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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de albuminuria anormal &#40;&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; y descenso del filtrado glomerular &#40;FG&#41; &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41; seg&#250;n cuartiles de la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#46;</p>"
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caracterizado por la p&#233;rdida de la elasticidad de la pared vascular y un incremento de la rigidez arterial&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Preservar la elasticidad vascular es crucial&#44; ya que la distensi&#243;n y recuperaci&#243;n del calibre de las arterias en la s&#237;stole y di&#225;stole&#44; respectivamente&#44; act&#250;a como un amortiguador del flujo sangu&#237;neo&#44; permitiendo la perfusi&#243;n continua de los &#243;rganos diana&#46; En individuos j&#243;venes&#44; la elasticidad de la pared vascular disminuye de manera secuencial desde la aorta hasta las arterias musculares perif&#233;ricas&#46; De manera fisiol&#243;gica&#44; existe un gradiente entre la rigidez perif&#233;rica y la a&#243;rtica &#40;gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#91;GRA<span class="elsevierStyleInf">p-a</span>&#93;&#41;&#46; Este gradiente facilita una onda refleja que retorna de manera retardada a la aorta ascendente durante la di&#225;stole&#44; lo que sostiene la presi&#243;n arterial diast&#243;lica y mitiga la presi&#243;n puls&#225;til en la microcirculaci&#243;n&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Con la senescencia vascular disminuye la elasticidad de la pared vascular y aumenta la rigidez a&#243;rtica&#46; El aumento de la rigidez a&#243;rtica promueve un retorno acelerado de la onda refleja durante la s&#237;stole&#44; lo que condiciona un incremento de la presi&#243;n arterial sist&#243;lica central &#40;PASc&#41; y la presi&#243;n del pulso central &#40;PPc&#41;&#46; Adem&#225;s&#44; puede producirse una atenuaci&#243;n o inversi&#243;n del GRA<span class="elsevierStyleInf">p-a</span>&#44; lo que facilita la conversi&#243;n de un flujo sangu&#237;neo continuo fisiol&#243;gico en la microcirculaci&#243;n a un flujo puls&#225;til&#46; Este &#250;ltimo en microcirculaci&#243;n induce da&#241;o en &#243;rganos de baja resistencia como el ri&#241;&#243;n y el cerebro<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Existe una &#237;ntima relaci&#243;n entre la rigidez a&#243;rtica y la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; considerada como el est&#225;ndar de oro para determinar la rigidez a&#243;rtica&#46; La velocidad de pulso car&#243;tida-radial &#40;VP<span class="elsevierStyleInf">c-r</span>&#41; refleja la rigidez de las arterias musculares &#40;rigidez perif&#233;rica&#41; y la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> se ha utilizado como &#237;ndice del GRA<span class="elsevierStyleInf">p-a</span><a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a>&#46; Otros par&#225;metros derivados de la morfolog&#237;a de la onda de pulso central como la PPc y el &#237;ndice de aumento &#40;IA&#41;&#44; que expresa qu&#233; parte de la PPc corresponde a la onda refleja&#44; han sido propuestos como marcadores subrogados de la rigidez a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hay estudios que han evaluado de forma aislada en sujetos con HTA&#44; DM o ERC la asociaci&#243;n de alguno de los par&#225;metros de rigidez arterial con la funci&#243;n renal<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">8&#8211;11</span></a>&#46; Los resultados de la asociaci&#243;n entre la rigidez a&#243;rtica y el filtrado glomerular &#40;FG&#41; no son consistentes&#46; Mientras que algunos estudios objetivan una asociaci&#243;n significativa<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; en otros la relaci&#243;n entre la rigidez a&#243;rtica y FG desaparece tras el ajuste multivariable<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a>&#46; El mecanismo por el que un aumento de la rigidez a&#243;rtica produce disfunci&#243;n renal no est&#225; completamente aclarado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En nuestro conocimiento&#44; no existen investigaciones que analicen de forma conjunta y usando los distintos marcadores de rigidez arterial a&#243;rtica&#44; la posible asociaci&#243;n entre rigidez a&#243;rtica y funci&#243;n renal en pacientes con diferentes factores de riesgo vascular &#40;HTA&#44; DM&#44; ERC y su asociaci&#243;n&#41;&#46; Dado que los diversos &#237;ndices de rigidez arterial central &#40;RAC&#41; est&#225;n influenciados por variables diferentes&#44; pero hemodin&#225;micamente relacionadas<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">7&#44;12</span></a>&#44; el an&#225;lisis de su posible asociaci&#243;n con la funci&#243;n renal podr&#237;a contribuir a clarificar los mecanismos fisiopatol&#243;gicos de dicha relaci&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nuestro objetivo fue doble&#46; Por una parte&#44; describir el comportamiento de la RAC en sujetos con diferentes factores de riesgo vascular y&#44; por otra parte&#44; analizar el impacto de la rigidez a&#243;rtica sobre la funci&#243;n renal valorada por el FG y la albuminuria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pacientes</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se estudiaron 286 sujetos evaluados y revisados en la consulta externa de nefrolog&#237;a de un hospital universitario&#46; 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Se investig&#243; el h&#225;bito tab&#225;quico considerando como fumadores tanto los activos como los que lo hab&#237;an abandonado frente a los que nunca hab&#237;an fumado &#40;no fumadores&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se determinaron en sangre los par&#225;metros hematol&#243;gicos y bioqu&#237;micos que inclu&#237;an hemograma&#44; creatinina&#44; l&#237;pidos&#44; &#225;cido &#250;rico&#44; glucemia&#44; hemoglobina glicada &#40;en DM&#41;&#44; metabolismo fosfoc&#225;lcico con parathormona &#40;PTH&#41; y vitamina D &#40;en ERC&#41;&#46; El filtrado glomerular estimado &#40;FGe&#41; se calcul&#243; por la f&#243;rmula <span class="elsevierStyleItalic">chronic kidney disease&#44; epidemiology</span> &#40;CKD-EPI&#41;&#46; En todos los sujetos se determin&#243;&#44; en la primera orina de la ma&#241;ana&#44; el cociente alb&#250;mina-creatinina&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Como controles de los par&#225;metros de funci&#243;n arterial se utilizaron 38 sujetos sanos&#44; no fumadores&#44; sin historia de ECV ni otras enfermedades y con funci&#243;n renal normal&#46; En estos sujetos solo se determinaron par&#225;metros anal&#237;ticos de funci&#243;n renal&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se consider&#243; la presencia de ERC cuando exist&#237;a un cociente alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g y&#47;o un FGe inferior a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#46; Dado que puede haber mayor riesgo de morbimortalidad cardiovascular en sujetos con valores de albuminuria en rango normal&#44; se a&#241;adi&#243; un subgrupo de albuminuria &#40;normal-alta&#41; que fue clasificada en las siguientes categor&#237;as&#58; normal 0-10<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; normal-alta&#58; 11-29<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; aumento moderado&#58; 30-299<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; aumento severo&#58; m&#225;s de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#46; Los sujetos fueron distribuidos en cinco grupos&#58; control&#44; HTA&#44; DM&#44; ERC y ERC m&#225;s DM&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Todos los sujetos dieron su consentimiento tras ser informados y el estudio cumpli&#243; todos los requisitos &#233;ticos del centro donde se realiz&#243;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estudio de la rigidez arterial a&#243;rtica y perif&#233;rica</span><p id="par0070" class="elsevierStylePara elsevierViewall">Tras permanecer en reposo durante 15 minutos&#44; se tom&#243; la presi&#243;n arterial braquial &#40;PAb&#41;&#44; media de tres determinaciones&#44; con un aparato oscilom&#233;trico Omron M3 &#40;Omron electr&#243;nica Iberia&#44; S&#46;A&#46;U&#46;&#44; Madrid&#41;&#46; El estudio de la presi&#243;n arterial central &#40;PAc&#41; y de la VP<span class="elsevierStyleInf">c-f</span> se hizo mediante tonometr&#237;a de aplanamiento usando un dispositivo SphygmoCor &#40;AtCor Medical&#44; Sidney&#44; Australia&#41;&#46; De la onda de pulso obtenida por tonometr&#237;a sobre la arteria radial y usando una funci&#243;n de transferencia generalizada&#44; se obtuvo la onda de presi&#243;n a&#243;rtica central y sus diferentes componentes &#40;la PASc&#44; la presi&#243;n arterial diast&#243;lica central &#91;PADc&#93; y la presi&#243;n de pulso central &#91;PPc&#93;&#41;&#46; En la onda de la presi&#243;n a&#243;rtica generada se identific&#243; el punto de uni&#243;n de la onda incidente anter&#243;grada y la onda reflejada &#40;punto de inflexi&#243;n&#41;&#46; La presi&#243;n de aumento &#40;PAu&#41; fue la PASc m&#225;xima menos la presi&#243;n en el punto de inflexi&#243;n&#46; El IA se defini&#243; como la PAu dividida entre la PPc y se expresa como porcentaje&#46; Dada la influencia de la frecuencia cardiaca &#40;FC&#41; sobre el IA&#44; el dispositivo SphygmoCor estandariza el IA a una FC de 75 L&#47;min &#40;IA<span class="elsevierStyleInf">75</span>&#41;&#46; Para la determinaci&#243;n de la velocidad de pulso car&#243;tida-femoral &#40;representativa de la rigidez a&#243;rtica o central&#41;&#44; la onda de pulso se obtuvo de forma secuencial sobre la arteria car&#243;tida com&#250;n y la arteria femoral&#44; calcul&#225;ndose el tiempo de recorrido entre los dos puntos a partir de la diferencia entre la onda R del registro electrocardiogr&#225;fico simult&#225;neo y el inicio de la onda de pulso en los respectivos sitios arteriales&#46; Con la misma t&#233;cnica&#44; pero usando la arteria radial&#44; se determin&#243; la VP<span class="elsevierStyleInf">c-r</span>&#44; representativa de la rigidez arterial perif&#233;rica&#46; De la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> se calcul&#243; el GRA<span class="elsevierStyleInf">p-a</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">De la onda de pulso a&#243;rtica tambi&#233;n se deriv&#243; el &#237;ndice de viabilidad subendoc&#225;rdica o &#237;ndice de Buckberg &#40;iBuckberg&#41; que resulta de la integral tiempo-presi&#243;n diast&#243;lica&#47; integral tiempo-presi&#243;n sist&#243;lica&#44; y que representa una medida en reposo del aporte y consumo de ox&#237;geno del miocardio<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">13</span></a>&#46; En el 44&#37; de los enfermos con ERC y en 42&#37; del grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM se estudi&#243; el grado de calcificaci&#243;n de la aorta abdominal mediante una radiograf&#237;a lateral de columna lumbar determin&#225;ndose el &#237;ndice de Kauppila &#40;iKauppila&#41;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0080" class="elsevierStylePara elsevierViewall">Las variables cualitativas se expresan como frecuencias relativas&#46; Las variables continuas se expresan como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar &#40;x<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; cuando la distribuci&#243;n era normal y como mediana &#40;rango intercuart&#237;lico &#91;IQR&#93;&#41; en el caso de distribuci&#243;n no normal&#46; Algunas de las variables con distribuci&#243;n muy sesgada como el cociente alb&#250;mina&#47;creatinina en orina&#44; fueron convertidas a sus logaritmos naturales&#46; Para establecer la normalidad de la distribuci&#243;n de las variables se usaron las pruebas de Shapiro-Wilk y Kolmogorov-Smirnov dependiendo del tama&#241;o de la muestra&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La comparaci&#243;n de las variables cualitativas entre los grupos se hizo usando el test &#967;<span class="elsevierStyleSup">2</span> y la de las variables cuantitativas mediante el an&#225;lisis de la varianza &#40;ANOVA&#41; de un factor con ajuste a covariables &#40;ANCOVA&#41; que podr&#237;an incidir en los resultados&#46; Se us&#243; el ANOVA de dos factores para analizar el posible efecto de dos variables cualitativas y su posible interacci&#243;n sobre la variable dependiente de inter&#233;s&#46; Para maximizar posibles diferencias en la funci&#243;n renal entre los grupos y cuando se cumpl&#237;a el requisito de igualdad de matrices de covarianza&#44; se us&#243; el an&#225;lisis multivariado de la varianza &#40;MANOVA&#41; introduciendo como variables dependientes el FGe y la albuminuria&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El estudio de la relaci&#243;n entre variables se hizo mediante el coeficiente de correlaci&#243;n de Pearson o de Spearman dependiendo de su distribuci&#243;n&#46; La relaci&#243;n independiente entre variables se investig&#243; mediante la regresi&#243;n lineal m&#250;ltiple seleccionando las covariables potenciales que demostraban correlaci&#243;n significativa&#46; Para valorar los efectos independientes y el valor predictivo de los par&#225;metros de rigidez arterial sobre la funci&#243;n renal &#40;FGe y albuminuria&#41; se us&#243; la regresi&#243;n log&#237;stica binaria&#46; Para una mayor precisi&#243;n de la capacidad predictiva de los marcadores de rigidez arterial sobre la funci&#243;n renal y su posible interacci&#243;n con la DM&#44; se us&#243; la regresi&#243;n log&#237;stica multinomial utilizando como variable dependiente categ&#243;rica cuatro posibles clases de la funci&#243;n renal&#58; normal &#40;albuminuria y FGe normales&#41;&#59; albuminuria &#40;alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#59; reducci&#243;n del FGe &#40;FGe inferior a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#59; reducci&#243;n del FGe y albuminuria &#40;FGe inferior a 60 L&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#44; y las cuatro categor&#237;as de albuminuria &#40;normal&#44; normal-alta&#44; moderada y severa&#41;&#46; En estos an&#225;lisis&#44; como categor&#237;as de referencia se usaron la funci&#243;n renal normal &#40;FGe &#8805; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y albuminuria &#8804; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; y la albuminuria normal &#40;&#8804; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;<span class="elsevierStyleItalic">&#44;</span> respectivamente&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En los resultados estad&#237;sticos se consideraron significativos valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Todos los an&#225;lisis estad&#237;sticos se hicieron con el programa estad&#237;stico IBM SPSS &#40;<span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span>&#41;&#44; versi&#243;n 25 para Windows&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Estudiamos 286 sujetos que se distribuyeron en cinco grupos&#58; 1&#41; grupo control&#44; 2&#41; pacientes con HTA esencial sin ERC&#44; 3&#41; pacientes con DM sin ERC&#44; 4&#41; pacientes con ERC sin DM y 5&#41; pacientes con ERC m&#225;s DM&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se expresan las caracter&#237;sticas cl&#237;nicas y los datos de laboratorio de los grupos&#46; Hab&#237;a diferencias significativas entre los grupos en la edad&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; porcentaje de mujeres&#44; antecedentes de ECV&#44; terapia con bloqueadores del sistema renina-angiotensina &#40;SRA&#41; y con estatinas&#46; La duraci&#243;n de la DM&#44; la presencia de retinopat&#237;a y la terapia con insulina eran mayores y m&#225;s frecuentes en los que adem&#225;s de DM ten&#237;an ERC&#46; La nefropat&#237;a subyacente en el grupo con ERC era nefroangiosclerosis&#58; 58&#44;4&#37;&#59; glomerulonefritis cr&#243;nica &#40;GNC&#41;&#58; 24&#44;7&#37;&#59; otras &#40;poliquistosis renal&#44; pielonefritis cr&#243;nica&#44; no filiada&#41;&#58; 16&#44;9&#37;&#46; En el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM la nefropat&#237;a era nefroangiosclerosis&#58; 42&#44;6&#37;&#59; nefropat&#237;a diab&#233;tica &#40;ND&#41;&#58; 56&#44;4&#37; y GNC&#58;1&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El FGe era significativamente m&#225;s bajo y la albuminuria m&#225;s alta en los grupos con ERC &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Aunque en el ANOVA se observaron diferencias cuantitativas&#44; pero no estad&#237;sticamente significativas en el FGe y en la albuminuria entre los grupos con ERC y ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#44; el an&#225;lisis multivariante de la varianza evidenci&#243; diferencias significativas del FGe y logaritmo del cociente alb&#250;mina&#47;creatinina &#40;log&#46;alb&#46;&#47;creat&#46;&#41; &#40;&#91;ERC&#58; FGe&#58; 39&#123;2&#125;&#59; ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#58; FGe&#58; 48&#123;3&#125; mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#44; p &#61; 0&#44;015&#93;&#59; &#91;ERC&#58; log-alb&#47;creat&#46; 4&#44;43&#123;0&#44;2&#125;&#59; ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#58; log&#46;alb&#46;&#47;creat&#46; 5&#44;05&#44; p &#61; 0&#44;021&#93;&#41;&#46; Cuando se introduc&#237;an en el MANOVA como covariables la VP<span class="elsevierStyleInf">c-f</span> y el GRA<span class="elsevierStyleInf">p-a</span>&#44; persist&#237;a la diferencia en el FGe &#40;36 vs&#46; 50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#44; p &#61; 0&#44;001&#41;&#44; pero desaparec&#237;a en el log&#46;alb&#47;creat&#46; &#40;4&#44;6 vs&#46; 4&#44;9&#44; p &#61; 0&#44;3&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El porcentaje y la intensidad de calcificaciones de aorta abdominal fueron significativamente mayores en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM frente al grupo con ERC &#40;87 vs&#46; 65&#37;&#44; p &#61; 0&#44;02 y iKauppila 8 &#91;7&#93; vs&#46; 2 &#91;10&#93;&#44; p &#61; 0&#44;008&#41;&#44; respectivamente&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El porcentaje de enfermos con ERC estadio 1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>2 y 3a<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3b fue mayor en los sujetos con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM que en los que no ten&#237;an DM &#40;24&#44;5 y 58&#44;1&#37; vs&#46; 14&#44;3 y 41&#44;6&#37;&#44; respectivamente&#44; p &#61; 0&#44;04&#41; mientras que en el grupo con ERC sin DM fue mayor el porcentaje con ERC estadio 4 &#40;41&#44;6 vs&#46; 25&#44;8&#37;&#44; p &#61; 0&#44;04&#41;&#46; No hubo diferencias significativas en el porcentaje de sujetos con ERC estadio 5 &#40;1 vs&#46; 2&#44;6&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se expresan los valores de la PAb y PPc&#44; y los par&#225;metros de rigidez arterial y del &#237;ndice de viabilidad subendoc&#225;rdica tras el ajuste multivariante&#46; Los valores de los marcadores de pulsatilidad eran significativamente m&#225;s elevados en el grupo que combinaba ERC y DM&#46; Los grupos con ERC con y sin DM ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> mayores&#46; Los valores del GRA<span class="elsevierStyleInf">p-a</span> eran significativamente inferiores en los grupos con ERC y DM&#46; El iBuckberg de