Original article
Prevalence of renal stones in Andalusian population: Results of PreLiRenA study
Prevalencia de la litiasis renal en Andalucía: resultados del estudio PreLiRenA
R. Cano-Castiñeiraa,
, J. Carrasco-Valientea, L.A. Pérula-de-Torresb, C. Jiménez-Garcíab, I. Olaya-Carob, M. Criado-Larumbeb, M.J. Requena-Tapiaa
Corresponding author
a Unidad de Gestión Clínica de Urología, Hospital Universitario Reina Sofía, Córdoba, Spain
b Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba-Guadalquivir, Instituto Maimónides de investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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"apellidos" => "Requena-Tapia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Urología, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad Docente de Medicina Familiar y Comunitaria de Córdoba, Distrito Sanitario Córdoba-Guadalquivir, Instituto Maimónides de investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de la litiasis renal en Andalucía: resultados del estudio PreLiRenA" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 700 "Ancho" => 1658 "Tamanyo" => 42855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Prevalence of kidney stones by sex according to BMI. Prevalence data expressed in percentages. BMI: body mass index; RL: renal lithiasis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of renal lithiasis (RL) is estimated at between 4 and 20%, with a peak incidence between the fourth and fifth decades of life.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> An important aspect of this disease is the high percentage of recurrences, ranging from 40 to 60% at years 5 and 9, respectively.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The only epidemiological study at the national level until now was conducted in 1984, establishing an annual incidence of 0.27% and a prevalence of 4.16%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These results have served as a frame of reference for subsequent studies.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A limitation to be taken into account is that most of the studies conducted are based on care-related data, so they do not reflect its true magnitude, since not all cases are reported (hidden morbidity).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6,10,11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the last few years, several studies have referred to an increase in the magnitude of the lithiasic disease especially in highly developed industrialized countries,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10,12</span></a> and this seems to be due to a greater prevalence of cardiovascular risk factors. Dietary factors and lifestyles seem to play a crucial role in the risk of RL.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,13,14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, due to social and economic implications, it is necessary to gather more accurate and up-to-date data on the epidemiology of RL, for the development of strategies, promotion and prevention schemes, and clinical action protocols aimed at reducing and controlling this health issue.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main aim of this study was to estimate the prevalence and incidence of RL in Andalusia in a population between 40 and 65 years of age. As a secondary aim, we set ourselves the objective of determining which factors (comorbidity and socio-demographic factors) are associated with it.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A more detailed description of the methodology in this work has been previously published.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">An observational, cross-sectional, epidemiological study was conducted in the population scope. By using multistage randomized sampling method, we selected a sample of 2439 individuals, between 40 and 65 years of age, of both sexes, resident in Andalusia, who were interviewed by 2 people with previous experience in conducting surveys of a similar nature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The exclusion criteria were: inability to understand interview questions, not speaking Spanish, not being resident in Andalusia or their refusal to participate.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Consent to participate in the study was obtained from all patients. The study was approved by the Ethics and Clinical Research Committee of the Reina Sofía Hospital in Córdoba.</p><p id="par0055" class="elsevierStylePara elsevierViewall">For the estimation of the sample size, we took into account an expected proportion of RL of 5% (prevalence obtained from the study by Sánchez-Martín<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>), a level of confidence of 95% and an accuracy of ±1.1%. On the basis of a non-response rate of 25%, the estimated size was 2432 individuals.</p><p id="par0060" class="elsevierStylePara elsevierViewall">We used a randomized sampling system stratified by province, sex, and age groups. Sample subjects were obtained from the user database of the Andalusian Health Service. In order to check whether the sampling was representative of the study population, we took as a reference that population registered in the Spanish population census, provided by the National Institute of Statistics.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Sampling with replacement was used, for which a reserve list was made available with subjects of similar socio-demographic characteristics; when the originally chosen candidate was considered as ‘not locatable’, after having tried to contact them at least on three occasions, another one was chosen from that list.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The interview had a short average duration (10<span class="elsevierStyleHsp" style=""></span>min), in order to prevent dropouts due to a ‘fatigue’ effect. In order to verify the reliability of the information gathered, a concordance analysis (using the test-retest procedure) was conducted on a subsample of 40 subjects, contrasting the results obtained in the original interview with those provided by a specialist urologist.