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Original articles
Correlation of serum Klotho, fetuin-A, and MGP levels with coronary artery calcification in maintenance hemodialysis patients
Dan Wanga,1, XiuLin Chub,1, JuHua Caoc, YunHua Pengd,
Corresponding author
wanglei_1346_gphc@hotmail.com

Corresponding author.
a Department of East Hospital Nephrology, Yantaishan Hospital, Yantai City, Shandong Province, China
b Department of Nephrology, The People's Hospital of Xushui, Baoding City, Hebei Province, China
c Department of Outpatient, The General Hospital of Western Theater Command of Chinese people's liberation army, Chengdu City, Sichuan Province, China
d Department of Nephrology, Dafeng People's Hospital, Yancheng City, JiangSu Province, China
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Klotho&#44; fetuin-A&#44; and MGP proteins in three defined groups of CAC scores&#46; &#40;A&#8210;B&#41; Protein expressions of Klotho&#44; fetuin-A&#44; and MGP in three defined groups of CAC scores were detected by Western blot&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Introduction</span><p id="para0009" class="elsevierStylePara elsevierViewall">Chronic Kidney Disease &#40;CKD&#41; is a growing health problem worldwide&#44; affecting approximately 10&#37;&#8210;16&#37; of the adult population worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The prevalence of CKD in China has reached 10&#46;8&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> and the number of Maintenance Hemodialysis &#40;MHD&#41; patients is also gradually increasing&#46; MHD patients are more likely to have vascular calcifications<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> and Coronary Artery Calcification &#40;CAC&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4-6</span></a> In light of this&#44; evaluating and preventing CAC is becoming increasingly important&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">CAC is not a simple precipitation of calcium and phosphorus&#44; but an active and constantly changing process&#44;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> which is currently thought to be the deposition of an organized extracellular matrix caused by osteoblast-like cells&#46; It is formed when Vascular Smooth Muscle Cells &#40;VSMCs&#41; undergo transdifferentiation as a result of factors such as hyperphosphatemia&#46; VSMCs produce a matrix composed of collagen and non-collagen proteins&#46; If pro-mineralization factors exceed inhibitory factors&#44; the lesion will be mineralized&#44;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> and the imbalance between pro-mineralization factors &#40;hyperphosphatemia&#44; inflammation&#41; and the inhibitory factors &#40;fetuin-A and others&#41; ultimately leads to vascular calcification even in early CKD&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">An aging suppressor gene named Klotho was first reported in 1997&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> As an FGF-23 co-receptor&#44; Klotho is primarily expressed in the choroid plexus&#44; distal convoluted tubules&#44; and parathyroid glands&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> Various aging-related disorders have been linked to Klotho&#44; including organ atrophy&#44; premature atherosclerosis&#44; calcified vascular and soft tissues&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0012" class="elsevierStylePara elsevierViewall">The 62-kilodalton glycoprotein&#44; feluin-A&#44; is a cystatin-family member&#46; As secreted from the liver&#44; the 349-amino acid protein consists of a heavy and light chain that is joined and linked&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Two cystatin domains exist at the N-terminus of the heavy chain&#44; D1 and D2&#46; Acidic amino acids in the D1 domain are believed to be responsible for the ability of fetuin to inhibit calcium and phosphorus precipitation&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> It is mainly due to fetuin-A that serum prevents calcium and phosphorus precipitation <span class="elsevierStyleItalic">in vitro</span>&#46; Currently&#44; fetuin-A is recognized as an active regulator of osteogenesis within the vessels&#46; Fetuin-A binds to annexin II and I on cell surfaces in the presence of calcium&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> As a result of this binding&#44; fetuin-A can enter the endosomes within VSMCs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Fetuin-A inhibits VMSC apoptosis intracellularly&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> Furthermore&#44; it inhibits mineralization and suppresses calcium phosphate nucleation&#46;<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> In addition&#44; fetuin-A inhibits bone morphogenetic protein-2&#44; a key osteogenic protein that triggers the transdifferentiation of calcifying vascular cells&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">A vascular calcification inhibitor&#44; Matrix Gla Protein &#40;MGP&#41;&#44; depends on vitamin K for its activation&#46; A higher plasma level of desphospho-uncarboxylated MGP &#40;indicative of poor vascular vitamin K status&#41; is linked with an increased cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> MGP levels have been demonstrated to be high in Maintenance Hemodialysis &#40;MHD&#41; patients&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0014" class="elsevierStylePara elsevierViewall">However&#44; the effects of serum Klotho&#44; fetuin-A&#44; and MGP levels on CAC and the predictive