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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Los pacientes con enfermedad renal cr&#243;nica avanzada &#40;ERCA&#41; presentan una amplia variedad de s&#237;ntomas con un elevado coste en atenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Desde los estadios in&#237;ciales de la ERCA&#44; los s&#237;ntomas son muy variables y afectan negativamente a la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Los s&#237;ntomas no controlados en esta poblaci&#243;n contribuyen a un mayor sufrimiento&#44; y el manejo sintom&#225;tico es una prioridad<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#46; La escasez de estudios realizados en Espa&#241;a impide comparar la sintomatolog&#237;a entre los diferentes grupos de tratamiento&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue describir la prevalencia y la severidad de los s&#237;ntomas en pacientes con ERC estadios 4 y 5 en di&#225;lisis y predi&#225;lisis&#44; y comparar la sintomatolog&#237;a en ambos grupos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En este estudio de observaci&#243;n transversal&#44; se realiz&#243; un an&#225;lisis descriptivo de la prevalencia e intensidad de s&#237;ntomas de los pacientes con ERCA&#44; tanto en di&#225;lisis como en predi&#225;lisis&#46; Los datos del estudio fueron recogidos entre los meses de abril y septiembre de 2015&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n fueron&#58; &#40;1&#41; pacientes adultos con ERC estadios 4-5 en predi&#225;lisis o di&#225;lisis desde hace m&#225;s de 3 meses&#59; y &#40;2&#41; pacientes hispanoparlantes&#46; Se excluyeron los pacientes con deterioro cognitivo y aquellos menores de 18 a&#241;os&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron datos sociodemogr&#225;ficos y cl&#237;nicos durante las entrevistas que tuvieron lugar en la consulta ERCA y en la sala de di&#225;lisis&#46; Se incluyeron variables de inter&#233;s como la sintomatolog&#237;a medida con la versi&#243;n espa&#241;ola modificada de la <span class="elsevierStyleItalic">Palliative Care Outcome Scale-Symptoms Renal</span> &#40;POS-S Renal&#41;&#44; filtrado glomerular estimado mediante CKD-EPI y la comorbilidad estimada mediante el &#237;ndice de comorbilidad de Charlson modificado &#40;ICCm&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3-5</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Un total de 180 pacientes con ERC estadios 4 y 5 fueron incluidos en este estudio&#44; de los cuales 124 pacientes estaban en predi&#225;lisis y 56 en di&#225;lisis &#40;44 hemodi&#225;lisis y 12 di&#225;lisis peritoneal&#41;&#46; Los resultados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Las principales comorbilidades fueron&#58; diabetes&#44; cardiopat&#237;a isqu&#233;mica&#44; enfermedad vascular perif&#233;rica y neoplasias&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas m&#225;s frecuentes fueron&#58; debilidad &#40;68&#44;7&#37; &#91;IC&#58; 22-76&#37;&#93;&#41;&#44; dolor &#40;53&#44;1&#37; &#91;IC&#58; 45-61&#37;&#93;&#41;&#44; depresi&#243;n &#40;45&#37; &#91;IC&#58; 36-51&#37;&#93;&#41; y dificultad para dormir &#40;44&#44;4&#37; &#91;IC&#58; 37-53&#37;&#93;&#41;&#46; Se encontraron diferencias significativas en la prevalencia de s&#237;ntomas&#44; entre predi&#225;lisis y di&#225;lisis&#44; para debilidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; poca movilidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; somnolencia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; estre&#241;imiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; y piernas inquietas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; La comparaci&#243;n de la prevalencia de s&#237;ntomas entre predi&#225;lisis y di&#225;lisis se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Los s&#237;ntomas m&#225;s intensos fueron&#58; debilidad &#40;18&#44;8&#37;&#41;&#44; dolor &#40;14&#44;6&#37;&#41; y prurito &#40;11&#44;8&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Existen varios factores como la insuficiencia renal&#44; la comorbilidad asociada o el tratamiento renal sustitutivo &#40;TRS&#41; que pueden influir en la sintomatolog&#237;a de estos pacientes<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">M&#225;s del 44&#37; de los pacientes presentaron debilidad&#44; dolor&#44; depresi&#243;n y dificultad para dormir&#46; Estos s&#237;ntomas son consistentes en la mayor&#237;a de estudios y se asocian con una peor calidad de vida<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; S&#237;ntomas como debilidad&#44; poca movilidad&#44; somnolencia&#44; estre&#241;imiento y piernas inquietas presentaron una diferencia significativa en ambos grupos&#44; siendo m&#225;s frecuentes en