los pacientes con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM era significativamente inferior al de los otros grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">La VP<span class="elsevierStyleInf">c-f</span> ajustada a edad y presi&#243;n arterial media &#40;PAM&#41; de los sujetos sin nefropat&#237;a &#40;8&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41; era significativamente inferior a la de los diagnosticados de nefroangiosclerosis &#40;9&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41;&#44; GNC &#40;9&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41; &#40;p &#61; 0&#44;003&#41; y ND &#40;11&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41; &#40;p &#61; 0&#44;001&#41;&#44; La VP<span class="elsevierStyleInf">c-f</span> de estos &#250;ltimos era significativamente mayor que la de los enfermos con nefroangiosclerosis y GNC &#40;p &#61; 0&#44;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Considerando todos los sujetos&#44; se observ&#243; una correlaci&#243;n directa significativa entre la VP<span class="elsevierStyleInf">c-f</span> y la edad&#44; correlaci&#243;n que fue inversa en el caso del GRA<span class="elsevierStyleInf">p-a</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se evidenci&#243; una correlaci&#243;n directa y significativa del FGe con el GRA<span class="elsevierStyleInf">p-a</span> e iBuckberg&#44; y significativa e inversa entre FGe y VP<span class="elsevierStyleInf">c-f</span>&#44; IA<span class="elsevierStyleInf">75</span> y PPc &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Tambi&#233;n fue significativa&#44; pero de sentido contrario&#44; la correlaci&#243;n entre esos par&#225;metros y la albuminuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La prevalencia de una albuminuria anormal y un descenso del FGe fue progresivamente creciente con los cuartiles m&#225;s altos de VP<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Considerando los enfermos en los que se determin&#243; PTH&#44; se comprob&#243; una correlaci&#243;n directa y significativa entre la PTH y la PPc &#40;r &#61; 0&#44;232&#59; p &#61; 0&#44;02&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se observ&#243; una correlaci&#243;n inversa entre el iBuckberg&#44; la edad y la albuminuria y directa con el FGe&#46; Todos los &#237;ndices de rigidez a&#243;rtica se correlacionaron significativamente con el iBuckberg&#44; En la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez a&#243;rtica asociado independiente y negativamente con la magnitud del iBuckberg fue la VP<span class="elsevierStyleInf">c-f</span> &#40;&#946; &#61; -2&#44;76&#59; p &#61; 0&#44;014&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de regresi&#243;n m&#250;ltiple con ajuste multivariante a antecedentes de ECV&#44; tabaquismo&#44; presencia de DM&#44; PAM y log&#46;alb&#46;&#47;creat&#46; en orina&#44; los &#250;nicos par&#225;metros de rigidez a&#243;rtica asociados de forma independiente e inversa con el valor del FGe fueron la VP<span class="elsevierStyleInf">c-f</span> y el IA<span class="elsevierStyleInf">75</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>-A&#41;&#46; Cuando en el modelo ajustado se introduc&#237;an individualmente los marcadores de rigidez arterial&#44; todos se asociaban de forma significativa&#44; pero la relaci&#243;n m&#225;s potente con el FGe &#40;mayor R<span class="elsevierStyleSup">2</span> y mayor coeficiente &#946; estandarizado&#41; correspond&#237;a a la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Un hecho similar se observ&#243; cuando se analizaron en la regresi&#243;n log&#237;stica binaria las variables que predec&#237;an el descenso del FGe &#40;valores inferiores a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico marcador con capacidad predictora significativa del descenso del FGe &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>-B&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez arterial con una asociaci&#243;n significativa y positiva con la magnitud de la albuminuria fue la VP<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>-A&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> tambi&#233;n fue el &#250;nico &#237;ndice de rigidez a&#243;rtica con capacidad predictora de una albuminuria anormal &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#58; 1&#44;66&#59; intervalo de confianza &#91;IC&#93; 95&#37;&#58; 1&#44;25-2&#44;20&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>-B&#41;&#46; Introducidos individualmente los marcadores de rigidez&#44; solo la VP<span class="elsevierStyleInf">c-f</span> mostraba una capacidad predictora significativa de una albuminuria anormal&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a> se observan las variables con valor predictivo de la funci&#243;n renal y las diversas categor&#237;as de albuminuria en la regresi&#243;n multinomial&#46; La VP<span class="elsevierStyleInf">c-f</span> fue el &#250;nico par&#225;metro de rigidez arterial que se asoci&#243; de forma significativa con el descenso del FGe &#40;OR &#91;IC 95&#37;&#93;&#58; 1&#44;63 &#91;1&#44;31-2&#44;02&#93;&#59; p &#61; 0&#44;001&#41;&#44; el aumento de la albuminuria &#40;OR&#58; 1&#44;61 &#91;1&#44;29-2&#44;03&#93;&#59; p &#61; 0&#44;001&#41; y su combinaci&#243;n &#40;OR&#58; 2&#44;33 &#91;1&#44;90-2&#44;85&#93;&#59; p &#61; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-A&#41;&#46; La presencia de DM se asoci&#243; de forma significativa con el aumento de la albuminuria &#40;OR&#58; 3&#44;34 &#91;1&#44;33-8&#44;36&#93;&#59; p &#61; 0&#44;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-A&#41;&#46; No se observ&#243; interacci&#243;n entre la DM y los par&#225;metros de rigidez arterial&#46; Tanto la presencia de DM como la VP<span class="elsevierStyleInf">c-f</span> se asociaron significativamente con todos los grados de albuminuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-B&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nuestros resultados demuestran que la ERC se asocia a un aumento de la RAC y a una disminuci&#243;n del GRA<span class="elsevierStyleInf">p-a</span>&#44; cambios que son m&#225;s marcados cuando la ERC coexiste con la DM&#46; Por otra parte&#44; la VP<span class="elsevierStyleInf">c-f</span> es el marcador de RAC m&#225;s relacionado de forma independiente con la funci&#243;n renal y con mayor poder predictivo de un descenso del FGe y de un aumento de la albuminuria&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Indicadores de rigidez a&#243;rtica en presencia de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; diabetes mellitus&#44; enfermedad renal cr&#243;nica&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">La rigidez arterial es la expresi&#243;n del efecto que tiene sobre la pared arterial la interacci&#243;n entre factores hemodin&#225;micos y metab&#243;licos&#46; Consecuentemente&#44; se producen alteraciones estructurales de la pared vascular con aumento de la relaci&#243;n entre col&#225;geno y elastina&#44; entre otras&#46; Son muchos los mecanismos subyacentes del aumento de la rigidez arterial&#58; las alteraciones moleculares inducidas por la mecanotransducci&#243;n entre la matriz extracelular y las c&#233;lulas musculares lisas vasculares&#44; los cambios fenot&#237;picos de estas c&#233;lulas&#44; la disfunci&#243;n endotelial&#44; el estr&#233;s oxidativo&#44; la calcificaci&#243;n de la capa media vascular&#44; las alteraciones metab&#243;licas&#44; los fen&#243;menos inflamatorios&#44; el tejido adiposo perivascular&#44; las hormonas sexuales y los factores gen&#233;ticos y epigen&#233;ticos<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Todos estos mecanismos participan en diferente grado en el aumento de la rigidez arterial que se observa en presencia de diferentes factores de riesgo vascular como la edad&#44; HTA&#44; DM y ERC<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">De formas similar al proceso de envejecimiento normal&#44; en presencia de esos factores de riesgo vascular se produce un EVA que se traduce en un aumento de la rigidez arterial<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">M&#225;s del 90&#37; de los enfermos de nuestro estudio eran hipertensos&#46; La HTA se asocia a una mayor rigidez arterial y&#44; a su vez&#44; un incremento de esta promueve un aumento de la presi&#243;n arterial<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a>&#46; Adem&#225;s de las modificaciones estructurales de la pared arterial producidas por la HTA que inducen a largo plazo un aumento de la rigidez arterial&#44; cuando se eleva la presi&#243;n arterial de forma aguda la carga soportada por la pared vascular es transferida desde las fibras el&#225;sticas a las de col&#225;geno aumentando la rigidez arterial&#46; Como se ha comprobado en nuestro estudio y en otros<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a>&#44; hay una correlaci&#243;n significativa &#40;con morfolog&#237;a de funci&#243;n cuadr&#225;tica&#41; entre la edad y la VP<span class="elsevierStyleInf">c-f</span>&#46; Otros factores como el sexo y la obesidad pueden modificar la rigidez arterial<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Por todo ello&#44; es necesario considerar estas variables cuando se analiza la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los valores de VP<span class="elsevierStyleInf">c-f</span> en todos los grupos de enfermos eran superiores a los de los controles&#46; Sin embargo&#44; tras el ajuste a la edad&#44; presi&#243;n arterial&#44; sexo e IMC&#44; desaparec&#237;a la diferencia significativa entre el grupo control y el grupo con HTA&#46; Pese al ajuste&#44; los sujetos con DM&#44; ERC y ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM presentaron valores de VP<span class="elsevierStyleInf">c-f</span> superiores a los de los otros grupos&#46; La mayor contribuci&#243;n a la varianza de la VP<span class="elsevierStyleInf">c-f</span> era el grupo al que pertenec&#237;an &#40;27&#44;7&#37;&#41;&#44; la edad &#40;22&#44;9&#37;&#41; y la PAM &#40;20&#44;3&#37;&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La causa de un valor similar marginal &#40;tras ajuste&#41; de la VP<span class="elsevierStyleInf">c-f</span> en los grupos control y con HTA no est&#225; clara&#46; Es posible que los criterios usados para clasificar los grupos&#44; excluyendo del grupo 2 &#40;HTA&#41; los que ten&#237;an albuminuria y descenso del FGe&#44; genere una selecci&#243;n de los enfermos con mejor salud vascular&#46; Se ha comprobado que&#44; pese a la presencia de factores de riesgo vascular&#44; hay enfermos con una edad vascular &#40;medida por la VP<span class="elsevierStyleInf">c-f</span>&#41; inferior a la edad cronol&#243;gica &#40;<span class="elsevierStyleItalic">supernormal vascular aging</span> &#91;SUPERNOVA&#93;&#41;&#44; con menos eventos vasculares&#46; En el estudio prospectivo que valid&#243; el significado cl&#237;nico del concepto de edad vascular supernormal&#44; en el grupo SUPERNOVA hab&#237;a un 59&#44;7&#37; con HTA<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a>&#46; En nuestro estudio&#44; un 27&#44;5&#37; de los enfermos del grupo con HTA ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> inferiores al punto de corte del percentil 10 de los valores de referencia de la VP<span class="elsevierStyleInf">c-f</span> de la Sociedad Europea de Cardiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">23</span></a>&#46; En este subgrupo de nuestra investigaci&#243;n&#44; el valor de la VP<span class="elsevierStyleInf">c-f</span>&#44; ajustado a edad&#44; sexo y PAM&#44; era 5&#44;8 &#40;1&#41; m&#47;s&#44; y ninguno ten&#237;a antecedentes de ECV&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Otro hecho que podr&#237;a contribuir a una menor VP<span class="elsevierStyleInf">c-f</span> en todos los grupos de enfermos es el tratamiento con bloqueadores del SRA&#46; Estos f&#225;rmacos tienen capacidad para reducir la rigidez arterial m&#225;s all&#225; de sus efectos antihipertensivos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Como se ha descrito en otros estudios&#44; la presencia de DM y ERC se asocia a alteraciones metab&#243;licas&#44; inflamatorias&#44; estr&#233;s oxidativo y calcificaciones vasculares&#44; entre otras&#44; que inducen un aumento de la rigidez arterial medida por la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">25</span></a>&#46; En nuestra investigaci&#243;n los grupos 3 &#40;DM&#41; y 4 &#40;ERC&#41; ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> m&#225;s elevados que el grupo con HTA&#44; aunque esta diferencia estaba en el l&#237;mite de la significaci&#243;n estad&#237;stica &#40;p &#61; 0&#44;07&#41; en el grupo que solo ten&#237;a DM&#46; Es posible que el n&#250;mero m&#225;s reducido de sujetos en este grupo limitase la significaci&#243;n&#46; Por otra parte&#44; la duraci&#243;n de la DM que en este grupo era solo de dos a&#241;os&#44; es un importante determinante de la rigidez a&#243;rtica en la DM&#46; El papel de la DM en el da&#241;o vascular y en el aumento de la rigidez arterial determinada por la VP<span class="elsevierStyleInf">c-f</span> se refuerza con el hecho de que la VP<span class="elsevierStyleInf">c-f</span> fue superior en el grupo con ND frente a los que ten&#237;an nefropat&#237;a glomerular no diab&#233;tica pese a un valor superior de albuminuria en estos &#250;ltimos&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La mayor VP<span class="elsevierStyleInf">c-f</span> observada en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM en comparaci&#243;n con el grupo con ERC puede atribuirse al efecto aditivo de las alteraciones metab&#243;licas&#44; inflamatorias y estr&#233;s oxidativo que acontecen cuando concurren los dos procesos&#44; y al mayor n&#250;mero e intensidad de calcificaciones de la aorta abdominal que objetivamos en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#46; Se ha demostrado que en sujetos con ERC y DM la calcificaci&#243;n de la aorta abdominal se asocia con valores elevados de la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En nuestra investigaci&#243;n obtuvimos resultados similares en la rigidez arterial en los diferentes grupos usando otro par&#225;metro de rigidez arterial como es el GRA<span class="elsevierStyleInf">p-a</span>&#46; Aplicando este &#237;ndice de rigidez arterial&#44; el grupo con DM ten&#237;a valores significativamente inferiores a los grupos control y con HTA&#46; La diferencia en el valor de la VP<span class="elsevierStyleInf">c-f</span> entre estos grupos estaba&#44; sin embargo&#44; en el l&#237;mite de la significaci&#243;n&#46; Durante el envejecimiento o en presencia de factores de riesgo vascular&#44; aumenta la rigidez a&#243;rtica &#40;medida por la VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; sin embargo&#44; la rigidez de las arterias perif&#233;ricas musculares &#40;medida por la VP<span class="elsevierStyleInf">c-r</span>&#41; apenas se modifica&#46; Consecuentemente el GRA<span class="elsevierStyleInf">p-a</span> disminuye progresivamente&#46; En nuestro estudio observamos una correlaci&#243;n significativa entre la edad y VP<span class="elsevierStyleInf">c-f</span>&#44; correlaci&#243;n que no se vislumbr&#243; en el caso de la VP<span class="elsevierStyleInf">c-r</span>&#46; Una ventaja de usar el GRA<span class="elsevierStyleInf">p-a</span> es su independencia del valor de la PAM<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a>&#46; De hecho&#44; en nuestro estudio&#44; el porcentaje de la varianza de la VP<span class="elsevierStyleInf">c-f</span> dependiente de la PAM era del 20&#37;&#46; Este porcentaje se reduc&#237;a al 1&#37; en el caso del GRA<span class="elsevierStyleInf">p-a</span>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">La PPc se considera un indicador indirecto de la RAC&#46; La p&#233;rdida de la elasticidad arterial reduce su distensibilidad y aumenta la velocidad de la trasmisi&#243;n de la onda de pulso produci&#233;ndose un retorno precoz de la onda refleja que se suma a la onda anter&#243;grada generada por la s&#237;stole ventricular lo que se traduce en un aumento de la PASc y&#44; consecuentemente&#44; de la PPc&#46; En nuestro trabajo comprobamos que todos los enfermos ten&#237;an&#44; tras un ajuste multivariante&#44; una PPc mayor que el grupo control siendo esta diferencia significativa cuando concurr&#237;an ERC y DM&#46; Pese a esto&#44; el porcentaje de sujetos con una PPc superior a 50<span class="elsevierStyleHsp" style=""></span>mmHg&#44; valor que ha demostrado ser predictivo de eventos cardiovasculares<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">27</span></a>&#44; fue significativamente mayor en todos los grupos de enfermos&#46; Otros estudios han demostrado que&#44; en sujetos con HTA y en pacientes con DM&#44; el aumento de la PPc se asociaba a una mayor impedancia de la aorta proximal y a una mayor rigidez a&#243;rtica<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">12&#44;28</span></a>&#44; y&#44; en sujetos con ERC<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">29</span></a>&#44; una correlaci&#243;n directa entre la PPc y los valores de PTH como tambi&#233;n observamos en nuestra investigaci&#243;n&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Cuando aumenta la rigidez arterial&#44; la onda refleja se propaga con m&#225;s velocidad uni&#233;ndose a la onda anter&#243;grada en la s&#237;stole con el consiguiente aumento del IA que se ha considerado marcador de la onda refleja y&#44; por tanto&#44; de la rigidez arterial<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a>&#46; En nuestra investigaci&#243;n&#44; el IA<span class="elsevierStyleInf">75</span> fue significativamente mayor en todos los enfermos que en los controles&#46; A diferencia de los otros marcadores de rigidez a&#243;rtica no existieron diferencias del IA<span class="elsevierStyleInf">75</span> entre los grupos con HTA&#44; DM y ERC pese a que la VP<span class="elsevierStyleInf">c-f</span> fue mayor en los grupos con ERC&#44; hecho observado tambi&#233;n en otros estudios<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a>&#46; Otras investigaciones comprobaron en sujetos con DM la coexistencia de una VP<span class="elsevierStyleInf">c-f</span> elevada con valores de IA<span class="elsevierStyleInf">75</span> y onda refleja similares o inferiores al grupo control<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">28&#44;31</span></a>&#46; Un aumento de la rigidez a&#243;rtica con menor incremento o descenso de la onda refleja podr&#237;a sugerir una mayor penetraci&#243;n de la energ&#237;a puls&#225;til en la microcirculaci&#243;n cerebral y renal&#44; lo que&#44; sin embargo&#44; no concuerda con la correlaci&#243;n significativa negativa entre IA<span class="elsevierStyleInf">75</span> y GRA<span class="elsevierStyleInf">p-a</span> objetivada en nuestra investigaci&#243;n&#46; Es posible que el IA<span class="elsevierStyleInf">75</span> no sea un buen marcador de la rigidez a&#243;rtica y de la onda refleja&#46; Las limitaciones del IA<span class="elsevierStyleInf">75</span> como medida de la magnitud de la onda refleja derivan de que no solo es influenciado por la velocidad de la onda de pulso sino tambi&#233;n por otros factores cardiacos<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Se puede deducir de nuestros hallazgos que la rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular como la HTA&#44; la DM y la