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The study variables were: (1) RL (colloquial language was used: ‘kidney stones’), year of diagnosis, the professional who diagnosed them with this process, treatment received, spontaneous stone expulsion; (2) socio-demographic variables: age, sex, nationality, municipality of residence, level of studies and social class based on occupation; and (3) clinical variables: high blood pressure (HBP), diabetes mellitus (DM), hypercholesterolemia, gout, a family history of RL, weight (kg) and size (cm), from which body mass index was calculated (BMI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>weight/size<span class="elsevierStyleSup">2</span>).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">EPIDAT 3.1 and SPSS 17.0 software was used. Descriptive statistics was carried out and the 95% confidence intervals (CI 95%) of the main study estimators were calculated. A bivariate analysis was then done to check the relationship between independent variables (socio-demographic and clinical ones) and the presence of RL, for which Chi-square tests, Fisher's exact test, Student's <span class="elsevierStyleItalic">t</span> test or ANOVA (after verification of normality using Kolmogorov–Smirnov test) were used. The contrasts used were bilateral (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.05). Crude odds ratios (cOR) were estimated with their respective CI 95%. Finally, a multivariate analysis was performed, where multiple logistic regression was used. In order to create the model, we used the ‘enter’ method of the SPSS software, where the socio-demographic variables and those covariables which proved to be statistically significant in the bivariate analysis were introduced. Social class was treated as a dummy variable, considering the lowest social class as the reference category. Goodness of fit was checked by using Hosmer–Lemeshow test.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">2858 people were contacted by phone over a period of six months in order to reach the pre-established sample size. 85.3% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2439) of the subjects met the inclusion criteria and agreed to participate in the survey.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean age was 51.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.6 years – standard deviation (SD) – (CI 95%: 50.70–51.30), 51.3% corresponding to women.</p><p id="par0095" class="elsevierStylePara elsevierViewall">No significant differences were found between the study population and the sample with respect to the demographic variables (age, sex and province of residence).</p><p id="par0100" class="elsevierStylePara elsevierViewall">The prevalence of RL obtained was 16.4% (CI 95%: 14.87–17.85), this being 16.5% in the case of women (CI 95%: 14.44–18.63) and 16.2% in men (CI 95%: 14.04–18.31), with a resulting men/women ratio of 0.93. The incidence obtained (year 2011) was 1.2% (CI 95%: 0.74–1.64).</p><p id="par0105" class="elsevierStylePara elsevierViewall">As can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, in the case of men prevalence increases with age, this being higher in the group from 60 to 65 years (23.8) (linear trend Chi-square<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12.939; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Emergency and primary care physicians made the diagnosis of RL more frequently (51.2 and 27.5% respectively). In 13.5% of cases, the diagnosis was made by an urologist.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The spontaneous resolution rate was 29.64%. 71.46% of lithiasic subjects required treatment, medical expulsive treatment being the most widely used (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The prevalence of cardiovascular risk factors in the sample was: HBP 26.9% (CI 95%: 25.08–28.64); DM 8.7% (CI 95%: 7.60–9.87); dyslipidemia 33.91% (CI 95%: 32.01–35.81); and gout 9.8% (CI 95%: 8.60–11.00). 29% (CI 95%: 27.17–30.81) of the subjects showed a family history (first grade) of RL.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The mean BMI was 26.21<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.41 (CI 95%: 26.04–26.39), with 17% of obese individuals (BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>30) and 39% of overweight subjects (BMI: 24.9–29.9%) being found in the sample.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The BMI in patients with lithiasis was 26.97<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.54 (CI 95%: 26.52–27.42), higher than that obtained in patients with no renal lithiasis (26.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.37; CI 95%: 25.88–26.26; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0135" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> there is a direct linear association between BMI values and the presence of RL in both sexes (Chi-square for men<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7.498; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006; Chi-square for women<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11.073; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In the bivariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) the presence of a family history of RL, as well as suffering from HBP, DM, dyslipidemia, gout and/or obesity were significantly related to the presence of RL, whereas in the multivariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) the independent factors associated with the presence of RL were the following: belonging to the upper social class (class I) (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.49), the presence of a family history of RL (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.91), HBP (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.64), suffering from gout (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.98) and having a high BMI (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.03).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In the test–retest, a coincidence was found in the diagnosis of RL in 93.1% of subjects (CI 95%: 79.6–98.4).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The lithiasic disease poses a major health issue, where it is necessary to know its true prevalence of so that it can be treated, not only for an improvement in the disease, but because, as shown by Parks and Coe in 1996,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> conservative treatment is cost-effective to avoid RL recurrences. There are several studies which have referred to an increase in the use of health resources for the treatment of these patients,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,12,17</span></a> which entails a significant socio-economic impact.