pacientes en di&#225;lisis &#40;excepto el estre&#241;imiento&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La debilidad es un s&#237;ntoma muy frecuente en ERCA&#46; Varios factores&#44; como los trastornos del sue&#241;o&#44; la depresi&#243;n&#44; la anemia y el TRS&#44; pueden influir en la aparici&#243;n de este s&#237;ntoma<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; La debilidad fue el s&#237;ntoma m&#225;s prevalente y de mayor intensidad&#44; siendo mayor su prevalencia en di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La poca movilidad est&#225; relacionada con la debilidad&#44; la comorbilidad y el TRS&#46; El deterioro de la movilidad tras iniciar TRS est&#225; asociado con la mortalidad a corto plazo en pacientes con edad avanzada<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; En este estudio la poca movilidad fue m&#225;s frecuente en pacientes con TRS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a la somnolencia diurna&#44; esta est&#225; relacionada con otros trastornos del sue&#241;o &#40;apnea del sue&#241;o&#44; insomnio y s&#237;ndrome de piernas inquietas&#41;&#44; y con otros s&#237;ntomas como la debilidad y la depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Diversos factores&#44; como los trastornos psicol&#243;gicos&#44; el estilo de vida&#44; el tratamiento y la comorbilidad&#44; pueden influir en la aparici&#243;n de este problema<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Los resultados indican que la somnolencia diurna fue m&#225;s com&#250;n en pacientes en di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El estre&#241;imiento es un problema com&#250;n en ERCA&#44; y est&#225; asociado a las restricciones diet&#233;ticas&#44; la poca movilidad o el tratamiento farmacol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Este s&#237;ntoma present&#243; una mayor prevalencia en pacientes en predi&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de piernas inquietas est&#225; relacionado con el TRS y con otros trastornos del sue&#241;o&#44; provocando una disminuci&#243;n de la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; En este sentido&#44; este problema fue m&#225;s frecuente en el grupo de di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este estudio tiene varias limitaciones&#46; Se trata de un estudio transversal que se ha realizado en un solo centro y por tanto los resultados pueden no ser generalizables&#46; Adem&#225;s&#44; los grupos predi&#225;lisis y di&#225;lisis no fueron homog&#233;neos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Concluimos que los pacientes con ERCA presentan una elevada carga de s&#237;ntomas&#46; En general&#44; existe un perfil sintom&#225;tico similar en predi&#225;lisis y di&#225;lisis&#44; con la debilidad como s&#237;ntoma m&#225;s frecuente en ambos grupos&#46;</p></span>"
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                  \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">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleItalic">Pacientes&#44; n</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="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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" 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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">G&#233;nero</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;031&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>Hombres&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;031&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>Mujeres&#44; &#37;&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="elsevierStyleItalic">FGe CKD-EPI ml&#47;min&#47;1&#44;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></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="left" valign="top">17 &#40;5&#44;7&#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&#44;6 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;6 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;585&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;8 &#40;27&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;5 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;3 &#40;39&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;240&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>Enfermedad vascular&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;9&nbsp;\t\t\t\t\t\t\n
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Prevalencia de síntomas en enfermedad renal crónica avanzada
Prevalence of symptoms in advanced chronic kidney disease
Daniel Gutiérrez Sáncheza,b, Juan P. Leiva-Santosc, María José Macías Lópezd, Antonio I. Cuesta-Vargasb,
Autor para correspondencia
acuesta@uma.es

Autor para correspondencia.
a Fundación Cudeca, Arroyo de la Miel, Málaga, España
b Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, Málaga, España
c Hospital de Manacor, Mallorca, Islas Baleares, España
d Servicio de Nefrología, Hospital Regional Universitario de Málaga, Málaga, España
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y comparar la sintomatolog&#237;a en ambos grupos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En este estudio de observaci&#243;n transversal&#44; se realiz&#243; un an&#225;lisis descriptivo de la prevalencia e intensidad de s&#237;ntomas de los pacientes con ERCA&#44; tanto en di&#225;lisis como en predi&#225;lisis&#46; Los datos del estudio fueron recogidos entre los meses de abril y septiembre de 2015&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los criterios de inclusi&#243;n fueron&#58; &#40;1&#41; pacientes adultos con ERC estadios 4-5 en predi&#225;lisis o di&#225;lisis desde hace m&#225;s de 3 meses&#59; y &#40;2&#41; pacientes hispanoparlantes&#46; Se excluyeron los pacientes con deterioro cognitivo y aquellos menores de 18 a&#241;os&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron datos sociodemogr&#225;ficos y cl&#237;nicos durante las entrevistas que tuvieron lugar en la consulta ERCA y en la sala de di&#225;lisis&#46; Se incluyeron variables de inter&#233;s como la sintomatolog&#237;a medida con la versi&#243;n espa&#241;ola modificada de la <span class="elsevierStyleItalic">Palliative Care Outcome Scale-Symptoms Renal</span> &#40;POS-S Renal&#41;&#44; filtrado glomerular estimado mediante CKD-EPI y la comorbilidad estimada mediante el &#237;ndice de comorbilidad de Charlson modificado &#40;ICCm&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3-5</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Un total de 180 pacientes con ERC estadios 4 y 5 fueron incluidos en este estudio&#44; de los cuales 124 pacientes estaban en predi&#225;lisis y 56 en di&#225;lisis &#40;44 hemodi&#225;lisis y 12 di&#225;lisis peritoneal&#41;&#46; Los resultados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Las principales comorbilidades fueron&#58; diabetes&#44; cardiopat&#237;a isqu&#233;mica&#44; enfermedad vascular perif&#233;rica y neoplasias&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas m&#225;s frecuentes fueron&#58; debilidad &#40;68&#44;7&#37; &#91;IC&#58; 22-76&#37;&#93;&#41;&#44; dolor &#40;53&#44;1&#37; &#91;IC&#58; 45-61&#37;&#93;&#41;&#44; depresi&#243;n &#40;45&#37; &#91;IC&#58; 36-51&#37;&#93;&#41; y dificultad para dormir &#40;44&#44;4&#37; &#91;IC&#58; 37-53&#37;&#93;&#41;&#46; Se encontraron diferencias significativas en la prevalencia de s&#237;ntomas&#44; entre predi&#225;lisis y di&#225;lisis&#44; para debilidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; poca movilidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; somnolencia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; estre&#241;imiento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; y piernas inquietas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; La comparaci&#243;n de la prevalencia de s&#237;ntomas entre predi&#225;lisis y di&#225;lisis se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Los s&#237;ntomas m&#225;s intensos fueron&#58; debilidad &#40;18&#44;8&#37;&#41;&#44; dolor &#40;14&#44;6&#37;&#41; y prurito &#40;11&#44;8&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Existen varios factores como la insuficiencia renal&#44; la comorbilidad asociada o el tratamiento renal sustitutivo &#40;TRS&#41; que pueden influir en la sintomatolog&#237;a de estos pacientes<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">M&#225;s del 44&#37; de los pacientes presentaron debilidad&#44; dolor&#44; depresi&#243;n y dificultad para dormir&#46; Estos s&#237;ntomas son consistentes en la mayor&#237;a de estudios y se asocian con una peor calidad de vida<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; S&#237;ntomas como debilidad&#44; poca movilidad&#44; somnolencia&#44; estre&#241;imiento y piernas inquietas presentaron una diferencia significativa en ambos grupos&#44; siendo m&#225;s frecuentes en pacientes en di&#225;lisis &#40;excepto el estre&#241;imiento&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La debilidad es un s&#237;ntoma muy frecuente en ERCA&#46; Varios factores&#44; como los trastornos del sue&#241;o&#44; la depresi&#243;n&#44; la anemia y el TRS&#44; pueden influir en la aparici&#243;n de este s&#237;ntoma<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; La debilidad fue el s&#237;ntoma m&#225;s prevalente y de mayor intensidad&#44; siendo mayor su prevalencia en di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La poca movilidad est&#225; relacionada con la debilidad&#44; la comorbilidad y el TRS&#46; El deterioro de la movilidad tras iniciar TRS est&#225; asociado con la mortalidad a corto plazo en pacientes con edad avanzada<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; En este estudio la poca movilidad fue m&#225;s frecuente en