ERC&#46; Este aumento es especialmente notable cuando hay ERC y cuando esta coexiste con DM&#46; La VP<span class="elsevierStyleInf">c-f</span> y el GRA<span class="elsevierStyleInf">p-a</span> son los marcadores m&#225;s consistentes para analizar la RAC cuando coexisten los factores de riesgo vascular aqu&#237; estudiados&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">La relevancia de un aumento de la rigidez a&#243;rtica vendr&#225; determinada por su posible repercusi&#243;n en la lesi&#243;n de &#243;rganos diana que acontece en presencia de factores de riesgo vascular&#44; da&#241;o que puede contribuir a la morbimortalidad cardiovascular&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Indicadores de rigidez a&#243;rtica y funci&#243;n renal</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Indicadores de rigidez a&#243;rtica y filtrado glomerular estimado</span><p id="par0235" class="elsevierStylePara elsevierViewall">El otro objetivo de nuestra investigaci&#243;n fue analizar la posible asociaci&#243;n de la rigidez a&#243;rtica con dos par&#225;metros de la funci&#243;n renal&#58; FG y albuminuria&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Analizado globalmente el conjunto de los sujetos&#44; observamos una correlaci&#243;n significativa entre todos los marcadores estudiados de rigidez a&#243;rtica y el FGe &#40;correlaci&#243;n directa en el caso del GRA<span class="elsevierStyleInf">p-a</span> e inversa en los otros indicadores&#41;&#44; y entre esos indicadores y la albuminuria &#40;correlaci&#243;n inversa en el caso del GRA<span class="elsevierStyleInf">p-a</span> y directa en los dem&#225;s&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Introducidos conjuntamente todos los marcadores de rigidez a&#243;rtica en la regresi&#243;n m&#250;ltiple&#44; la VP<span class="elsevierStyleInf">c-f</span> y el IA<span class="elsevierStyleInf">75</span> fueron los &#250;nicos que&#44; tras el ajuste multivariante&#44; se asociaban de forma independiente y significativa con la magnitud del FGe mientras que en la regresi&#243;n log&#237;stica solo la VP<span class="elsevierStyleInf">c-f</span> fue predictora de la presencia de un FGe subnormal&#46; Introducidos individualmente y tras el ajuste multivariante&#44; todos los marcadores de rigidez se asociaban de forma significativa con el valor del FGe y predec&#237;an su disminuci&#243;n&#44; pero la VP<span class="elsevierStyleInf">c-f</span> era el marcador m&#225;s robusto asociado con el FGe&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">El mayor valor de FGe del grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM comparado con el grupo con ERC persist&#237;a cuando en el MANOVA se hac&#237;a el ajuste a la VP<span class="elsevierStyleInf">c-f</span>&#46; As&#237;&#44; en nuestra investigaci&#243;n&#44; el efecto negativo de la rigidez a&#243;rtica sobre el valor del FGe parece ser superado por la hiperfiltraci&#243;n inducida por la DM&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Hay pocos estudios que analicen la asociaci&#243;n entre FG y albuminuria con varios par&#225;metros de rigidez arterial&#46; Los resultados de algunos estudios realizados sobre FG y rigidez arterial a&#243;rtica no han sido uniformes&#46; Se ha demostrado un aumento progresivo de la VP<span class="elsevierStyleInf">c-f</span> con el estadio de ERC y una asociaci&#243;n independiente entre VP<span class="elsevierStyleInf">c-f</span> y FG incluso en estadios muy precoces de insuficiencia renal<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">35&#8211;37</span></a>&#46; Otro estudio ha demostrado la asociaci&#243;n entre la rigidez a&#243;rtica determinada por la VP<span class="elsevierStyleInf">c-f</span> y el FGe en sujetos con y sin HTA y DM<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Otras investigaciones&#44; sin embargo&#44; no demuestran asociaci&#243;n entre rigidez arterial central y FG&#46; Upadhyay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a> comprobaron en una cohorte de Framingham que en la ERC ligera-moderada el FG no se asociaba de forma independiente con la rigidez a&#243;rtica valorada por varios &#237;ndices &#40;VP<span class="elsevierStyleInf">c-f</span>&#44; PPc&#44; IA&#41;&#46; La causa de esta discrepancia no est&#225; clara&#46; Es posible que el uso de la cistatina para estimar el FG y un ajuste multivariable muy riguroso a los factores de riesgo cardiovascular en el estudio de Upadhyay contribuyan a los diferentes resultados&#46; Estos factores de riesgo pueden ejercer efectos importantes en la rigidez arterial en sujetos con ERC&#46; En nuestra investigaci&#243;n&#44; seguimos observando una asociaci&#243;n significativa de la VP<span class="elsevierStyleInf">c-f</span> con el FGe cuando a&#241;adimos el perfil lip&#237;dico a las otras variables de ajuste&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Se concluye que existe una asociaci&#243;n inversa entre rigidez a&#243;rtica y FGe&#44; y un valor predictivo significativo de aquella de la presencia de un descenso del FGe en sujetos con factores de riesgo vascular&#46; La VP<span class="elsevierStyleInf">c-f</span> es el &#237;ndice de rigidez a&#243;rtica m&#225;s robusto comparado con otros marcadores de rigidez central&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Indicadores de rigidez a&#243;rtica y albuminuria</span><p id="par0270" class="elsevierStylePara elsevierViewall">En nuestra investigaci&#243;n&#44; la rigidez a&#243;rtica determinada por la Vp<span class="elsevierStyleInf">c-f</span>&#44; tras el ajuste multivariante&#44; se asociaba directa y significativamente con la magnitud y prevalencia de albuminuria&#46; Igual que en el caso de FGe&#44; todos los dem&#225;s marcadores de rigidez desaparec&#237;an del modelo cuando se incorporaba la VP<span class="elsevierStyleInf">c-f</span>&#46; Sin embargo&#44; incluidos de forma individual&#44; todos se relacionaban con la albuminuria&#44; aunque con mucha menos intensidad que la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Otros estudios han evidenciado una relaci&#243;n entre la rigidez a&#243;rtica y la albuminuria&#46; En un trabajo realizado en la cohorte de Framingham<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a> se observ&#243; una asociaci&#243;n independiente de la VP<span class="elsevierStyleInf">c-f</span> y PPc con la prevalencia de albuminuria con una OR cuantitativamente mayor para la VP<span class="elsevierStyleInf">c-f</span>&#46; En otros estudios poblacionales tanto el FGe como la albuminuria se asociaban de forma independiente con la rigidez a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a> siendo esta relaci&#243;n inversa con el FGe y directa con la albuminuria&#46; La asociaci&#243;n directa entre rigidez arterial y albuminuria se objetiv&#243; incluso con valores de albuminuria considerados normales<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a>&#46; En algunas publicaciones&#44; la relaci&#243;n directa entre la rigidez arterial con albuminuria es m&#225;s fuerte y consistente que la relaci&#243;n inversa entre la rigidez a&#243;rtica y el FG<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">11&#44;35</span></a>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; la asociaci&#243;n de un descenso del FGe y un aumento de la albuminuria con la VP<span class="elsevierStyleInf">c-f</span> no se modificaba sustancialmente cuando ambas se inclu&#237;an en la regresi&#243;n&#46; Esto suscita la posibilidad de que los mecanismos que vinculan estas variables con el riesgo cardiovascular son&#44; al menos en parte&#44; independientes uno de otro&#44; aunque puedan compartir factores como HTA y DM&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Nuestra investigaci&#243;n evidencia que el aumento de la rigidez arterial&#44; evaluado por la VP<span class="elsevierStyleInf">c-f</span>&#44; es un determinante crucial de los dos par&#225;metros de la funci&#243;n renal&#58; FGe y la albuminuria&#46; La existencia de DM y el incremento de la rigidez arterial contribuyen significativamente a la presencia y magnitud de la albuminuria sin que se observe una interacci&#243;n significativa entre ellas&#46; La asociaci&#243;n significativa de ambas variables con la albuminuria&#44; cuando se incluyen conjuntamente en el modelo&#44; sugiere que su efecto sobre la albuminuria se produce por procesos distintos&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">El mecanismo por el que el aumento de la rigidez a&#243;rtica contribuye a la disfunci&#243;n renal no est&#225; claro&#46; Woodard et al&#46; demostraron una relaci&#243;n inversa entre FG determinado por aclaramiento de iohexol y la rigidez a&#243;rtica&#46; Evidenciaron&#44; con un an&#225;lisis de mediaci&#243;n&#44; que la rigidez a&#243;rtica puede contribuir a la reducci&#243;n del FG por trasmisi&#243;n de excesiva pulsatilidad a la microcirculaci&#243;n renal que promueve vasoconstricci&#243;n din&#225;mica y rarefacci&#243;n vascular<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">39</span></a>&#46; En otro sentido&#44; un aumento de la relaci&#243;n del flujo retr&#243;grado&#47;anter&#243;grado a&#243;rtico&#44; observado en casos de aumento de la rigidez a&#243;rtica y que se correlaciona inversamente con el flujo sangu&#237;neo intrarrenal&#44; puede ser el mediador de la asociaci&#243;n entre el aumento de rigidez a&#243;rtica y el descenso del FG<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a>&#46; El da&#241;o microvascular renal y las alteraciones hemodin&#225;micas promovidas por el aumento de la presi&#243;n de pulso a&#243;rtico secundario a la mayor rigidez a&#243;rtica tambi&#233;n pueden producir albuminuria<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">La presencia de un gradiente normal de rigidez arterial perif&#233;rica-a&#243;rtica contribuye&#44; por una parte&#44; a mantener la perfusi&#243;n coronaria y evitar la sobrecarga cardiaca y&#44; por otra&#44; limita la trasmisi&#243;n de la energ&#237;a puls&#225;til a la periferia y protege a la microcirculaci&#243;n de &#243;rganos con habitual baja resistencia como el ri&#241;&#243;n y el cerebro<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a>&#46; Teniendo en cuenta las consecuencias fisiopatol&#243;gicas de una disminuci&#243;n del gradiente se ha propuesto que el gradiente de rigidez&#44; valorado por la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> podr&#237;a ser mejor que la VP<span class="elsevierStyleInf">c-f</span> para valorar la posible asociaci&#243;n de la rigidez a&#243;rtica con la lesi&#243;n de &#243;rganos diana y con la morbimortalidad&#46; En sujetos con ERC tratados con di&#225;lisis el GRA<span class="elsevierStyleInf">p-a</span> tiene mayor poder predictivo de mortalidad que la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">43</span></a>&#46; Este hecho no se ha confirmado en estudios poblacionales<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">44</span></a>&#46; Por otra parte&#44; en sujetos con HTA&#44; el GRA<span class="elsevierStyleInf">p-a</span> ha demostrado una asociaci&#243;n con el FG significativa y similar a la VP<span class="elsevierStyleInf">c-f</span>&#44; pero de sentido inverso<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">45</span></a>&#46; En nuestro estudio el GRA<span class="elsevierStyleInf">p-a</span>&#44; igual que los otros marcadores de rigidez a&#243;rtica &#40;aunque en sentido inverso&#41;&#44; se asociaba con la magnitud del FGe y de la albuminuria cuando se introduc&#237;a de forma aislada en el modelo de regresi&#243;n&#44; pero su asociaci&#243;n significativa desaparec&#237;a cuando en el modelo se inclu&#237;a la VP<span class="elsevierStyleInf">c-f</span> que era el marcador de rigidez m&#225;s consistentemente asociado con la disfunci&#243;n renal&#46; De nuestros hallazgos se puede deducir que la disminuci&#243;n del GRA<span class="elsevierStyleInf">p-a</span> es fundamentalmente atribuible a un aumento de la VP<span class="elsevierStyleInf">c-f</span> &#40;que debe seguir siendo considerado como el marcador m&#225;s importante de la rigidez a&#243;rtica&#41; m&#225;s que a un descenso de la VP<span class="elsevierStyleInf">c-r</span>&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Consecuencias cardiacas del aumento de la rigidez a&#243;rtica</span><p id="par0300" class="elsevierStylePara elsevierViewall">Adem&#225;s de su repercusi&#243;n en la funci&#243;n renal&#44; el aumento de la rigidez a&#243;rtica tambi&#233;n tiene efectos cardiacos&#46; Un aumento de la VP<span class="elsevierStyleInf">c-f</span> favorece la llegada de la onda refleja a la aorta ascendente durante la s&#237;stole aumentando la PASc con la consiguiente sobrecarga cardiaca y&#44; por otra parte&#44; disminuye la presi&#243;n arterial diast&#243;lica a&#243;rtica comprometiendo la perfusi&#243;n coronaria que se produce fundamentalmente en la di&#225;stole&#46; Estudios experimentales han demostrado que una aorta proximal r&#237;gida se asocia a una reducci&#243;n de la perfusi&#243;n coronaria&#44; especialmente a nivel subendoc&#225;rdico<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">46</span></a>&#46; En nuestro estudio&#44; observamos una correlaci&#243;n directa entre el iBuckberg&#44; estimaci&#243;n no invasiva del aporte de ox&#237;geno y de la perfusi&#243;n subendoc&#225;rdica&#44; con el FGe&#44; e inversa con la albuminuria&#44; y una correlaci&#243;n inversa con los par&#225;metros de rigidez a&#243;rtica &#40;salvo una relaci&#243;n directa con el GRA<span class="elsevierStyleInf">p-a</span>&#41;&#46; Sin embargo&#44; en la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez a&#243;rtica asociado independiente e inversamente con la magnitud del iBuckberg fue la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Se ha demostrado que&#44; tanto en la poblaci&#243;n general como en las poblaciones de alto riesgo vascular&#44; el FGe y la albuminuria&#44; independientemente de otros factores de riesgo vascular tradicionales&#44; predicen la morbimortalidad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">47</span></a>&#46; La asociaci&#243;n observada en nuestra investigaci&#243;n de la rigidez a&#243;rtica con el FGe&#44; la albuminuria y la perfusi&#243;n subendoc&#225;rdica suscita la posibilidad de que el aumento de rigidez a&#243;rtica sea el nexo entre la disfunci&#243;n renal y los eventos cardiovasculares&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0310" class="elsevierStylePara elsevierViewall">Podemos concluir de nuestros hallazgos que la rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular como la HTA&#44; la DM y la ERC&#46; Este incremento es especialmente notable cuando hay ERC y cuando esta coexiste con DM&#46; Una mayor rigidez a&#243;rtica se asocia de forma inversa e independiente con la magnitud del FGe y de forma directa con la cuant&#237;a de la albuminuria&#46; Por otra parte&#44; el aumento de la rigidez a&#243;rtica predice la presencia de una disminuci&#243;n de FGe y de una albuminuria anormal&#46; La Vp<span class="elsevierStyleInf">c-f</span> es el par&#225;metro de rigidez a&#243;rtica que se asocia de forma m&#225;s significativa y consistente con la disfunci&#243;n renal&#46; Aunque la VP<span class="elsevierStyleInf">c-f</span> depende fundamentalmente del grosor y elasticidad de la pared de la aorta y de las arterias ileofemorales&#44; puede integrar las variables diferentes&#44; pero hemodin&#225;micamente relacionadas&#44; que determinan los otros marcadores de rigidez a&#243;rtica&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene limitaciones&#46; Es un estudio transversal por lo que no se puede establecer una relaci&#243;n causal entre rigidez aortica y disfunci&#243;n renal&#46; Realmente se trata de una asociaci&#243;n bidireccional&#46; Un aumento de la rigidez a&#243;rtica puede producir alteraciones renales y&#44; por otra parte&#44; en la ERC concurren m&#250;ltiples alteraciones fisiopatol&#243;gicas que pueden condicionar un aumento de la rigidez a&#243;rtica&#46; Adem&#225;s&#44; existen variables independientes que afectan simult&#225;neamente a la elasticidad de la pared vascular y originan da&#241;o renal&#46; En nuestro estudio no realizamos todas las determinaciones de laboratorio en la totalidad de los sujetos lo que puede limitar el efecto de estas variables en las asociaciones observadas&#46; No obstante&#44; la inclusi&#243;n de las variables disponibles de laboratorio en nuestros an&#225;lisis de regresi&#243;n no modific&#243; sustancialmente los resultados&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Nuestra investigaci&#243;n tambi&#233;n tiene aspectos relevantes&#46; Se usa la VP<span class="elsevierStyleInf">c-f</span> que se considera el est&#225;ndar de oro para el estudio de la rigidez a&#243;rtica&#46; Se ha reunido un n&#250;mero importante de sujetos que se han distribuido en grupos representativos de diferentes factores de riesgo vascular&#46; En nuestro conocimiento&#44; no hay estudios que analicen la rigidez a&#243;rtica en un grupo tan variado de enfermos&#46; Finalmente&#44; el uso de una metodolog&#237;a estad&#237;stica rigurosa nos permite analizar la asociaci&#243;n de las diversas variables con ajustes para minimizar los efectos de las diferencias de edad y comorbilidades entre los distintos grupos&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Se requieren estudios prospectivos para analizar la verdadera implicaci&#243;n de las alteraciones de la RAC y perif&#233;rica en las lesiones de &#243;rgano diana y en la morbimortalidad cardiovascular en los sujetos con factores de riesgo vascular&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0330" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0335" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El aumento de la rigidez arterial central &#40;RAC&#41; participa en la morbimortalidad cardiovascular de los enfermos con factores de riesgo vascular&#46; El descenso del filtrado glomerular &#40;FG&#41; y el aumento de la excreci&#243;n urinaria de alb&#250;mina &#40;uALB&#41; se relacionan con eventos cardiovasculares&#46; Los mecanismos fisiopatol&#243;gicos de esta asociaci&#243;n no est&#225;n completamente definidos&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue analizar la RAC&#44; comparando varios marcadores&#44; en sujetos con hipertensi&#243;n arterial &#40;HTA&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; enfermedad renal cr&#243;nica &#40;ERC&#41; y su combinaci&#243;n&#44; y estudiar la posible asociaci&#243;n de la RAC con la disfunci&#243;n renal&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 286 sujetos distribuidos en varios grupos&#58; control&#59; HTA&#59; DM sin ERC&#59; ERC sin DM&#59; ERC con DM&#46; Para la determinaci&#243;n de la RAC se usaron varios &#237;ndices obtenidos por tonometr&#237;a de aplanamiento&#58; velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41; y gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#40;GRA<span class="elsevierStyleInf">p-a</span>&#41;&#44; entre otros&#46; De la onda del pulso a&#243;rtico se obtuvo el &#237;ndice de viabilidad subendoc&#225;rdica &#40;iBuckberg&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Para el estudio de la asociaci&#243;n entre los marcadores de rigidez arterial y la funci&#243;n renal se usaron la regresi&#243;n m&#250;ltiple&#44; la regresi&#243;n log&#237;stica binaria y la multinomial&#44; todas con ajuste multivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los valores ajustados de la VP<span class="elsevierStyleInf">c-f</span> &#40;mediana &#91;rango intercuart&#237;lico&#93; &#91;m&#47;seg&#93;&#41; fueron significativamente mayores en los sujetos con DM &#40;9 &#91;1&#44;2&#93;&#41;&#59; ERC &#40;9&#44;4 &#91;0&#44;7&#93;&#41; y DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC &#40;10&#44;9 &#91;0&#44;7&#93;&#41; que en el grupo control &#40;8&#44;2 &#91;1&#44;3&#93;&#41; y grupo con HTA &#40;8&#44;3 &#91;0&#44;9&#93;&#41;&#44; p &#61; 0&#44;001&#46; Los enfermos con DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC ten&#237;an valores de VP<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> superiores a todos los dem&#225;s grupos &#40;p &#61; 0&#44;001&#41;&#46; El GRA<span class="elsevierStyleInf">p-a</span> de los enfermos fue significativamente inferior al de los controles&#44; y el grupo con DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC ten&#237;a valores significativamente inferiores a los de los otros grupos&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico marcador de rigidez a&#243;rtica que se asociaba de forma independiente e inversa con la magnitud del FG &#40;&#946; &#61; &#8211;4&#44; p &#61; 0&#44;001&#41; y predec&#237;a la presencia de disminuci&#243;n del FG &#40;OR &#91;IC 95&#37;&#93;&#58; 1&#44;50 &#91;1&#44;17-1&#44;92&#93;&#59; p &#61; 0&#44;001&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico &#237;ndice asociado de forma directa con la cuant&#237;a de la uALB &#40;&#946; &#61; 0&#44;15&#59; p &#61; 0&#44;02&#41; y predec&#237;a la existencia de una uALB anormal &#40;OR&#58; 1&#44;66 &#91;1&#44;25-2&#44;20&#93;&#44; p &#61; 0&#44;001&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> tambi&#233;n se asociaba con el iBuckberg &#40;&#946; &#61; -2&#44;73&#59; p &#61; 0&#44;01&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En la regresi&#243;n multinomial se confirm&#243; que la VP<span class="elsevierStyleInf">c-f</span> es un determinante significativo del FG y de la uALB&#46; Por otra parte&#44; el aumento de la VP<span class="elsevierStyleInf">c-f</span> y la presencia de DM contribu&#237;an de forma significativa a la magnitud de la uALB&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular y es mayor cuando coexisten DM y ERC&#46; El aumento de la rigidez a&#243;rtica se asocia de forma inversa con el FG y directamente con la magnitud de la albuminuria&#44; y tiene capacidad predictiva de una disminuci&#243;n del FG y de una albuminuria anormal&#46; La VP<span class="elsevierStyleInf">c-f</span> es el par&#225;metro de rigidez a&#243;rtica que se asocia de forma m&#225;s consistente con la disfunci&#243;n renal&#46; El aumento de la rigidez a&#243;rtica podr&#237;a ser uno de los patomecanismos que vinculan la disfunci&#243;n renal con los eventos cardiovasculares&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamento y objetivos"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Rationale and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Increased aortic or central arterial stiffness &#40;CAS&#41; is a major factor in cardiovascular morbidity and mortality in patients with vascular risk factors&#46; Decreased glomerular filtration rate &#40;GFR&#41; and increased urinary albumin excretion &#40;uALB&#41; are associated with lethal and non-lethal cardiovascular events&#46; The pathophysiological mechanisms of this association are not fully defined&#46;</p><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was&#58; 1&#46;- To analyze the CAS&#44; comparing several markers&#44; in subjects with arterial hypertension &#40;HTN&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; chronic kidney disease &#40;CKD&#41; and their combination&#46; 2&#46;- To study the possible association of CAS with renal dysfunction &#40;decrease in GFR and increase in uALB&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A total of 286 subjects were included&#44; divided into several groups&#58; Control &#40;n&#58; 38&#41;&#59; HTN &#40;n&#58;51&#41;&#59; DM without CKD &#40;n&#58;26&#41;&#59; CKD without DM &#40;n&#58;77&#41;&#59; CKD with DM &#40;n&#58;94&#41;&#46; Several indices obtained by applanation tonometry were used to determine the CAS&#58; carotid-femoral pulse velocity &#40;VP<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span>&#41;&#59; central pulse pressure &#40;cPP&#41;&#59; augmentation index standardized to a cardiac frequency of 75 l&#47;min &#40;IA<span class="elsevierStyleInf"><span class="elsevierStyleBold">75</span></span>&#41;&#59; peripheral &#47; aortic arterial stiffness gradient &#40;ASG<span class="elsevierStyleInf">p-a</span>&#41;&#46; As a marker of peripheral arterial stiffness&#44; the carotid-radial pulse velocity &#40;PV<span class="elsevierStyleInf">c-r</span>&#41; was determined&#46; The ASG<span class="elsevierStyleInf">p-a</span> was calculated from the PV<span class="elsevierStyleInf">c-r</span> &#47;PV<span class="elsevierStyleInf">c-f</span> ratio&#46; The subendocardial viability index &#40;iBuckberg&#41; was obtained from the aortic pulse wave&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Multiple regression&#44; binary logistic regression&#44; and multinomial regression were used to study the association between arterial stiffness markers and renal function&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The adjusted values of the PV<span class="elsevierStyleInf">c-f</span> &#91;&#40;median &#40;interquartile range&#41; &#40;m&#47;sec&#41;&#93; were significantly higher in subjects with DM &#91;&#40;9 &#40;1&#46;2&#41;&#93;&#44; CKD &#91;&#40;9&#46;4 &#40;0&#46;7&#41;&#93; and DM with CKD &#91;&#40;10&#46;9 &#40;0&#46;7&#41;&#93; than in the control group &#91;&#40;8&#46;2 &#40;1&#46;3&#41;&#93; and group with HTN &#91;&#40;8&#46;3 &#40;0&#46;9&#41;&#93;&#44; &#40;p&#58;0&#46;001&#41;&#46; Patients with DM with CKD had higher PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> values than all other groups &#40;p&#58; 0&#46;001&#41;&#46; The ASG<span class="elsevierStyleInf"><span class="elsevierStyleBold">p-a</span></span> of the patients was significantly lower than that of the controls&#44; and the group with DM with CKD had significantly lower values than the other groups&#46; The cPP in the DM with CKD group was significantly higher than in the other groups&#46; All patients had an AI<span class="elsevierStyleInf">75</span> higher than the control group&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">When all aortic stiffness markers were introduced together in the regression&#44; PV <span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was the only one that&#44; after multivariate adjustment&#44; was independently and inversely associated with GFR &#40;&#946;&#59; &#8211;4&#44; p&#58;0&#46;001&#41; and predicted the presence of GFR decrease &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#41;&#44; &#91;&#40;OR &#40;95&#37;CI&#41;&#58; 1&#46;50 &#40;1&#46;17-1&#46;92&#59; p&#58;0&#46;001&#93;&#46; The PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was the only index directly associated with albuminuria &#40;&#946;&#58; 0&#46;15&#44; p&#58; 0&#46;02&#41; and predicted the existence of abnormal albuminuria &#40;&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#44; &#91;&#40;OR&#59; 1&#46;66 &#40;1&#46;25-2&#46;20&#41;&#44; p&#58;0&#46;001&#41;&#93;&#46; The PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was also associated with the iBuckberg &#40;&#946;&#58; -2&#46;73&#44; p&#58; 0&#46;01&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Multinomial regression confirmed that PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> is a significant determinant of GFR and uALB&#46; On the other hand&#44; the increase in PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> and the presence of DM contribute significantly to the magnitude of albuminuria&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Aortic stiffness increases in the presence of vascular risk factors such as hypertension&#44; DM and CKD&#46; This increase is greater when DM and CKD coexist&#46; Increased aortic stiffness is inversely associated with GFR and directly with uALB&#44; and is predictive of decreased GFR and abnormal uALB&#46; The VP<span class="elsevierStyleInf">c-f</span> is the parameter of aortic stiffness that is most consistently associated with renal dysfunction&#46; Increased aortic stiffness could be one of the pathomechanisms linking renal dysfunction to cardiovascular events&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Rationale and objectives"
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            "titulo" => "Material and methods"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Correlaci&#243;n entre la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; velocidad de pulso car&#243;tida-radial &#40;VP<span class="elsevierStyleInf">c-r</span>&#41; y el gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#40;GRA<span class="elsevierStyleInf">p-a</span>&#41; con la edad&#46;</p>"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Correlaci&#243;n entre la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; y el gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#40;GRA<span class="elsevierStyleInf">p-a</span>&#41; con el filtrado glomerular estimado &#40;FGe&#41; y la albuminuria &#40;log&#46;alb&#47;creat&#46;&#41;&#46;</p>"
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de albuminuria anormal &#40;&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; y descenso del filtrado glomerular &#40;FG&#41; &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41; seg&#250;n cuartiles de la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Datos expresados como mediana &#40;rango intercuart&#237;lico&#41; o porcentaje &#40;&#37;&#41;&#59; DM&#58; diabetes mellitus&#59; ECV&#58; enfermedad cardiovascular&#59; ERC&#58; enfermedad renal cr&#243;nica&#59; FGe&#58; filtrado glomerular estimado&#59; HDL-c&#58; colesterol de lipoprote&#237;nas de alta densidad&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal&#59; LDL-c&#58; colesterol de lipoprote&#237;nas de baja densidad&#59; Log&#46;alb&#47;creat&#46;&#58; logaritmo del cociente alb&#250;mina&#47;creatinina&#59; NA&#58; no aplicable&#59; ND&#58; no determinado&#59; NS&#58; no significativo&#59; PTH&#58; parathormona&#59; SRA&#58; sistema renina angiotensina&#46;</p>"
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                  <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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="7" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GRUPO</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Datos cl&#237;nicos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;3&#44;4&#44;5&#58;0&#44;0012 vs&#46; 4&#44;5&#58;0&#44;033 vs&#46; 5&#58;0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;3&#44;4&#44;5&#58;0&#44;0013 vs&#46; 4&#58;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 vs&#46; 1&#44;3&#44;4&#44;5&#58;0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duraci&#243;n de DM &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 vs&#46; 5&#58;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabaquismo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS entre 2&#44;3&#44;4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Historia de ECV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 vs&#46; 3&#44;4&#44;5&#58;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retinopat&#237;a diab&#233;tica &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 vs&#46; 5&#58;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bloqueo SRA &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 vs&#46; 4&#44;5&#58;0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estatinas &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 vs&#46; 2&#44;3&#44;4&#58; 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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia con vit&#46; D &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Kauppila&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FGe &#40;mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;2&#44;3 vs&#46; 4&#44;5&#58;0&#44;0014 vs&#46; 5&#58;0&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Log&#46;alb&#47;creat&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 vs&#46; 3&#58;0&#44;011&#44;2&#44;3 vs&#46; 4&#44;5&#58;0&#44;0014 vs&#46; 5&#58;0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triglic&#233;ridos &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL-c &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HDL-c &#40;mg&#47;dL&#41;&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="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;cido &#250;rico &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;5 vs&#46; 3&#58;0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calcio &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>F&#243;sforo&#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;4 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;6 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PTH &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">127&#40;111&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">132 &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25&#40;OH&#41; vit&#46; D &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "tipo" => "MULTIMEDIATABLA"
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            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">DM&#58; diabetes mellitus&#59; ERC&#58; enfermedad renal cr&#243;nica&#59; FC&#58; frecuencia cardiaca&#59; GRA<span class="elsevierStyleInf">p-a</span>&#58; gradiente de rigidez arterial perif&#233;rica-a&#243;rtica&#59; HTA&#58; hipertensi&#243;n arterial&#59; IA<span class="elsevierStyleInf">75</span>&#58; &#237;ndice de aumento a frecuencia cardiaca de 75 L&#47;min&#59; iBuckberg&#58; &#237;ndice de Buckberg&#59; IMC&#58; &#237;ndice de masa corporal&#59; NS&#58; no significativo&#59; PAM&#58; presi&#243;n arterial media&#59; PASb&#58; presi&#243;n arterial sist&#243;lica&#59; PASc&#58; presi&#243;n arterial sist&#243;lica central&#59; PPb&#58; presi&#243;n de pulso braquial&#59; PPc&#58; presi&#243;n de pulso central&#59; VP<span class="elsevierStyleInf">c-f</span>&#58; velocidad de pulso car&#243;tida-femoral&#59; VP<span class="elsevierStyleInf">c-r</span>&#58; velocidad de pulso car&#243;tida-radial&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">HTA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Variable</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ajustadas a edad&#44; sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PASb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 7&#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;4&#44;5&#58; 0&#44;006&#59;1 vs&#46; 3&#58;0&#44;033 vs&#46; 5&#58;0&#44;001&#59; 4 vs&#46; 5&#58;0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PADb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;4&#44;5&#58;0&#44;001&#59; 1 vs&#46; 3&#58;0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PPb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 vs&#46; 1&#44;2&#44;3&#44;4&#58; 0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  """
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            1 => array:2 [
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Regresi&#243;n log&#237;stica binaria&#46; OR de marcadores de rigidez arterial tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a> predictores de disminuci&#243;n de FGe &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#46; Regresi&#243;n lineal m&#250;ltiple de marcadores de rigidez arterial asociados con el valor de la albuminuria tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a></th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Regresi&#243;n log&#237;stica binaria&#46; OR de marcadores de rigidez arterial tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a> predictores de aumento de albuminuria &#40;alb&#250;mina&#47;creatinina<span class="elsevierStyleHsp" style=""></span>&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Ajuste a presi&#243;n arterial media&#44; log alb&#250;mina&#47;creatinina&#44; presencia de DM&#44; tabaquismo&#44; antecedentes de enfermedad cardiovascular&#46; &#946; estand&#58; coeficiente &#946; estandarizado&#59; ES&#58; error est&#225;ndar&#59; FGe&#58; filtrado glomerular estimado&#59; GRA<span class="elsevierStyleInf">p-a</span>&#58; gradiente de rigidez arterial perif&#233;rica-a&#243;rtica&#59; IA<span class="elsevierStyleInf">75</span>&#58; &#237;ndice de aumento a 75 L&#47;min&#59; IC&#58; intervalo de confianza&#59; NS&#58; no significativo&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio</span>&#59; PPc&#58; presi&#243;n de pulso central&#59; VP<span class="elsevierStyleInf">c-f&#58;</span> velocidad de pulso car&#243;tida-femoral&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#46; Asociaci&#243;n de variables con las diferentes categor&#237;as de funci&#243;n renal comparadas con funci&#243;n renal normal &#40;categor&#237;a de referencia&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;5&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;05 &#40;0&#44;43-2&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VP<span class="elsevierStyleInf">c-f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;63 &#40;1&#44;31-2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">2&#46; Albuminuria &#40;&#62; 30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;g&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;5&#44;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;34 &#40;1&#44;33-8&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VP<span class="elsevierStyleInf">c-f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;61 &#40;1&#44;29-2&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">3&#46; Reducci&#243;n de FGe</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">albuminuria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;8&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;10 &#40;0&#44;52-2&#44;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VP<span class="elsevierStyleInf">c-f</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;33 &#40;1&#44;90-2&#44;85&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">B&#46; Asociaci&#243;n de variables con las diferentes categor&#237;as de albuminuria comparadas con la albuminuria normal &#40;categor&#237;a de referencia&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#946;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ES&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;30 &#40;1&#44;83-10&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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Original
Estudio de la asociación de marcadores de rigidez arterial central y periférica con la función renal en pacientes con hipertensión arterial, diabetes mellitus y enfermedad renal crónica
Study of the association of markers of central and peripheral arterial stiffness with renal function in patients with arterial hypertension, diabetes mellitus and chronic kidney disease
Jary Perelló Martíneza, Alfredo Michán Doñab,c, Rafael Santamaría Olmod,e, Juan Carlos Hidalgo Santiagof, Josefina Gálvez Moralg, Pablo Gómez-Fernándezh,
Autor para correspondencia
pgomezf@senefro.org

Autor para correspondencia.
