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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic">A pesar de que el uso de la di&#225;lisis cr&#243;nica est&#225; muy extendido&#44; a&#250;n no existe consenso en cuanto a cu&#225;l es el mejor momento para comenzar el tratamiento renal sustitutivo&#44; por lo que se suelen utilizar como referencia las recomendaciones de la Iniciativa para la Calidad de los Resultados de la Insuficiencia Renal de la Fundaci&#243;n Nacional del Ri&#241;&#243;n &#40;NKF-KDOQI&#41;&#46; Esto ha provocado que durante la &#250;ltima d&#233;cada hay surgido una tendencia a iniciar la di&#225;lisis antes&#44; especialmente en el caso de las personas de edad avanzada&#44; lo que ha conllevado a una reducci&#243;n considerable de las tasas de supervivencia&#44; debido a la mayor carga de comorbilidades que sufre esta poblaci&#243;n&#46; Los datos de estudios de cohorte retrospectivos han sido corroborados por el ensayo controlado aleatorizado que se ha realizado recientemente en Australia y Nueva Zelanda&#44; el estudio IDEAL&#46; Este estudio tiene ciertas limitaciones&#44; ya que existen diferentes factores de confusi&#243;n que afectan a la poblaci&#243;n estudiada&#46; Nuestro trabajo es una revisi&#243;n basada en la evidencia que se centra en la reducci&#243;n de las tasas de supervivencia que se ha producido con el inicio temprano de la di&#225;lisis&#46;</span></p>"
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