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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> Entre 2004 y 2009&#44; se observ&#243; en Argentina un aumento significativo del n&#250;mero de pacientes que iniciaban un tratamiento cr&#243;nico de hemodi&#225;lisis &#40;HD&#41; con una tasa de filtrado glomerular estimada &#40;TFGe&#41; &#8805;&#160;10&#160;ml&#47;min&#47;1&#44;73&#160;m2&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Para su estudio&#44; calculamos las razones de riesgo &#40;RR&#41; de mortalidad en una cohorte de individuos incidentes en HD del Registro Argentino de Di&#225;lisis Cr&#243;nica &#40;2004-2009&#41;&#44; que se agrup&#243;&#44; en funci&#243;n de la TFG inicial estimada por CKD-EPI &#40;0-4&#44;9&#59; 5-9&#44;9&#59; 10-14&#44;9&#59; y &#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#44; siendo 0-4&#44;9 el grupo de referencia&#41;&#44; en tres cohortes&#58; &#171;poblaci&#243;n total&#187;&#44; &#171;cohorte sana&#187; &#40;&#60;&#160;65&#160;a&#241;os sin diabetes ni ning&#250;n tipo de comorbilidad&#41; y &#171;cohorte con entrada prevista&#187; &#40;con acceso vascular permanente&#41;&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Tras ajustar los datos de la poblaci&#243;n &#40;n&#160;&#61;&#160;16&#160;931&#41; en funci&#243;n de la edad&#44; el sexo&#44; las enfermedades coexistentes&#44; la alb&#250;mina s&#233;rica&#44; los ingresos y la existencia de un acceso vascular temporal&#44; se observ&#243; una RR de 1&#44;19 &#40;95 &#37; IC&#58; 1&#44;07-1&#44;33&#41; en el grupo con una TFGe&#160;&#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#46; En la cohorte formada por 3897&#160;individuos &#171;sanos&#187;&#44; se obtuvieron&#44; tras ajustar las mismas covariables&#44; unas RR de 1&#44;44 &#40;95 &#37; IC&#58; 1&#44;08-1&#44;65&#41; y 1&#44;65 &#40;95 &#37; IC&#58; 1&#44;06-2&#44;55&#41; para los grupos con TFGe iniciales de 10-14&#44;9 y &#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#44; respectivamente&#46; En los pacientes con &#171;entrada prevista&#187; &#40;n&#160;&#61;&#160;6280&#41;&#44; tras ajustar los resultados en funci&#243;n de la edad&#44; el sexo&#44; la comorbilidad&#44; el nivel de alb&#250;mina s&#233;rica y los ingresos&#44; las RR de todos los grupos no difirieron significativamente de las del grupo de control&#46;<span class="elsevierStyleBold"> Conclusiones&#58;</span> Iniciar el tratamiento de HD con una TFGe&#160;&#62;&#160;10&#160;ml&#47;min&#47;1&#44;73&#160;m<span class="elsevierStyleSup">2</span> no revela ninguna ventaja de supervivencia&#46; La mayor mortalidad del grupo con mayor TFGe que inicia la di&#225;lisis es un &#171;artefacto&#187; que est&#225; relacionado con una mayor edad&#44; la existencia de m&#225;s comorbilidades&#44; la hipoalbuminemia y el uso de accesos vasculares temporales&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background</span><span class="elsevierStyleBold">&#58;</span> A significant increase in the number of patients starting chronic hemodialysis &#40;HD&#41; with an estimated glomerular filtration rate &#40;eGFR&#41;&#8805;10mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> was observed in Argentina between 2004 and 2009&#46; <span class="elsevierStyleBold">Methods</span><span class="elsevierStyleBold">&#58;</span> In order to study this topic&#44; we calculated the mortality hazard ratios &#40;HR&#41; in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis &#91;<span class="elsevierStyleItalic">Registro Argentino de Di&#225;lisis Cr&#243;nica</span>&#93; &#40;2004-2009&#41;&#44; grouped according to the initial eGFR &#40;0-4&#46;9&#44; 5-9&#46;9&#44; 10-14&#46;9 and &#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#59; reference group 0-4&#46;9&#41; estimated by CKD-EPI&#59; in three cohorts&#58; &#8220;total population&#8221;&#44; &#8220;healthy &#40;&#60;65 years&#44; without diabetes or comorbidities&#41; and &#8220;planned entry&#8221; &#40;with permanent vascular access&#41;&#46; <span class="elsevierStyleBold">Results</span><span class="elsevierStyleBold">&#58;</span> After adjusting the population &#40;n&#61;16&#44;931&#41; for age&#44; gender&#44; coexisting conditions&#44; serum albumin&#44; income&#44; and temporary vascular access a HR of 1&#46;19 &#40;95&#37;CI&#58;1&#46;07-1&#46;33&#41; was observed in the group with eGFR&#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; In the cohort of 3&#44;897 &#8220;healthy&#8221; after adjusting for the same co-variates&#44; HRs of 1&#46;44 &#40;95&#37;CI&#58; 1&#46;08-1&#46;65&#41; and 1&#46;65 &#40;95&#37;CI&#58; 1&#46;06-2&#46;55&#41; were obtained for the groups with baseline eGFR values of 10-14&#46;9 and &#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; respectively&#46; In &#8220;planned entry&#8221; patients &#40;n&#61;6&#44;280&#41;&#44; after adjusting for age&#44; gender&#44; co-morbidities&#44; serum albumin and income&#44; HRs in all groups were not significantly different as compared to the control group&#46; <span class="elsevierStyleBold">Conclusions</span><span class="elsevierStyleBold">&#58;</span> HD&#160;initiation with eGFR&#62;10mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> shows no survival advantage&#46; The higher mortality in the group with &#62;eGFR starting dialysis looks like an &#8220;artifact&#8221; related to higher age&#44; more co-morbidities&#44; low albuminemia and the use of temporary vascular access&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:46 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