a Unidad de Nefrología, Hospital Universitario, Jerez de la Frontera, Cádiz, España
b Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, España
c Unidad de Medicina Interna, Hospital Universitario, Jerez de la Frontera, Cádiz, España
d Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
e Servicio de Nefrología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
f Centro de Salud Jerez Sur, Jerez de la Frontera, Cádiz, España
g Centro de Salud Antonia Mesa Fernández, Córdoba, España
h Unidad de Factores de Riesgo Vascular, Hospital Universitario, Jerez de la Frontera, Cádiz, España
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            "entidad" => "Unidad de Factores de Riesgo Vascular&#44; Hospital Universitario&#44; Jerez de la Frontera&#44; C&#225;diz&#44; Espa&#241;a"
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    "titulosAlternativos" => array:1 [
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        "titulo" => "Study of the association of markers of central and peripheral arterial stiffness with renal function in patients with arterial hypertension&#44; diabetes mellitus and chronic kidney disease"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de albuminuria anormal &#40;&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; y descenso del filtrado glomerular &#40;FG&#41; &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41; seg&#250;n cuartiles de la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">En la hipertensi&#243;n arterial &#40;HTA&#41;&#44; en la diabetes mellitus &#40;DM&#41; y en la enfermedad renal cr&#243;nica &#40;ERC&#41; hay un aumento de la rigidez a&#243;rtica que participa en la patog&#233;nesis de las lesiones de &#243;rganos diana y en la morbimortalidad cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; En el incremento de la rigidez a&#243;rtica intervienen m&#250;ltiples factores &#40;hemodin&#225;micos&#44; metab&#243;licos&#44; inflamatorios&#44; disfunci&#243;n endotelial y calcificaci&#243;n vascular&#44; entre otros&#41;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; En estas situaciones se produce un envejecimiento vascular precoz &#40;EVA&#41; caracterizado por la p&#233;rdida de la elasticidad de la pared vascular y un incremento de la rigidez arterial&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Preservar la elasticidad vascular es crucial&#44; ya que la distensi&#243;n y recuperaci&#243;n del calibre de las arterias en la s&#237;stole y di&#225;stole&#44; respectivamente&#44; act&#250;a como un amortiguador del flujo sangu&#237;neo&#44; permitiendo la perfusi&#243;n continua de los &#243;rganos diana&#46; En individuos j&#243;venes&#44; la elasticidad de la pared vascular disminuye de manera secuencial desde la aorta hasta las arterias musculares perif&#233;ricas&#46; De manera fisiol&#243;gica&#44; existe un gradiente entre la rigidez perif&#233;rica y la a&#243;rtica &#40;gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#91;GRA<span class="elsevierStyleInf">p-a</span>&#93;&#41;&#46; Este gradiente facilita una onda refleja que retorna de manera retardada a la aorta ascendente durante la di&#225;stole&#44; lo que sostiene la presi&#243;n arterial diast&#243;lica y mitiga la presi&#243;n puls&#225;til en la microcirculaci&#243;n&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Con la senescencia vascular disminuye la elasticidad de la pared vascular y aumenta la rigidez a&#243;rtica&#46; El aumento de la rigidez a&#243;rtica promueve un retorno acelerado de la onda refleja durante la s&#237;stole&#44; lo que condiciona un incremento de la presi&#243;n arterial sist&#243;lica central &#40;PASc&#41; y la presi&#243;n del pulso central &#40;PPc&#41;&#46; Adem&#225;s&#44; puede producirse una atenuaci&#243;n o inversi&#243;n del GRA<span class="elsevierStyleInf">p-a</span>&#44; lo que facilita la conversi&#243;n de un flujo sangu&#237;neo continuo fisiol&#243;gico en la microcirculaci&#243;n a un flujo puls&#225;til&#46; Este &#250;ltimo en microcirculaci&#243;n induce da&#241;o en &#243;rganos de baja resistencia como el ri&#241;&#243;n y el cerebro<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Existe una &#237;ntima relaci&#243;n entre la rigidez a&#243;rtica y la velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; considerada como el est&#225;ndar de oro para determinar la rigidez a&#243;rtica&#46; La velocidad de pulso car&#243;tida-radial &#40;VP<span class="elsevierStyleInf">c-r</span>&#41; refleja la rigidez de las arterias musculares &#40;rigidez perif&#233;rica&#41; y la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> se ha utilizado como &#237;ndice del GRA<span class="elsevierStyleInf">p-a</span><a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a>&#46; Otros par&#225;metros derivados de la morfolog&#237;a de la onda de pulso central como la PPc y el &#237;ndice de aumento &#40;IA&#41;&#44; que expresa qu&#233; parte de la PPc corresponde a la onda refleja&#44; han sido propuestos como marcadores subrogados de la rigidez a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hay estudios que han evaluado de forma aislada en sujetos con HTA&#44; DM o ERC la asociaci&#243;n de alguno de los par&#225;metros de rigidez arterial con la funci&#243;n renal<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">8&#8211;11</span></a>&#46; Los resultados de la asociaci&#243;n entre la rigidez a&#243;rtica y el filtrado glomerular &#40;FG&#41; no son consistentes&#46; Mientras que algunos estudios objetivan una asociaci&#243;n significativa<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; en otros la relaci&#243;n entre la rigidez a&#243;rtica y FG desaparece tras el ajuste multivariable<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a>&#46; El mecanismo por el que un aumento de la rigidez a&#243;rtica produce disfunci&#243;n renal no est&#225; completamente aclarado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En nuestro conocimiento&#44; no existen investigaciones que analicen de forma conjunta y usando los distintos marcadores de rigidez arterial a&#243;rtica&#44; la posible asociaci&#243;n entre rigidez a&#243;rtica y funci&#243;n renal en pacientes con diferentes factores de riesgo vascular &#40;HTA&#44; DM&#44; ERC y su asociaci&#243;n&#41;&#46; Dado que los diversos &#237;ndices de rigidez arterial central &#40;RAC&#41; est&#225;n influenciados por variables diferentes&#44; pero hemodin&#225;micamente relacionadas<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">7&#44;12</span></a>&#44; el an&#225;lisis de su posible asociaci&#243;n con la funci&#243;n renal podr&#237;a contribuir a clarificar los mecanismos fisiopatol&#243;gicos de dicha relaci&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nuestro objetivo fue doble&#46; Por una parte&#44; describir el comportamiento de la RAC en sujetos con diferentes factores de riesgo vascular y&#44; por otra parte&#44; analizar el impacto de la rigidez a&#243;rtica sobre la funci&#243;n renal valorada por el FG y la albuminuria&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pacientes</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se estudiaron 286 sujetos evaluados y revisados en la consulta externa de nefrolog&#237;a de un hospital universitario&#46; Se incluyeron enfermos previamente diagnosticados de HTA&#44; DM&#44; ERC o una combinaci&#243;n de ellas&#46; Para ser incluidos en el estudio&#44; se requiri&#243; que los enfermos no hubiesen tenido ning&#250;n evento cardiovascular en los &#250;ltimos seis meses&#44; que la funci&#243;n renal estuviese estable en los &#250;ltimos tres meses y que en este tiempo no hubiese modificaciones en la terapia antidiab&#233;tica&#44; antihipertensiva o hipolipemiante&#46; Se excluyeron sujetos con enfermedades inmunol&#243;gicas que requiriesen terapia inmunosupresora&#44; aquellos diagnosticados de procesos malignos&#44; de HTA de origen endocrino o aneurisma a&#243;rtico&#44; y los que presentaban fibrilaci&#243;n auricular que dificultase la captaci&#243;n de la onda de pulso por tonometr&#237;a&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se recogieron en la historia cl&#237;nica datos de enfermedad cardiovascular &#40;ECV&#41; que requiriese ingreso hospitalario y de arteriopat&#237;a perif&#233;rica diagnosticada por s&#237;ntomas y&#47;o un &#237;ndice tobillo-brazo inferior a 0&#44;9&#46; Se investig&#243; el h&#225;bito tab&#225;quico considerando como fumadores tanto los activos como los que lo hab&#237;an abandonado frente a los que nunca hab&#237;an fumado &#40;no fumadores&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se determinaron en sangre los par&#225;metros hematol&#243;gicos y bioqu&#237;micos que inclu&#237;an hemograma&#44; creatinina&#44; l&#237;pidos&#44; &#225;cido &#250;rico&#44; glucemia&#44; hemoglobina glicada &#40;en DM&#41;&#44; metabolismo fosfoc&#225;lcico con parathormona &#40;PTH&#41; y vitamina D &#40;en ERC&#41;&#46; El filtrado glomerular estimado &#40;FGe&#41; se calcul&#243; por la f&#243;rmula <span class="elsevierStyleItalic">chronic kidney disease&#44; epidemiology</span> &#40;CKD-EPI&#41;&#46; En todos los sujetos se determin&#243;&#44; en la primera orina de la ma&#241;ana&#44; el cociente alb&#250;mina-creatinina&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Como controles de los par&#225;metros de funci&#243;n arterial se utilizaron 38 sujetos sanos&#44; no fumadores&#44; sin historia de ECV ni otras enfermedades y con funci&#243;n renal normal&#46; En estos sujetos solo se determinaron par&#225;metros anal&#237;ticos de funci&#243;n renal&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se consider&#243; la presencia de ERC cuando exist&#237;a un cociente alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g y&#47;o un FGe inferior a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#46; Dado que puede haber mayor riesgo de morbimortalidad cardiovascular en sujetos con valores de albuminuria en rango normal&#44; se a&#241;adi&#243; un subgrupo de albuminuria &#40;normal-alta&#41; que fue clasificada en las siguientes categor&#237;as&#58; normal 0-10<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; normal-alta&#58; 11-29<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; aumento moderado&#58; 30-299<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; aumento severo&#58; m&#225;s de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#46; Los sujetos fueron distribuidos en cinco grupos&#58; control&#44; HTA&#44; DM&#44; ERC y ERC m&#225;s DM&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Todos los sujetos dieron su consentimiento tras ser informados y el estudio cumpli&#243; todos los requisitos &#233;ticos del centro donde se realiz&#243;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estudio de la rigidez arterial a&#243;rtica y perif&#233;rica</span><p id="par0070" class="elsevierStylePara elsevierViewall">Tras permanecer en reposo durante 15 minutos&#44; se tom&#243; la presi&#243;n arterial braquial &#40;PAb&#41;&#44; media de tres determinaciones&#44; con un aparato oscilom&#233;trico Omron M3 &#40;Omron electr&#243;nica Iberia&#44; S&#46;A&#46;U&#46;&#44; Madrid&#41;&#46; El estudio de la presi&#243;n arterial central &#40;PAc&#41; y de la VP<span class="elsevierStyleInf">c-f</span> se hizo mediante tonometr&#237;a de aplanamiento usando un dispositivo SphygmoCor &#40;AtCor Medical&#44; Sidney&#44; Australia&#41;&#46; De la onda de pulso obtenida por tonometr&#237;a sobre la arteria radial y usando una funci&#243;n de transferencia generalizada&#44; se obtuvo la onda de presi&#243;n a&#243;rtica central y sus diferentes componentes &#40;la PASc&#44; la presi&#243;n arterial diast&#243;lica central &#91;PADc&#93; y la presi&#243;n de pulso central &#91;PPc&#93;&#41;&#46; En la onda de la presi&#243;n a&#243;rtica generada se identific&#243; el punto de uni&#243;n de la onda incidente anter&#243;grada y la onda reflejada &#40;punto de inflexi&#243;n&#41;&#46; La presi&#243;n de aumento &#40;PAu&#41; fue la PASc m&#225;xima menos la presi&#243;n en el punto de inflexi&#243;n&#46; El IA se defini&#243; como la PAu dividida entre la PPc y se expresa como porcentaje&#46; Dada la influencia de la frecuencia cardiaca &#40;FC&#41; sobre el IA&#44; el dispositivo SphygmoCor estandariza el IA a una FC de 75 L&#47;min &#40;IA<span class="elsevierStyleInf">75</span>&#41;&#46; Para la determinaci&#243;n de la velocidad de pulso car&#243;tida-femoral &#40;representativa de la rigidez a&#243;rtica o central&#41;&#44; la onda de pulso se obtuvo de forma secuencial sobre la arteria car&#243;tida com&#250;n y la arteria femoral&#44; calcul&#225;ndose el tiempo de recorrido entre los dos puntos a partir de la diferencia entre la onda R del registro electrocardiogr&#225;fico simult&#225;neo y el inicio de la onda de pulso en los respectivos sitios arteriales&#46; Con la misma t&#233;cnica&#44; pero usando la arteria radial&#44; se determin&#243; la VP<span class="elsevierStyleInf">c-r</span>&#44; representativa de la rigidez arterial perif&#233;rica&#46; De la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> se calcul&#243; el GRA<span class="elsevierStyleInf">p-a</span>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">De la onda de pulso a&#243;rtica tambi&#233;n se deriv&#243; el &#237;ndice de viabilidad subendoc&#225;rdica o &#237;ndice de Buckberg &#40;iBuckberg&#41; que resulta de la integral tiempo-presi&#243;n diast&#243;lica&#47; integral tiempo-presi&#243;n sist&#243;lica&#44; y que representa una medida en reposo del aporte y consumo de ox&#237;geno del miocardio<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">13</span></a>&#46; En el 44&#37; de los enfermos con ERC y en 42&#37; del grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM se estudi&#243; el grado de calcificaci&#243;n de la aorta abdominal mediante una radiograf&#237;a lateral de columna lumbar determin&#225;ndose el &#237;ndice de Kauppila &#40;iKauppila&#41;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0080" class="elsevierStylePara elsevierViewall">Las variables cualitativas se expresan como frecuencias relativas&#46; Las variables continuas se expresan como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar &#40;x<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; cuando la distribuci&#243;n era normal y como mediana &#40;rango intercuart&#237;lico &#91;IQR&#93;&#41; en el caso de distribuci&#243;n no normal&#46; Algunas de las variables con distribuci&#243;n muy sesgada como el cociente alb&#250;mina&#47;creatinina en orina&#44; fueron convertidas a sus logaritmos naturales&#46; Para establecer la normalidad de la distribuci&#243;n de las variables se usaron las pruebas de Shapiro-Wilk y Kolmogorov-Smirnov dependiendo del tama&#241;o de la muestra&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La comparaci&#243;n de las variables cualitativas entre los grupos se hizo usando el test &#967;<span class="elsevierStyleSup">2</span> y la de las variables cuantitativas mediante el an&#225;lisis de la varianza &#40;ANOVA&#41; de un factor con ajuste a covariables &#40;ANCOVA&#41; que podr&#237;an incidir en los resultados&#46; Se us&#243; el ANOVA de dos factores para analizar el posible efecto de dos variables cualitativas y su posible interacci&#243;n sobre la variable dependiente de inter&#233;s&#46; Para maximizar posibles diferencias en la funci&#243;n renal entre los grupos y cuando se cumpl&#237;a el requisito de igualdad de matrices de covarianza&#44; se us&#243; el an&#225;lisis multivariado de la varianza &#40;MANOVA&#41; introduciendo como variables dependientes el FGe y la albuminuria&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El estudio de la relaci&#243;n entre variables se hizo mediante el coeficiente de correlaci&#243;n de Pearson o de Spearman dependiendo de su distribuci&#243;n&#46; La relaci&#243;n independiente entre variables se investig&#243; mediante la regresi&#243;n lineal m&#250;ltiple seleccionando las covariables potenciales que demostraban correlaci&#243;n significativa&#46; Para valorar los efectos independientes y el valor predictivo de los par&#225;metros de rigidez arterial sobre la funci&#243;n renal &#40;FGe y albuminuria&#41; se us&#243; la regresi&#243;n log&#237;stica binaria&#46; Para una mayor precisi&#243;n de la capacidad predictiva de los marcadores de rigidez arterial sobre la funci&#243;n renal y su posible interacci&#243;n con la DM&#44; se us&#243; la regresi&#243;n log&#237;stica multinomial utilizando como variable dependiente categ&#243;rica cuatro posibles clases de la funci&#243;n renal&#58; normal &#40;albuminuria y FGe normales&#41;&#59; albuminuria &#40;alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#59; reducci&#243;n del FGe &#40;FGe inferior a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#59; reducci&#243;n del FGe y albuminuria &#40;FGe inferior a 60 L&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y alb&#250;mina&#47;creatinina en orina superior a 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#44; y las cuatro categor&#237;as de albuminuria &#40;normal&#44; normal-alta&#44; moderada y severa&#41;&#46; En estos an&#225;lisis&#44; como categor&#237;as de referencia se usaron la funci&#243;n renal normal &#40;FGe &#8805; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y albuminuria &#8804; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; y la albuminuria normal &#40;&#8804; 10<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;<span class="elsevierStyleItalic">&#44;</span> respectivamente&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En los resultados estad&#237;sticos se consideraron significativos valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Todos los an&#225;lisis estad&#237;sticos se hicieron con el programa estad&#237;stico IBM SPSS &#40;<span class="elsevierStyleItalic">Statistical Package for the Social Sciences</span>&#41;&#44; versi&#243;n 25 para Windows&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0100" class="elsevierStylePara elsevierViewall">Estudiamos 286 sujetos que se distribuyeron en cinco grupos&#58; 1&#41; grupo control&#44; 2&#41; pacientes con HTA esencial sin ERC&#44; 3&#41; pacientes con DM sin ERC&#44; 4&#41; pacientes con ERC sin DM y 5&#41; pacientes con ERC m&#225;s DM&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se expresan las caracter&#237;sticas cl&#237;nicas y los datos de laboratorio de los grupos&#46; Hab&#237;a diferencias significativas entre los grupos en la edad&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; porcentaje de mujeres&#44; antecedentes de ECV&#44; terapia con bloqueadores del sistema renina-angiotensina &#40;SRA&#41; y con estatinas&#46; La duraci&#243;n de la DM&#44; la presencia de retinopat&#237;a y la terapia con insulina eran mayores y m&#225;s frecuentes en los que adem&#225;s de DM ten&#237;an ERC&#46; La nefropat&#237;a subyacente en el grupo con ERC era nefroangiosclerosis&#58; 58&#44;4&#37;&#59; glomerulonefritis cr&#243;nica &#40;GNC&#41;&#58; 24&#44;7&#37;&#59; otras &#40;poliquistosis renal&#44; pielonefritis cr&#243;nica&#44; no filiada&#41;&#58; 16&#44;9&#37;&#46; En el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM la nefropat&#237;a era nefroangiosclerosis&#58; 42&#44;6&#37;&#59; nefropat&#237;a diab&#233;tica &#40;ND&#41;&#58; 56&#44;4&#37; y GNC&#58;1&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El FGe era significativamente m&#225;s bajo y la albuminuria m&#225;s alta en los grupos con ERC &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Aunque en el ANOVA se observaron diferencias cuantitativas&#44; pero no estad&#237;sticamente significativas en el FGe y en la albuminuria entre los grupos con ERC y ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#44; el an&#225;lisis multivariante de la varianza evidenci&#243; diferencias significativas