value of these biomarkers in MHD patients are unclear&#46; This study investigated Klotho&#44; fetuin-A&#44; and MGP in CAC in MHD patients&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Research objects</span><p id="para0015" class="elsevierStylePara elsevierViewall">100 patients receiving MHD in Yantaishan Hospital were selected&#46; MHD was performed with bicarbonate dialysate containing 1&#46;5 mmoL&#47;L Ca<span class="elsevierStyleSup">2&#43;</span> on a polysulfone membrane dialyzer&#46; Blood flow was 200&#8210;250 mL&#47;min&#44; dialysate flow rate was 500 mL&#47;min&#44; and dialysate temperature was 37&#176;C&#46; The anticoagulant treatment was conventional heparin or low molecular-weight heparin&#46; MHD was generally performed 4&#8210;5h per time&#44; 2&#8210;3 times a week&#46; An autologous arteriovenous fistula was established as vascular access&#46; Patients with hypoproteinemia&#44; active hectic diseases&#44; hepatobiliary disease&#44; severe infection&#44; gastrointestinal bleeding&#44; retinal bleeding&#44; or other active bleeding conditions were excluded&#46; Patients were divided into 3 groups according to CAC scores &#40;0&#8210;100&#44; 100&#8210;400&#44; and &#62; 400&#41;&#46; Basic clinical data were recorded&#46; This study was an observational clinical study following the Strengthening the Reporting of Observational Studies in Epidemiology &#40;STROBE&#41; guidelines&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Biochemical analysis</span><p id="para0016" class="elsevierStylePara elsevierViewall">Fasting venous blood was collected to detect hemoglobin&#44; Albumin &#40;Alb&#41;&#44; blood calcium&#44; and blood phosphorus levels&#46; Totalcalcium&#40;mgdL&#41;&#61;totalcalcium&#43;0&#46;8&#215;&#91;4&#8722;Alb&#40;mgdL&#41;&#93;&#46; The corrected total calcium is used to calculate the calcium-phosphorus product&#46; Dialysis adequacy was evaluated by calculating the ratio of urea clearance to Volume &#40;Kt&#47;V&#41;&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Serum Klotho&#44; fetuin-A&#44; and MGP levels</span><p id="para0017" class="elsevierStylePara elsevierViewall">Fasting venous blood was centrifuged and cryopreserved for follow-up testing&#46; Serum Klotho&#44; fetuin-A and MGP levels were detected by ELISA&#44; and then the correlation between serum Klotho&#44; fetuin-A and MGP levels and CAC in MHD patients was analyzed&#46; Specifically&#44; serum Klotho levels were detected using an ELISA kit &#40;IBL-International&#44; Japan&#41;&#46; Klotho in all samples exceeded the detection limit of 6 pg&#47;mL&#46; Intra-assay and inter-assay variations were 3&#46;6&#37; and 3&#46;2&#37; for the Klotho standard and 2&#46;8&#37; and 3&#46;6&#37; for the human sample&#44; respectively&#46; Serum fetuin-A levels were detected using an ELISA kit &#40;Bio-Swamp&#44; USA&#41;&#46; The mean intra-assay and inter-assay variations were 5&#46;6&#37; and 6&#46;2&#37;&#44; respectively&#46; The reference range for healthy adults is 0&#46;5&#8210;1&#46;0 g&#47;L&#44; with a minimum sensitivity of 2&#46;5 ng&#47;mL&#46; Serum MGP levels were detected using an ELISA kit &#40;Bio-Swamp&#41;&#46; Intra-assay and inter-assay variations were 5&#46;4&#37; and 7&#46;2&#37;&#44; respectively&#46; The lower limit is 5 pg&#47;mL&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Isolation of peripheral blood mononuclear cells &#40;PBMCs&#41;</span><p id="para0018" class="elsevierStylePara elsevierViewall">Venous blood &#40;1&#46;5 mL&#41; was diluted with phosphate buffer at 1&#58;1 and transferred into a centrifuge tube containing 3 mL Ficoll Paque &#40;GE Healthcare&#44; Uppsala&#44; Sweden&#41;&#46; PBMCs were collected after centrifugation at 400&#215; g at room temperature for 20 min and rinsed twice in 10 mL PBS&#46; PBMCs were re-suspended in a lysis buffer for protein extraction&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Western blot</span><p id="para0019" class="elsevierStylePara elsevierViewall">The protein expression levels of Klotho&#44; fetuin-A and MGP in PBMCs of MHD patients were detected by Western blot&#44; which in turn increased the reliability of the results of serum Klotho&#44; fetuin-A and MGP levels&#46; The cell lysate was prepared&#44; and the protein concentration was detected by the BCA protein detection reagent&#46; Protein &#40;10&#8210;30 &#956;g&#41; was electrophoresed on an 8&#37; or 12&#37; SDS-polyacrylamide gel&#44; transferred to a PVDF membrane&#44; and sealed at room temperature for 2h in 5&#37; skim milk containing PBST&#46; Subsequently&#44; the membrane was incubated with the primary antibody at 4&#176;C overnight and then re-detected with HRP-bound secondary antibody &#40;1&#58;3000&#41; for 2h&#46; Protein expression was finally shown using the ECL kit&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">CAC score</span><p id="para0020" class="elsevierStylePara elsevierViewall">CT scans were performed using 64-slice spiral technology &#40;Lightspeed VCT&#44; USA&#41;&#46; Continuous images were acquired by plain axial scan combined with retrospective electrocardio gram gating during diastole of the cardiac cycle from the carina to the apex&#46; At 60&#37;&#8210;80&#37; R-R interval&#44; the images were obtained during a single breath-hold&#46; Plain 3&#46;0-mm images were reconstructed at a 40&#37; R-R interval in the diastolic phase&#46; CAC scores were calculated using SmartScore software &#40;GE Healthcare&#44; USA&#41;&#46; Attenuation values over 130 hounsfield units were considered to be the cut-off