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ORIGINAL
Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC
Prevalence rates of chronic kidney disease and its association with cardiometabolic factors and cardiovascular diseases. SIMETAP-CKD study
Antonio Ruiz-Garciaa,1,
Autor para correspondencia
antoniodoctor@gmail.com

Autor para correspondencia.
, Ezequiel Arranz-Martínezb,1, Nerea Iturmendi-Martínezc, Teresa Fernández-Vicented, Montserrat Rivera-Teijidoe, Juan Carlos García-Álvareze
a Lipids and Cardiovascular Prevention Unit, Centro de Salud Universitario Pinto, Pinto, Madrid, España
b Centro de Salud San Blas, Parla, Madrid, España
c Centro de Salud Argüelles, Madrid, España
d Centro de Salud Torrejón de la Calzada, Torrejón de la Calzada, Madrid, España
e Centro de Salud Universitario Dr. Mendiguchía-Carriche, Leganés, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La insuficiencia o enfermedad renal cr&#243;nica &#40;ERC&#41; se caracteriza por un deterioro gradual de la funci&#243;n de filtrado&#44; eliminaci&#243;n de toxinas y control del volumen del organismo&#44; que puede favorecer el desarrollo de problemas cardiovasculares como la insuficiencia card&#237;aca y la enfermedad cardiovascular arterioscler&#243;tica &#40;ECVA&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La ERC es un importante problema de salud p&#250;blica&#44; cuya carga de enfermedad est&#225; aumentando a escala mundial y est&#225; vinculada a graves resultados de salud&#44; mala calidad de vida y elevados costes de la atenci&#243;n&#44; sobre todo&#44; los derivados del tratamiento renal sustitutivo que precisan los pacientes con enfermedad renal en etapa terminal &#40;ERT&#41;&#44; por lo que es necesario reorientar la estrategia hacia una detecci&#243;n precoz y tratamiento temprano con el objeto de mejorar los resultados de salud y disminuir la necesidad de tratamiento renal sustitutivo<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La ERC constituye por s&#237; misma un factor de riesgo cardiovascular &#40;FRCV&#41;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a>&#46; Los pacientes con ERC asociada o no a otros FRCV tienen mayor probabilidad de mortalidad cardiovascular y por todas las causas<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a>&#46; La mortalidad aumenta exponencialmente a medida que empeora la funci&#243;n renal&#44; principalmente debida a causa cardiovascular<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a>&#46; Existe una marcada asociaci&#243;n entre el pron&#243;stico cl&#237;nico&#44; albuminuria y el filtrado glomerular estimado &#40;FGe&#41; reducido &#40;&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">2&#44;5</span></a>&#46; Los metaan&#225;lisis realizados por el Chronic Kidney Disease &#40;CKD&#41; Prognosis Consortium<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">6&#44;7</span></a> demostraron la asociaci&#243;n del FGe reducido y la presencia de albuminuria con un mayor riesgo de mortalidad global&#44; mortalidad cardiovascular&#44; fallo renal&#44; insuficiencia renal aguda y progresi&#243;n de la ERC tanto en la poblaci&#243;n general como en poblaciones con riesgo cardiovascular &#40;RCV&#41; alto&#44; independientemente de otros FRCV&#46; Las personas con ERC tienen de 5 a 10 veces m&#225;s probabilidades de morir prematuramente que de progresar a ERT&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Entre el 8 y el 16&#37; de la poblaci&#243;n mundial padece ERC&#44; aunque los datos difieren significativamente entre pa&#237;ses y regiones del mundo<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">3&#44;8&#8211;10</span></a>&#46; Durante las &#250;ltimas d&#233;cadas&#44; la prevalencia de ERC se ha incrementado por el aumento de la prevalencia de la hipertensi&#243;n arterial &#40;HTA&#41;&#44; obesidad y diabetes &#40;DM&#41;&#44; y por la mayor longevidad de la poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; La DM y la HTA son las principales causas de ERC en los pa&#237;ses con &#237;ndices sociodemogr&#225;ficos altos&#44; y en la mayor&#237;a de los pa&#237;ses con &#237;ndices bajos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a>&#46; Aunque est&#225; bien establecido que el manejo y el tratamiento adecuados de la DM&#44; HTA y dislipidemia son efectivos para retrasar la progresi&#243;n de la ERC<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">11&#8211;13</span></a>&#44; la incidencia de los principales episodios adversos cardiovasculares y renales contin&#250;a siendo alta en los pacientes con ERC&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En la conferencia de KDIGO &#40;Kidney Disease&#58; Improving Global Outcomes&#41; titulada <span class="elsevierStyleItalic">Identificaci&#243;n e intervenci&#243;n tempranas en la ERC</span><a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a>&#44; se identificaron estrategias para la detecci&#243;n&#44; cribado&#44; estratificaci&#243;n del riesgo y tratamiento &#243;ptimo y precoz de la ERC&#44; como la promoci&#243;n de estilos saludables de vida y el control de los principales FRCV&#44; con el fin de retardar o retrasar su progresi&#243;n&#44; disminuir las complicaciones y la carga de la enfermedad&#46; Los participantes