del FGe y logaritmo del cociente alb&#250;mina&#47;creatinina &#40;log&#46;alb&#46;&#47;creat&#46;&#41; &#40;&#91;ERC&#58; FGe&#58; 39&#123;2&#125;&#59; ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#58; FGe&#58; 48&#123;3&#125; mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#44; p &#61; 0&#44;015&#93;&#59; &#91;ERC&#58; log-alb&#47;creat&#46; 4&#44;43&#123;0&#44;2&#125;&#59; ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#58; log&#46;alb&#46;&#47;creat&#46; 5&#44;05&#44; p &#61; 0&#44;021&#93;&#41;&#46; Cuando se introduc&#237;an en el MANOVA como covariables la VP<span class="elsevierStyleInf">c-f</span> y el GRA<span class="elsevierStyleInf">p-a</span>&#44; persist&#237;a la diferencia en el FGe &#40;36 vs&#46; 50<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#44; p &#61; 0&#44;001&#41;&#44; pero desaparec&#237;a en el log&#46;alb&#47;creat&#46; &#40;4&#44;6 vs&#46; 4&#44;9&#44; p &#61; 0&#44;3&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El porcentaje y la intensidad de calcificaciones de aorta abdominal fueron significativamente mayores en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM frente al grupo con ERC &#40;87 vs&#46; 65&#37;&#44; p &#61; 0&#44;02 y iKauppila 8 &#91;7&#93; vs&#46; 2 &#91;10&#93;&#44; p &#61; 0&#44;008&#41;&#44; respectivamente&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El porcentaje de enfermos con ERC estadio 1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>2 y 3a<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3b fue mayor en los sujetos con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM que en los que no ten&#237;an DM &#40;24&#44;5 y 58&#44;1&#37; vs&#46; 14&#44;3 y 41&#44;6&#37;&#44; respectivamente&#44; p &#61; 0&#44;04&#41; mientras que en el grupo con ERC sin DM fue mayor el porcentaje con ERC estadio 4 &#40;41&#44;6 vs&#46; 25&#44;8&#37;&#44; p &#61; 0&#44;04&#41;&#46; No hubo diferencias significativas en el porcentaje de sujetos con ERC estadio 5 &#40;1 vs&#46; 2&#44;6&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se expresan los valores de la PAb y PPc&#44; y los par&#225;metros de rigidez arterial y del &#237;ndice de viabilidad subendoc&#225;rdica tras el ajuste multivariante&#46; Los valores de los marcadores de pulsatilidad eran significativamente m&#225;s elevados en el grupo que combinaba ERC y DM&#46; Los grupos con ERC con y sin DM ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> mayores&#46; Los valores del GRA<span class="elsevierStyleInf">p-a</span> eran significativamente inferiores en los grupos con ERC y DM&#46; El iBuckberg de los pacientes con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM era significativamente inferior al de los otros grupos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">La VP<span class="elsevierStyleInf">c-f</span> ajustada a edad y presi&#243;n arterial media &#40;PAM&#41; de los sujetos sin nefropat&#237;a &#40;8&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41; era significativamente inferior a la de los diagnosticados de nefroangiosclerosis &#40;9&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41;&#44; GNC &#40;9&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3&#41; &#40;p &#61; 0&#44;003&#41; y ND &#40;11&#44;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#41; &#40;p &#61; 0&#44;001&#41;&#44; La VP<span class="elsevierStyleInf">c-f</span> de estos &#250;ltimos era significativamente mayor que la de los enfermos con nefroangiosclerosis y GNC &#40;p &#61; 0&#44;001&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Considerando todos los sujetos&#44; se observ&#243; una correlaci&#243;n directa significativa entre la VP<span class="elsevierStyleInf">c-f</span> y la edad&#44; correlaci&#243;n que fue inversa en el caso del GRA<span class="elsevierStyleInf">p-a</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se evidenci&#243; una correlaci&#243;n directa y significativa del FGe con el GRA<span class="elsevierStyleInf">p-a</span> e iBuckberg&#44; y significativa e inversa entre FGe y VP<span class="elsevierStyleInf">c-f</span>&#44; IA<span class="elsevierStyleInf">75</span> y PPc &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Tambi&#233;n fue significativa&#44; pero de sentido contrario&#44; la correlaci&#243;n entre esos par&#225;metros y la albuminuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La prevalencia de una albuminuria anormal y un descenso del FGe fue progresivamente creciente con los cuartiles m&#225;s altos de VP<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Considerando los enfermos en los que se determin&#243; PTH&#44; se comprob&#243; una correlaci&#243;n directa y significativa entre la PTH y la PPc &#40;r &#61; 0&#44;232&#59; p &#61; 0&#44;02&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Se observ&#243; una correlaci&#243;n inversa entre el iBuckberg&#44; la edad y la albuminuria y directa con el FGe&#46; Todos los &#237;ndices de rigidez a&#243;rtica se correlacionaron significativamente con el iBuckberg&#44; En la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez a&#243;rtica asociado independiente y negativamente con la magnitud del iBuckberg fue la VP<span class="elsevierStyleInf">c-f</span> &#40;&#946; &#61; -2&#44;76&#59; p &#61; 0&#44;014&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de regresi&#243;n m&#250;ltiple con ajuste multivariante a antecedentes de ECV&#44; tabaquismo&#44; presencia de DM&#44; PAM y log&#46;alb&#46;&#47;creat&#46; en orina&#44; los &#250;nicos par&#225;metros de rigidez a&#243;rtica asociados de forma independiente e inversa con el valor del FGe fueron la VP<span class="elsevierStyleInf">c-f</span> y el IA<span class="elsevierStyleInf">75</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>-A&#41;&#46; Cuando en el modelo ajustado se introduc&#237;an individualmente los marcadores de rigidez arterial&#44; todos se asociaban de forma significativa&#44; pero la relaci&#243;n m&#225;s potente con el FGe &#40;mayor R<span class="elsevierStyleSup">2</span> y mayor coeficiente &#946; estandarizado&#41; correspond&#237;a a la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Un hecho similar se observ&#243; cuando se analizaron en la regresi&#243;n log&#237;stica binaria las variables que predec&#237;an el descenso del FGe &#40;valores inferiores a 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico marcador con capacidad predictora significativa del descenso del FGe &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>-B&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez arterial con una asociaci&#243;n significativa y positiva con la magnitud de la albuminuria fue la VP<span class="elsevierStyleInf">c-f</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>-A&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> tambi&#233;n fue el &#250;nico &#237;ndice de rigidez a&#243;rtica con capacidad predictora de una albuminuria anormal &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#58; 1&#44;66&#59; intervalo de confianza &#91;IC&#93; 95&#37;&#58; 1&#44;25-2&#44;20&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>-B&#41;&#46; Introducidos individualmente los marcadores de rigidez&#44; solo la VP<span class="elsevierStyleInf">c-f</span> mostraba una capacidad predictora significativa de una albuminuria anormal&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a> se observan las variables con valor predictivo de la funci&#243;n renal y las diversas categor&#237;as de albuminuria en la regresi&#243;n multinomial&#46; La VP<span class="elsevierStyleInf">c-f</span> fue el &#250;nico par&#225;metro de rigidez arterial que se asoci&#243; de forma significativa con el descenso del FGe &#40;OR &#91;IC 95&#37;&#93;&#58; 1&#44;63 &#91;1&#44;31-2&#44;02&#93;&#59; p &#61; 0&#44;001&#41;&#44; el aumento de la albuminuria &#40;OR&#58; 1&#44;61 &#91;1&#44;29-2&#44;03&#93;&#59; p &#61; 0&#44;001&#41; y su combinaci&#243;n &#40;OR&#58; 2&#44;33 &#91;1&#44;90-2&#44;85&#93;&#59; p &#61; 0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-A&#41;&#46; La presencia de DM se asoci&#243; de forma significativa con el aumento de la albuminuria &#40;OR&#58; 3&#44;34 &#91;1&#44;33-8&#44;36&#93;&#59; p &#61; 0&#44;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-A&#41;&#46; No se observ&#243; interacci&#243;n entre la DM y los par&#225;metros de rigidez arterial&#46; Tanto la presencia de DM como la VP<span class="elsevierStyleInf">c-f</span> se asociaron significativamente con todos los grados de albuminuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>-B&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Nuestros resultados demuestran que la ERC se asocia a un aumento de la RAC y a una disminuci&#243;n del GRA<span class="elsevierStyleInf">p-a</span>&#44; cambios que son m&#225;s marcados cuando la ERC coexiste con la DM&#46; Por otra parte&#44; la VP<span class="elsevierStyleInf">c-f</span> es el marcador de RAC m&#225;s relacionado de forma independiente con la funci&#243;n renal y con mayor poder predictivo de un descenso del FGe y de un aumento de la albuminuria&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Indicadores de rigidez a&#243;rtica en presencia de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; diabetes mellitus&#44; enfermedad renal cr&#243;nica&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">La rigidez arterial es la expresi&#243;n del efecto que tiene sobre la pared arterial la interacci&#243;n entre factores hemodin&#225;micos y metab&#243;licos&#46; Consecuentemente&#44; se producen alteraciones estructurales de la pared vascular con aumento de la relaci&#243;n entre col&#225;geno y elastina&#44; entre otras&#46; Son muchos los mecanismos subyacentes del aumento de la rigidez arterial&#58; las alteraciones moleculares inducidas por la mecanotransducci&#243;n entre la matriz extracelular y las c&#233;lulas musculares lisas vasculares&#44; los cambios fenot&#237;picos de estas c&#233;lulas&#44; la disfunci&#243;n endotelial&#44; el estr&#233;s oxidativo&#44; la calcificaci&#243;n de la capa media vascular&#44; las alteraciones metab&#243;licas&#44; los fen&#243;menos inflamatorios&#44; el tejido adiposo perivascular&#44; las hormonas sexuales y los factores gen&#233;ticos y epigen&#233;ticos<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Todos estos mecanismos participan en diferente grado en el aumento de la rigidez arterial que se observa en presencia de diferentes factores de riesgo vascular como la edad&#44; HTA&#44; DM y ERC<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">De formas similar al proceso de envejecimiento normal&#44; en presencia de esos factores de riesgo vascular se produce un EVA que se traduce en un aumento de la rigidez arterial<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">M&#225;s del 90&#37; de los enfermos de nuestro estudio eran hipertensos&#46; La HTA se asocia a una mayor rigidez arterial y&#44; a su vez&#44; un incremento de esta promueve un aumento de la presi&#243;n arterial<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a>&#46; Adem&#225;s de las modificaciones estructurales de la pared arterial producidas por la HTA que inducen a largo plazo un aumento de la rigidez arterial&#44; cuando se eleva la presi&#243;n arterial de forma aguda la carga soportada por la pared vascular es transferida desde las fibras el&#225;sticas a las de col&#225;geno aumentando la rigidez arterial&#46; Como se ha comprobado en nuestro estudio y en otros<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a>&#44; hay una correlaci&#243;n significativa &#40;con morfolog&#237;a de funci&#243;n cuadr&#225;tica&#41; entre la edad y la VP<span class="elsevierStyleInf">c-f</span>&#46; Otros factores como el sexo y la obesidad pueden modificar la rigidez arterial<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Por todo ello&#44; es necesario considerar estas variables cuando se analiza la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los valores de VP<span class="elsevierStyleInf">c-f</span> en todos los grupos de enfermos eran superiores a los de los controles&#46; Sin embargo&#44; tras el ajuste a la edad&#44; presi&#243;n arterial&#44; sexo e IMC&#44; desaparec&#237;a la diferencia significativa entre el grupo control y el grupo con HTA&#46; Pese al ajuste&#44; los sujetos con DM&#44; ERC y ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM presentaron valores de VP<span class="elsevierStyleInf">c-f</span> superiores a los de los otros grupos&#46; La mayor contribuci&#243;n a la varianza de la VP<span class="elsevierStyleInf">c-f</span> era el grupo al que pertenec&#237;an &#40;27&#44;7&#37;&#41;&#44; la edad &#40;22&#44;9&#37;&#41; y la PAM &#40;20&#44;3&#37;&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La causa de un valor similar marginal &#40;tras ajuste&#41; de la VP<span class="elsevierStyleInf">c-f</span> en los grupos control y con HTA no est&#225; clara&#46; Es posible que los criterios usados para clasificar los grupos&#44; excluyendo del grupo 2 &#40;HTA&#41; los que ten&#237;an albuminuria y descenso del FGe&#44; genere una selecci&#243;n de los enfermos con mejor salud vascular&#46; Se ha comprobado que&#44; pese a la presencia de factores de riesgo vascular&#44; hay enfermos con una edad vascular &#40;medida por la VP<span class="elsevierStyleInf">c-f</span>&#41; inferior a la edad cronol&#243;gica &#40;<span class="elsevierStyleItalic">supernormal vascular aging</span> &#91;SUPERNOVA&#93;&#41;&#44; con menos eventos vasculares&#46; En el estudio prospectivo que valid&#243; el significado cl&#237;nico del concepto de edad vascular supernormal&#44; en el grupo SUPERNOVA hab&#237;a un 59&#44;7&#37; con HTA<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a>&#46; En nuestro estudio&#44; un 27&#44;5&#37; de los enfermos del grupo con HTA ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> inferiores al punto de corte del percentil 10 de los valores de referencia de la VP<span class="elsevierStyleInf">c-f</span> de la Sociedad Europea de Cardiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">23</span></a>&#46; En este subgrupo de nuestra investigaci&#243;n&#44; el valor de la VP<span class="elsevierStyleInf">c-f</span>&#44; ajustado a edad&#44; sexo y PAM&#44; era 5&#44;8 &#40;1&#41; m&#47;s&#44; y ninguno ten&#237;a antecedentes de ECV&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Otro hecho que podr&#237;a contribuir a una menor VP<span class="elsevierStyleInf">c-f</span> en todos los grupos de enfermos es el tratamiento con bloqueadores del SRA&#46; Estos f&#225;rmacos tienen capacidad para reducir la rigidez arterial m&#225;s all&#225; de sus efectos antihipertensivos<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Como se ha descrito en otros estudios&#44; la presencia de DM y ERC se asocia a alteraciones metab&#243;licas&#44; inflamatorias&#44; estr&#233;s oxidativo y calcificaciones vasculares&#44; entre otras&#44; que inducen un aumento de la rigidez arterial medida por la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">25</span></a>&#46; En nuestra investigaci&#243;n los grupos 3 &#40;DM&#41; y 4 &#40;ERC&#41; ten&#237;an valores de VP<span class="elsevierStyleInf">c-f</span> m&#225;s elevados que el grupo con HTA&#44; aunque esta diferencia estaba en el l&#237;mite de la significaci&#243;n estad&#237;stica &#40;p &#61; 0&#44;07&#41; en el grupo que solo ten&#237;a DM&#46; Es posible que el n&#250;mero m&#225;s reducido de sujetos en este grupo limitase la significaci&#243;n&#46; Por otra parte&#44; la duraci&#243;n de la DM que en este grupo era solo de dos a&#241;os&#44; es un importante determinante de la rigidez a&#243;rtica en la DM&#46; El papel de la DM en el da&#241;o vascular y en el aumento de la rigidez arterial determinada por la VP<span class="elsevierStyleInf">c-f</span> se refuerza con el hecho de que la VP<span class="elsevierStyleInf">c-f</span> fue superior en el grupo con ND frente a los que ten&#237;an nefropat&#237;a glomerular no diab&#233;tica pese a un valor superior de albuminuria en estos &#250;ltimos&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">La mayor VP<span class="elsevierStyleInf">c-f</span> observada en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM en comparaci&#243;n con el grupo con ERC puede atribuirse al efecto aditivo de las alteraciones metab&#243;licas&#44; inflamatorias y estr&#233;s oxidativo que acontecen cuando concurren los dos procesos&#44; y al mayor n&#250;mero e intensidad de calcificaciones de la aorta abdominal que objetivamos en el grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM&#46; Se ha demostrado que en sujetos con ERC y DM la calcificaci&#243;n de la aorta abdominal se asocia con valores elevados de la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En nuestra investigaci&#243;n obtuvimos resultados similares en la rigidez arterial en los diferentes grupos usando otro par&#225;metro de rigidez arterial como es el GRA<span class="elsevierStyleInf">p-a</span>&#46; Aplicando este &#237;ndice de rigidez arterial&#44; el grupo con DM ten&#237;a valores significativamente inferiores a los grupos control y con HTA&#46; La diferencia en el valor de la VP<span class="elsevierStyleInf">c-f</span> entre estos grupos estaba&#44; sin embargo&#44; en el l&#237;mite de la significaci&#243;n&#46; Durante el envejecimiento o en presencia de factores de riesgo vascular&#44; aumenta la rigidez a&#243;rtica &#40;medida por la VP<span class="elsevierStyleInf">c-f</span>&#41;&#44; sin embargo&#44; la rigidez de las arterias perif&#233;ricas musculares &#40;medida por la VP<span class="elsevierStyleInf">c-r</span>&#41; apenas se modifica&#46; Consecuentemente el GRA<span class="elsevierStyleInf">p-a</span> disminuye progresivamente&#46; En nuestro estudio observamos una correlaci&#243;n significativa entre la edad y VP<span class="elsevierStyleInf">c-f</span>&#44; correlaci&#243;n que no se vislumbr&#243; en el caso de la VP<span class="elsevierStyleInf">c-r</span>&#46; Una ventaja de usar el GRA<span class="elsevierStyleInf">p-a</span> es su independencia del valor de la PAM<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a>&#46; De hecho&#44; en nuestro estudio&#44; el porcentaje de la varianza de la VP<span class="elsevierStyleInf">c-f</span> dependiente de la PAM era del 20&#37;&#46; Este porcentaje se reduc&#237;a al 1&#37; en el caso del GRA<span class="elsevierStyleInf">p-a</span>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">La PPc se considera un indicador indirecto de la RAC&#46; La p&#233;rdida de la elasticidad arterial reduce su distensibilidad y aumenta la velocidad de la trasmisi&#243;n de la onda de pulso produci&#233;ndose un retorno precoz de la onda refleja que se suma a la onda anter&#243;grada generada por la s&#237;stole ventricular lo que se traduce en un aumento de la PASc y&#44; consecuentemente&#44; de la PPc&#46; En nuestro trabajo comprobamos que todos los enfermos ten&#237;an&#44; tras un ajuste multivariante&#44; una PPc mayor que el grupo control siendo esta diferencia significativa cuando concurr&#237;an ERC y DM&#46; Pese a esto&#44; el porcentaje de sujetos con una PPc superior a 50<span class="elsevierStyleHsp" style=""></span>mmHg&#44; valor que ha demostrado ser predictivo de eventos cardiovasculares<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">27</span></a>&#44; fue significativamente mayor en todos los grupos de enfermos&#46; Otros estudios han demostrado que&#44; en sujetos con HTA y en pacientes con DM&#44; el aumento de la PPc se asociaba a una mayor impedancia de la aorta proximal y a una mayor rigidez a&#243;rtica<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">12&#44;28</span></a>&#44; y&#44; en sujetos con ERC<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">29</span></a>&#44; una correlaci&#243;n directa entre la PPc y los valores de PTH como tambi&#233;n observamos en nuestra investigaci&#243;n&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Cuando aumenta la rigidez arterial&#44; la onda refleja se propaga con m&#225;s velocidad uni&#233;ndose a la onda anter&#243;grada en la s&#237;stole con el consiguiente aumento del IA que se ha considerado marcador de la onda refleja y&#44; por tanto&#44; de la rigidez arterial<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a>&#46; En nuestra investigaci&#243;n&#44; el IA<span class="elsevierStyleInf">75</span> fue significativamente mayor en todos los enfermos que en los controles&#46; A diferencia de los otros marcadores de rigidez a&#243;rtica no existieron diferencias del IA<span class="elsevierStyleInf">75</span> entre los grupos con HTA&#44; DM y ERC pese a que la VP<span class="elsevierStyleInf">c-f</span> fue mayor en los grupos con ERC&#44; hecho observado tambi&#233;n en otros estudios<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a>&#46; Otras investigaciones comprobaron en sujetos con DM la coexistencia de una VP<span class="elsevierStyleInf">c-f</span> elevada con valores de IA<span class="elsevierStyleInf">75</span> y onda refleja similares o inferiores al grupo control<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">28&#44;31</span></a>&#46; Un aumento de la rigidez a&#243;rtica con menor incremento o descenso de la onda refleja podr&#237;a sugerir una mayor penetraci&#243;n de la energ&#237;a puls&#225;til en la microcirculaci&#243;n cerebral y renal&#44; lo que&#44; sin embargo&#44; no concuerda con la correlaci&#243;n significativa negativa entre IA<span class="elsevierStyleInf">75</span> y GRA<span class="elsevierStyleInf">p-a</span> objetivada en nuestra investigaci&#243;n&#46; Es posible que el IA<span class="elsevierStyleInf">75</span> no sea un buen marcador de la rigidez a&#243;rtica y de la onda refleja&#46; Las limitaciones del IA<span class="elsevierStyleInf">75</span> como medida de la magnitud de la onda refleja derivan de que no solo es influenciado por la velocidad de la onda de pulso sino tambi&#233;n por otros factores cardiacos<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Se puede deducir de nuestros hallazgos que la rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular como la HTA&#44; la DM y la ERC&#46; Este aumento es especialmente notable cuando hay ERC y cuando esta coexiste con DM&#46; La VP<span class="elsevierStyleInf">c-f</span> y el GRA<span class="elsevierStyleInf">p-a</span> son los marcadores m&#225;s consistentes para analizar la RAC cuando coexisten los factores de riesgo vascular aqu&#237; estudiados&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">La relevancia de un aumento de la rigidez a&#243;rtica vendr&#225; determinada por su posible repercusi&#243;n en la lesi&#243;n de &#243;rganos diana que acontece en presencia de factores de riesgo vascular&#44; da&#241;o que puede contribuir a la morbimortalidad cardiovascular&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Indicadores de rigidez a&#243;rtica y funci&#243;n renal</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Indicadores de rigidez a&#243;rtica y filtrado glomerular estimado</span><p id="par0235" class="elsevierStylePara elsevierViewall">El otro objetivo de nuestra investigaci&#243;n fue analizar la posible asociaci&#243;n de la rigidez a&#243;rtica con dos par&#225;metros de la funci&#243;n renal&#58; FG y albuminuria&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Analizado globalmente el conjunto de los sujetos&#44; observamos una correlaci&#243;n significativa entre todos los marcadores estudiados de rigidez a&#243;rtica y el FGe &#40;correlaci&#243;n directa en el caso del GRA<span class="elsevierStyleInf">p-a</span> e inversa en los otros indicadores&#41;&#44; y entre esos indicadores y la albuminuria &#40;correlaci&#243;n inversa en el caso del GRA<span class="elsevierStyleInf">p-a</span> y directa en los dem&#225;s&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Introducidos conjuntamente todos los marcadores de rigidez a&#243;rtica en la regresi&#243;n m&#250;ltiple&#44; la VP<span class="elsevierStyleInf">c-f</span> y el IA<span class="elsevierStyleInf">75</span> fueron los &#250;nicos que&#44; tras el ajuste multivariante&#44; se asociaban de forma independiente y significativa con la magnitud del FGe mientras que en la regresi&#243;n log&#237;stica solo la VP<span class="elsevierStyleInf">c-f</span> fue predictora de la presencia de un FGe subnormal&#46; Introducidos individualmente y tras el ajuste multivariante&#44; todos los marcadores de rigidez se asociaban de forma significativa con el valor del FGe y predec&#237;an su disminuci&#243;n&#44; pero la VP<span class="elsevierStyleInf">c-f</span> era el marcador m&#225;s robusto asociado con el FGe&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">El mayor valor de FGe del grupo con ERC<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>DM comparado con el grupo con ERC persist&#237;a cuando en el MANOVA se hac&#237;a el ajuste a la VP<span class="elsevierStyleInf">c-f</span>&#46; As&#237;&#44; en nuestra investigaci&#243;n&#44; el efecto negativo de la rigidez a&#243;rtica sobre el valor del FGe parece ser superado por la hiperfiltraci&#243;n inducida por la DM&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">Hay pocos estudios que analicen la asociaci&#243;n entre FG y albuminuria con varios par&#225;metros de rigidez arterial&#46; Los resultados de algunos estudios realizados sobre FG y rigidez arterial a&#243;rtica no han sido uniformes&#46; Se ha demostrado un aumento progresivo de la VP<span class="elsevierStyleInf">c-f</span> con el estadio de ERC y una asociaci&#243;n independiente entre VP<span class="elsevierStyleInf">c-f</span> y FG incluso en estadios muy precoces de insuficiencia renal<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">35&#8211;37</span></a>&#46; Otro estudio ha demostrado la asociaci&#243;n entre la rigidez a&#243;rtica determinada por la VP<span class="elsevierStyleInf">c-f</span> y el FGe en sujetos con y sin HTA y DM<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Otras investigaciones&#44; sin embargo&#44; no demuestran asociaci&#243;n entre rigidez arterial central y FG&#46; Upadhyay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">11</span></a> comprobaron en una cohorte de Framingham que en la ERC ligera-moderada el FG no se asociaba de forma independiente con la rigidez a&#243;rtica valorada por varios &#237;ndices &#40;VP<span class="elsevierStyleInf">c-f</span>&#44; PPc&#44; IA&#41;&#46; La causa de esta discrepancia no est&#225; clara&#46; Es posible que el uso de la cistatina para estimar el FG y un ajuste multivariable muy riguroso a los factores de riesgo cardiovascular en el estudio de Upadhyay contribuyan a los diferentes resultados&#46; Estos factores de riesgo pueden ejercer efectos importantes en la rigidez arterial en sujetos con ERC&#46; En nuestra investigaci&#243;n&#44; seguimos observando una asociaci&#243;n significativa de la VP<span class="elsevierStyleInf">c-f</span> con el FGe cuando a&#241;adimos el perfil lip&#237;dico a las otras variables de ajuste&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">Se concluye que existe una asociaci&#243;n inversa entre rigidez a&#243;rtica y FGe&#44; y un valor predictivo significativo de aquella de la presencia de un descenso del FGe en sujetos con factores de riesgo vascular&#46; La VP<span class="elsevierStyleInf">c-f</span> es el &#237;ndice de rigidez a&#243;rtica m&#225;s robusto comparado con otros marcadores de rigidez central&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Indicadores de rigidez a&#243;rtica y albuminuria</span><p id="par0270" class="elsevierStylePara elsevierViewall">En nuestra investigaci&#243;n&#44; la rigidez a&#243;rtica determinada por la Vp<span class="elsevierStyleInf">c-f</span>&#44; tras el ajuste multivariante&#44; se asociaba directa y significativamente con la magnitud y prevalencia de albuminuria&#46; Igual que en el caso de FGe&#44; todos los dem&#225;s marcadores de rigidez desaparec&#237;an del modelo cuando se incorporaba la VP<span class="elsevierStyleInf">c-f</span>&#46; Sin embargo&#44; incluidos de forma individual&#44; todos se relacionaban con la albuminuria&#44; aunque con mucha menos intensidad que la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Otros estudios han evidenciado una relaci&#243;n entre la rigidez a&#243;rtica y la albuminuria&#46; En un trabajo realizado en la cohorte de Framingham<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a> se observ&#243; una asociaci&#243;n independiente de la VP<span class="elsevierStyleInf">c-f</span> y PPc con la prevalencia de albuminuria con una OR cuantitativamente mayor para la VP<span class="elsevierStyleInf">c-f</span>&#46; En otros estudios poblacionales tanto el FGe como la albuminuria se asociaban de forma independiente con la rigidez a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a> siendo esta relaci&#243;n inversa con el FGe y directa con la albuminuria&#46; La asociaci&#243;n directa entre rigidez arterial y albuminuria se objetiv&#243; incluso con valores de albuminuria considerados normales<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a>&#46; En algunas publicaciones&#44; la relaci&#243;n directa entre la rigidez arterial con albuminuria es m&#225;s fuerte y consistente que la relaci&#243;n inversa entre la rigidez a&#243;rtica y el FG<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">11&#44;35</span></a>&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; la asociaci&#243;n de un descenso del FGe y un aumento de la albuminuria con la VP<span class="elsevierStyleInf">c-f</span> no se modificaba sustancialmente cuando ambas se inclu&#237;an en la regresi&#243;n&#46; Esto suscita la posibilidad de que los mecanismos que vinculan estas variables con el riesgo cardiovascular son&#44; al menos en parte&#44; independientes uno de otro&#44; aunque puedan compartir factores como HTA y DM&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Nuestra investigaci&#243;n evidencia que el aumento de la rigidez arterial&#44; evaluado por la VP<span class="elsevierStyleInf">c-f</span>&#44; es un determinante crucial de los dos par&#225;metros de la funci&#243;n renal&#58; FGe y la albuminuria&#46; La existencia de DM y el incremento de la rigidez arterial contribuyen significativamente a la presencia y magnitud de la albuminuria sin que se observe una interacci&#243;n significativa entre ellas&#46; La asociaci&#243;n significativa de ambas variables con la albuminuria&#44; cuando se incluyen conjuntamente en el modelo&#44; sugiere que su efecto sobre la albuminuria se produce por procesos distintos&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">El mecanismo por el que el aumento de la rigidez a&#243;rtica contribuye a la disfunci&#243;n renal no est&#225; claro&#46; Woodard et al&#46; demostraron una relaci&#243;n inversa entre FG determinado por aclaramiento de iohexol y la rigidez a&#243;rtica&#46; Evidenciaron&#44; con un an&#225;lisis de mediaci&#243;n&#44; que la rigidez a&#243;rtica puede contribuir a la reducci&#243;n del FG por trasmisi&#243;n de excesiva pulsatilidad a la microcirculaci&#243;n renal que promueve vasoconstricci&#243;n din&#225;mica y rarefacci&#243;n vascular<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">39</span></a>&#46; En otro sentido&#44; un aumento de la relaci&#243;n del flujo retr&#243;grado&#47;anter&#243;grado a&#243;rtico&#44; observado en casos de aumento de la rigidez a&#243;rtica y que se correlaciona inversamente con el flujo sangu&#237;neo intrarrenal&#44; puede ser el mediador de la asociaci&#243;n entre el aumento de rigidez a&#243;rtica y el descenso del FG<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a>&#46; El da&#241;o microvascular renal y las alteraciones hemodin&#225;micas promovidas por el aumento de la presi&#243;n de pulso a&#243;rtico secundario a la mayor rigidez a&#243;rtica tambi&#233;n pueden producir albuminuria<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">La presencia de un gradiente normal de rigidez arterial perif&#233;rica-a&#243;rtica contribuye&#44; por una parte&#44; a mantener la perfusi&#243;n coronaria y evitar la sobrecarga cardiaca y&#44; por otra&#44; limita la trasmisi&#243;n de la energ&#237;a puls&#225;til a la periferia y protege a la microcirculaci&#243;n de &#243;rganos con habitual baja resistencia como el ri&#241;&#243;n y el cerebro<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a>&#46; Teniendo en cuenta las consecuencias fisiopatol&#243;gicas de una disminuci&#243;n del gradiente se ha propuesto que el gradiente de rigidez&#44; valorado por la relaci&#243;n VP<span class="elsevierStyleInf">c-r</span>&#47;VP<span class="elsevierStyleInf">c-f</span> podr&#237;a ser mejor que la VP<span class="elsevierStyleInf">c-f</span> para valorar la posible asociaci&#243;n de la rigidez a&#243;rtica con la lesi&#243;n de &#243;rganos diana y con la morbimortalidad&#46; En sujetos con ERC tratados con di&#225;lisis el GRA<span class="elsevierStyleInf">p-a</span> tiene mayor poder predictivo de mortalidad que la VP<span class="elsevierStyleInf">c-f</span><a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">43</span></a>&#46; Este hecho no se ha confirmado en estudios poblacionales<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">44</span></a>&#46; Por otra parte&#44; en sujetos con HTA&#44; el GRA<span class="elsevierStyleInf">p-a</span> ha demostrado una asociaci&#243;n con el FG significativa y similar a la VP<span class="elsevierStyleInf">c-f</span>&#44; pero de sentido inverso<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">45</span></a>&#46; En nuestro estudio el GRA<span class="elsevierStyleInf">p-a</span>&#44; igual que los otros marcadores de rigidez a&#243;rtica &#40;aunque en sentido inverso&#41;&#44; se asociaba con la magnitud del FGe y de la albuminuria cuando se introduc&#237;a de forma aislada en el modelo de regresi&#243;n&#44; pero su asociaci&#243;n significativa desaparec&#237;a cuando en el modelo se inclu&#237;a la VP<span class="elsevierStyleInf">c-f</span> que era el marcador de rigidez m&#225;s consistentemente asociado con la disfunci&#243;n renal&#46; De nuestros hallazgos se puede deducir que la disminuci&#243;n del GRA<span class="elsevierStyleInf">p-a</span> es fundamentalmente atribuible a un aumento de la VP<span class="elsevierStyleInf">c-f</span> &#40;que debe seguir siendo considerado como el marcador m&#225;s importante de la rigidez a&#243;rtica&#41; m&#225;s que a un descenso de la VP<span class="elsevierStyleInf">c-r</span>&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Consecuencias cardiacas del aumento de la rigidez a&#243;rtica</span><p id="par0300" class="elsevierStylePara elsevierViewall">Adem&#225;s de su repercusi&#243;n en la funci&#243;n renal&#44; el aumento de la rigidez a&#243;rtica tambi&#233;n tiene efectos cardiacos&#46; Un aumento de la VP<span class="elsevierStyleInf">c-f</span> favorece la llegada de la onda refleja a la aorta ascendente durante la s&#237;stole aumentando la PASc con la consiguiente sobrecarga cardiaca y&#44; por otra parte&#44; disminuye la presi&#243;n arterial diast&#243;lica a&#243;rtica comprometiendo la perfusi&#243;n coronaria que se produce fundamentalmente en la di&#225;stole&#46; Estudios experimentales han demostrado que una aorta proximal r&#237;gida se asocia a una reducci&#243;n de la perfusi&#243;n coronaria&#44; especialmente a nivel subendoc&#225;rdico<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">46</span></a>&#46; En nuestro estudio&#44; observamos una correlaci&#243;n directa entre el iBuckberg&#44; estimaci&#243;n no invasiva del aporte de ox&#237;geno y de la perfusi&#243;n subendoc&#225;rdica&#44; con el FGe&#44; e inversa con la albuminuria&#44; y una correlaci&#243;n inversa con los par&#225;metros de rigidez a&#243;rtica &#40;salvo una relaci&#243;n directa con el GRA<span class="elsevierStyleInf">p-a</span>&#41;&#46; Sin embargo&#44; en la regresi&#243;n m&#250;ltiple&#44; tras el ajuste multivariante&#44; el &#250;nico marcador de rigidez a&#243;rtica asociado independiente e inversamente con la magnitud del iBuckberg fue la VP<span class="elsevierStyleInf">c-f</span>&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Se ha demostrado que&#44; tanto en la poblaci&#243;n general como en las poblaciones de alto riesgo vascular&#44; el FGe y la albuminuria&#44; independientemente de otros factores de riesgo vascular tradicionales&#44; predicen la morbimortalidad cardiovascular<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">47</span></a>&#46; La asociaci&#243;n observada en nuestra investigaci&#243;n de la rigidez a&#243;rtica con el FGe&#44; la albuminuria y la perfusi&#243;n subendoc&#225;rdica suscita la posibilidad de que el aumento de rigidez a&#243;rtica sea el nexo entre la disfunci&#243;n renal y los eventos cardiovasculares&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0310" class="elsevierStylePara elsevierViewall">Podemos concluir de nuestros hallazgos que la rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular como la HTA&#44; la DM y la ERC&#46; Este incremento es especialmente notable cuando hay ERC y cuando esta coexiste con DM&#46; Una mayor rigidez a&#243;rtica se asocia de forma inversa e independiente con la magnitud del FGe y de forma directa con la cuant&#237;a de la albuminuria&#46; Por otra parte&#44; el aumento de la rigidez a&#243;rtica predice la presencia de una disminuci&#243;n de FGe y de una albuminuria anormal&#46; La Vp<span class="elsevierStyleInf">c-f</span> es el par&#225;metro de rigidez a&#243;rtica que se asocia de forma m&#225;s significativa y consistente con la disfunci&#243;n renal&#46; Aunque la VP<span class="elsevierStyleInf">c-f</span> depende fundamentalmente del grosor y elasticidad de la pared de la aorta y de las arterias ileofemorales&#44; puede integrar las variables diferentes&#44; pero hemodin&#225;micamente relacionadas&#44; que determinan los otros marcadores de rigidez a&#243;rtica&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene limitaciones&#46; Es un estudio transversal por lo que no se puede establecer una relaci&#243;n causal entre rigidez aortica y disfunci&#243;n renal&#46; Realmente se trata de una asociaci&#243;n bidireccional&#46; Un aumento de la rigidez a&#243;rtica puede producir alteraciones renales y&#44; por otra parte&#44; en la ERC concurren m&#250;ltiples alteraciones fisiopatol&#243;gicas que pueden condicionar un aumento de la rigidez a&#243;rtica&#46; Adem&#225;s&#44; existen variables independientes que afectan simult&#225;neamente a la elasticidad de la pared vascular y originan da&#241;o renal&#46; En nuestro estudio no realizamos todas las determinaciones de laboratorio en la totalidad de los sujetos lo que puede limitar el efecto de estas variables en las asociaciones observadas&#46; No obstante&#44; la inclusi&#243;n de las variables disponibles de laboratorio en nuestros an&#225;lisis de regresi&#243;n no modific&#243; sustancialmente los resultados&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Nuestra investigaci&#243;n tambi&#233;n tiene aspectos relevantes&#46; Se usa la VP<span class="elsevierStyleInf">c-f</span> que se considera el est&#225;ndar de oro para el estudio de la rigidez a&#243;rtica&#46; Se ha reunido un n&#250;mero importante de sujetos que se han distribuido en grupos representativos de diferentes factores de riesgo vascular&#46; En nuestro conocimiento&#44; no hay estudios que analicen la rigidez a&#243;rtica en un grupo tan variado de enfermos&#46; Finalmente&#44; el uso de una metodolog&#237;a estad&#237;stica rigurosa nos permite analizar la asociaci&#243;n de las diversas variables con ajustes para minimizar los efectos de las diferencias de edad y comorbilidades entre los distintos grupos&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Se requieren estudios prospectivos para analizar la verdadera implicaci&#243;n de las alteraciones de la RAC y perif&#233;rica en las lesiones de &#243;rgano diana y en la morbimortalidad cardiovascular en los sujetos con factores de riesgo vascular&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Financiaci&#243;n</span><p id="par0330" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0335" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Estudio de la rigidez arterial a&#243;rtica y perif&#233;rica"