point for calcification lesions&#46; Areas greater than 0&#46;5 mm<span class="elsevierStyleSup">2</span> were considered calcified&#46; Left main&#44; Left Anterior Descending &#40;LAD&#41;&#44; Left Circumflex &#40;LCX&#41;&#44; and right coronary artery were marked for calcification&#46; LAD calcification refers to the calcification of diagonal branches&#44; while LCX calcification refers to obtuse marginal branches&#46; Total CAC scores were calculated automatically&#46; CT scan &#40;512&#215;512 matrix&#59; 25&#8210;28 cm filed of view&#41;&#58; peak voltage at 120 KV&#44; tube current at 450 mA&#44; collimator width of 1&#46;5 mm&#44; pitch of 0&#46;24&#44; scanning time for 5&#8210;8s&#44; gantry rotation time for 0&#46;35s&#44; slice thickness of 2&#46;5 mm&#44; and reconstruction interval of 2&#46;5 mm&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Carotid intima-media thickness &#40;IMT&#41; measurement</span><p id="para0021" class="elsevierStylePara elsevierViewall">Common Carotid Artery &#40;CCA&#41; was examined from both longitudinal and transverse angles using a color Doppler ultrasound system &#40;LOGIC 9&#44; General Electric&#41;&#46; During the left ventricular diastolic period&#44; CCA images at 1&#46;5&#8210;2 cm below the carotid sinus were obtained&#46; Measurements were repeated for 3 cardiac cycles on each side&#46; There are two parallel bright lines in the posterior wall of CCA&#44; and the echo intensity was relatively low&#46; IMT was calculated based on the vertical distance between the two lines&#44; which is the average of six carotid artery measurements&#46; It was the same sonographer who performed each scan&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Statistical analysis</span><p id="para0022" class="elsevierStylePara elsevierViewall">Analyses were performed with SPSS 16&#46;0 software&#46; Two-sided tests were used for all statistical inferences&#59; p &#60; 0&#46;05 was considered statistically significant&#46; If the data fit the homogeneity of variance and the normal distribution&#44; the comparison was done with an independent sample <span class="elsevierStyleItalic">t</span>-test&#59; if not&#44; the Wilcoxon rank sum test was used&#46; One-way analysis of variance was used for comparison among groups&#44; and the least significant difference method was for that between two means&#46; Variance heterogeneity data were assessed by the Wilcoxon rank sum test&#46; Continuous variables were analyzed by Principal Component Analysis &#40;PCA&#41;&#44; and categorical variables were analyzed by Multiple Correspondence Analysis &#40;MCA&#41; to build a random forest model to assess the importance of each variable&#46; Then&#44; multiple stepwise regression analysis was performed with CAC score as the dependent variable and gender &#40;female &#61; 0&#44; male &#61; 1&#41;&#44; age&#44; BMI&#44; dialysis vintage&#44; Kt&#47;V&#44; IMT&#44; blood calcium level&#44; blood phosphorus level&#44; calcium-phosphorus product&#44; iPTH&#44; Klotho&#44; fetuin-A&#44; and MGP as independent variables&#46; Partial regression coefficient and 95&#37; CI were calculated&#46; The Receiver Operating Characteristic &#40;ROC&#41; curve was plotted and Area Under the Curve &#40;AUC&#41; was analyzed&#46;</p></span></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Results</span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Patient baseline characteristics</span><p id="para0023" class="elsevierStylePara elsevierViewall">Among the 100 patients&#44; 46 &#40;46&#46;00&#37;&#41; were males and 54 &#40;54&#46;00&#37;&#41; were females&#46; The mean age was 60&#46;40&#177;11&#46;50 years&#44; and the mean dialysis vintage was 6&#46;79&#177;2&#46;85 years&#46; The top 3 underlying diseases were chronic glomerulonephritis &#40;26 cases&#44; 26&#46;00&#37;&#41;&#44; diabetes &#40;18 cases&#44; 18&#46;00&#37;&#41;&#44; and hypertensive nephropathy &#40;14 cases&#44; 14&#46;00&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">CAC scores</span><p id="para0024" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> summarizes the characteristics of patients in the three defined groups of CAC scores 0&#8210;100&#44; 100&#8210;400&#44; and &#62; 400&#46; There were significant differences in BMI&#44; dialysis vintage&#44; Kt&#47;V&#44; IMT&#44; blood phosphorus&#44; calcium-phosphorus product&#44; Klotho&#44; fetuin-A&#44; and MGP&#46; With the increase of CAC score&#44; MHD patients had increased dialysis vintage&#44; higher BMI&#44; IMT&#44; blood phosphorus levels&#44; calcium-phosphorus product&#44; and lower Kt&#47;V&#46; The serum levels of Klotho&#44; fetuin-A and MGP in MHD patients were measured by ELISA&#46; With the increase in CAC score&#44; serum MGP showed an increasing trend&#44; and serum Klotho and fetuin-A showed a decreasing trend&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Klotho&#44; fetuin-A&#44; and MGP proteins in three defined groups of CAC scores</span><p id="para0025" class="elsevierStylePara elsevierViewall">Klotho&#44; fetuin-A&#44; and MGP protein expression levels in PBMCs of MHD patients in different CAC score groups were detected by Western blot&#46; With the increase of CAC score&#44; Klotho and fetuin-A proteins gradually decreased&#44; while MGP proteins gradually increased &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a> A&#8210;B&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Analysis of influencing factors of CAC in MHD patients</span><p id="para0026" class="elsevierStylePara elsevierViewall">Multiple stepwise regression analysis with CAC score as the dependent variable and gender &#40;female &#61; 0&#44; male &#61; 1&#41;&#44; age&#44; BMI&#44; dialysis vintage&#44; Kt&#47;V&#44; IMT&#44; blood calcium level&#44; blood phosphorus level&#44; calcium-phosphorus product&#44; iPTH&#44; Klotho&#44; fetuin-A&#44; and MGP as independent variables showed that after controlling gender and age&#44; dialysis vintage&#44; blood phosphorus&#44; serum Klotho&#44; fetuin-A&#44; and MGP were independent risk factors for CAC in MHD patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Diagnostic value of serum Klotho&#44; fetuin-A&#44; and MGP for CAC in patients with MHD</span><p id="para0027" class="elsevierStylePara elsevierViewall">ROC curves were drawn to analyze the value of serum Klotho&#44; fetuin-A&#44; and MGP levels in predicting CAC in MHD patients&#46; The AUC of serum Klotho&#44; fetuin-A&#44; and MGP was 0&#46;777&#44; 0&#46;744&#44; and 0&#46;815&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a> A&#8210;C&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia></span></span><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0024">Discussion</span><p id="para0028" class="elsevierStylePara elsevierViewall">Vascular calcification is common in patients with MHD&#46; Data showed that 27&#37; of patients receiving dialysis for 1 year found vascular calcification&#44; and the incidence increased to 83&#37; of patients receiving dialysis for more than 8 years&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> One hundred MHD patients with dialysis vintage of 6&#46;79 &#177; 2&#46;85 years were included in this study&#44; of which 20 &#40;20&#46;00&#37;&#41;&#44; 25 &#40;25&#46;00&#37;&#41; and 55 &#40;55&#46;00&#37;&#41; had CAC scores of 0&#8210;100&#44; 100&#8210;400 and &#62; 400&#44; respectively&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">MHD patients often have renal phosphorus metabolism disorder&#44; and intake of phosphorus-rich foods results in phosphorus retention and stimulate iPTH secretion&#46; Calcium and phosphorus can be released from bones into the extracellular space due to excess iPTH&#44; aggravating hyperphosphatemia&#44; which is associated with vascular calcification&#46; Hyperphosphatemia&#44; calcium-phosphorus accumulation&#44; and high calcium intake are associated with CAC&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Vascular calcification can be alleviated by applying sevelamer hydrochloride actively to correct hyperphosphatemia&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> It has been indicated that inorganic phosphorus not only induces the transformation of VSMCs to osteoblast-like cells but stimulates osteoblast proliferation&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> It would seem that hyperphosphatemia may cause vascular walls to thicken&#44; resulting in vascular calcification in patients with MHD&#46; MHD and serum calcium and phosphorus levels are independent risk factors for CAC&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> For every 0&#46;322 mmoL&#47;L increase in blood phosphorus levels&#44; the risk of developing CAC is comparable to that of 2&#46;5 years of hemodialysis&#46; According to a systematic review&#44; dialysis duration and age are the most significant risk factors for CAC&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> In this study&#44; the authors found that dialysis vintage and blood phosphorus levels were risk factors for the development of CAC&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">The renal protective mechanism of Klotho against CKD has been reported previously&#46; Klotho gene manipulation can improve renal function in mice with progressive kidney injury&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Renal fibrosis is associated with Klotho deficiency&#44; and Klotho treatment could prevent fibrotic kidney changes in mice&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Klotho deletion results in increased renal inflammation through RelA &#40;Serine&#41;<span class="elsevierStyleSup">536</span> phosphorylation&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a> In addition&#44; Klotho can improve vascular calcification&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> In this study&#44; serum fetuin-A levels were inversely associated with the severity of CAC&#46; In addition&#44; Klotho protein expression in PBMCs from MHD patients gradually decreased with increasing CAC score&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">During arterial calcification&#44; fetuin-A acts as a calcification inhibitor&#46; It has been reported that serum fetuin-A level is negatively associated with CAC in 30 MHD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> Moreover&#44; serum fetuin-A levels are reduced in patients with calcification scores &#62; 5&#44; and serum fetuin-A &#60; 0&#46;29 g&#47;L is associated with the risk of cardiovascular calcification progression&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Moreover&#44; the volume of coronary plaque in MHD patients is significantly larger&#46;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> Similar to studies in MHD patients&#44; serum fetuin-A i also significantly correlated with CAC score in non-dialysis ESRD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> This study found that serum fetuin-A level was negatively correlated with the severity of CAC&#44; which was consistent with the above studies&#46; In addition&#44; fetuin-A protein expression in PBMCs from MHD patients gradually