clin J Am Soc Nephrol 2011;6(3):591-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21115631" 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" => "Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2868172" 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" => "Nolph KD, Moore HL, Twardowski ZJ, Khanna R, Prowant B, Meyer M, et al. Cross-sectional assessment of weekly urea and creatinine clearances in patients on continuous ambulatory peritoneal dialysis. ASAIO J 1992;38:M139-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1457833" 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" => "Randerson DH, Chapman GV, Farrell PC. Amino acid and dietary status in CAPD patients. In: Atkins RC, Farrell PC, Thomson N, eds. Peritoneal Dialysis. Edinburgh, Scotland: Churchill-Livingstone; 1981. pp. 180-91."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hernández-Ávila JE, González-Avilés L, Rosales-Mendoza E. Manual de usuario. SNUT Sistema de Evaluación de Hábitos Nutricionales y Consumo de Nutrimentos. México: Instituto Nacional de Salud Pública; 2003."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Graff J, Fugleberg S, Brahm J, Fogh-Andersen N. The transport of phosphate between the plasma and dialysate compartments in peritoneal dialysis is influenced by an electric potential difference. Clin Physiol 1996;16:291-300. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8736715" 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" => "Rippe B, Venturoli D, Simonsen O, de Arteaga J. Fluid an electrolyte transport across the peritoneal membrane during CAPD according to the three-pore model. Perit Dial Int 2004;24:10-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Delmez JA, Slatopolsky E, Martin KJ, Gearing BN, Harter HR. Minerals, vitamin D, and parathyroid hormone in continuous ambulatory peritoneal dialysis. Kidney Int 1982;21:862-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6897087" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Messa P, Gropuzzo M, Cleva M, Boscutti G, Mioni G, Cruciatti A, et al. Behaviour of phosphate removal with different dialysis schedules. Nephron Dial Transplant 1998;13 Suppl 6:43-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861014001844"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Granja CA, Juerguensen P, Finkelstein FO. Phosphate balance in peritoneal dialysis patients: Role of ultrafiltration. Contrib Nephrol 2009;163:198-205. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19494614" 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" => "K/DOQI 2006 Updates Clinical Practice Guidelines and Recomendations for Peritoneal Dialysis Adequacy. National Kidney Foundation; 2006."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Churchill DN, Taylor DW, Keshaviah PR, Thorpe KE, Beecroft ML. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7:198-207. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8785388" 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" => "Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002;13:1307-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961019" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lo WK, Ho YW, Li CS, Wong KS, Chan TM. Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study. Kidney Int 2003;64:649-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12846762" 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" => "Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009;(113):S1-130."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003400000005/v0_201502091605/X201325141405461X/v0_201502091605/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/20132514/0000003400000005/v0_201502091605/X201325141405461X/v0_201502091605/en/P1-E574-S4691-A12281-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141405461X?idApp=UINPBA000064"
]

Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2014.Jun.12281

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	3	7
2024 October	44	34	78
2024 September	69	31	100
2024 August	92	55	147
2024 July	65	31	96
2024 June	70	38	108
2024 May	77	32	109
2024 April	86	45	131
2024 March	66	22	88
2024 February	52	27	79
2024 January	51	22	73
2023 December	87	23	110
2023 November	111	35	146
2023 October	128	31	159
2023 September	105	25	130
2023 August	49	22	71
2023 July	67	39	106
2023 June	98	26	124
2023 May	80	42	122
2023 April	74	22	96
2023 March	94	18	112
2023 February	63	26	89
2023 January	46	26	72
2022 December	52	28	80
2022 November	74	37	111
2022 October	75	58	133
2022 September	53	31	84
2022 August	56	53	109
2022 July	70	57	127
2022 June	75	45	120
2022 May	66	57	123
2022 April	60	65	125
2022 March	68	51	119
2022 February	77	56	133
2022 January	67	38	105
2021 December	41	42	83
2021 November	49	43	92
2021 October	49	35	84
2021 September	36	37	73
2021 August	41	41	82
2021 July	34	30	64
2021 June	30	28	58
2021 May	41	39	80
2021 April	81	40	121
2021 March	67	41	108
2021 February	68	17	85
2021 January	30	13	43
2020 December	42	26	68
2020 November	36	23	59
2020 October	32	16	48
2020 September	26	17	43
2020 August	43	12	55
2020 July	58	12	70
2020 June	54	12	66
2020 May	41	24	65
2020 April	34	15	49
2020 March	34	22	56
2020 February	38	26	64
2020 January	52	19	71
2019 December	64	40	104
2019 November	30	28	58
2019 October	33	12	45
2019 September	33	18	51
2019 August	26	28	54
2019 July	29	19	48
2019 June	32	22	54
2019 May	39	22	61
2019 April	138	63	201
2019 March	46	27	73
2019 February	33	21	54
2019 January	46	26	72
2018 December	101	37	138
2018 November	82	30	112
2018 October	77	23	100
2018 September	85	9	94
2018 August	53	21	74
2018 July	54	11	65
2018 June	65	15	80
2018 May	58	10	68
2018 April	67	11	78
2018 March	42	8	50
2018 February	39	11	50
2018 January	38	6	44
2017 December	60	11	71
2017 November	71	13	84
2017 October	60	5	65
2017 September	57	8	65
2017 August	76	15	91
2017 July	57	15	72
2017 June	86	8	94
2017 May	82	9	91
2017 April	61	11	72
2017 March	63	8	71
2017 February	63	14	77
2017 January	32	9	41
2016 December	79	10	89
2016 November	73	17	90
2016 October	159	12	171
2016 September	222	5	227
2016 August	232	6	238
2016 July	211	10	221
2016 June	129	0	129
2016 May	152	0	152
2016 April	133	0	133
2016 March	101	0	101
2016 February	161	0	161
2016 January	138	0	138
2015 December	149	0	149
2015 November	139	0	139
2015 October	132	0	132
2015 September	103	0	103
2015 August	101	0	101
2015 July	131	0	131
2015 June	59	0	59
2015 May	77	0	77
2015 April	17	0	17

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter