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El diagn&#243;stico de SPI se asocia a alteraciones en la calidad de vida del paciente&#44; fundamentalmente cl&#237;nica depresiva o ansiosa&#44; as&#237; como a un deterioro de la higiene de sue&#241;o con aparici&#243;n de somnolencia diurna y fatiga&#46; Algunos estudios se&#241;alan&#44; incluso&#44; una relaci&#243;n directa entre el SPI y un aumento de la mortalidad<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5-7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las lteraciones hipotal&#225;micas de las c&#233;lulas dopamin&#233;rgicas como respuesta a niveles elevados de algunos neurotransmisores&#44; la reducci&#243;n de la inhibici&#243;n a nivel de c&#243;rtex motor&#44; la hiperreactividad del reflejo flexor espinal o alteraciones de reflejos troncales cerebrales han sido algunos de los diversos y complejos mecanismos neurol&#243;gicos implicados en la fisiopatolog&#237;a de este s&#237;ndrome<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8-10</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Desde el punto de vista etiol&#243;gico&#44; fundamentalmente existen las formas primarias o idiop&#225;ticas y las secundarias&#46; En cuanto a las formas secundarias&#44; existen multitud de etiolog&#237;as descritas&#44; si bien las m&#225;s frecuentes son las asociadas a anemia con d&#233;ficit de hierro&#44; neuropat&#237;a diab&#233;tica&#44; enfermedades neurodegenerativas &#8212;como la esclerosis m&#250;ltiple o la enfermedad de Parkinson&#8212; y a la presencia de enfermedad renal cr&#243;nica en situaciones de uremia avanzadas<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Con relaci&#243;n al SPI asociado a la uremia&#44; muchas veces es un s&#237;ndrome infradiagnosticado&#46; Su prevalencia es variable y se estima entre un 12 y un 30&#37;&#46; Esta prevalencia resulta superior entre los pacientes incluidos en programas de terapia sustitutiva renal&#44; fundamentalmente en hemodi&#225;lisis &#40;HD&#41;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;14&#44;15</span></a>&#46; No obstante&#44; los estudios publicados en la literatura son pocos&#44; de peque&#241;o tama&#241;o y en alg&#250;n caso con informaci&#243;n contradictoria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Actualmente&#44; la terapia farmacol&#243;gica de SPI se basa principalmente en el uso de agonistas dopamin&#233;rgicos no ergotam&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Su principal ventaja&#44; en comparaci&#243;n con el uso cl&#225;sico de levodopa y gabapentina&#44; radica principalmente en la presencia de menores efectos adversos a nivel gastrointestinal&#46; Los m&#225;s utilizados son pramipexol&#44; ropinirol y&#44; m&#225;s recientemente&#44; rotigotina<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">16&#8211;18</span></a>&#46; Rotigotina&#44; adicionalmente presenta un mejor control de la sintomatolog&#237;a&#44; menor incidencia de efectos adversos y de potenciaci&#243;n parad&#243;jica de s&#237;ntomas &#40;<span class="elsevierStyleItalic">augmentation effect</span>&#41; as&#237; como facilidad de administraci&#243;n y dosificaci&#243;n en el paciente en HD<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Dada la potencial repercusi&#243;n en la calidad de vida y las implicaciones m&#233;dicas que conlleva su tratamiento&#44; junto con la ausencia de series publicadas a nivel nacional con relaci&#243;n al SPI&#44; pensamos que ser&#237;a interesante realizar este estudio para describir la prevalencia de SPI en nuestra unidad de HD as&#237; como analizar los posibles efectos de la rotigotina sobre la sintomatolog&#237;a&#44; la calidad de vida y la higiene del sue&#241;o de nuestros pacientes con SPI&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Durante los meses de enero a abril de 2015 se realiz&#243; un estudio unic&#233;ntrico prospectivo de 12 semanas de duraci&#243;n en los pacientes en programa de HD peri&#243;dica de nuestro centro diagnosticados de SPI&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica e Investigaci&#243;n Cl&#237;nica hospitalaria y realizado de acuerdo con las normas de la declaraci&#243;n de Helsinki&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n fueron los siguientes&#58; edad igual o superior a 18 a&#241;os de edad&#44; ser diagnosticados de SPI y otorgar el consentimiento informado&#46; Los criterios de exclusi&#243;n establecidos fueron&#58; falta de consentimiento informado e incapacidad intelectual para contestar a las preguntas de los cuestionarios&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El programa de HD peri&#243;dica de nuestro hospital distribuye a los pacientes principalmente en 6 grupos de 10-12 pacientes&#46; Estos grupos realizan sesiones solo en la modalidad de HD de alto flujo con una duraci&#243;n de 3&#44;5-4<span class="elsevierStyleHsp" style=""></span>h en d&#237;as alternos &#40;L-X-V o M-J-S&#41;&#44; en unos horarios de ma&#241;ana&#44; mediod&#237;a &#40;3&#44;5&#160;h&#41; y tarde&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se establecieron 2<span class="elsevierStyleHsp" style=""></span>fases comparativas de estudio con una duraci&#243;n de 6<span class="elsevierStyleHsp" style=""></span>semanas cada una&#46; En la primera fase &#40;fase 1&#41; los pacientes en HD de nuestro centro fueron diagnosticados de SPI de acuerdo con los criterios cl&#237;nicos internacionales del <span class="elsevierStyleItalic">International Restless Leg Syndrome Study Group</span> &#40;IRLSSG&#44; 2012&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a>&#46; Todos los pacientes con SPI fueron evaluados por el mismo neur&#243;logo de nuestro hospital&#46; Los pacientes que reun&#237;an 4<span class="elsevierStyleHsp" style=""></span>criterios fueron diagnosticados de SPI&#46; En la segunda fase &#40;fase 2&#41; se procedi&#243; a la administraci&#243;n de parches transd&#233;rmicos de rotigotina de forma progresiva durante las primeras 2<span class="elsevierStyleHsp" style=""></span>semanas &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; y en caso de correcta tolerancia y ausencia de efectos adversos se progres&#243; en la dosis diaria recibida &#40;2<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#46; Tras una sesi&#243;n explicativa individualizada de la sistem&#225;tica de administraci&#243;n&#44; los parches transd&#233;rmicos de rotigotina se mantuvieron durante las 24&#160;h&#44; con rotaci&#243;n en los sitios de