decreased with increasing CAC score&#46;</p><p id="para0032" class="elsevierStylePara elsevierViewall">MGP can regulate intrachondral bone formation and vascular calcification and is associated with the downregulation of calcium deposition in the extracellular matrix of soft tissues&#46; It has been suggested that elevated serum uncarboxylated MGP &#40;ucMGP&#41; is associated with aortic calcification&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> A negative correlation exists between ucMGP level and CAC in patients with CKD&#46; UcMGP can be used as a proxy for the presence of vascular calcification&#46; Another study<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> has shown that baseline ucMGP levels are higher in MHD patients than normal&#46; This study found that serum MGP level was positively correlated with the severity of CAC&#46; In addition&#44; MGP protein expression in PBMCs from MHD patients gradually increased with increasing CAC score&#46;</p><p id="para0033" class="elsevierStylePara elsevierViewall">In addition&#44; the authors found that serum Klotho&#44; fetuin-A&#44; and MGP were biomarkers for the recognition of CAC in MHD patients with high sensitivity and specificity&#44; indicating values for clinically predicting CAC&#46;</p></span><span id="sec0018" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0025">Conclusion</span><p id="para0034" class="elsevierStylePara elsevierViewall">In conclusion&#44; serum Klotho&#44; fetuin-A&#44; and MGP were closely associated with the severity of CAC in MHD patients and were expected to be promising diagnostic markers for CAC in MHD patients&#46;</p></span><span id="sec0019" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0026">Ethics approval</span><p id="para0035" class="elsevierStylePara elsevierViewall">The present study was approved by the Ethics Committee of Yantaishan Hospital and written informed consent was provided by all patients prior to the study start&#46; All procedures were performed in accordance with the ethical standards of the Institutional Review Board and The Declaration of Helsinki&#44; and its later amendments or comparable ethical standards &#40;201906GZ4&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0027">Data available</span><p id="para0036" class="elsevierStylePara elsevierViewall">Data is available from the corresponding author on request&#46;</p></span><span id="sec0021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0028">Authors&#39; contributions</span><p id="para0037" class="elsevierStylePara elsevierViewall">Dan Wang and XiuLin Chu the initiator of the study conducted the main experimental part&#44; described the results&#44; and wrote the article&#46; JuHua Cao performed the statistical calculations&#44; and participated in drafting of the manuscript&#46; Dan Wang and YunHua Peng participated in collecting the research material&#46; Lei Wang supervised the work&#46;</p></span></span>"
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          "identificador" => "xres2291028"
          "titulo" => "Abstract"
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              "titulo" => "Objective"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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              "titulo" => "Serum Klotho&#44; fetuin-A&#44; and MGP levels"
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              "titulo" => "Isolation of peripheral blood mononuclear cells &#40;PBMCs&#41;"
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              "titulo" => "Western blot"
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              "titulo" => "CAC score"
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              "titulo" => "Carotid intima-media thickness &#40;IMT&#41; measurement"
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              "titulo" => "Patient baseline characteristics"
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              "titulo" => "CAC scores"
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              "titulo" => "Klotho&#44; fetuin-A&#44; and MGP proteins in three defined groups of CAC scores"
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              "titulo" => "Analysis of influencing factors of CAC in MHD patients"
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              "titulo" => "Diagnostic value of serum Klotho&#44; fetuin-A&#44; and MGP for CAC in patients with MHD"
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    "fechaRecibido" => "2023-10-18"
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            1 => "Klotho"
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    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara006" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Serum Klotho&#44; fetuin-A&#44; and MGP were independent risk factors for CAC&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">Serum Klotho&#44; fetuin-A&#44; and MGP were valuable in the diagnosis of CAC in MHD patients&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0004" class="elsevierStylePara elsevierViewall">There is a close relationship between Klotho&#44; fetuin-A&#44; and MGP levels in MHD patients and CAC&#46;</p></li></ul></p></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Objective</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">This study was to investigate the role of serum Klotho&#44; fetuin-A&#44; and Matrix Gla Protein &#40;MGP&#41; in Coronary Artery Calcification &#40;CAC&#41; in patients with Maintenance