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In Spain, several epidemiological studies on RL have been conducted since the year 1977,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> but it was in 1984 when what can be considered as the only study at the national level with adequate methodology was published, establishing an annual incidence of 0.27% and a prevalence of 4.16%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This study has served as a reference for further work.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–9,11,20</span></a> In 2007, Sánchez-Martín et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> conducted a review of the data available in Spain so far on the incidence and prevalence of RL, obtaining a mean incidence of 0.73% and a prevalence of 5.06%. Many of these studies used care-related data, which are not the most appropriate ones for estimating the true incidence and prevalence of this disease among the general population.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In countries where RL is included in population-based surveys, prevalence rates ranging from 3.5 to 18.5%<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,21–24</span></a> have been found. This highlights the importance of RL for public health policies in different countries.</p><p id="par0165" class="elsevierStylePara elsevierViewall">There are several studies referring to an increase of RL all across the world.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,17</span></a> Chronological studies conducted in the last few years showed a significant increase of this disease with respect to the previous data available in the same geographic areas.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10,12,22,25</span></a> According to these studies, the highest incidence occurs between the third and fifth decades of life, a time with greater work activity with an important influence of dietary habits and lifestyles.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Therefore, in our study we have been able to verify that the prevalence and incidence of RL are higher than those found in other research reviews previously published in Spain,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–9</span></a> but being very similar to those obtained in the most recent international epidemiological studies.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10,12</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">This increase, especially in countries with greater industrial development, appears to be linked to changes in dietary habits and lifestyles that would play an important role in the risk of lithiasic disease and might be influencing this increase.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Some recent researches have analyzed the role of cardiovascular risk factors in the occurrence of RL. Factors such as HBP, DM, high BMI and metabolic syndrome have been associated with an increased risk of suffering from RL.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14,26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In line with what has been reported in the literature, in the multivariate analysis we were able to note a directly proportional relationship between the presence of RL and blood pressure and BMI figures.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Obese patients show a series of changes in the urinary excretion of calcium, oxalate, citrate and uric acid<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> that predispose them to the occurrence of RL. Bearing in mind that the WHO has considered obesity as one of the epidemics of the 21st century,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> these data might help explain the changes observed in the prevalence of RL in the last few years.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Likewise, gout was also significantly associated with the presence of RL. It is well known that patients with gout show a higher risk of suffering from RL, with a drop in urine pH being one of the factors responsible for this.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Another factor that might explain this high prevalence of RL in our environment is climate. Average temperature has been associated with the geographical variations of the lithiasic disease.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The average temperature in Andalusia is high and higher than that in other Spanish regions. It would be interesting to expand the study to the rest of the Spanish territory, since weather conditions are different and an ecological correlation study illustrating differences in prevalence among the geographical areas of the country would support this hypothesis.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The improvement in diagnostic procedures in the last few years (ultrasound imaging, computed tomography) has considerably influenced the number of diagnoses in asymptomatic patients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Since this study has not only considered the diagnosis of symptomatic lithiasis, but also asymptomatic lithiasis, we believe that this might also have affected the increased prevalence of RL observed.</p><p id="par0205" class="elsevierStylePara elsevierViewall">In our study, we have seen that the overall prevalence of RL was somehow higher in women (16.5%) than in men (16.2%), with a resulting men/women ratio of 0.93 and, although the differences found were not statistically significant, they go in line with what has been previously reported, with a decrease in the differences between both sexes that were illustrated in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,17</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Considering that, as we have documented, the initial diagnosis is made in most cases either in the emergency department (51.2%) and in primary care (27.5%), with only 13.5% of cases being made by an urologist, it is important to make other professionals aware of the need for an appropriate clinical management of this disease.