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                0 => array:3 [
                  "referenciaCompleta" => "NKF-DOQI clinical practice guidelines for hemodialysis adequacy. National Kidney Foundation. Am J Kidney Dis 1997;30(3 Suppl 2):S15-66."
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                    0 => null
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            1 => array:3 [
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006;48 Suppl 1:S2-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16813990" target="_blank">[Pubmed]</a>"
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            ]
            2 => array:3 [
              "identificador" => "bib3"
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              ]
            ]
            3 => array:3 [
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                ]
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            4 => array:3 [
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            5 => array:3 [
              "identificador" => "bib6"
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            6 => array:3 [
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                  "referenciaCompleta" => "Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996;7(2):198-207."
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            7 => array:3 [
              "identificador" => "bib8"
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                  "referenciaCompleta" => "Tattersall JE, Pedrini L, Martin-Malo AM. When to start dialysis. Nephrol Dial Transplant 2002;17Suppl7:10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11208984" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Korevaar JC, Jansen MA, Dekker FW, Jager KJ, Boeschoten EW, Krediet RT, et al. When to initiate dialysis: effect of proposed US guidelines on survival. Lancet 2001;358:1046-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11589934" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "The CARI Guidelines: Caring for Australians with Renal Impairment. Available at: http://www.cari.org.au/dialysis_accept_published.php [accessed November 11, 2012]."
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                  "referenciaCompleta" => "17 Traynor JP, Simpson K, Geddes CC, Deighan CJ, Fox JG. Early initiation of dialysis fails to prolong survival in patients with end stage renal failure. J Am Soc Nephrol 2002;13:2125-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12138145" target="_blank">[Pubmed]</a>"
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              "etiqueta" => "18"
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                  "referenciaCompleta" => "Lassalle M, Labeeuw M, Frimat L, Villar E, Joyeux V, Couchoud C, et al. Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival. Kidney Int 2010;77:700-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20147886" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Venturelli C, Brunori G. When to start chronic dialysis: as late as possible. G Ital Nefrol 2010;27(6):568-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21132638" target="_blank">[Pubmed]</a>"
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              "identificador" => "bib22"
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                0 => array:3 [
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              "identificador" => "bib23"
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            23 => array:3 [
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            25 => array:3 [
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              ]
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                0 => array:3 [
                  "referenciaCompleta" => "Registro Argentino de Diálisis Crónica 2009-2010. Informe 2011. Available at: http://san.org.ar/docs/REGISTRO_ARGENTINO_DE_DIALISIS_CRONICA2009_2010.pdf [accessed November 11, 2012]."
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              ]
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              "identificador" => "bib28"
              "etiqueta" => "28"
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                0 => array:3 [
                  "referenciaCompleta" => "Marinovich S, Lavorato C, Celia E, Araujo JL, Bisignano L, Soratti M. Mortalidad según el registro de pacientes en Diálisis Crónica de Argentina 2004-2005. Revista de Nefrología, Diálisis y Trasplante 2009;29(2):13-28. Available at: http://www.renal.org.ar/imagenes/revistas_anteriores/revista_29_2.pdf [accessed November 11, 2012]."