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              "titulo" => "Indicadores de rigidez a&#243;rtica en presencia de factores de riesgo cardiovascular &#40;hipertensi&#243;n arterial&#44; diabetes mellitus&#44; enfermedad renal cr&#243;nica&#41;"
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              "titulo" => "Indicadores de rigidez a&#243;rtica y funci&#243;n renal"
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                  "identificador" => "sec0050"
                  "titulo" => "Indicadores de rigidez a&#243;rtica y filtrado glomerular estimado"
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                  "identificador" => "sec0055"
                  "titulo" => "Indicadores de rigidez a&#243;rtica y albuminuria"
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              "titulo" => "Consecuencias cardiacas del aumento de la rigidez a&#243;rtica"
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    "fechaRecibido" => "2024-02-07"
    "fechaAceptado" => "2024-05-11"
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            0 => "Rigidez a&#243;rtica"
            1 => "Velocidad de pulso"
            2 => "Gradiente de rigidez arterial"
            3 => "Filtrado glomerular"
            4 => "Albuminuria"
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            0 => "Aortic stiffness"
            1 => "Pulse velocity"
            2 => "Arterial stiffness gradient"
            3 => "Glomerular filtration rate"
            4 => "Albuminuria"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El aumento de la rigidez arterial central &#40;RAC&#41; participa en la morbimortalidad cardiovascular de los enfermos con factores de riesgo vascular&#46; El descenso del filtrado glomerular &#40;FG&#41; y el aumento de la excreci&#243;n urinaria de alb&#250;mina &#40;uALB&#41; se relacionan con eventos cardiovasculares&#46; Los mecanismos fisiopatol&#243;gicos de esta asociaci&#243;n no est&#225;n completamente definidos&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue analizar la RAC&#44; comparando varios marcadores&#44; en sujetos con hipertensi&#243;n arterial &#40;HTA&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; enfermedad renal cr&#243;nica &#40;ERC&#41; y su combinaci&#243;n&#44; y estudiar la posible asociaci&#243;n de la RAC con la disfunci&#243;n renal&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 286 sujetos distribuidos en varios grupos&#58; control&#59; HTA&#59; DM sin ERC&#59; ERC sin DM&#59; ERC con DM&#46; Para la determinaci&#243;n de la RAC se usaron varios &#237;ndices obtenidos por tonometr&#237;a de aplanamiento&#58; velocidad de pulso car&#243;tida-femoral &#40;VP<span class="elsevierStyleInf">c-f</span>&#41; y gradiente de rigidez arterial perif&#233;rica-a&#243;rtica &#40;GRA<span class="elsevierStyleInf">p-a</span>&#41;&#44; entre otros&#46; De la onda del pulso a&#243;rtico se obtuvo el &#237;ndice de viabilidad subendoc&#225;rdica &#40;iBuckberg&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Para el estudio de la asociaci&#243;n entre los marcadores de rigidez arterial y la funci&#243;n renal se usaron la regresi&#243;n m&#250;ltiple&#44; la regresi&#243;n log&#237;stica binaria y la multinomial&#44; todas con ajuste multivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los valores ajustados de la VP<span class="elsevierStyleInf">c-f</span> &#40;mediana &#91;rango intercuart&#237;lico&#93; &#91;m&#47;seg&#93;&#41; fueron significativamente mayores en los sujetos con DM &#40;9 &#91;1&#44;2&#93;&#41;&#59; ERC &#40;9&#44;4 &#91;0&#44;7&#93;&#41; y DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC &#40;10&#44;9 &#91;0&#44;7&#93;&#41; que en el grupo control &#40;8&#44;2 &#91;1&#44;3&#93;&#41; y grupo con HTA &#40;8&#44;3 &#91;0&#44;9&#93;&#41;&#44; p &#61; 0&#44;001&#46; Los enfermos con DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC ten&#237;an valores de VP<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> superiores a todos los dem&#225;s grupos &#40;p &#61; 0&#44;001&#41;&#46; El GRA<span class="elsevierStyleInf">p-a</span> de los enfermos fue significativamente inferior al de los controles&#44; y el grupo con DM<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>ERC ten&#237;a valores significativamente inferiores a los de los otros grupos&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico marcador de rigidez a&#243;rtica que se asociaba de forma independiente e inversa con la magnitud del FG &#40;&#946; &#61; &#8211;4&#44; p &#61; 0&#44;001&#41; y predec&#237;a la presencia de disminuci&#243;n del FG &#40;OR &#91;IC 95&#37;&#93;&#58; 1&#44;50 &#91;1&#44;17-1&#44;92&#93;&#59; p &#61; 0&#44;001&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> era el &#250;nico &#237;ndice asociado de forma directa con la cuant&#237;a de la uALB &#40;&#946; &#61; 0&#44;15&#59; p &#61; 0&#44;02&#41; y predec&#237;a la existencia de una uALB anormal &#40;OR&#58; 1&#44;66 &#91;1&#44;25-2&#44;20&#93;&#44; p &#61; 0&#44;001&#41;&#46; La VP<span class="elsevierStyleInf">c-f</span> tambi&#233;n se asociaba con el iBuckberg &#40;&#946; &#61; -2&#44;73&#59; p &#61; 0&#44;01&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En la regresi&#243;n multinomial se confirm&#243; que la VP<span class="elsevierStyleInf">c-f</span> es un determinante significativo del FG y de la uALB&#46; Por otra parte&#44; el aumento de la VP<span class="elsevierStyleInf">c-f</span> y la presencia de DM contribu&#237;an de forma significativa a la magnitud de la uALB&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La rigidez a&#243;rtica aumenta en presencia de factores de riesgo vascular y es mayor cuando coexisten DM y ERC&#46; El aumento de la rigidez a&#243;rtica se asocia de forma inversa con el FG y directamente con la magnitud de la albuminuria&#44; y tiene capacidad predictiva de una disminuci&#243;n del FG y de una albuminuria anormal&#46; La VP<span class="elsevierStyleInf">c-f</span> es el par&#225;metro de rigidez a&#243;rtica que se asocia de forma m&#225;s consistente con la disfunci&#243;n renal&#46; El aumento de la rigidez a&#243;rtica podr&#237;a ser uno de los patomecanismos que vinculan la disfunci&#243;n renal con los eventos cardiovasculares&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Rationale and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Increased aortic or central arterial stiffness &#40;CAS&#41; is a major factor in cardiovascular morbidity and mortality in patients with vascular risk factors&#46; Decreased glomerular filtration rate &#40;GFR&#41; and increased urinary albumin excretion &#40;uALB&#41; are associated with lethal and non-lethal cardiovascular events&#46; The pathophysiological mechanisms of this association are not fully defined&#46;</p><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was&#58; 1&#46;- To analyze the CAS&#44; comparing several markers&#44; in subjects with arterial hypertension &#40;HTN&#41;&#44; diabetes mellitus &#40;DM&#41;&#44; chronic kidney disease &#40;CKD&#41; and their combination&#46; 2&#46;- To study the possible association of CAS with renal dysfunction &#40;decrease in GFR and increase in uALB&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A total of 286 subjects were included&#44; divided into several groups&#58; Control &#40;n&#58; 38&#41;&#59; HTN &#40;n&#58;51&#41;&#59; DM without CKD &#40;n&#58;26&#41;&#59; CKD without DM &#40;n&#58;77&#41;&#59; CKD with DM &#40;n&#58;94&#41;&#46; Several indices obtained by applanation tonometry were used to determine the CAS&#58; carotid-femoral pulse velocity &#40;VP<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span>&#41;&#59; central pulse pressure &#40;cPP&#41;&#59; augmentation index standardized to a cardiac frequency of 75 l&#47;min &#40;IA<span class="elsevierStyleInf"><span class="elsevierStyleBold">75</span></span>&#41;&#59; peripheral &#47; aortic arterial stiffness gradient &#40;ASG<span class="elsevierStyleInf">p-a</span>&#41;&#46; As a marker of peripheral arterial stiffness&#44; the carotid-radial pulse velocity &#40;PV<span class="elsevierStyleInf">c-r</span>&#41; was determined&#46; The ASG<span class="elsevierStyleInf">p-a</span> was calculated from the PV<span class="elsevierStyleInf">c-r</span> &#47;PV<span class="elsevierStyleInf">c-f</span> ratio&#46; The subendocardial viability index &#40;iBuckberg&#41; was obtained from the aortic pulse wave&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Multiple regression&#44; binary logistic regression&#44; and multinomial regression were used to study the association between arterial stiffness markers and renal function&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The adjusted values of the PV<span class="elsevierStyleInf">c-f</span> &#91;&#40;median &#40;interquartile range&#41; &#40;m&#47;sec&#41;&#93; were significantly higher in subjects with DM &#91;&#40;9 &#40;1&#46;2&#41;&#93;&#44; CKD &#91;&#40;9&#46;4 &#40;0&#46;7&#41;&#93; and DM with CKD &#91;&#40;10&#46;9 &#40;0&#46;7&#41;&#93; than in the control group &#91;&#40;8&#46;2 &#40;1&#46;3&#41;&#93; and group with HTN &#91;&#40;8&#46;3 &#40;0&#46;9&#41;&#93;&#44; &#40;p&#58;0&#46;001&#41;&#46; Patients with DM with CKD had higher PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> values than all other groups &#40;p&#58; 0&#46;001&#41;&#46; The ASG<span class="elsevierStyleInf"><span class="elsevierStyleBold">p-a</span></span> of the patients was significantly lower than that of the controls&#44; and the group with DM with CKD had significantly lower values than the other groups&#46; The cPP in the DM with CKD group was significantly higher than in the other groups&#46; All patients had an AI<span class="elsevierStyleInf">75</span> higher than the control group&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">When all aortic stiffness markers were introduced together in the regression&#44; PV <span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was the only one that&#44; after multivariate adjustment&#44; was independently and inversely associated with GFR &#40;&#946;&#59; &#8211;4&#44; p&#58;0&#46;001&#41; and predicted the presence of GFR decrease &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#41;&#44; &#91;&#40;OR &#40;95&#37;CI&#41;&#58; 1&#46;50 &#40;1&#46;17-1&#46;92&#59; p&#58;0&#46;001&#93;&#46; The PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was the only index directly associated with albuminuria &#40;&#946;&#58; 0&#46;15&#44; p&#58; 0&#46;02&#41; and predicted the existence of abnormal albuminuria &#40;&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#44; &#91;&#40;OR&#59; 1&#46;66 &#40;1&#46;25-2&#46;20&#41;&#44; p&#58;0&#46;001&#41;&#93;&#46; The PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> was also associated with the iBuckberg &#40;&#946;&#58; -2&#46;73&#44; p&#58; 0&#46;01&#41;&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Multinomial regression confirmed that PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> is a significant determinant of GFR and uALB&#46; On the other hand&#44; the increase in PV<span class="elsevierStyleInf"><span class="elsevierStyleBold">c-f</span></span> and the presence of DM contribute significantly to the magnitude of albuminuria&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Aortic stiffness increases in the presence of vascular risk factors such as hypertension&#44; DM and CKD&#46; This increase is greater when DM and CKD coexist&#46; Increased aortic stiffness is inversely associated with GFR and directly with uALB&#44; and is predictive of decreased GFR and abnormal uALB&#46; The VP<span class="elsevierStyleInf">c-f</span> is the parameter of aortic stiffness that is most consistently associated with renal dysfunction&#46; Increased aortic stiffness could be one of the pathomechanisms linking renal dysfunction to cardiovascular events&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#46;&#176;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 vs&#46; 2&#44;3&#44;4&#44;5&#58;0&#44;0012 vs&#46; 4&#44;5&#58;0&#44;033 vs&#46; 5&#58;0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;3&#44;4&#44;5&#58;0&#44;0013 vs&#46; 4&#58;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duraci&#243;n de DM &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 vs&#46; 5&#58;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tabaquismo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NS entre 2&#44;3&#44;4&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Historia de ECV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 vs&#46; 3&#44;4&#44;5&#58;0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retinopat&#237;a diab&#233;tica &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3 vs&#46; 5&#58;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="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bloqueo SRA &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;3 vs&#46; 4&#44;5&#58;0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estatinas &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 vs&#46; 2&#44;3&#44;4&#58; 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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapia con vit&#46; D &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;ndice de Kauppila&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 vs&#46; 5&#58;0&#44;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Datos de laboratorio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FGe &#40;mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;25<span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2&#44;3 vs&#46; 4&#44;5&#58;0&#44;0014 vs&#46; 5&#58;0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Log&#46;alb&#47;creat&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;1 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;9 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 3&#58;0&#44;011&#44;2&#44;3 vs&#46; 4&#44;5&#58;0&#44;0014 vs&#46; 5&#58;0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Triglic&#233;ridos &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">139 &#40;97&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">150 &#40;116&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">143 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163 &#40;93&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDL-c &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">136 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Variable</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ajustadas a edad&#44; sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PASb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 7&#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;4&#44;5&#58; 0&#44;006&#59;1 vs&#46; 3&#58;0&#44;033 vs&#46; 5&#58;0&#44;001&#59; 4 vs&#46; 5&#58;0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PADb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;4&#44;5&#58;0&#44;001&#59; 1 vs&#46; 3&#58;0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PPb &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 vs&#46; 1&#44;2&#44;3&#44;4&#58; 0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IA<span class="elsevierStyleInf">75</span> &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 2&#44;3&#44;4&#44;5&#58;0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>iBuckberg &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 vs&#46; 1&#44;2&#44;4&#58; 0&#44;001&#59; 5 vs&#46; 3&#58;0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ajustadas a edad&#44; sexo&#44; talla y FC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PASc &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 vs&#46; 5&#58;0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PPc &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 vs&#46; 1&#44;2&#44;4&#58;0&#44;007&#59; 2 vs&#46; 1&#58;0&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Valores ajustados a edad&#44; sexo&#44; PAM&#44; talla&#44; IMC y FC</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>VP<span class="elsevierStyleInf">c-f</span> &#40;m&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;2 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;3 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;9 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 vs&#46; 1&#44;2&#58; 0&#44;0015 vs&#46; 1&#44; 2&#44;3&#44;4&#58; 0&#44;0013 vs&#46; 1&#44;2&#58;0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>VP<span class="elsevierStyleInf">c-r</span> &#40;m&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;6 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;8&#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946; estand&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Constante&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Regresi&#243;n log&#237;stica binaria&#46; OR de marcadores de rigidez arterial tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a> predictores de disminuci&#243;n de FGe &#40;&#60; 60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R<span class="elsevierStyleSup">2</span> del modelo &#40;Nagelkerke&#41;0&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#46; Regresi&#243;n lineal m&#250;ltiple de marcadores de rigidez arterial asociados con el valor de la albuminuria tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a></th></tr><tr title="table-row"><th class="td" title="\n
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B&#46; Regresi&#243;n log&#237;stica binaria&#46; OR de marcadores de rigidez arterial tras ajuste multivariante<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a> predictores de aumento de albuminuria &#40;alb&#250;mina&#47;creatinina<span class="elsevierStyleHsp" style=""></span>&#62; 30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">R<span class="elsevierStyleSup">2</span> del modelo &#40;Nagelkerke&#41;0&#44;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#46; Asociaci&#243;n de variables con las diferentes categor&#237;as de funci&#243;n renal comparadas con funci&#243;n renal normal &#40;categor&#237;a de referencia&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;63 &#40;1&#44;31-2&#44;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">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="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">2&#46; Albuminuria &#40;&#62; 30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg&#47;g&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">3&#46; Reducci&#243;n de FGe</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#43;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">albuminuria</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intersecci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;8&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presencia de DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  """
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                  \t\t\t\t" style="border-bottom: 2px solid black">B&#46; Asociaci&#243;n de variables con las diferentes categor&#237;as de albuminuria comparadas con la albuminuria normal &#40;categor&#237;a de referencia&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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