aplicaci&#243;n&#46; En caso de requerir disminuci&#243;n de la dosis&#44; esta se hizo de forma progresiva para evitar el efecto rebote de la sintomatolog&#237;a&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Al inicio del estudio se recogieron los principales datos demogr&#225;ficos &#40;edad&#44; sexo&#44; etiolog&#237;a de la insuficiencia renal cr&#243;nica&#44; tiempo de permanencia en HD&#41; y comorbilidades asociadas &#40;diabetes mellitus&#44; hipertensi&#243;n arterial&#44; vasculopat&#237;a perif&#233;rica&#44; cardiopat&#237;a isqu&#233;mica&#44; &#237;ndice de comorbilidad de Charlson&#44; tabaquismo&#44; h&#225;bito en&#243;lico&#44; toma de derivados de cafe&#237;na&#41;&#46; Tanto al inicio como al final de cada una de las fases previamente establecidas&#44; se analizaron los principales datos bioqu&#237;micos&#44; la medicaci&#243;n habitual del paciente relacionada con el SPI&#44; as&#237; como las caracter&#237;sticas y datos de adecuaci&#243;n en HD &#40;Kt&#47;V&#44; m&#233;todo 2&#46;&#170; generaci&#243;n Daugirdas&#41;&#46; Del mismo modo se analizaron las siguientes variables&#58;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Grado de gravedad de los s&#237;ntomas del s&#237;ndrome de piernas inquietas y cuestionario espec&#237;fico de s&#237;ntomas</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se determin&#243; el grado de gravedad de los s&#237;ntomas mediante la escala de gravedad &#40;GRLS&#41; establecida por el IRLSSG<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> y la sintomatolog&#237;a en ambas extremidades inferiores mediante un cuestionario propio de s&#237;ntomas espec&#237;ficos &#40;QS&#41;&#46; El GRLS es una encuesta validada con relaci&#243;n a la repercusi&#243;n de la sintomatolog&#237;a del SPI en cada paciente&#46; Consta de 10 preguntas con 5 posibles respuestas&#46; Cada respuesta se punt&#250;a de 0 a 4&#46; La forma m&#225;s sencilla de analizar es la suma de la puntuaci&#243;n total&#46; A partir de 15 puntos&#44; se considera sintomatolog&#237;a grave&#46; A mayor puntuaci&#243;n&#44; mayor gravedad&#46; El QS valora mediante una escala cualitativa &#40;1&#58; nulo&#44; 2-3&#58; poco 4&#58; bastante&#59; 5&#58; mucho&#41; la presencia de los siguientes s&#237;ntomas&#58; dolor muscular&#44; calambres&#44; hormigueo&#44; quemaz&#243;n y entumecimiento&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Calidad de vida e higiene de sue&#241;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">La calidad de vida se evalu&#243; mediante el cuestionario de salud homologado adaptado a SPI&#58; John Hopkins RLS QoL &#40;JH-QoL&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a>&#46; Consta de 18 preguntas con 5 posibles respuestas y puntuaci&#243;n de 0 a 4&#46; La forma m&#225;s sencilla de analizar es la suma de la puntuaci&#243;n total&#46; De forma global&#44; a mayor puntuaci&#243;n&#44; peor calidad de vida para SPI&#46; Por &#250;ltimo&#44; la higiene del sue&#241;o fue evaluada mediante la encuesta validada SCOPA<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a>&#46; Se compone de 2 apartados&#46; En el primero se valora el sue&#241;o nocturno&#46; Consta de 6 cuestiones&#44; 5 m&#225;s espec&#237;ficas y valoradas desde 0 &#40;no&#41; hasta 3 &#40;mucho&#41; y una sexta de valoraci&#243;n global con 7 posibilidades desde 0 &#40;muy mal&#41; hasta 7 &#40;muy bien&#41;&#46; En el segundo apartado se valora la somnolencia diurna&#46; Consta de 6 cuestiones espec&#237;ficas valoradas de 0 &#40;nunca&#41; a 3 &#40;frecuentemente&#41;&#46; El an&#225;lisis global se hace mediante la suma de puntos en cada apartado &#40;sue&#241;o nocturno&#47;somnolencia diurna&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Eficacia del tratamiento&#44; cumplimentaci&#243;n terap&#233;utica y efectos adversos</span><p id="par0075" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a la eficacia del tratamiento&#44; se defini&#243; como respuesta parcial a una reducci&#243;n superior al 20&#37; en la QS&#59; respuesta completa se defini&#243; como una reducci&#243;n superior al 80&#37; en la QS y la presencia de s&#237;ntomas &#171;cero&#187; se defini&#243; por una puntuaci&#243;n inferior a 5 puntos en la QS&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La cumplimentaci&#243;n terap&#233;utica&#44; al tratarse de un parche transd&#233;rmico de f&#225;cil aplicaci&#243;n&#44; se evalu&#243; mediante revisi&#243;n al inicio de la sesi&#243;n de HD&#46; Aquellos pacientes que presentaban ausencia del parche transd&#233;rmico en 3<span class="elsevierStyleHsp" style=""></span>revisiones ordinarias fueron catalogados como incumplidores&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Los efectos adversos analizados mediante anamnesis durante las sesiones habituales de HD fueron&#58; reacciones de tipo al&#233;rgico en la zona de aplicaci&#243;n &#40;eritema o induraci&#243;n&#44; dolor local&#44; prurito&#41;&#44; cefalea&#44; somnolencia&#44; n&#225;useas&#44; v&#243;mitos&#44; dispepsia&#44; hipertensi&#243;n y potenciaci&#243;n parad&#243;jica de los s&#237;ntomas &#40;<span class="elsevierStyleItalic">augmentation effect</span>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSS versi&#243;n 18&#46;0 &#40;SPSS Inc&#44; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41;&#46; Los datos no presentaron una distribuci&#243;n normal tras el test de Kolmogorov-Smirnov&#46; Las variables cuantitativas se expresaron mediante la media y desviaci&#243;n est&#225;ndar&#46; Las variables cualitativas&#44; mediante porcentaje&#46; La comparaci&#243;n de los datos cuantitativos se realiz&#243; mediante el test de Wilcoxon para variables relacionadas no param&#233;tricas y los datos cualitativos mediante el test de McNemar&#46; El an&#225;lisis intergrupos se realiz&#243; mediante la prueba U de Mann-Whitney&#44; considerando significaci&#243;n estad&#237;stica un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se analizaron un total de 66 pacientes prevalentes en programa de HD&#46; Cinco fueron excluidos &#40;3 por demencia&#44; uno por negativa y otro por alteraci&#243;n psiqui&#225;trica&#41;&#46; De los 61 pacientes restantes&#44; 14 fueron diagnosticados de SPI&#44; con una prevalencia del 22&#44;9&#37;&#46; Durante el periodo de estudio hubo 5 abandonos &#40;uno por paro cardiorrespiratorio&#44; 3 por revocaci&#243;n de consentimiento informado y uno por enfermedad hematol&#243;gica maligna&#41;&#44; ninguno relacionado con el tema del presente estudio&#46; De los 9 pacientes restantes&#44; un 44&#44;4&#37; eran hombres&#44; con una edad media de 70&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;9 a&#241;os y un tiempo medio de permanencia en HD de 111&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>160&#44;8 meses&#46; El &#237;ndice de Charlson medio fue de 10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46; Las principales comorbilidades fueron&#58; hipertensi&#243;n arterial &#40;88&#44;9&#37;&#41;&#44; diabetes mellitus &#40;77&#44;8&#37;&#41;&#44; vasculopat&#237;a perif&#233;rica &#40;55&#44;6&#37;&#41; y cardiopat&#237;a isqu&#233;mica &#40;22&#44;2&#37;&#41;&#46; La principal etiolog&#237;a de enfermedad renal cr&#243;nica fue la diabetes mellitus &#40;44&#44;4&#37;&#41;&#46; El resto de las etiolog&#237;as se muestran en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Entre los factores desencadenantes&#44; un 44&#44;4&#37; consum&#237;a derivados de cafe&#237;na de forma regular&#44; un 25&#37; presentaba consumo de alcohol y un 35&#44;7&#37; presentaba tabaquismo activo&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">No se observaron diferencias significativas en cuanto a los principales par&#225;metros bioqu&#237;micos y datos de adecuaci&#243;n de HD en ambas fases del estudio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Del mismo modo&#44; no se realizaron modificaciones en la medicaci&#243;n habitual del paciente relacionada con SPI durante el estudio &#40;88&#44;9&#37; analgesia convencional&#44; 33&#44;3&#37; antidepresivos o ansiol&#237;ticos y un 11&#44;1&#37; tomaba opioides&#44; respectivamente&#41;&#46; Ning&#250;n paciente tomaba levodopa&#44; clonidina&#44; gabapentina&#44; L-carnitina ni antiem&#233;ticos&#46; No se realizaron cambios en las caracter&#237;sticas del filtro de HD &#40;helixona 33&#37;&#44; polisulfona 44&#37;&#44; polisulfona <span class="elsevierStyleItalic">hi-flow</span> 11&#37;&#44; poliacrilonitrilo 11&#37;&#41; ni se encontraron cambios relevantes en relaci&#243;n con el tratamiento habitual administrado durante las sesiones de HD &#40;hierro intravenoso 77&#44;8 vs&#46; 72&#44;5&#37;&#59; agentes eritropoy&#233;ticos 30&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;6 vs&#46; 28&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;4 mcg darbopoetina&#47;semana&#41; a lo largo del estudio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados de las principales variables analizadas en las distintas fases del estudio quedan reflejados en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Con relaci&#243;n a la gravedad de los s&#237;ntomas relacionados con SPI&#44; un 73&#44;3&#37; presentaba sintomatolog&#237;a grave &#40;GRLS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15 ptos&#41;&#46; Por otra parte&#44; un 35&#44;7&#37; refer&#237;a calambres&#44; un 28&#44;5&#37; entumecimiento y un 21&#44;4&#37; dolor muscular y quemaz&#243;n&#44; respectivamente&#44; en el QS de extremidades inferiores&#46; No se objetivaron cambios relevantes en la escala GRLS &#40;19&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;2 vs&#46; 21&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;2&#59; <span class="elsevierStyleItalic">p 0&#44;524</span>&#41; ni en el cuestionario QS &#40;9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7 vs&#46; 10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4&#59; <span class="elsevierStyleItalic">p 0&#44;428</span>&#41; durante la fase 1 del estudio&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Durante la fase 2 del estudio&#44; observamos una mejor&#237;a significativa en GRLS &#40;21&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3 vs&#46; 5&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#41; y QS &#40;10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4 vs&#46; 5&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1&#59; <span class="elsevierStyleItalic">p 0&#44;004</span>&#41; tras la introducci&#243;n del tratamiento con rotigotina&#46; La dosis de rotigotina transd&#233;rmica administrada fue de 2<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; con un cumplimento terap&#233;utico completo&#46; Un 88&#44;8&#37; de los pacientes respondieron al tratamiento con rotigotina&#44; con una reducci&#243;n media de 15&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;2 puntos en la escala GRLS al finalizar la fase 2 del estudio&#46; Un 77&#44;7&#37; present&#243; una respuesta parcial &#40;reducci&#243;n superior al 20&#37; QS&#41; y un 11&#44;1&#37; present&#243; una remisi&#243;n completa &#40;reducci&#243;n superior al 80&#37; QS&#41;&#46; Un 55&#44;5&#37; alcanz&#243; sintomatolog&#237;a &#171;cero&#187;&#44; definida por una puntuaci&#243;n inferior a 5 puntos en la QS&#46; No se objetivaron reacciones al&#233;rgicas en la zona de aplicaci&#243;n de los parches transd&#233;rmicos&#46; &#218;nicamente un paciente present&#243; intolerancia digestiva leve en forma de dispepsia&#44; que cedi&#243; tras la reducci&#243;n de rotigotina a 1<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; Ninguno de los pacientes de nuestro estudio present&#243; <span class="elsevierStyleItalic">augmentation effect&#46;</span></p><p id="par0115" class="elsevierStylePara elsevierViewall">En cuanto a los resultados obtenidos para la calidad de vida relacionada con SPI e higiene de sue&#241;o&#44; observamos un empeoramiento para las escalas JH-QoL &#40;19&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;3 vs&#46; 22&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4&#59; <span class="elsevierStyleItalic">p 0&#44;096</span>&#41; y SCOPA &#40;total 15&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3 vs&#46; 16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3&#59; <span class="elsevierStyleItalic">p 0&#44;124</span>&#59; diurno 5&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6 vs&#46; 5&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6&#59; <span class="elsevierStyleItalic">p 0&#44;368</span>&#59; nocturno 9&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7 vs&#46; 10&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7&#59; <span class="elsevierStyleItalic">p 0&#44;347</span>&#44; respectivamente&#41; durante la fase 1 del estudio&#44; si bien estos resultados no alcanzaron la significaci&#243;n estad&#237;stica previamente establecida&#46; De forma global&#44; tras la introducci&#243;n de rotigotina &#40;fase 2&#41;&#44; observamos una mejor&#237;a significativa en t&#233;rminos de calidad de vida relacionada con SPI &#40;JH-QoL 22&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4 vs&#46; 4&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;1&#59; <span class="elsevierStyleItalic">p 0&#44;004</span>&#41; y en los distintos apartados de la higiene del sue&#241;o &#40;SCOPA total 16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3 vs&#46; 6&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#59; diurno 5&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6 vs&#46; 1&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7&#59; <span class="elsevierStyleItalic">p 0&#44;013</span>&#59; nocturno 10&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7 vs&#46; 6&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#59; respectivamente&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra los resultados del an&#225;lisis comparativo de la diferencia de las medias de las principales variables entre las fases de estudio&#46; Se evidenci&#243; una mejor&#237;a significativa en t&#233;rminos de gravedad de los s&#237;ntomas &#40;1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;5 vs&#46; &#8722;13&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;7&#59; <span class="elsevierStyleItalic">p 0&#44;003</span>&#41;&#44; presencia de s&#237;ntomas espec&#237;ficos en extremidades inferiores &#40;0&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4 vs&#46; &#8722;4&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;1&#59; <span class="elsevierStyleItalic">p 0&#44;004</span>&#41;&#44; calidad de vida relacionada con el SPI &#40;2&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;6 vs&#46; &#8722;12&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#41; e higiene del sue&#241;o &#40;total 0&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1 vs&#46; &#8722;9&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#59; diurno 0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 vs&#46; -4&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;9&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#59; nocturno 0&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7 vs&#46; &#8722;4&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3&#59; <span class="elsevierStyleItalic">p 0&#44;001</span>&#44; respectivamente&#41; tras la introducci&#243;n de rotigotina&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio demuestran que el SPI present&#243; una prevalencia considerable en nuestra unidad de HD&#46; Del mismo modo&#44; el uso de rotigotina mejor&#243; la sintomatolog&#237;a cl&#237;nica&#44; la calidad de vida e higiene de sue&#241;o en nuestros pacientes con SPI en HD&#44; por lo que resulta ser un f&#225;rmaco seguro&#44; con m&#237;nimos efectos adversos y con cumplimento terap&#233;utico completo&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a la prevalencia de SPI en nuestra unidad de HD&#44; es pr&#225;cticamente superponible a la descrita con anterioridad en la literatura<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#44;22</span></a>&#58; oscila entre un 12 y un 30&#37;&#44; a pesar de la gran comorbildidad y tiempo de permanencia en HD de nuestros pacientes&#46; Con relaci&#243;n a la sintomatolog&#237;a&#44; el diagn&#243;stico de SPI se asocia a alteraciones en la calidad de vida del paciente&#44; fundamentalmente cl&#237;nica depresiva o ansiosa&#44; al igual que a un deterioro de la higiene de sue&#241;o&#44; con aparici&#243;n de somnolencia diurna y fatiga<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#44;19&#44;20</span></a>&#46; Estos datos son similares a los observados en nuestro estudio&#44; en el que m&#225;s de un 75&#44;5&#37; de los pacientes presentaba sintomatolog&#237;a grave&#46; La presencia de todos estos s&#237;ntomas repercut&#237;a en la calidad de vida y en la higiene del sue&#241;o&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Actualmente&#44; la terapia con agonistas dopamin&#233;rgicos no ergotam&#237;nicos se ha convertido en la terapia de primera l&#237;nea para la afectaci&#243;n moderada-severa de SPI&#46; Los m&#225;s utilizados son pramipexol&#44; ropinirol y m&#225;s&#44; recientemente&#44; rotigotina<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">15-17</span></a>&#46; No obstante&#44; todav&#237;a son escasos los trabajos publicados de cara a establecer el mejor tratamiento del SPI en los pacientes en HD<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">23</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Dentro de este grupo de f&#225;rmacos&#44; el uso de rotigotina se ha extendido en la actividad diaria debido a su eficacia&#44; buena tolerancia&#44; pocos efectos adversos&#44; baja prevalencia de potenciaci&#243;n parad&#243;jica de s&#237;ntomas o <span class="elsevierStyleItalic">augmentation efect</span> y la no necesidad de ajuste de dosis en los pacientes con insuficiencia renal<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">24&#44;25</span></a><span class="elsevierStyleItalic">&#46;</span> Estas ventajas se deben sobre todo a la administraci&#243;n en forma de parche transd&#233;rmico&#44; que garantiza una liberaci&#243;n continuada a lo largo de todo el d&#237;a y con la que se obtienen niveles s&#233;ricos estables que minimizan la posibilidad de ac&#250;mulo sin necesidad de monitorizar los niveles sangu&#237;neos y la aparici&#243;n de efectos adversos relevantes&#46; Por otro lado&#44; la aplicaci&#243;n transd&#233;rmica facilita la adherencia terap&#233;utica&#44; al disminuir el n&#250;mero de comprimidos en unos pacientes en su mayor&#237;a polimedicados&#44; al igual que es una herramienta adicional de cara a la valoraci&#243;n del cumplimiento terap&#233;utico&#46; Su principal desventaja es el elevado coste econ&#243;mico&#44; superior al resto de los agonistas no ergotam&#237;nicos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; rotigotina result&#243; un f&#225;rmaco seguro y eficaz&#44; con m&#237;nimos efectos adversos y con cumplimento terap&#233;utico completo&#44; no hubo abandonos y se alcanz&#243; una mejor&#237;a significativa en la sintomatolog&#237;a cl&#237;nica&#44; la calidad de vida relacionada con SPI y la higiene del sue&#241;o&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En nuestro caso&#44; debemos mencionar que&#44; hasta la fecha&#44; el SPI ur&#233;mico era una entidad infravalorada en nuestra unidad de HD&#44; como lo demuestra el hecho de que ninguno de los pacientes diagnosticados recibiera tratamiento espec&#237;fico para SPI&#46; Este hecho probablemente obedec&#237;a&#44; entre otros motivos&#44; a que gran parte de la sintomatolog&#237;a en los miembros inferiores de los pacientes pudiera ser atribuida a otros factores o comorbilidades asociadas&#44; al escaso inter&#233;s que suscitaba en el personal m&#233;dico debido al poco conocimiento fisiopatol&#243;gico de esta entidad y a la ausencia de un tratamiento altamente eficaz sin efectos adversos relevantes&#46; Todos estos aspectos conllevaban el uso de diversos medicamentos sin pautas claras&#44; basado en las propias experiencias cl&#237;nicas o en los escasos trabajos publicados&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Dada la prevalencia de SPI&#44; con la importante e intensa sintomatolog&#237;a que conlleva y el deterioro de la calidad que asocia&#44; junto con el hecho de que no existan &#8212;al menos en nuestro estudio&#8212; alteraciones en los datos del hemograma ni en los par&#225;metros bioqu&#237;micos de la pr&#225;ctica cl&#237;nica habitual que permitan relacionarlos con este s&#237;ndrome&#44; consideraremos establecer diversas estrategias de actuaci&#243;n para valorar la presencia de SPI en nuestros pacientes a partir de los resultados obtenidos en este estudio&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En este sentido&#44; a todos los pacientes incidentes en nuestra unidad de HD se les aplicar&#225;n los criterios cl&#237;nicos de la IRLSSG para su diagn&#243;stico&#46; Aquellos casos con dudas razonables ser&#225;n comentados con el Servicio de Neurolog&#237;a para una valoraci&#243;n m&#225;s exhaustiva&#46; Del mismo modo&#44; se valorar&#225; la gravedad de los s&#237;ntomas y la calidad de vida e higiene del sue&#241;o mediante los test anteriormente descritos y se ofrecer&#225;&#44; adem&#225;s de unos consejos higi&#233;nicos diet&#233;ticos&#44; el tratamiento m&#233;dico oportuno en funci&#243;n de las caracter&#237;sticas cl&#237;nicas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Dentro de las m&#250;ltiples limitaciones de nuestro estudio&#44; debemos mencionar el reducido n&#250;mero de pacientes incluidos &#8212;que oblig&#243; a la utilizaci&#243;n de test estad&#237;sticos no param&#233;tricos&#8212; as&#237; como el corto tiempo de seguimiento&#46; El tama&#241;o muestral estuvo condicionado por nuestra limitada poblaci&#243;n en HD&#44; mientras que el per&#237;odo de 12 semanas se estableci&#243; para evitar posibles confusiones tras los cambios habituales en los medicamentos prescritos despu&#233;s de los resultados de las determinaciones anal&#237;ticas trimestrales en nuestra unidad de HD&#46; As&#237; pues&#44; no podemos descartar la posibilidad de que un per&#237;odo de estudio mayor pudiese conllevar alg&#250;n cambio con relaci&#243;n a la efectividad&#44; seguridad y tolerancia de la rotigotina&#46; Estudios con mayor n&#250;mero de pacientes y tiempo de duraci&#243;n ser&#237;an necesarios para confirmar los beneficios observados tras el uso de rotigotina en el tratamiento del SPI de nuestros pacientes en HD&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Como conclusiones podemos decir que el SPI present&#243; una prevalencia considerable en nuestro estudio&#44; con una intensa sintomatolog&#237;a y una calidad de vida e higiene del sue&#241;o deterioradas&#46; El uso de rotigotina mejor&#243; la sintomatolog&#237;a cl&#237;nica&#44; la calidad de vida y la higiene de sue&#241;o en los pacientes con SPI en HD&#58; result&#243; ser un f&#225;rmaco seguro&#44; con m&#237;nimos efectos adversos y con cumplimento terap&#233;utico completo&#46; No obstante&#44; ser&#237;an necesarios futuros estudios para confirmar el beneficio de rotigotina en la poblaci&#243;n en HD con SPI&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de piernas inquietas &#40;SPI&#41; es un trastorno neurol&#243;gico caracterizado por una molesta sintomatolog&#237;a&#44; asociado a deterioro de calidad de vida e higiene de sue&#241;o&#46; Rotigotina constituye una novedosa alternativa terap&#233;utica&#44; si bien existen escasos estudios publicados sobre rotigotina en pacientes en hemodi&#225;lisis &#40;HD&#41; con SPI&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">1&#46;- Establecer la prevalencia de SPI en nuestra unidad de HD&#46; 2&#46;- Evaluar la eficacia y el perfil de seguridad asociado a rotigotina as&#237; como su efecto sobre la sintomatolog&#237;a&#44; calidad de vida e higiene del sue&#241;o en nuestra poblaci&#243;n en HD con SPI&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio unic&#233;ntrico&#44; prospectivo de 12 semanas de duraci&#243;n&#46; Dos fases &#40;6 semanas&#41;&#58; fase 1 &#40;no tratamiento&#41; y fase 2 &#40;rotigotina&#41;&#46; Analizamos&#58; 1&#46;- Datos demogr&#225;ficos&#44; bioqu&#237;micos&#44; par&#225;metros de adecuaci&#243;n de HD y tratamiento m&#233;dico relacionado con SPI&#46; 2&#46;- Cuestionario sobre s&#237;ntomas en extremidades inferiores &#40;QS&#41;&#46; 3&#46;- Escala de gravedad de los s&#237;ntomas &#40;GRLS&#41;&#46; 4&#46;- Calidad de vida SPI&#58; John Hopkins RLS-QoL &#40;JH-QoL&#41;&#46; 5&#46;- Higiene del sue&#241;o&#58; Escala SCOPA&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 66 pacientes en HD&#46; De ellos&#44; 14 con SPI&#59; el 44&#44;4&#37; eran hombres&#44; con 70&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;9 a&#241;os y 111&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>160&#44;8 meses en HD&#46; El 22&#44;9&#37;&#44; con SPI&#46; &#218;nicamente en la fase 2 observamos una mejor&#237;a significativa para QS &#40;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;4 vs&#46; 5&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;0&#41;&#44; GRLS &#40;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs&#46; 5&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;6&#41;&#44; JH-QoL &#40;22&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;4 vs&#46; 4&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;0&#41; y SCOPA &#40;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3 vs&#46; 6&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&#41;&#46; Un 77&#44;7 y un 11&#44;1&#37; presentaron remisi&#243;n parcial &#40;&#62;20&#37;&#41; y completa &#40;&#62;80&#37;&#41;&#44; respectivamente&#46; Un 55&#44;5&#37; alcanz&#243; sintomatolog&#237;a &#171;cero&#187;&#46; Un &#250;nico paciente present&#243; intolerancia digestiva y ninguno&#44; <span class="elsevierStyleItalic">augmentation efect</span>&#46; No observamos cambios en datos bioqu&#237;micos&#44; adecuaci&#243;n dial&#237;tica ni tratamiento m&#233;dico&#46; El an&#225;lisis intergrupos mostr&#243; una mejor&#237;a significativa en la fase 2 con relaci&#243;n a QS&#44; GRLSS&#44; JH-QoL y SCOPA&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio&#44; el SPI ur&#233;mico present&#243; una prevalencia considerable&#46; Rotigotina mejor&#243; la sintomatolog&#237;a cl&#237;nica&#44; la calidad de vida y la higiene de sue&#241;o en los pacientes con SPI en HD&#44; por lo que resulta ser un f&#225;rmaco seguro&#44; con m&#237;nimos efectos adversos y con cumplimento terap&#233;utico completo&#46; No obstante&#44; ser&#237;an necesarios futuros estudios para confirmar el beneficio de rotigotina en la poblaci&#243;n en HD con SPI&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
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        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Restless legs syndrome &#40;RLS&#41; is a neurological disorder characterised by bothersome symptoms associated with impaired quality of life and sleep hygiene&#46; Rotigotine is a novel therapeutic alternative&#44; although few studies have been published in patients on haemodialysis &#40;HD&#41; with RLS treated with rotigotine&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">1&#46;- To establish the prevalence of RLS in our HD unit&#46; 2&#46;- To evaluate the efficacy and safety profile of rotigotine and its effect on symptoms&#44; quality of life and sleep hygiene in our HD population with RLS&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A single-centre&#44; 12-week prospective study&#46; Two stages &#40;6 weeks&#41;&#58; stage 1 &#40;no treatment&#41; and stage 2 &#40;rotigotine&#41;&#46; We analysed&#58; 1&#46;- Demographic data&#44; biochemistry data&#44; HD suitability parameters and RLS medical treatment data&#46; 2&#46;- Lower extremity symptoms questionnaire &#40;QS&#41;&#46; 3&#46;- RLS severity symptoms scale &#40;SRLSS&#41;&#46; 4&#46;- RLS Quality of life&#58; John Hopkins RLS-QoL &#40;JH-QoL&#41;&#46; 5&#46;- Sleep hygiene&#58; SCOPA Scale&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We included 66 HD patients&#44; 14 with RLS&#59; 44&#46;4&#37; male&#44; 70&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9 years and 111&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>160&#46;8 months on HD&#46; And 22&#46;9&#37; RLS&#46; Exclusively in stage 2&#44; a significant improvement for QS &#40;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4 vs&#46; 5&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&#41;&#44; SRLSS &#40;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs&#46; 5&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;6&#41;&#44; JH-QoL &#40;22&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4 vs&#46; 4&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;0&#41; and SCOPA &#40;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3 vs&#46; 6&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&#41; were observed&#46; A 77&#46;7 and 11&#46;1&#37;&#44; showed partial &#40;&#62; 20&#37;&#41; and complete &#40;&#62; 80&#37;&#41; remission&#44; respectively&#44; while 55&#46;5&#37; achieved &#171;zero&#187; symptoms&#46; Only one patient had gastrointestinal intolerance and none experienced augmentation effect&#46; No changes in biochemical data&#44; suitability for dialysis or medical treatment were found&#46; The inter-group analysis showed a significant improvement in relation to QS&#44; SRLSS&#44; JH-QoL and SCOPA in stage 2&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">RLS showed a considerable prevalence in our HD unit&#46; Rotigotine improved clinical symptoms&#44; quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance&#46; Nevertheless&#44; future studies should be performed to confirm the benefits of rotigotine in RLS patients on haemodialysis&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1061
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            "Tamanyo" => 61053
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Principal etiolog&#237;a de la enfermedad renal cr&#243;nica en pacientes con SPI en HD&#46; Resultados expresados en porcentajes &#40;&#37;&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes mellitus&#59; Enf&#46; AE&#58; enfermedad ateroemb&#243;lica&#59; Enf&#46; glomerular 1&#46;&#170;&#58; enfermedad glomerular primaria&#59; HTA&#58; hipertensi&#243;n arterial&#59; Nefropat&#237;a T-I&#58; nefropat&#237;a tubulointersticial&#59; SPI&#58; s&#237;ndrome de piernas inquietas&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Fase 1 y fase 2 &#40;rotigotina 2<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#58; resultados expresados&#58; media &#40;desviaci&#243;n est&#225;ndar&#41;&#46; Inicio vs&#46; final&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Ca&#58; calcio&#59; Hs-PCR&#58; prote&#237;na C reactiva&#59; i-PTH&#58; hormona paratiroidea intacta&#59; K&#58; potasio&#59; Kt&#47;V&#58; m&#233;todo 2&#46;&#170; generaci&#243;n Daurgirdas&#59; Mg&#58; magnesio&#59; P&#58; f&#243;sforo&#59; VitD&#58; vitamina D&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">No se encontraron diferencias significativas entre los grupos estudiados&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">237&#44;2 &#40;80&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \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><span class="elsevierStyleItalic">Glucosa&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">155&#44;8 &#40;62&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">28&#44;2 &#40;13&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">27&#44;1 &#40;7&#44;2&#41;</span>&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><span class="elsevierStyleItalic">Alb&#250;mina&#44; g&#47;dL</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">3&#44;7 &#40;0&#44;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">3&#44;7 &#40;0&#44;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">3&#44;8 &#40;0&#44;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">3&#44;7 &#40;0&#44;2&#41;</span>&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><span class="elsevierStyleItalic">Prealb&#250;mina&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">28&#44;5 &#40;10&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">28&#44;1 &#40;4&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">29&#44;2 &#40;6&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">29&#44;7 &#40;7&#44;2&#41;</span>&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><span class="elsevierStyleItalic">Colesterol total&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">143&#44;2 &#40;57&#44;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">148&#44;1 &#40;59&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">153&#44;2 &#40;34&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">149&#44;9 &#40;34&#44;8&#41;</span>&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><span class="elsevierStyleItalic">Colesterol HDL&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">42&#44;6 &#40;11&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">41&#44;2 &#40;11&#44;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">42&#44;7 &#40;10&#44;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">41&#44;2 &#40;43&#44;6&#41;</span>&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><span class="elsevierStyleItalic">Colesterol LDL&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">68&#44;7 &#40;42&#44;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">63&#44;4 &#40;49&#44;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">67&#44;2 &#40;65&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">65&#44;9 &#40;33&#44;7&#41;</span>&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><span class="elsevierStyleItalic">Triglic&#233;ridos&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">156&#44;1 &#40;74&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">158&#44;6 &#40;72&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">157&#44;2 &#40;70&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">157&#44;2 &#40;71&#44;2&#41;</span>&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="5" 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="5" align="left" valign="top"><span class="elsevierStyleItalic">Datos del hemograma</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><span class="elsevierStyleItalic">Hemoglobina&#44; g&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;8&#40;1&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">11&#44;1 &#40;0&#44;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;5 &#40;1&#44;2&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;9 &#40;0&#44;7&#41;</span>&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><span class="elsevierStyleItalic">Ferritina&#44; ng&#47;mL</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">411&#44;6 &#40;210&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">427&#44;2 &#40;267&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">424&#44;1 &#40;204&#44;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">421&#44;9 &#40;300&#44;1&#41;</span>&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><span class="elsevierStyleItalic">Hs-PCR&#44; ng&#47;L</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">7&#44;8 &#40;1&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">8&#44;1&#40;1&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">8&#44;1 &#40;1&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">8&#44;3 &#40;1&#44;2&#41;</span>&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="5" 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="5" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Adecuaci&#243;n de la di&#225;lisis</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><span class="elsevierStyleItalic">Horas semana HD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">11&#44;1 &#40;0&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">11&#44;1 &#40;0&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">11&#44;1 &#40;0&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">11&#44;1 &#40;0&#44;8&#41;</span>&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><span class="elsevierStyleItalic">Dosis di&#225;lisis&#44; Kt&#47;V</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">1&#44;63 &#40;0&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">1&#44;63 &#40;0&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">1&#44;62 &#40;0&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;2 &#40;2&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;2 &#40;2&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">5&#44;7 &#40;1&#44;1&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">22&#44;1 &#40;4&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">22&#44;1 &#40;4&#44;4&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">4&#44;3 &#40;4&#44;1&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">5&#44;6 &#40;3&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">5&#44;6 &#40;3&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">1&#44;4 &#40;0&#44;7&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&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="elsevierStyleItalic">SCOPA nocturno</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">9&#44;8 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;4 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">10&#44;4 &#40;2&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">6&#44;1 &#40;1&#44;1&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de las diferencias de las medias de las principales variables entre los grupos de estudio&#46; Resultados expresados&#58; media &#40;desviaci&#243;n est&#225;ndar&#41;&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">GRLS&#58; escala de gravedad de s&#237;ntomas del <span class="elsevierStyleItalic">International restless leg syndrome study</span> Group&#59; JH-QoL&#58; <span class="elsevierStyleItalic">John Hopkins restless leg syndrome quality of life</span>&#59; QS&#58; escala de s&#237;ntomas de extremidades inferiores&#59; SCOPA&#58; escala de higiene de sue&#241;o&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis mediante el test estad&#237;stico no param&#233;trico U de Mann Whitney&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">1&#44;8 &#40;8&#44;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;13&#44;3 &#40;8&#44;7&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;4&#44;2 &#40;3&#44;1&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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="elsevierStyleItalic">JH-QoL</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;12&#44;7 &#40;3&#44;8&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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="elsevierStyleItalic">SCOPA total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#44;9 &#40;0&#44;9&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;9&#44;2 &#40;5&#44;3&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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="elsevierStyleItalic">SCOPA diurno</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#44;2 &#40;0&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;4&#44;1 &#40;3&#44;9&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&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="elsevierStyleItalic">SCOPA nocturno</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#44;6 &#40;0&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#8722;4&#44;4 &#40;2&#44;3&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">CGI&#58; <span class="elsevierStyleItalic">clinical global impression</span>&#59; CV&#58; calidad de vida&#59; EA&#58; efectos adversos&#59; EE&#46; UU&#46;&#58; Estados Unidos&#59; GRLS&#58; escala de gravedad de s&#237;ntomas del <span class="elsevierStyleItalic">International Restless Leg Syndrome Study Group</span>&#59; HD&#58; hemodi&#225;lisis&#59; iv&#58; intravenoso&#59; PLM&#58; movimientos de piernas peri&#243;dico&#59; PSQI&#58; <span class="elsevierStyleItalic">Pitsburg Sleep Quality Index&#59;</span> RLS-6&#58; <span class="elsevierStyleItalic">Restless leg syndrom scale 6</span>&#59; SPI&#58; s&#237;ndrome de piernas inquietas&#59; VAS&#58; escala visual anal&#243;gica&#46;</p>"
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                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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor &#40;pa&#237;s&#44; a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Participantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Grupos de intervenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables analizadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Principales resultados&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trenkwalder &#40;Alemania&#44; 1995&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;11 HD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; madopar &#40;L-dopa 100 mg<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>benserazida 25<span class="elsevierStyleHsp" style=""></span>mg&#41;<br>Control&#58; placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuestionario propio severidad de los s&#237;ntomas SPI&#44; PLM&#44; CV &#40;Hamburger VAS&#41;&#44; CGI&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">L-dopa mejor&#243; significativamente las principales variables analizadas&#44; sin efectos secundarios relevantes&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">Thorp &#40;EE&#46; UU&#46;&#44; 2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; gabapentina &#40;200-300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a post-HD&#41;<br>Control&#58; placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuestionario propio severidad s&#237;ntomas&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 pacientes abandonaron por letargia atribuida a gabapentina<br>Gabapentina result&#243; un f&#225;rmaco eficaz en el tratamiento del SPI en los pacientes en HD&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">Sloand &#40;EE&#46;&#160;UU&#46;&#44; 2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; hierro dextrano iv &#40;1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#41;<br>Control&#58; suero salino iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Severidad de los s&#237;ntomas SPI &#40;Rochester&#41;&#44; datos bioqu&#237;micos ferrocin&#233;tica&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cefalea&#44; n&#225;useas y v&#243;mitos&#44; sin diferencias entre grupos<br>Hierro dextrano se asoci&#243; a mejor&#237;a de s&#237;ntomas de SPI y elevaci&#243;n de niveles ferrocin&#233;ticos&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">Micozkadioglu &#40;Turqu&#237;a&#44; 2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; gabapentina &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a post-HD&#41;<br>Control&#58; levodopa 125<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RLS-6&#44; CV &#40;SF-36&#41;&#44; Calidad del sue&#241;o &#40;PSQI&#41;&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Un paciente abandon&#243; por fatiga y s&#237;ncope en grupo gabapentina<br>Reducci&#243;n significativa grupo gabapentina&#58; RLS-6&#44; SF-36 y PSQI&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">Pellecchia &#40;Italia&#44; 2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; ropinirol &#40;0&#44;25-2<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;<br>Control&#58; levodopa liberaci&#243;n sostenida &#40;25&#47;100-50&#47;200<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GRLS&#44; tiempo de sue&#241;o &#40;polisomnograf&#237;a&#41;&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ropinirol fue superior a levodopa de liberaci&#243;n sostenida en el tratamiento del SPI&#44; sin EA relevantes&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">Sagheb &#40;Ir&#225;n&#44; 2012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 grupos de intervenci&#243;n &#40;15 pacientes&#41;&#58;<br>vitamina C &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#41; y vitamina E &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#41;&#59; vitamina C &#40;200<span class="elsevierStyleHsp" style=""></span>mg&#41; y placebo&#59; vitamina E &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#41; y placebo&#59; doble placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">GRLS&#44; EA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitamina C y E as&#237; como su combinaci&#243;n mejoraron GRLS a corto plazo<br>N&#225;useas y dispepsia en grupos vitam&#237;nicos&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">Dauviliers &#40;EE&#46;&#160;UU&#46;&#44; 2016&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Intervenci&#243;n&#58; rotigotina &#40;1-3<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;<br>Control&#58; placebo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PLM&#44; GRLS&#44; CGI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rotigotina mejor&#243; los movimientos peri&#243;dicos de piernas y los s&#237;ntomas de SPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Principales estudios cl&#237;nicos aleatorizados con intervenci&#243;n farmacol&#243;gica en pacientes con s&#237;ndrome de piernas inquietas en terapia sustitutiva renal</p>"
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