Hemodialysis &#40;MHD&#41; and their predictive value for CAC&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Methods</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">100 patients receiving MHD were selected&#46; Serum Klotho&#44; fetuin-A&#44; and MGP levels were detected by ELISA&#46; CAC scores were assessed by coronary CT scan&#46; Multifactor analysis was used to evaluate the risk factors affecting CAC&#46; The ability of serum Klotho&#44; fetuin-A&#44; and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Results</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Serum Klotho&#44; fetuin-A&#44; and MGP were independent risk factors for CAC&#46; Serum Klotho&#44; fetuin-A&#44; and MGP were valuable in the diagnosis of CAC in MHD patients&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Conclusion</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">There is a close relationship between Klotho&#44; fetuin-A&#44; and MGP levels in MHD patients and CAC&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abss0002"
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          ]
          1 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss0005"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="notep0001">Equal contributions to this study&#46;</p>"
        "identificador" => "fn1"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 959
            "Ancho" => 2167
            "Tamanyo" => 111596
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Klotho&#44; fetuin-A&#44; and MGP proteins in three defined groups of CAC scores&#46; &#40;A&#8210;B&#41; Protein expressions of Klotho&#44; fetuin-A&#44; and MGP in three defined groups of CAC scores were detected by Western blot&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0002"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 773
            "Ancho" => 3250
            "Tamanyo" => 144524
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Diagnostic value of serum Klotho&#44; fetuin-A&#44; and MGP in CAC in MHD patients&#46; &#40;A&#8210;C&#41; ROC curve analysis of serum Klotho&#44; fetuin-A&#44; and MGP levels to predict CAC in MHD patients&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Table "
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          ]
        ]
        "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"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">MHD &#40;n &#61; 100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Gender &#40;male&#47;female&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#47;54 &#40;46&#46;00&#37;&#47;54&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;4 &#177; 11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Body mass index &#40;kg&#47;m2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22&#46;64 &#177; 0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Dialysis vintage &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;79 &#177; 2&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Chronic glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26 &#40;26&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Diabetic nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18 &#40;18&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Hypertensive nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14 &#40;14&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Polycystic kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;7&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Chronic interstitial nephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;6&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Uric acid nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;5&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Obstructive nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;4&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Unknown etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 &#40;20&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">General data and medical history of patients&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0004"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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"><a name="en0027"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="1" align="left" valign="top" scope="col"></th><a name="en0028"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">CAC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0029"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">CAC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0030"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">CAC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0031"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="1" align="left" valign="top" scope="col"></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0033"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">0&#8210;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0034"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">100&#8210;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0035"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&#62; 400&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
                  \t\t\t\t\ttop\n