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Finally, one might say that despite phone survey being an appropriate and sufficiently contrasted method from the point of view of its validity and reliability to know the magnitude of certain health problems among the population (especially the population that does not attend health care services), it is true that this procedure has inherent limitations and disadvantages that may arise during its performance. In order to detect difficulties in the data collection phase (refusal to participate, understanding of the questions, etc.) a pilot study was conducted in a subsample of subjects. Although information biases might occur due to a lack of data verification (due to memory problems for example), RL, especially when it is symptomatic, due to its presentation form, is a disease that the patient often recalls without difficulty in most cases. When we evaluated the reliability of the diagnosis of RL by verifying the concordance between what was declared to the interviewer by the patient and what was reported a posteriori to an urologist, we obtained a satisfactory result (93% of coincidence).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0220" class="elsevierStylePara elsevierViewall">The prevalence of RL in Andalusia is high in the age range studied, and substantially higher than that previously published in our environment. This increase is probably related to changes in the consumption pattern of dietary factors and in certain lifestyles, which should be studied in depth. These figures have major labor implications for the working population, where it generates a considerable expenditure, so we deem it important to make efforts in order to improve medical practice, both in its prevention as well as in its diagnosis and treatment.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0225" class="elsevierStylePara elsevierViewall">The study has the support of the grant ‘Pedro Cifuentes Diaz’ given in the call of the Foundation for Research in Urology 2012.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres413787" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389450" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres413786" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec389451" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-12-25" "fechaAceptado" => "2014-02-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389450" "palabras" => array:3 [ 0 => "Urolithiasis" 1 => "Prevalence" 2 => "Incidence" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec389451" "palabras" => array:3 [ 0 => "Litiasis renal" 1 => "Prevalencia" 2 => "Incidencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Urolithiasis is a disease having a high recurrence rate and associated morbidity. A not well quantified increase is being seen in recent years that could be related with various factors. The main purpose of our study has been to estimate urolithiasis prevalence and incidence in the region of Andalusia, determining which factors are associated.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">We performed an observational and cross-sectional study. Using a multistage randomized procedure, we selected a sample of 2439 subjects, aging from 40 to 65 years old, who currently lived in Andalusia. Data was collected through phone interviews, questioning the chosen subjects about their kidney stones history, comorbidity and socio-demographic characteristics. We conducted a descriptive, bivariate and multivariate analysis with logistic regression.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">A total of 2439 subjects were surveyed. Subjects had mean age of 51.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.61 years – standard deviation; (95% confidence interval – 95% CI: 50.70–51.30), 48.7% of whom were male. Prevalence of urolithiasis obtained was 16.4% (95% CI: 14.87–17.85%) and an incidence of 1.2 (95% CI: 0.74–1.64). Variables significantly associated with the presence of urolithiasis found in the multivariate study were: presence of a family history of kidney stones (odds ratio – OR: 1.91; 95% CI: 1.51–2.40, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), hypertension (OR:1.58; 95% CI:1.24–2.02; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001), gout (OR:1.98; 95% CI: 1.26–3.12; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.003) and a high BMI (OR: 1.60; 95% CI 1.19–2.17; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.008).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">A significant increase in the prevalence and incidence of urolithiasis is observed in the environment in regard to the previously available figures. The presence of a family history of urolithiasis, hypertension, gout as well as having a high BMI could influence the observed epidemiological changes in renal lithiasis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La urolitiasis es una enfermedad con alta tasa de recidiva y gran morbilidad asociada. Se está percibiendo un aumento no bien cuantificado en los últimos años que podría estar relacionado con diversos factores. El objetivo principal fue estimar la magnitud de la urolitiasis en Andalucía y determinar qué factores se hallan asociados.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio observacional, transversal. Mediante procedimiento aleatorizado polietápico seleccionamos una muestra de 2.439 sujetos, de 40 a 65 años, residentes en Andalucía. La recogida de datos se realizó mediante encuesta telefónica, interrogando a los sujetos sobre antecedentes de litiasis renal, comorbilidad y características sociodemográficas. Realizamos un análisis estadístico descriptivo, bivariado y multivariado (regresión logística múltiple).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Fueron encuestados 2.439 sujetos, con una edad media de 51,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7,61 años-desviación típica (intervalo de confianza al 95% [IC 95%]: 50,70–51,30) de los cuales el 48,7% eran varones. La prevalencia de urolitiasis fue del 16,4% (IC 95%: 14,87–17,85) y la incidencia del 1,2% (IC 95%: 0,74–1,64). Como variables asociadas a la presencia de urolitiasis en el estudio multivariado encontramos la presencia de antecedentes familiares de litiasis renal (<span class="elsevierStyleItalic">odds ratio</span> [OR]: 1,91; IC 95%: 1,51–2,40; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001); la hipertensión arterial (OR: 1,58; IC 95%: 1,24–2,02; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001), padecer gota (OR: 1,98; IC 95%: 1,26–3,12; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003) y un índice de masa corporal elevado (OR: 1,60; IC 95%:1,19–2,17; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,008).</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Se constata un incremento importante de la prevalencia e incidencia de urolitiasis en nuestro medio con respecto a las cifras que previamente conocíamos. La presencia de antecedentes familiares de urolitiasis, la hipertensión arterial, la gota, unido a un índice de masa corporal elevado, podrían desempeñar un importante papel en los cambios epidemiológicos observados en la litiasis renal.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cano-Castiñeira R, Carrasco-Valiente J, Pérula-de-Torres LA, Jiménez-García C, Olaya-Caro I, Criado-Larumbe M, et al. Prevalencia de la litiasis renal en Andalucía: resultados del estudio PreLiRenA. Actas Urol Esp. 2015;39:26–31.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 700 "Ancho" => 1658 "Tamanyo" => 42855 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Prevalence of kidney stones by sex according to BMI. Prevalence data expressed in percentages. BMI: body mass index; RL: renal lithiasis.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">95% CI: confidence interval for 95%.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Age group (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence (%) of renal lithiasis (95% CI)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Male \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Female \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">40–44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (9.2–16.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.7 (10.6–18.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 (11.1–16.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">45–49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.1 (8.1–16.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.8 (12.1–21.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.4 (11.3–17.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">50–54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5 (12.0–23.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2 (13.7–24.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.4 (14.5–22.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">55–59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4 (11.6–23.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9 (10.9–20.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.6 (12.8–20.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">60–65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.8 (17.9–29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7 (11.8–21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1 (16.3–23.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.2 (14.0–18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.5 (14.4–18.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.4 (14.9–17.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644363.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Prevalence of renal lithiasis by sex and age groups.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment performed \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Expulsive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">233 (80.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Extracorporeal shock wave lithotripsy (ESWL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (9.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Interventionist/surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Does not remember \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">301 (100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644360.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Type of treatment performed in patients with lithiasis.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">95% CI: confidence interval for 95%; obesity: BMI<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>30; cOR: crude odds ratio; overweight: BMI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>25–29.9.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Renal lithiasis (%)</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">cOR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Foreigners \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gout \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Overweight or obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab644361.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Bivariate analysis of the variables associated with renal lithiasis.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">95% CI: confidence interval for 95%; BMI: body mass index; OR: odds ratio.</p><p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Ómnibus test: 86.806, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001; Hosmer–Lemeshow test: 8.004, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.433.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Wald test \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI for OR</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Social class I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nationality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gout \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 3 | 0 | 3 |
| 2020 June | 1 | 0 | 1 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 8 | 3 | 11 |
| 2018 January | 10 | 0 | 10 |
| 2017 December | 4 | 1 | 5 |
| 2017 November | 14 | 2 | 16 |
| 2017 October | 10 | 2 | 12 |
| 2017 September | 15 | 0 | 15 |
| 2017 August | 12 | 5 | 17 |
| 2017 July | 13 | 3 | 16 |
| 2017 June | 14 | 3 | 17 |
| 2017 May | 8 | 4 | 12 |
| 2017 April | 14 | 12 | 26 |
| 2017 March | 26 | 36 | 62 |
| 2017 February | 21 | 1 | 22 |
| 2017 January | 4 | 3 | 7 |
| 2016 December | 0 | 2 | 2 |
| 2016 November | 0 | 5 | 5 |
| 2016 October | 0 | 1 | 1 |
| 2016 September | 0 | 3 | 3 |
| 2016 August | 0 | 1 | 1 |
| 2016 June | 0 | 2 | 2 |
| 2016 May | 0 | 15 | 15 |
| 2016 April | 0 | 4 | 4 |
| 2016 March | 0 | 9 | 9 |
| 2016 February | 0 | 8 | 8 |
| 2016 January | 0 | 10 | 10 |
| 2015 December | 0 | 9 | 9 |
| 2015 November | 0 | 10 | 10 |
| 2015 October | 0 | 10 | 10 |
| 2015 September | 0 | 3 | 3 |
| 2015 July | 0 | 2 | 2 |
| 2015 June | 0 | 1 | 1 |
| 2015 May | 0 | 2 | 2 |
| 2015 April | 0 | 1 | 1 |
| 2015 March | 0 | 2 | 2 |
| 2015 February | 1 | 1 | 2 |
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