pacientes con TRS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a la somnolencia diurna&#44; esta est&#225; relacionada con otros trastornos del sue&#241;o &#40;apnea del sue&#241;o&#44; insomnio y s&#237;ndrome de piernas inquietas&#41;&#44; y con otros s&#237;ntomas como la debilidad y la depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Diversos factores&#44; como los trastornos psicol&#243;gicos&#44; el estilo de vida&#44; el tratamiento y la comorbilidad&#44; pueden influir en la aparici&#243;n de este problema<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Los resultados indican que la somnolencia diurna fue m&#225;s com&#250;n en pacientes en di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">El estre&#241;imiento es un problema com&#250;n en ERCA&#44; y est&#225; asociado a las restricciones diet&#233;ticas&#44; la poca movilidad o el tratamiento farmacol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Este s&#237;ntoma present&#243; una mayor prevalencia en pacientes en predi&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de piernas inquietas est&#225; relacionado con el TRS y con otros trastornos del sue&#241;o&#44; provocando una disminuci&#243;n de la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; En este sentido&#44; este problema fue m&#225;s frecuente en el grupo de di&#225;lisis &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este estudio tiene varias limitaciones&#46; Se trata de un estudio transversal que se ha realizado en un solo centro y por tanto los resultados pueden no ser generalizables&#46; Adem&#225;s&#44; los grupos predi&#225;lisis y di&#225;lisis no fueron homog&#233;neos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Concluimos que los pacientes con ERCA presentan una elevada carga de s&#237;ntomas&#46; En general&#44; existe un perfil sintom&#225;tico similar en predi&#225;lisis y di&#225;lisis&#44; con la debilidad como s&#237;ntoma m&#225;s frecuente en ambos grupos&#46;</p></span>"
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                  \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">Caracter&#237;sticas&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">Total&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">Predi&#225;lisis&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">Di&#225;lisis&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">p&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"><span class="elsevierStyleItalic">Pacientes&#44; n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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">Edad&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#44;3 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#44;8 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;7 &#40;15&#44;9&#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;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">G&#233;nero</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;031&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>Hombres&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;031&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>Mujeres&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;031&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">FGe CKD-EPI ml&#47;min&#47;1&#44;73</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;7 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;5&#44;7&#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&#44;6 &#40;2&#44;6&#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;<span class="elsevierStyleHsp" style=""></span>0&#44;001&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">Hematocrito&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;6 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;7 &#40;5&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;028&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">Alb&#250;mina s&#233;rica&#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="left" valign="top">3&#44;9 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;9 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;585&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">Tiempo en MRC o di&#225;lisis&#44; meses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;8 &#40;27&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;5 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#44;3 &#40;39&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Causas de la ERC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;240&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>Enfermedad vascular&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&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>Nefropat&#237;a diab&#233;tica&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;719&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>Enfermedad glomerular&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;5&nbsp;\t\t\t\t\t\t\n
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