                  \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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0038"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;n &#61; 20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0039"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;n &#61; 25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0040"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;n &#61; 55&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CAC score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">48&#46;32 &#177; 18&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">238&#46;77 &#177; 85&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1076&#46;84 &#177; 340&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Gender &#40;male&#47;female&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&#47;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&#46;85 &#177; 7&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;24 &#177; 6&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;67 &#177; 6&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;895&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">BMI &#40;kg&#47;m2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&#46;45 &#177; 0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22&#46;30 &#177; 0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">23&#46;23 &#177; 0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Dialysis vintage &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;20 &#177; 0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;10 &#177; 0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;50 &#177; 0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Kt&#47;V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;28 &#177; 0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;24 &#177; 0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;20 &#177; 0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">IMT &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;76 &#177; 0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;82 &#177; 0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;95 &#177; 0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Hb &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">112&#46;16 &#177; 8&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;94 &#177; 9&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;36 &#177; 9&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Alb &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">39&#46;34 &#177; 3&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">38&#46;51 &#177; 4&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">39&#46;08 &#177; 4&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;803&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calcium &#40;mmoL&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;12 &#177; 0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;09 &#177; 0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;06 &#177; 0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phosphorus &#40;mmoL&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;72 &#177; 0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;95 &#177; 0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;24 &#177; 0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Calcium-phosphorus product &#40;mmoL2&#47;L2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#177; 0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;08 &#177; 0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;61 &#177; 0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Klotho &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">545&#46;18 &#177; 64&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">526&#46;34 &#177; 52&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">501&#46;75 &#177; 46&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fetuin-A &#40;mg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">94&#46;18 &#177; 6&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;49 &#177; 4&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">69&#46;54 &#177; 3&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">MGP &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">170&#46;07 &#177; 17&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">204&#46;15 &#177; 13&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">309&#46;51 &#177; 10&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3711725.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Comparison of coronary artery calcification parameters in different groups&#46;</p>"
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      4 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
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        "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"><a name="en0117"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><a name="en0118"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B</th><a name="en0119"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37;CI</th><a name="en0120"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value</th></tr><tr title="table-row"><a name="en0123"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0124"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Dialysis vintage &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">19&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Phosphorus &#40;mmoL&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Klotho &#40;pg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Fetuin-A &#40;mg&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-9&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-21&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">-5&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;039&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos