array:25 [
  "pii" => "S2013251417301074"
  "issn" => "20132514"
  "doi" => "10.1016/j.nefroe.2017.05.010"
  "estado" => "S300"
  "fechaPublicacion" => "2017-05-01"
  "aid" => "299"
  "copyright" => "Sociedad Española de Nefrología"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia (English Version). 2017;37:343-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5439
    "formatos" => array:3 [
      "EPUB" => 553
      "HTML" => 3980
      "PDF" => 906
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S021169951630193X"
      "issn" => "02116995"
      "doi" => "10.1016/j.nefro.2016.10.019"
      "estado" => "S300"
      "fechaPublicacion" => "2017-05-01"
      "aid" => "299"
      "copyright" => "Sociedad Española de Nefrología"
      "documento" => "simple-article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "cor"
      "cita" => "Nefrologia. 2017;37:343-5"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4676
        "formatos" => array:3 [
          "EPUB" => 312
          "HTML" => 3618
          "PDF" => 746
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>"
        "titulo" => "Prevalencia y riesgo de progresi&#243;n de enfermedad renal cr&#243;nica en pacientes diab&#233;ticos e hipertensos seguidos en atenci&#243;n primaria en la Comunidad de Madrid"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "343"
            "paginaFinal" => "345"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed in primary care in Madrid"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Guadalupe Alem&#225;n-Vega, Isabel G&#243;mez Caba&#241;as, Laura Reques Sastre, Javier Rosado Mart&#237;n, Elena Polentinos-Castro, Ricardo Rodr&#237;guez Barrientos"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Guadalupe"
                "apellidos" => "Alem&#225;n-Vega"
              ]
              1 => array:2 [
                "nombre" => "Isabel"
                "apellidos" => "G&#243;mez Caba&#241;as"
              ]
              2 => array:2 [
                "nombre" => "Laura"
                "apellidos" => "Reques Sastre"
              ]
              3 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Rosado Mart&#237;n"
              ]
              4 => array:2 [
                "nombre" => "Elena"
                "apellidos" => "Polentinos-Castro"
              ]
              5 => array:2 [
                "nombre" => "Ricardo"
                "apellidos" => "Rodr&#237;guez Barrientos"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2013251417301074"
          "doi" => "10.1016/j.nefroe.2017.05.010"
          "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/S2013251417301074?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951630193X?idApp=UINPBA000064"
      "url" => "/02116995/0000003700000003/v1_201706230110/S021169951630193X/v1_201706230110/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2013251417301086"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2017.05.011"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "303"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia &#40;English Version&#41;. 2017;37:345-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2832
      "formatos" => array:3 [
        "EPUB" => 318
        "HTML" => 2022
        "PDF" => 492
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "The use of a quality care programme for the management of renal disease in the Aragon region"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "345"
          "paginaFinal" => "347"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Utilidad de un programa de calidad asistencial para la gesti&#243;n cl&#237;nica de las enfermedades nefrol&#243;gicas en Arag&#243;n"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Luis Miguel Lou Arnal, Ana Berni Wennekers, Olga Gracia Garc&#237;a, Jos&#233; Manuel Logro&#241;o Gonz&#225;lez, Antonio Gasc&#243;n Mari&#241;o, Mercedes Garc&#237;a Mena, Rosario Moreno L&#243;pez, Samia Etaaboudi, Orlando Martins, Angel Blasco Forc&#233;n, Jos&#233; Esteban Ruiz Laiglesia"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "Luis Miguel"
              "apellidos" => "Lou Arnal"
            ]
            1 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Berni Wennekers"
            ]
            2 => array:2 [
              "nombre" => "Olga"
              "apellidos" => "Gracia Garc&#237;a"
            ]
            3 => array:2 [
              "nombre" => "Jos&#233; Manuel"
              "apellidos" => "Logro&#241;o Gonz&#225;lez"
            ]
            4 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Gasc&#243;n Mari&#241;o"
            ]
            5 => array:2 [
              "nombre" => "Mercedes"
              "apellidos" => "Garc&#237;a Mena"
            ]
            6 => array:2 [
              "nombre" => "Rosario"
              "apellidos" => "Moreno L&#243;pez"
            ]
            7 => array:2 [
              "nombre" => "Samia"
              "apellidos" => "Etaaboudi"
            ]
            8 => array:2 [
              "nombre" => "Orlando"
              "apellidos" => "Martins"
            ]
            9 => array:2 [
              "nombre" => "Angel"
              "apellidos" => "Blasco Forc&#233;n"
            ]
            10 => array:2 [
              "nombre" => "Jos&#233; Esteban"
              "apellidos" => "Ruiz Laiglesia"
            ]
            11 => array:1 [
              "colaborador" => "On behalf of the Sociedad Aragonesa de Nefrolog&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699516301977"
        "doi" => "10.1016/j.nefro.2016.10.023"