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                ]
              ]
            ]
            28 => array:3 [
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                  "referenciaCompleta" => "Marinovich S, Lavorato C, Moriñigo C, Celia E, Bisignano L, Soratti M, et al. A new pronostic index for one-year survival in incident hemodialysis patients. Int J Artif Organs 2010;33(10):689-99. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21058267" target="_blank">[Pubmed]</a>"
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              ]
            ]
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            30 => array:3 [
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Tasa de filtrado glomerular inicial y supervivencia en hemodiálisis. El papel del acceso vascular permanente
Initial Glomerular Filtration Rate and Survival in Hemodialysis. The role of permanent vascular access
Sergio Marinovicha, Jaime Pérez-Loredob, Carlos Lavoratoa, Guillermo Rosa-Díeza, Liliana Bisignianoc, Víctor Fernándezc, Daniela Hansen-Kroghd
a Comité de Estadísticas y Registros, Sociedad Argentina de Nefrología, Ciudad Autónoma de Buenos Aires, Argentina,
b Cátedra de Nefrología, Universidad Católica Argentina, Ciudad Autónoma de Buenos Aires, Argentina,
c Comisión Científico Técnica, Instituto Central Único Coordinador de Ablación e Implante, Ciudad Autónoma de Buenos Aires, Argentina,
d Departamento de Informática, Instituto Central Único Coordinador de Ablación e Implante, Ciudad Autónoma de Buenos Aires, Argentina,
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes&#58;</span> Entre 2004 y 2009&#44; se observ&#243; en Argentina un aumento significativo del n&#250;mero de pacientes que iniciaban un tratamiento cr&#243;nico de hemodi&#225;lisis &#40;HD&#41; con una tasa de filtrado glomerular estimada &#40;TFGe&#41; &#8805;&#160;10&#160;ml&#47;min&#47;1&#44;73&#160;m2&#46; <span class="elsevierStyleBold">M&#233;todos&#58;</span> Para su estudio&#44; calculamos las razones de riesgo &#40;RR&#41; de mortalidad en una cohorte de individuos incidentes en HD del Registro Argentino de Di&#225;lisis Cr&#243;nica &#40;2004-2009&#41;&#44; que se agrup&#243;&#44; en funci&#243;n de la TFG inicial estimada por CKD-EPI &#40;0-4&#44;9&#59; 5-9&#44;9&#59; 10-14&#44;9&#59; y &#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#44; siendo 0-4&#44;9 el grupo de referencia&#41;&#44; en tres cohortes&#58; &#171;poblaci&#243;n total&#187;&#44; &#171;cohorte sana&#187; &#40;&#60;&#160;65&#160;a&#241;os sin diabetes ni ning&#250;n tipo de comorbilidad&#41; y &#171;cohorte con entrada prevista&#187; &#40;con acceso vascular permanente&#41;&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Tras ajustar los datos de la poblaci&#243;n &#40;n&#160;&#61;&#160;16&#160;931&#41; en funci&#243;n de la edad&#44; el sexo&#44; las enfermedades coexistentes&#44; la alb&#250;mina s&#233;rica&#44; los ingresos y la existencia de un acceso vascular temporal&#44; se observ&#243; una RR de 1&#44;19 &#40;95 &#37; IC&#58; 1&#44;07-1&#44;33&#41; en el grupo con una TFGe&#160;&#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#46; En la cohorte formada por 3897&#160;individuos &#171;sanos&#187;&#44; se obtuvieron&#44; tras ajustar las mismas covariables&#44; unas RR de 1&#44;44 &#40;95 &#37; IC&#58; 1&#44;08-1&#44;65&#41; y 1&#44;65 &#40;95 &#37; IC&#58; 1&#44;06-2&#44;55&#41; para los grupos con TFGe iniciales de 10-14&#44;9 y &#8805;&#160;15&#160;ml&#47;min&#47;1&#44;73&#160;m2&#44; respectivamente&#46; En los pacientes con &#171;entrada prevista&#187; &#40;n&#160;&#61;&#160;6280&#41;&#44; tras ajustar los resultados en funci&#243;n de la edad&#44; el sexo&#44; la comorbilidad&#44; el nivel de alb&#250;mina s&#233;rica y los ingresos&#44; las RR de todos los grupos no difirieron significativamente de las del grupo de control&#46;<span class="elsevierStyleBold"> Conclusiones&#58;</span> Iniciar el tratamiento de HD con una TFGe&#160;&#62;&#160;10&#160;ml&#47;min&#47;1&#44;73&#160;m<span class="elsevierStyleSup">2</span> no revela ninguna ventaja de supervivencia&#46; La mayor mortalidad del grupo con mayor TFGe que inicia la di&#225;lisis es un &#171;artefacto&#187; que est&#225; relacionado con una mayor edad&#44; la existencia de m&#225;s comorbilidades&#44; la hipoalbuminemia y el uso de accesos vasculares temporales&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background</span><span class="elsevierStyleBold">&#58;</span> A significant increase in the number of patients starting chronic hemodialysis &#40;HD&#41; with an estimated glomerular filtration rate &#40;eGFR&#41;&#8805;10mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> was observed in Argentina between 2004 and 2009&#46; <span class="elsevierStyleBold">Methods</span><span class="elsevierStyleBold">&#58;</span> In order to study this topic&#44; we calculated the mortality hazard ratios &#40;HR&#41; in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis &#91;<span class="elsevierStyleItalic">Registro Argentino de Di&#225;lisis Cr&#243;nica</span>&#93; &#40;2004-2009&#41;&#44; grouped according to the initial eGFR &#40;0-4&#46;9&#44; 5-9&#46;9&#44; 10-14&#46;9 and &#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> &#59; reference group 0-4&#46;9&#41; estimated by CKD-EPI&#59; in three cohorts&#58; &#8220;total population&#8221;&#44; &#8220;healthy &#40;&#60;65 years&#44; without diabetes or comorbidities&#41; and &#8220;planned entry&#8221; &#40;with permanent vascular access&#41;&#46; <span class="elsevierStyleBold">Results</span><span class="elsevierStyleBold">&#58;</span> After adjusting the population &#40;n&#61;16&#44;931&#41; for age&#44; gender&#44; coexisting conditions&#44; serum albumin&#44; income&#44; and temporary vascular access a HR of 1&#46;19 &#40;95&#37;CI&#58;1&#46;07-1&#46;33&#41; was observed in the group with eGFR&#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; In the cohort of 3&#44;897 &#8220;healthy&#8221; after adjusting for the same co-variates&#44; HRs of 1&#46;44 &#40;95&#37;CI&#58; 1&#46;08-1&#46;65&#41; and 1&#46;65 &#40;95&#37;CI&#58; 1&#46;06-2&#46;55&#41; were obtained for the groups with baseline eGFR values of 10-14&#46;9 and &#8805;15mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; respectively&#46; In &#8220;planned entry&#8221; patients &#40;n&#61;6&#44;280&#41;&#44; after adjusting for age&#44; gender&#44; co-morbidities&#44; serum albumin and income&#44; HRs in all groups were not significantly different as compared to the control group&#46; <span class="elsevierStyleBold">Conclusions</span><span class="elsevierStyleBold">&#58;</span> HD&#160;initiation with eGFR&#62;10mL&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> shows no survival advantage&#46; The higher mortality in the group with &#62;eGFR starting dialysis looks like an &#8220;artifact&#8221; related to higher age&#44; more co-morbidities&#44; low albuminemia and the use of temporary vascular access&#46;</p>"
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ISSN: 02116995
Idioma original: Español
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2017 Agosto 40 14 54
2017 Julio 36 16 52
2017 Junio 47 17 64
2017 Mayo 61 14 75
2017 Abril 39 16 55
2017 Marzo 41 14 55
2017 Febrero 30 6 36
2017 Enero 29 8 37
2016 Diciembre 75 10 85
2016 Noviembre 102 12 114
2016 Octubre 140 29 169
2016 Septiembre 227 6 233
2016 Agosto 274 6 280
2016 Julio 286 15 301
2016 Junio 203 0 203
2016 Mayo 189 0 189
2016 Abril 155 0 155
2016 Marzo 141 0 141
2016 Febrero 175 0 175
2016 Enero 155 0 155
2015 Diciembre 171 0 171
2015 Noviembre 149 0 149
2015 Octubre 173 0 173
2015 Septiembre 137 0 137
2015 Agosto 162 0 162
2015 Julio 152 0 152
2015 Junio 81 0 81
2015 Mayo 138 0 138
2015 Abril 46 0 46
2015 Febrero 1651 0 1651
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