        "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/S0211699516301977?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301086?idApp=UINPBA000064"
    "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301086/v1_201707070022/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2013251417300962"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2016.10.011"
    "estado" => "S300"
    "fechaPublicacion" => "2017-05-01"
    "aid" => "298"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia &#40;English Version&#41;. 2017;37:341-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4315
      "formatos" => array:3 [
        "EPUB" => 321
        "HTML" => 3305
        "PDF" => 689
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Spontaneous tendon ruptures in chronic renal failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "341"
          "paginaFinal" => "343"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Roturas tendinosas espont&#225;neas en la insuficiencia renal cr&#243;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Ruiz, Antonio R&#237;os, Jos&#233; Manuel Rodr&#237;guez, Santiago Llorente"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "Ruiz"
            ]
            1 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "R&#237;os"
            ]
            2 => array:2 [
              "nombre" => "Jos&#233; Manuel"
              "apellidos" => "Rodr&#237;guez"
            ]
            3 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Llorente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0211699516301928"
        "doi" => "10.1016/j.nefro.2016.10.018"
        "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/S0211699516301928?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417300962?idApp=UINPBA000064"
    "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417300962/v1_201707070022/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed by primary care physicians"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "343"
        "paginaFinal" => "345"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Guadalupe Alem&#225;n-Vega, Isabel G&#243;mez Caba&#241;as, Laura Reques Sastre, Javier Rosado Mart&#237;n, Elena Polentinos-Castro, Ricardo Rodr&#237;guez Barrientos"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Guadalupe"
            "apellidos" => "Alem&#225;n-Vega"
            "email" => array:1 [
              0 => "guadalupe&#46;aleman&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Isabel"
            "apellidos" => "G&#243;mez Caba&#241;as"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Laura"
            "apellidos" => "Reques Sastre"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Rosado Mart&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Elena"
            "apellidos" => "Polentinos-Castro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Ricardo"
            "apellidos" => "Rodr&#237;guez Barrientos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Medicina Preventiva y Salud P&#250;blica&#44; Hospital de La Princesa&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Atenci&#243;n Rural &#40;SAR&#41; Algete&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Medicina Preventiva y Salud P&#250;blica&#44; Escuela Nacional de Sanidad&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centro de Salud Universitario Reina Victoria&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Unidad Docente de Atenci&#243;n Familiar y Comunitaria Norte&#44; Unidad de Apoyo a la Investigaci&#243;n&#44; Gerencia Asistencial de Atenci&#243;n Primaria&#44; Red de Investigaci&#243;n en Servicios de Salud en Enfermedades Cr&#243;nicas &#40;REDISSEC&#41;&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Prevalencia y riesgo de progresi&#243;n de enfermedad renal cr&#243;nica en pacientes diab&#233;ticos e hipertensos seguidos en atenci&#243;n primaria en la Comunidad de Madrid"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; is a extremely important public health problem in part because it is not always diagnosed&#44; the prevalence is high &#40;10&#37; of the adult population&#41; with significant vascular morbidity and mortality<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;2</span></a> The prevalence is increased in diabetic &#40;men 29&#46;3&#37;&#47;women 22&#46;3&#37;&#41; and hypertensive patients &#40;men 57&#37;&#47;women 61&#46;4&#37;&#41; over the age of 60&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The care of CKD patients is a burden for the Spanish public health system&#59; the cost of care of patients with advanced CKD is aproximalety 800 million euros per year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> And the prevalence of CKD will increase due to the rise in life expectancies and a greater prevalence of obesity&#44; hypertension &#40;HTN&#41; and diabetes mellitus&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diabetic patients with kidney failure present higher morbidity and mortality rates than those with normal kidney function&#46; The estimated glomerular filtration rate &#40;eGFR&#41; has been used to stage CKD&#59; in 2013&#44; the &#8220;Kidney Disease&#58; Improving Global Outcomes&#8221; guidelines were updated to include the degree of albuminuria to better define de stage of CKD&#46; This allows stratified risk assessment of CKD progression and both cardiovascular and overall mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Studies on HTN<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and diabetes mellitus<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> recommend motorisation of albuminuria and the eGFR&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of electronic medical records &#40;EMR&#41; in primary care &#40;PC&#41; centres in Madrid allows us to obtain valid information to conduct epidemiological studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this work is to determine the prevalence and risk of CKD progression in diabetic and&#47;or hypertensive patients over the age of 40 in Primary Care facilities&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Observational study using EMRs under conditions of regular clinical practice in 263 PC centres in the Community of Madrid&#44; which provided health care to approximately 6&#44;384&#44;000 people &#40;population database&#41;&#46; The data was collected from October first 2012 to March 31st 2013&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients over the age of 40&#44; who had been diagnosed with HTN and&#47;or diabetes&#44; were included &#40;International Classification of Primary Care&#44; ICPC codes&#58; K86&#44; K87&#44; T90&#41;&#46; Excluded patients were those in whom less than 3 or more than 15 months had elapsed between the two consecutive determinations of creatinine or albuminuria&#46; These determination were needed to match the CKD definition set out in the &#8220;Kidney Disease&#58; Improving Global Outcomes&#8221;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> guidelines&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Creatinine and albuminuria values &#40;albumin&#47;creatinine ratio&#41; were obtained from the EMRs that incorporate all this information directly from all the laboratories in the Community of Madrid&#46; The eGFR value was estimated using the CKD-EPI equation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Data collection was performed retrospectively using &#8220;SQL&#8221; computer language on extracting information from the EMRs&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 24&#44;087 patients were included&#44; with a mean age of 68&#46;8 years &#40;SD&#58; 11&#46;5&#41;&#44; 56&#46;6&#37; were women&#59; 22&#37; &#40;5292 patients&#41; were diabetic&#59; 27&#46;5&#37; &#40;6613 patients&#41; hypertensive and 50&#46;6&#37; &#40;12&#44;182 patients&#41; had been diagnosed of both diabetes and hypertension&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the baseline clinical characteristics&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The prevalence of CKD in the population under study was 32&#46;27&#37; &#40;95&#37; CI&#58; 31&#46;67&#8211;32&#46;86&#41;&#44; with 11&#46;4&#37; &#40;95&#37; CI&#58; 11&#46;0&#8211;11&#46;8&#41; being due to the exclusive presence of albuminuria &#40;G1-G2&#47;A2-A3&#41;&#46; Among the diabetic patients&#44; the prevalence of CKD was 16&#46;95&#37; &#40;95&#37; CI&#58; 15&#46;91&#8211;17&#46;95&#41;&#46; In the hypertensive patients&#44; it was 24&#46;62&#37; &#40;95&#37; CI&#58; 23&#46;57&#8211;25&#46;66&#41;&#44; and in those with both diseases it was 31&#46;22&#37; &#40;95&#37; CI&#58; 30&#46;39&#8211;32&#46;04&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution across the different stages of CKD and the risk of progression&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The overall results of our study coincide with other publications&#44; in which a high prevalence of CKD is observed in hypertensive patients &#40;24&#37;&#41; over the age of 18&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Among diabetics&#44; there is a large variability&#44; with prevalences of 17&#46;3&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> to 34&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> It is evident that a greater proportion of diabetic patients have albuminuria as compatred with hypertensive patients&#46; This is particularly relevant since some studies have shown that it is an independent risk factor of cardiovascular and all-cause mortality r in primary prevention&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> By contrast&#44; the proportion of patients with a reduced eGFR is greater in hypertensive patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The study&#39;s limitations include the impossibility to separate different ethnic groups through the EMRs&#44; for which reason the differentiating equation cannot be applied for eGFR&#46; There may be a significant number of losses among patients with advanced CKD since they have prolonges follow up in hospital facilities&#46; Our work was performed in a population followed in PC that met the full definition of CKD&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> which means that the precision &#40;reduction of random error&#41; of this study is large in patients in early stages of CKD&#44; i&#46;e&#46; patients who are routinely monitored in our setting&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion&#44; the prevalence of CKD is greater in patients with HTN than diabetics&#44; although there was a greater proportion of diabetic patients with albuminuria&#46; These two populations are at risk of CKD progression and cardiovascular mortality&#59; controlling cardiovascular risk factors and adjusting nephrotoxic drugs according to the stage of the disease is thus extremely important to reduce disease progression&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alem&#225;n-Vega G&#44; G&#243;mez Caba&#241;as I&#44; Reques Sastre L&#44; Rosado Mart&#237;n J&#44; Polentinos-Castro E&#44; Rodr&#237;guez Barrientos R&#46; Prevalencia y riesgo de progresi&#243;n de enfermedad renal cr&#243;nica en pacientes diab&#233;ticos e hipertensos seguidos en atenci&#243;n primaria en la Comunidad de Madrid&#46; Nefrolog&#237;a&#46; 2017&#59;37&#58;343&#8211;345&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Last two values</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>eGFR CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;4 &#40;23&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Albumin&#47;creatinine ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;8 &#40;135&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>eGFR CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;6 &#40;23&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Albumin&#47;creatinine ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;3 &#40;145&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Cardiovascular risk factors</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182&#46;9 &#40;34&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LDL cholesterol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&#46;9 &#40;30&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133&#46;0 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;0 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HbA<span class="elsevierStyleInf">1c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;0 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1454351.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Baseline clinical characteristics of the patients&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The colours show the adjusted risk ratio for five events &#40;overall mortality&#44; cardiovascular mortality&#44; kidney failure treated with dialysis or transplant&#44; acute kidney failure and CKD progression&#41;&#46; The lowest risk corresponds to green &#40;&#8220;low risk&#8221; category&#59; in the event that there is no data of kidney injury&#44; it may not even be categorised as CKD&#41;&#44; followed by yellow &#40;&#8220;moderately increased&#8221; risk&#41;&#44; orange &#40;&#8220;high risk&#8221;&#41; and red &#40;&#8220;very high risk&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tablaImagen" => array:1 [
                0 => array:4 [
                  "imagenFichero" => "fx1.jpeg"
                  "imagenAlto" => 3172
                  "imagenAncho" => 1625
                  "imagenTamanyo" => 526835
                ]
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution &#40;in percentages&#41; in chronic kidney disease stages and risk of progression&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of diabetes mellitus and hypertension diagnosis in computerized medical records in primary health care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; De Burgos-Lunar"
                            1 => "M&#46;A&#46; Salinero-Fort"
                            2 => "J&#46; C&#225;rdenas-Valladolid"
                            3 => "S&#46; Soto-D&#237;az"
                            4 => "C&#46;Y&#46; Fuentes-Rodr&#237;guez"
                            5 => "J&#46;C&#46; Ab&#225;nades-Herranz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2288-11-146"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Res Methodol"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "146"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22035202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de consenso sobre la enfermedad renal cr&#243;nica&#46; S&#46;E&#46;N-semFYC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; S&#225;nchez-Celaya del Pozo"
                            1 => "S&#46; Tranche Iparraguirre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Prim"
                        "fecha" => "2014"
                        "volumen" => "46"
                        "paginaInicial" => "453"
                        "paginaFinal" => "454"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedad renal cr&#243;nica en atenci&#243;n primaria&#58; prevalencia y factores de riesgo asociados"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Salvador Gonz&#225;lez"
                            1 => "M&#46; Rodr&#237;guez Pascual"
                            2 => "L&#46; Ruip&#233;rez Guijarro"
                            3 => "A&#46; Ferr&#233; Gonz&#225;lez"
                            4 => "O&#46; Cunillera Puertolas"
                            5 => "L&#46;M&#46; Rodr&#237;guez Latre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Prim"
                        "fecha" => "2015"
                        "volumen" => "47"
                        "paginaInicial" => "236"
                        "paginaFinal" => "245"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and diabetes in the developing world a growing challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Hossai Kawar"
                            1 => "M&#46; El Nahas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMp068177"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "356"
                        "paginaInicial" => "213"
                        "paginaFinal" => "215"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17229948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal cr&#243;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; G&#243;mez-Huelgas"
                            1 => "A&#46; Mart&#237;nez-Castelao"
                            2 => "S&#46; Artola"
                            3 => "J&#46;L&#46; G&#243;rriz"
                            4 => "E&#46; Men&#233;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2014"
                        "volumen" => "142"
                        "paginaInicial" => "85&#46;e1"
                        "paginaFinal" => "85&#46;e10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de enfermedad renal cr&#243;nica en los hipertensos seguidos en los centros de salud de Espa&#241;a y grado de control de su presi&#243;n arterial &#40;estudio DISEHTAE&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Vara-Gonz&#225;lez"
                            1 => "E&#46; Mart&#237;n Riobo&#243;"
                            2 => "T&#46; Ure&#241;a Fern&#225;ndez"
                            3 => "A&#46; Dalf&#243;Baqu&#233;"
                            4 => "I&#46; Flor Becerra"
                            5 => "V&#46; L&#243;pez Fern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Prim"
                        "fecha" => "2008"
                        "volumen" => "40"
                        "paginaInicial" => "241"
                        "paginaFinal" => "245"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de enfermedad renal cr&#243;nica en pacientes con diabetes mellitus tipo 2 atendidos en atenci&#243;n primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;M&#46; Lou Arnal"
                            1 => "B&#46; Campos Guti&#233;rrez"
                            2 => "M&#46; Cuberes Izquierdo"
                            3 => "O&#46; Gracia Garc&#237;a"
                            4 => "J&#46;M&#46; Tur&#243;n Alcaine"
                            5 => "S&#46; Bielsa Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2010.Jun.10260"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrolog&#237;a"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "552"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20882094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The definition&#44; classification and prognosis of chronic kidney disease&#58; a KDIGO controversies conference report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Levey"
                            1 => "P&#46;E&#46; Jong"
                            2 => "J&#46; Coresh"
                            3 => "M&#46; El Nahas"
                            4 => "B&#46;C&#46; Astor"
                            5 => "K&#46; Matsushita"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2010.483"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2011"
                        "volumen" => "80"
                        "paginaInicial" => "17"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21150873"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Change in prevalence of chronic kidney disease in England over time&#58; comparison of nationally representative cross-sectional surveys from 2003 to 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;R&#46; Aitken"
                            1 => "P&#46;J&#46; Roderick"
                            2 => "S&#46; Fraser"
                            3 => "J&#46;S&#46; Mindell"
                            4 => "D&#46; O&#8217;Donoghue"
                            5 => "J&#46; Day"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2014-005480"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2014"
                        "volumen" => "4"
                        "paginaInicial" => "e005480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25270853"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study&#58; association with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;&#193;&#46; Salinero-Fort"
                            1 => "F&#46;J&#46; San Andr&#233;s-Rebollo"
                            2 => "C&#46; de Burgos-Lunar"
                            3 => "J&#46;C&#46; Ab&#225;nades-Herranz"
                            4 => "E&#46; Carrillo-de-Santa-Pau"
                            5 => "R&#46;M&#46; Chico-Moraleja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jdiacomp.2015.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Diabetes Complicat"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "227"
                        "paginaFinal" => "236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26627635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003700000003/v1_201707070022/S2013251417301074/v1_201707070022/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35436"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000003/v1_201707070022/S2013251417301074/v1_201707070022/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301074?idApp=UINPBA000064"
]
Share
Journal Information
Vol. 37. Issue. 3.May - June 2017
Pages 229-356
Vol. 37. Issue. 3.May - June 2017
Pages 229-356
Letter to the Editor
Open Access
Prevalence and risk of progression of chronic kidney disease in diabetics and hypertensive patients followed by primary care physicians
Prevalencia y riesgo de progresión de enfermedad renal crónica en pacientes diabéticos e hipertensos seguidos en atención primaria en la Comunidad de Madrid
Visits
11889
Guadalupe Alemán-Vegaa,
Corresponding author
, Isabel Gómez Cabañasb, Laura Reques Sastrec, Javier Rosado Martínd, Elena Polentinos-Castroe, Ricardo Rodríguez Barrientose
a Medicina Preventiva y Salud Pública, Hospital de La Princesa, Madrid, Spain
b Servicio de Atención Rural (SAR) Algete, Madrid, Spain
c Medicina Preventiva y Salud Pública, Escuela Nacional de Sanidad, Madrid, Spain
d Centro de Salud Universitario Reina Victoria, Madrid, Spain
e Unidad Docente de Atención Familiar y Comunitaria Norte, Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Tables (2)
Table 1. Baseline clinical characteristics of the patients.
Table 2. Distribution (in percentages) in chronic kidney disease stages and risk of progression.
Show moreShow less
Full Text
Dear Editor,

Chronic kidney disease (CKD) is a extremely important public health problem in part because it is not always diagnosed, the prevalence is high (10% of the adult population) with significant vascular morbidity and mortality1,2 The prevalence is increased in diabetic (men 29.3%/women 22.3%) and hypertensive patients (men 57%/women 61.4%) over the age of 60.3

The care of CKD patients is a burden for the Spanish public health system; the cost of care of patients with advanced CKD is aproximalety 800 million euros per year.2 And the prevalence of CKD will increase due to the rise in life expectancies and a greater prevalence of obesity, hypertension (HTN) and diabetes mellitus.4

Diabetic patients with kidney failure present higher morbidity and mortality rates than those with normal kidney function. The estimated glomerular filtration rate (eGFR) has been used to stage CKD; in 2013, the “Kidney Disease: Improving Global Outcomes” guidelines were updated to include the degree of albuminuria to better define de stage of CKD. This allows stratified risk assessment of CKD progression and both cardiovascular and overall mortality.5

Studies on HTN6 and diabetes mellitus7 recommend motorisation of albuminuria and the eGFR.

The use of electronic medical records (EMR) in primary care (PC) centres in Madrid allows us to obtain valid information to conduct epidemiological studies.1

The objective of this work is to determine the prevalence and risk of CKD progression in diabetic and/or hypertensive patients over the age of 40 in Primary Care facilities.

Observational study using EMRs under conditions of regular clinical practice in 263 PC centres in the Community of Madrid, which provided health care to approximately 6,384,000 people (population database). The data was collected from October first 2012 to March 31st 2013.

Patients over the age of 40, who had been diagnosed with HTN and/or diabetes, were included (International Classification of Primary Care, ICPC codes: K86, K87, T90). Excluded patients were those in whom less than 3 or more than 15 months had elapsed between the two consecutive determinations of creatinine or albuminuria. These determination were needed to match the CKD definition set out in the “Kidney Disease: Improving Global Outcomes”8 guidelines.

Creatinine and albuminuria values (albumin/creatinine ratio) were obtained from the EMRs that incorporate all this information directly from all the laboratories in the Community of Madrid. The eGFR value was estimated using the CKD-EPI equation.2

Data collection was performed retrospectively using “SQL” computer language on extracting information from the EMRs.

A total of 24,087 patients were included, with a mean age of 68.8 years (SD: 11.5), 56.6% were women; 22% (5292 patients) were diabetic; 27.5% (6613 patients) hypertensive and 50.6% (12,182 patients) had been diagnosed of both diabetes and hypertension. Table 1 presents the baseline clinical characteristics.

Table 1.

Baseline clinical characteristics of the patients.

  Mean (SD) 
Last two values
eGFR CKD-EPI  79.4 (23.4) 
Albumin/creatinine ratio  37.8 (135.0) 
eGFR CKD-EPI  79.6 (23.8) 
Albumin/creatinine ratio  42.3 (145.1) 
Cardiovascular risk factors
Cholesterol  182.9 (34.7) 
LDL cholesterol  104.9 (30.3) 
Mean SBP  133.0 (12.4) 
Mean DBP  75.0 (7.9) 
HbA1c  7.0 (1.2) 

The prevalence of CKD in the population under study was 32.27% (95% CI: 31.67–32.86), with 11.4% (95% CI: 11.0–11.8) being due to the exclusive presence of albuminuria (G1-G2/A2-A3). Among the diabetic patients, the prevalence of CKD was 16.95% (95% CI: 15.91–17.95). In the hypertensive patients, it was 24.62% (95% CI: 23.57–25.66), and in those with both diseases it was 31.22% (95% CI: 30.39–32.04).

Table 2 shows the distribution across the different stages of CKD and the risk of progression.

Table 2.

Distribution (in percentages) in chronic kidney disease stages and risk of progression.

The colours show the adjusted risk ratio for five events (overall mortality, cardiovascular mortality, kidney failure treated with dialysis or transplant, acute kidney failure and CKD progression). The lowest risk corresponds to green (“low risk” category; in the event that there is no data of kidney injury, it may not even be categorised as CKD), followed by yellow (“moderately increased” risk), orange (“high risk”) and red (“very high risk”).2

The overall results of our study coincide with other publications, in which a high prevalence of CKD is observed in hypertensive patients (24%) over the age of 18.8 Among diabetics, there is a large variability, with prevalences of 17.3%9 to 34.6%.7 It is evident that a greater proportion of diabetic patients have albuminuria as compatred with hypertensive patients. This is particularly relevant since some studies have shown that it is an independent risk factor of cardiovascular and all-cause mortality r in primary prevention.10 By contrast, the proportion of patients with a reduced eGFR is greater in hypertensive patients.3

The study's limitations include the impossibility to separate different ethnic groups through the EMRs, for which reason the differentiating equation cannot be applied for eGFR. There may be a significant number of losses among patients with advanced CKD since they have prolonges follow up in hospital facilities. Our work was performed in a population followed in PC that met the full definition of CKD,8 which means that the precision (reduction of random error) of this study is large in patients in early stages of CKD, i.e. patients who are routinely monitored in our setting.

In conclusion, the prevalence of CKD is greater in patients with HTN than diabetics, although there was a greater proportion of diabetic patients with albuminuria. These two populations are at risk of CKD progression and cardiovascular mortality; controlling cardiovascular risk factors and adjusting nephrotoxic drugs according to the stage of the disease is thus extremely important to reduce disease progression.

References
[1]
C. De Burgos-Lunar, M.A. Salinero-Fort, J. Cárdenas-Valladolid, S. Soto-Díaz, C.Y. Fuentes-Rodríguez, J.C. Abánades-Herranz, et al.
Validation of diabetes mellitus and hypertension diagnosis in computerized medical records in primary health care.
BMC Med Res Methodol, 11 (2011), pp. 146
[2]
M. Sánchez-Celaya del Pozo, S. Tranche Iparraguirre.
Documento de consenso sobre la enfermedad renal crónica. S.E.N-semFYC.
Aten Prim, 46 (2014), pp. 453-454
[3]
B. Salvador González, M. Rodríguez Pascual, L. Ruipérez Guijarro, A. Ferré González, O. Cunillera Puertolas, L.M. Rodríguez Latre.
Enfermedad renal crónica en atención primaria: prevalencia y factores de riesgo asociados.
Aten Prim, 47 (2015), pp. 236-245
[4]
B. Hossai Kawar, M. El Nahas.
Obesity and diabetes in the developing world a growing challenge.
N Engl J Med, 356 (2007), pp. 213-215
[5]
R. Gómez-Huelgas, A. Martínez-Castelao, S. Artola, J.L. Górriz, E. Menéndez.
Documento de consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal crónica.
Med Clin (Barc), 142 (2014), pp. 85.e1-85.e10
[6]
L. Vara-González, E. Martín Rioboó, T. Ureña Fernández, A. DalfóBaqué, I. Flor Becerra, V. López Fernández.
Prevalencia de enfermedad renal crónica en los hipertensos seguidos en los centros de salud de España y grado de control de su presión arterial (estudio DISEHTAE).
Aten Prim, 40 (2008), pp. 241-245
[7]
L.M. Lou Arnal, B. Campos Gutiérrez, M. Cuberes Izquierdo, O. Gracia García, J.M. Turón Alcaine, S. Bielsa García, et al.
Prevalencia de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 atendidos en atención primaria.
[8]
A.S. Levey, P.E. Jong, J. Coresh, M. El Nahas, B.C. Astor, K. Matsushita, et al.
The definition, classification and prognosis of chronic kidney disease: a KDIGO controversies conference report.
Kidney Int, 80 (2011), pp. 17-28
[9]
G.R. Aitken, P.J. Roderick, S. Fraser, J.S. Mindell, D. O’Donoghue, J. Day, et al.
Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010.
BMJ Open, 4 (2014), pp. e005480
[10]
M.Á. Salinero-Fort, F.J. San Andrés-Rebollo, C. de Burgos-Lunar, J.C. Abánades-Herranz, E. Carrillo-de-Santa-Pau, R.M. Chico-Moraleja, et al.
Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: association with chronic kidney disease.
J Diabetes Complicat, 30 (2016), pp. 227-236

Please cite this article as: Alemán-Vega G, Gómez Cabañas I, Reques Sastre L, Rosado Martín J, Polentinos-Castro E, Rodríguez Barrientos R. Prevalencia y riesgo de progresión de enfermedad renal crónica en pacientes diabéticos e hipertensos seguidos en atención primaria en la Comunidad de Madrid. Nefrología. 2017;37:343–345.

Copyright © 2016. Sociedad Española de Nefrología
Download PDF
Idiomas
Nefrología (English Edition)
Article options
Tools