consensuaron que estas medidas deb&#237;an implementarse de inmediato para las personas de riesgo alto y que&#44; idealmente&#44; esto deber&#237;a ocurrir en el &#225;mbito de la atenci&#243;n primaria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los objetivos del estudio SIMETAP-ERC fueron determinar en la poblaci&#243;n adulta las tasas de prevalencia cruda y ajustada por edad y sexo de ERC seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#44; valorando la albuminuria y el FGe seg&#250;n la ecuaci&#243;n Chronic Kidney Disease EPIdemiology collaboration &#40;CKD-EPI&#41;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#44; y evaluar las asociaciones existentes entre la ERC y factores cardiometab&#243;licos y enfermedades cardiovasculares&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">SIMETAP-ERC es un estudio observacional transversal&#44; autorizado por el Servicio de Salud de la Comunidad de Madrid &#40;SERMAS&#41;&#44; en el que participaron 121 m&#233;dicos de familia seleccionados competitivamente hasta alcanzar el tama&#241;o muestral necesario&#44; pertenecientes a 64 centros de atenci&#243;n primaria &#40;25&#37; de los centros de salud del SERMAS&#41;&#46; Se realiz&#243; un muestreo aleatorio simple del 5&#44;45&#37; de toda la poblaci&#243;n diana con 18 o m&#225;s a&#241;os &#40;194&#46;073 adultos&#41; asignada a los m&#233;dicos de atenci&#243;n primaria del SERMAS que participaban en el estudio&#44; mediante tablas de n&#250;meros aleatorios extra&#237;das mediante la funci&#243;n Excel ALEATORIO&#46;ENTRE&#40;inferior&#44; superior&#41;&#46; La informaci&#243;n sobre el material y m&#233;todos del estudio SIMETAP se detallaron en una publicaci&#243;n previa<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">16</span></a>&#46; Por protocolo&#44; se excluy&#243; a pacientes terminales&#44; institucionalizados&#44; con deterioro cognitivo&#44; embarazadas o sujetos sin informaci&#243;n de variables bioqu&#237;micas&#46; Se obtuvo el consentimiento informado de los sujetos del estudio&#44; con una tasa de respuesta del 65&#44;8&#37;&#44; reclut&#225;ndose 6&#46;588 sujetos de estudio con informaci&#243;n cl&#237;nica y de laboratorio suficiente para ser evaluados&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se consideraron las siguientes variables&#58; &#237;ndice de masa corporal &#40;IMC&#41;&#58; peso&#47;talla<span class="elsevierStyleSup">2</span> &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#59; sobrepeso&#58; IMC 25&#8211;29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; obesidad&#58; IMC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; adiposidad o &#237;ndice de grasa corporal CUN-BAE &#40;Cl&#237;nica Universitaria de Navarra-Body Adiposity Estimator&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">17</span></a> &#40;&#8722;44&#44;988<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#91;0&#44;503<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#91;10&#44;689<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>sexo&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#91;3&#44;172<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC&#93;&#8211;&#91;0&#44;026<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span>&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#91;0&#44;181<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>sexo&#93;&#8211;&#91;0&#44;02<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#93;&#8211;&#91;0&#44;005<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>sexo&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#91;0&#44;00021<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>IMC<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>edad&#93;&#41; sexo &#40;masculino<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44; femenino<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#59; CUN-BAE-obesidad &#40;&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#91;hombres&#93;&#59; &#62;<span class="elsevierStyleHsp" style=""></span>35&#37; &#91;mujeres&#93;&#41;&#59; obesidad abdominal&#58; per&#237;metro abdominal aumentado &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm &#91;hombres&#93;&#59; &#8805;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm &#91;mujeres&#93;&#41;&#59; &#237;ndice cintura-talla &#40;ICT&#41;&#58; per&#237;metro abdominal&#47;talla&#59; ICT aumentado&#58; ICT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;55&#59; HTA&#58; presi&#243;n arterial sist&#243;lica &#40;PAS&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>mmHg y&#47;o presi&#243;n arterial diast&#243;lica &#40;PAD&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; o tener tratamiento antihipertensivo&#59; hipercolesterolemia&#58; colesterol total<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; hipertrigliceridemia&#58; triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; colesterol unido a lipoprote&#237;nas de alta densidad &#40;c-HDL&#41;&#59; c-HDL bajo&#58; c-HDL<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41;&#44; &#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#59; colesterol no unido a HDL &#40;c-no-HDL&#41;&#59; colesterol unido a lipoprote&#237;nas de baja densidad &#40;c-LDL&#41;&#59; colesterol unido a lipoprote&#237;nas de muy baja densidad y remanentes &#40;c-VLDL&#41;&#59; &#237;ndice aterog&#233;nico de plasma&#58; log &#40;TG&#47;c-HDL&#41;&#46; &#205;ndice TG y glucosa &#40;ITyG&#41;&#58; Ln &#91;TGxGPA&#47;2&#93;&#59; dislipidemia aterog&#233;nica&#58; HTG y c-HDL bajo&#59; DM seg&#250;n la Asociaci&#243;n Americana de Diabetes &#40;ADA&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a>&#58; glucosa plasm&#225;tica en ayunas &#40;GPA&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>126<span class="elsevierStyleHsp" style=""></span>mg&#47;dL o hemoglobina glucada A1c &#40;HbA1c&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#37; determinada mediante m&#233;todos estandarizados <span class="elsevierStyleItalic">&#40;National Glycohemoglobin Standardization Program&#41;</span> seg&#250;n DCCT &#40;por sus siglas en ingl&#233;s <span class="elsevierStyleItalic">Diabetes Control and Complications Trial</span>&#41; o determinaci&#243;n de glucosa plasm&#225;tica<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL a cualquier hora o con prueba de tolerancia oral a la glucosa&#59; prediabetes en individuos sin DM seg&#250;n la ADA<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> &#40;GPA entre 100 y 125<span class="elsevierStyleHsp" style=""></span>mg&#47;dL o HbA1c entre 5&#44;7 y 6&#44;4&#37;&#41; y seg&#250;n la Sociedad Espa&#241;ola de Diabetes &#40;SED&#41;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a> &#40;GPA entre 110 y 125<span class="elsevierStyleHsp" style=""></span>mg&#47;dL o HbA1c entre 6 y 6&#44;4&#37;&#41;&#59; s&#237;ndrome metab&#243;lico&#58; seg&#250;n consenso armonizado IDF&#47;NHLBI&#47;AHA&#47;WHF&#47;IAS&#47;IASO<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a>&#59; ECVA&#58; enfermedad coronaria &#40;EC&#41;&#44; enfermedad cerebrovascular &#40;ictus&#41;&#44; enfermedad arterial perif&#233;rica &#40;EAP&#41;&#59; EC&#58; cardiopat&#237;a isqu&#233;mica&#44; infarto agudo de miocardio&#44; s&#237;ndrome coronario agudo&#44; revascularizaci&#243;n coronaria&#59; ictus&#58; isquemia cerebral&#44; hemorragia intracraneal&#44; ataque isqu&#233;mico transitorio&#59; EAP&#58; claudicaci&#243;n intermitente&#44; &#237;ndice tobillo-brazo<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;9&#59; categor&#237;as de RCV &#40;bajo&#44; moderado&#44; alto y muy alto&#41; seg&#250;n SCORE<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">21</span></a> y SCORE-OP<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> para pa&#237;ses de bajo riesgo&#59; FGe seg&#250;n la ecuaci&#243;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#59; categor&#237;as de FGe seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#58; G1 &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; G2 &#40;60&#8211;89<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; G3a &#40;45&#8211;59<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; G3b &#40;30&#8211;44<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; G4 &#40;15-29<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; y G5 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#59; FGe reducido&#58; FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; categor&#237;as de cociente alb&#250;mina-creatinina en orina &#40;CAC&#41; seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#58; A1 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#59; A2 &#40;30&#8211;300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#59; A3 &#40;&#62;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#59; albuminuria&#58; CAC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#46; ERC<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#58; FGe reducido y&#47;o albuminuria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el programa Statistical Package for the Social Sciences&#46; Las variables cualitativas se analizaron mediante porcentajes&#44; prueba chi-cuadrado&#44; y odds-ratios &#40;OR&#41;&#44; con intervalo de confianza al 95&#37; &#40;IC95&#37;&#41;&#46; Las variables continuas se evaluaron mediante media con desviaci&#243;n est&#225;ndar &#40;&#177;DE&#41; y prueba t-Student o el an&#225;lisis de varianza&#46; Se determinaron las medianas y rangos intercuart&#237;licos &#40;RIC&#41; de la variable edad y par&#225;metros renales&#46; Se determinaron las prevalencias crudas y las ajustadas por edad y sexo mediante m&#233;todo directo&#44; usando grupos etarios decenales estandarizados de la poblaci&#243;n espa&#241;ola en enero de 2015 seg&#250;n el Instituto Nacional de Estad&#237;stica<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para valorar el efecto individual de comorbilidades y FRCV sobre la variable dependiente ERC&#44; se realiz&#243; un an&#225;lisis multivariante de regresi&#243;n log&#237;stica mediante el m&#233;todo paso a paso hacia atr&#225;s <span class="elsevierStyleItalic">&#40;backward stepwise&#41;</span>&#44; introduciendo inicialmente en el modelo todas las variables que mostraran asociaci&#243;n en el an&#225;lisis univariado hasta un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;10&#44; excepto las variables CUN-BAE obesidad<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">17</span></a> y s&#237;ndrome metab&#243;lico<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a>&#44; por ser variables complejas cuyos criterios que los definen ya se inclu&#237;an en el an&#225;lisis&#59; y disfunci&#243;n er&#233;ctil&#44; por afectar solo a hombres&#46; Posteriormente&#44; se elimin&#243; en cada paso la variable que menos contribu&#237;a al ajuste del an&#225;lisis&#46; Todas las pruebas se consideraron estad&#237;sticamente significativas si el valor de p de 2 colas era inferior a 0&#44;05&#46; Se realiz&#243; una b&#250;squeda bibliogr&#225;fica en PubMed&#44; Medline&#44; Embase&#44; Google Scholar y Web of Science&#44; para comparar las tasas de prevalencia de ERC del presente estudio con otros similares publicados desde el a&#241;o 2001&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Poblaci&#243;n de estudio</span><p id="par0055" class="elsevierStylePara elsevierViewall">La poblaci&#243;n de estudio fue de 6&#46;588 adultos entre 18 y 102&#44;8 a&#241;os&#44; cuya media &#40;&#177;DE&#41; de edad era 55&#44;1 &#40;&#177;17&#44;5&#41; a&#241;os&#44; y la mediana &#40;RIC&#41; era 54&#44;69 &#40;41&#44;68&#8211;68&#44;09&#41; a&#241;os&#46; La diferencia del porcentaje entre hombres &#40;44&#44;1&#37; &#91;IC95&#37;&#58; 42&#44;9&#8211;45&#44;3&#37;&#93;&#41; y mujeres &#40;55&#44;9&#37; &#91;IC95&#37;&#58; 54&#44;7&#8211;57&#44;1&#37;&#93;&#41; era significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Las medianas &#40;RIC&#41; de edad de las poblaciones masculina y femenina eran 55&#44;0 &#40;42&#44;4&#8211;67&#44;5&#41; a&#241;os y 54&#44;5 &#40;41&#44;0&#8211;68&#44;8&#41; a&#241;os&#44; respectivamente&#44; no siendo significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;634&#41; la diferencia de las medias &#91;&#177;DE&#93; de edad entre hombres &#40;55&#44;3 &#91;&#177;16&#44;9&#93; a&#241;os&#41; y mujeres &#40;55&#44;0 &#91;&#177;18&#44;0&#93; a&#241;os&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tasas de prevalencia de enfermedad renal cr&#243;nica</span><p id="par0060" class="elsevierStylePara elsevierViewall">La prevalencia cruda de ERC fue 11&#44;48&#37; &#40;IC95&#37;&#58; 10&#44;72&#8211;12&#44;27&#37;&#41;&#44; sin diferencia significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;711&#41; entre hombres &#40;11&#44;64&#37; &#91;IC95&#37;&#58; 10&#44;49&#8211;12&#44;86&#37;&#93;&#41; y mujeres &#40;11&#44;35&#37; &#91;IC95&#37;&#58; 10&#44;34&#8211;12&#44;41&#37;&#93;&#41;&#46; La tasa de prevalencia ajustada por edad y sexo de ERC fue 9&#44;16&#37; &#40;8&#44;61&#37; en hombres&#59; 9&#44;69&#37; en mujeres&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La distribuci&#243;n de las tasas espec&#237;ficas por grupos etarios decenales de prevalencia de ERC aumentaba con la edad de forma precisa &#40;R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;999&#41; seg&#250;n la funci&#243;n polin&#243;mica y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0044x<span class="elsevierStyleSup">3</span>-0&#44;0319x<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;0761x-0&#44;0313&#44; sin detectarse diferencias significativas entre hombres y mujeres &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La prevalencia ajustada por edad y sexo de ERC en la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os era de 23&#44;75&#37; &#40;23&#44;49&#37; en hombres&#59; 24&#37; en mujeres&#41;&#44; sin diferencia significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;923&#41; entre las prevalencias crudas de ERC en hombres &#40;23&#44;39&#37; &#91;IC95&#37;&#58; 20&#44;99&#8211;25&#44;93&#37;&#93;&#41; y mujeres &#40;23&#44;23&#37; &#91;IC95&#37;&#58; 21&#44;11&#8211;25&#44;45&#37;&#93;&#41;&#46; En la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os&#44; la prevalencia ajustada por edad y sexo de ERC era del 33&#44;56&#37; &#40;34&#44;09&#37; en hombres&#59; 33&#44;27&#37; en mujeres&#41;&#44; sin diferencia significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;470&#41; entre las prevalencias crudas de ERC en hombres &#40;34&#44;33&#37; &#91;IC95&#37;&#58; 30&#44;54&#8211;38&#44;29&#37;&#93;&#41; y mujeres &#40;32&#44;52&#37; &#91;IC95&#37;&#58; 29&#44;40&#8211;35&#44;76&#37;&#93;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Las prevalencias de los distintos tipos de ERC seg&#250;n categor&#237;as de FGe y albuminuria seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> eran las siguientes&#58; G1 y G2 con albuminuria &#40;CAC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41;&#58; 3&#44;54&#37; &#40;IC95&#37;&#58; 3&#44;09&#8211;3&#44;98&#41;&#59; G3a con&#47;sin albuminuria&#58; 5&#44;48&#37; &#40;IC95&#37;&#58; 4&#44;93&#8211;6&#44;03&#41;&#59; G3b con&#47;sin albuminuria&#58; 1&#44;82&#37; &#40;IC95&#37;&#58; 1&#44;50&#8211;2&#44;14&#41;&#59; G4 con&#47;sin albuminuria&#58; 0&#44;49&#37; &#40;IC95&#37;&#58; 0&#44;32&#8211;0&#44;65&#41;&#59; G5 con&#47;sin albuminuria&#58; 0&#44;15&#37; &#40;IC95&#37;&#58; 0&#44;06&#8211;0&#44;25&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; No exist&#237;an diferencias significativas entre hombres y mujeres en las categor&#237;as de ERC seg&#250;n el FGe&#44; excepto en la categor&#237;a G2&#44; que era significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41; en hombres &#40;39&#44;36&#37; &#91;IC95&#37;&#58; 37&#44;58&#8211;41&#44;16&#93;&#41; que en mujeres &#40;36&#44;35&#37; &#91;IC95&#37;&#58; 34&#44;79&#8211;37&#44;92&#93;&#41;&#46; El porcentaje de sujetos de estudio con FGe reducido &#40;&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41; era del 7&#44;95&#37; &#40;IC95&#37;&#58; 7&#44;30&#8211;8&#44;61&#41;&#44; sin diferencia significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;169&#41; entre hombres &#40;7&#44;44&#37; &#91;IC95&#37;&#58; 6&#44;48&#8211;8&#44;39&#93;&#41; y mujeres &#40;8&#44;36&#37; &#91;IC95&#37;&#58; 7&#44;47&#8211;9&#44;25&#93;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">La prevalencia de albuminuria &#40;CAC<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; en hombres &#40;7&#44;37&#37; &#91;IC95&#37;&#58; 6&#44;42&#8211;8&#44;32&#93;&#41; fue significativamente m&#225;s alta &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; que en mujeres &#40;4&#44;89&#37; &#91;IC95&#37;&#58; 4&#44;19&#8211;5&#44;58&#93;&#41;&#46; El porcentaje de albuminuria estadio A1 era significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en mujeres que en hombres&#46; Los porcentajes de albuminuria estadios A2 y A3 eran significativamente mayores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; en los hombres que en mujeres &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Tabla 2</a>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis de las poblaciones con y sin ERC</span><p id="par0080" class="elsevierStylePara elsevierViewall">Las medianas &#40;RIC&#41; de edad de las poblaciones con y sin ERC eran 77&#44;33 &#40;65&#44;22&#8211;83&#44;38&#41; a&#241;os y 52&#44;42 &#40;40&#44;33&#8211;65&#44;18&#41; a&#241;os respectivamente&#44; siendo significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; la diferencia de las medias de edad &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; No hab&#237;a diferencia significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;711&#41; en el porcentaje de hombres y mujeres entre ambas poblaciones &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Todas las variables cl&#237;nicas cuantitativas eran significativamente mayores en la poblaci&#243;n con ERC que en la poblaci&#243;n sin ERC&#44; excepto las concentraciones de CT&#44; c-HDL&#44; c-LDL&#44; c-no-HDL&#44; alanina-aminotransferasa y el FGe que fueron mayores en la poblaci&#243;n sin ERC&#44; y la PAD&#44; las concentraciones de aspartato-aminotransferasa&#44; y los &#237;ndices colesterol total&#47;c-HDL y c-No-HDL&#47;c-HDL&#44; cuyas diferencias no eran significativas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Las medianas &#40;RIC&#41; de creatinina&#44; FGe y CAC de la poblaci&#243;n con ERC eran 1&#44;09 &#40;0&#44;91&#8211;1&#44;30&#41; mg&#47;dL&#44; 55&#44;6 &#40;46&#44;5&#8211;73&#44;3&#41; mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; y 36&#44;1 &#40;5&#44;1&#8211;100&#44;9&#41; mg&#47;g&#44; respectivamente&#46; Las medianas &#40;RIC&#41; de creatinina&#44; FGe y CAC de la poblaci&#243;n sin ERC eran 0&#44;80 &#40;0&#44;68&#8211;0&#44;90&#41; mg&#47;dL&#44; 94&#44;2 &#40;82&#44;7&#8211;106&#44;0&#41; mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; y 5&#44;3 &#40;3&#44;0&#8211;8&#44;7&#41; mg&#47;g&#44; respectivamente&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Todas las OR de los FRCV y comorbilidades entre las poblaciones con y sin ERC mostraban asociaci&#243;n con la ERC&#44; excepto el tabaquismo actual&#44; que mostraba asociaci&#243;n con los sujetos sin ERC&#44; y el sobrepeso&#44; cuya OR no era significativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Seg&#250;n la valoraci&#243;n del RCV por SCORE<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span>y SCORE-OP<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> para pa&#237;ses de bajo riesgo&#44; el 22&#44;49&#37; &#40;IC95&#37;&#58; 19&#44;56&#8211;25&#44;63&#41; de la poblaci&#243;n con ERC ten&#237;a un RCV alto y el 77&#44;51&#37; &#40;IC95&#37;&#58; 74&#44;54&#8211;80&#44;49&#41; ten&#237;a un RCV muy alto&#46; Entre las poblaciones con y sin ERC&#44; la OR de RCV alto era 1&#44;7 &#40;IC95&#37;&#58; 1&#44;4&#8211;2&#44;0&#41; y la OR de RCV muy alto era 10&#44;4 &#40;IC95&#37;&#58; 8&#44;7&#8211;12&#44;4&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El an&#225;lisis multivariante mostr&#243; que los FRCV y comorbilidades que se asociaban independientemente con la ERC eran HTA&#44; DM&#44; prediabetes seg&#250;n la ADA&#44; ICT aumentado&#44; insuficiencia card&#237;aca&#44; fibrilaci&#243;n auricular&#44; EAP&#44; EC e ictus &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Las encuestas realizadas en pa&#237;ses con ingresos altos mostraban unas tasas de prevalencia de ERC similares &#40;11&#44;3&#37; en EE&#46;UU&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a>&#44; 12&#44;5&#37; en Canad&#225;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">25</span></a> y 11&#44;1&#37; en Noruega<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">26</span></a>&#41;&#46; Seg&#250;n el informe 2019 GKHA &#40;Global Kidney Health Atlas&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a> de la Sociedad Internacional de Nefrolog&#237;a &#40;ISN&#41;&#44; basado en 2 encuestas realizadas en 2017 y 2019&#44; la prevalencia media de ERC en 21 pa&#237;ses de Europa occidental era 10&#44;1&#37;&#44; siendo en Espa&#241;a del 9&#44;6&#37;&#46; El estudio ISN-KDDC<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">27</span></a>&#44; realizado en 12 pa&#237;ses en desarrollo con muestreos no aleatorios de conveniencia&#44; cuyo sesgo de selecci&#243;n podr&#237;a sobrestimar la prevalencia&#44; mostraba una prevalencia de ERC del 14&#44;3&#37;&#44; con una alta variabilidad e incluso con diferencias significativas con otros estudios realizados en sus respectivos pa&#237;ses&#46; Mientras que el estudio ISN-KDDC<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">27</span></a> mostraba unas prevalencias en India y China del 16&#44;8&#37; y del 29&#44;9&#37; respectivamente&#44; otros estudios<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">28&#44;29</span></a> realizados con muestreo aleatorios en estos pa&#237;ses mostraban prevalencias muy inferiores &#40;7&#44;5&#37; y 16&#44;8&#37; respectivamente&#41;&#46; Este sesgo tambi&#233;n se comprob&#243; en EE&#46;UU&#46; entre el programa KEEP<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a> con sujetos de estudio con derivaci&#243;n activa y la Encuesta de Salud Nacional y Examen de Nutrici&#243;n &#40;NHANES&#41;&#44; con distintas tasas de prevalencias de ERC &#40;28&#44;7&#37; y 13&#44;1&#37;&#44; respectivamente&#41;&#46; La prevalencia ajustada del presente estudio SIMETAP-ERC &#40;9&#44;2&#37;&#41; fue algo inferior a la del metaan&#225;lisis de Hill et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">9</span></a> &#40;13&#44;4&#37;&#41;&#44; y muy similar a la del metaan&#225;lisis de la GBD-CKD Collaboration<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a> &#40;9&#44;1&#37;&#41;&#44; ambos metaan&#225;lisis con una alta heterogeneidad entre los estudios analizados&#46; La prevalencia de ERT en el estudio SIMETAP-ERC &#40;0&#44;15&#37;&#41; era similar a la del informe GKHA de la ISN<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">3</span></a>&#44; que oscilaba entre el 0&#44;1&#37; en los pa&#237;ses de ingresos medios altos y el 0&#44;2&#37; en los de ingresos altos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En Espa&#241;a&#44; el Estudio ENRICA<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a> mostr&#243; una prevalencia cruda de ERC del 15&#44;1&#37;&#44; similar al 14&#44;4&#37; de la cohorte de poblaci&#243;n en consultas de atenci&#243;n primaria del estudio IBERICAN<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a>&#46; Estos resultados difieren del estudio EPIRCE<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">33</span></a>&#44; que empleando el m&#233;todo del grupo Modification of Diet in Renal Diseases &#40;MDRD&#41;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">34</span></a> para valorar el FGe&#44; mostr&#243; una prevalencia de ERC del 9&#44;2&#37;&#44; igual que la del presente estudio utilizando la ecuaci&#243;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#46; El estudio SIMETAP-ERC confirm&#243; que la prevalencia de ERC aumentaba con la edad&#44; duplic&#225;ndose por cada tramo etario decenal a partir de los 40 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Otros estudios realizados en Espa&#241;a que utilizaron el m&#233;todo MDRD<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">34</span></a> para valorar la prevalencia del FGe reducido muestran resultados dispares&#44; como el estudio EPIRCE<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">33</span></a> &#40;21&#44;4&#37;&#41; en la poblaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os y los estudios PREV-ICTUS<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">35</span></a> &#40;25&#44;9&#37;&#41; y el de Salvador Gonz&#225;lez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">36</span></a> &#40;15&#44;1&#37;&#41; en poblaciones con 60 o m&#225;s a&#241;os&#46; Estos estudios<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">33&#44;35&#44;36</span></a> muestran resultados inferiores a otros que valoraron el FGe con la ecuaci&#243;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#44; como el estudio ENRICA<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a>&#44; en el que la prevalencia cruda de ERC era del 37&#44;3&#37; en la poblaci&#243;n &#8805;65 a&#241;os&#44; o la del presente estudio&#44; en el que las prevalencias de ERC ajustadas por edad en las poblaciones<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60 a&#241;os y &#8805;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os eran del 23&#44;8 y del 33&#44;6&#37; respectivamente&#46; La elecci&#243;n de la ecuaci&#243;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a> en vez del m&#233;todo MDRD<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">34</span></a> sigue las recomendaciones de las gu&#237;as KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> y del consenso espa&#241;ol para la detecci&#243;n y manejo de la ERC<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a>&#44; al relacionarse mejor con valores de FGe reducido&#44; ser m&#225;s precisa para valores<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span> y tener mayor capacidad para predecir mortalidad global&#44; mortalidad cardiovascular o el riesgo de fallo renal<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Todos los par&#225;metros antropom&#233;tricos eran significativamente mayores en la poblaci&#243;n con ERC&#44; existiendo una asociaci&#243;n con obesidad&#44; adiposidad&#44; obesidad abdominal&#44; y el ICT aumentado&#46; Aunque la obesidad se ha asociado con un mayor riesgo de ERC<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a>&#44; en el presente estudio solo el ICT aumentado mostraba una asociaci&#243;n independiente con la ERC&#44; junto con otras comorbilidades como HTA&#44; DM&#44; prediabetes&#44; IC&#44; FA&#44; EAP&#44; EC e ictus&#44; que tambi&#233;n aparec&#237;an asociadas en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">26&#44;31&#8211;33&#44;36</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A pesar de la reducci&#243;n del riesgo de los principales episodios adversos cardiovasculares durante las &#250;ltimas d&#233;cadas por el mejor control de la DM&#44; HTA y dislipidemia&#44; la prevalencia de individuos con DM2 y ERC en la poblaci&#243;n adulta sigue siendo muy alta y la tendencia contin&#250;a en aumento<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">39</span></a>&#44; probablemente debido a que este mejor control contribuye al incremento de la longevidad&#44; y por lo tanto a un mayor tiempo para poder desarrollar ERC<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a>&#46; El estudio SIMETAP-DM<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a> mostr&#243; que el 27&#44;6&#37; de la poblaci&#243;n adulta con DM ten&#237;a ERC&#44; prevalencia inferior a la de la encuesta NHANES<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">42</span></a> de EE&#46;UU&#46; &#40;43&#44;5&#37;&#41;&#44; y similar a la de otros estudios espa&#241;oles como el de Fern&#225;ndez-Fern&#225;ndez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">43</span></a> &#40;25&#44;3&#37;&#41;&#44; y al PERCEDIME2<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">44</span></a> &#40;27&#44;9&#37;&#41;&#46; En el presente estudio&#44; el 37&#44;8&#37; de la poblaci&#243;n con ERC padec&#237;a DM&#44; el 29&#44;8&#37; ten&#237;a criterios de prediabetes seg&#250;n la ADA<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> y el 11&#44;8&#37; criterios seg&#250;n la SED<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a>&#46; A pesar de que las OR entre las poblaciones con y sin ERC de la prediabetes seg&#250;n la ADA<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> y seg&#250;n la SED<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a> eran similares &#40;1&#44;6 y 1&#44;7 respectivamente&#41;&#44; solo la prediabetes seg&#250;n la ADA<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a> se asociaba de forma independiente con la ERC&#44; como tambi&#233;n se asocia la DM&#44; lo que apoya la estrecha relaci&#243;n existente entre las alteraciones del metabolismo gluc&#233;mico y la ERC<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">9&#44;11</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En el presente estudio&#44; la PAS era significativamente mayor &#40;7&#44;3<span class="elsevierStyleHsp" style=""></span>mmHg&#41; en la poblaci&#243;n con ERC que sin ERC&#44; y el 79&#44;6&#37; de la poblaci&#243;n con ERC ten&#237;a HTA&#44; siendo este factor el que mejor se asociaba independientemente con la ERC&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El hecho de que todos los par&#225;metros incluidos en las variables CUN-BAE obesidad<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">17</span></a> y s&#237;ndrome metab&#243;lico<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a> estuvieran asociados con la ERC justifica que ambas variables mostraran una asociaci&#243;n muy fuerte con la ERC &#40;OR 6&#44;3 y 4&#44;4 respectivamente&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Por otra parte&#44; el estudio SIMETAP-ERC mostr&#243; que el 25&#44;9&#37; de la poblaci&#243;n con ERC ten&#237;a ECVA &#40;EC&#58; 14&#44;2&#37;&#59; ictus&#58; 10&#44;8&#37;&#59; EAP&#58; 8&#44;1&#37;&#41; y que tanto la ECVA considerada globalmente como la EC&#44; el ictus o la EAP consideradas individualmente&#44; mostraban una asociaci&#243;n independiente con la ERC&#46; Aproximadamente el 55&#37; de los pacientes con IC y el 50&#37; de los pacientes con FA tienen alg&#250;n grado de insuficiencia renal y cerca del 20&#37; de los pacientes con ERC padecen FA<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">45&#44;46</span></a>&#46; En el presente estudio&#44; el 13&#44;5&#37; y el 14&#44;9&#37; de los sujetos con ERC padec&#237;an IC y FA respectivamente&#44; y ambas entidades se mostraban como factores independientes estrechamente asociados con la ERC&#46; M&#225;s del 77&#37; de la poblaci&#243;n con ERC ten&#237;a un RCV muy alto seg&#250;n SCORE<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; que inclu&#237;a a los pacientes con ERC grave &#40;FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#44; con DM y lesi&#243;n de &#243;rgano diana o FRCV principal &#40;tabaquismo&#44; HTA o hipercolesterolemia marcada&#41;&#44; con ECVA cl&#237;nica o documentada por imagen y a los sujetos con una puntuaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10&#46; Este elevado porcentaje est&#225; justificado por ser una poblaci&#243;n con una mediana de edad de 77 a&#241;os y una frecuencia elevada de ECVA &#40;26&#37;&#41; y factores cardiometab&#243;licos &#40;DM 38&#37;&#59; obesidad&#58; 40&#37;&#59; s&#237;ndrome metab&#243;lico 74&#37;&#59; HTA 77&#37;&#59; hipercolesterolemia 78&#37;&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Entre las limitaciones del presente estudio cabe mencionar que no se valor&#243; la presencia de da&#241;o renal objetivado directamente &#40;biopsia renal&#41; o indirectamente por pruebas de imagen&#44; la incapacidad para determinar causalidad&#44; la posible variabilidad entre los entrevistadores&#44; el calibrado o la posible heterogeneidad de los aparatos de medici&#243;n y laboratorio&#44; y que no se incluyeron a mujeres en periodo de gestaci&#243;n&#44; pacientes terminales&#44; institucionalizados&#44; o con deterioro cognitivo&#46; Por otra parte&#44; el dise&#241;o transversal del presente estudio no permiti&#243; valorar la persistencia de la albuminuria o del FGe reducido&#44; estimar tasas de incidencia&#44; ni inferir relaciones causales entre los factores de riesgo y la ERC&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las diferentes metodolog&#237;as de muestreo y determinaciones del FGe y las distintas medianas de edad de las poblaciones de los estudios de comparaci&#243;n podr&#237;an explicar las diferentes tasas de prevalencia de ERC&#46; Una fortaleza del presente estudio fue el amplio muestreo aleatorio sobre una base poblacional que incluy&#243; a todos los grupos de edad&#46; El estudio SIMETAP-ERC muestra que la ERC est&#225; muy influenciada por la edad&#44; por lo que se precisa ajustar las tasas por edad para poder comparar con otras poblaciones&#46; Otras fortalezas del presente estudio fueron valorar la asociaci&#243;n de la ERC con numerosas variables cardiometab&#243;licas&#44; y las determinaciones de FGe seg&#250;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a> y CAC en toda la poblaci&#243;n&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La derivaci&#243;n tard&#237;a a Nefrolog&#237;a de pacientes con ERT que padecen DM o HTA es frecuente en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">47</span></a>&#46; La estrategia m&#225;s eficiente para reducir la carga de la ERC y disminuir su progresi&#243;n es la detecci&#243;n precoz mediante el cribado del FGe reducido y albuminuria en personas con DM&#44; HTA&#44; obesidad y ECVA&#44; que permita el diagn&#243;stico y el tratamiento en las primeras etapas de la ERC<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">48&#8211;50</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El estudio SIMETAP-ERC muestra una progresiva prevalencia de ERC&#44; sobre todo a partir de los 50 a&#241;os&#44; cuya carga sanitaria incrementa el riesgo de ERT&#44; mortalidad global y mortalidad cardiovascular&#46; La valoraci&#243;n de la de la situaci&#243;n epidemiol&#243;gica de ERC es muy importante para optimizar los recursos de salud disponibles&#44; planificar las intervenciones destinadas a prevenir este problema de salud y reducir la carga de la enfermedad mediante la implementaci&#243;n de estrategias de detecci&#243;n precoz y prevenci&#243;n de f&#225;cil aplicaci&#243;n en el &#225;mbito de la atenci&#243;n primaria&#44; como son las modificaciones de los estilos de vida y el adecuado control de los principales factores de riesgo asociados con la ERC&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusiones</span><p id="par0155" class="elsevierStylePara elsevierViewall">La prevalencia ajustada por edad y sexo de ERC en la poblaci&#243;n adulta era del 9&#44;2&#37; &#40;FGe reducido&#58; 8&#37;&#59; albuminuria&#58; 6&#37;&#41;&#46; Las tasas espec&#237;ficas por grupos etarios decenales de prevalencia de ERC se incrementaban con la edad sin diferencias significativas entre hombres y mujeres&#44; duplic&#225;ndose por cada grupo etario decenal a partir de los 40 a&#241;os&#44; y siendo del 24&#37; en la poblaci&#243;n con 60 o m&#225;s a&#241;os y del 34&#37; a partir de los 70 a&#241;os&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Las comorbilidades m&#225;s frecuentes que se asociaban con la ERC eran HTA &#40;77&#37;&#41; hipercolesterolemia &#40;77&#37;&#41;&#44; s&#237;ndrome metab&#243;lico &#40;74&#37;&#41;&#44; obesidad abdominal &#40;63&#37;&#41;&#44; hipertrigliceridemia &#40;42&#37;&#41;&#44; obesidad &#40;40&#37;&#41;&#44; DM &#40;38&#37;&#41;&#44; c-HDL bajo &#40;37&#37;&#41; y prediabetes &#40;30&#37;&#41; y ECVA &#40;26&#37;&#41;&#46; Las variables que se asociaban independientemente con la ERC eran HTA&#44; DM&#44; prediabetes&#44; ICT aumentado&#44; insuficiencia card&#237;aca&#44; fibrilaci&#243;n auricular y ECVA&#46; La elevada carga cardiovascular de la ERC &#40;77&#37; con RCV muy alto&#41; en una poblaci&#243;n de avanzada edad justifica la necesidad de implementar medidas poblacionales de detecci&#243;n precoz y el &#243;ptimo control de los factores cardiometab&#243;licos asociados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiaci&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">La financiaci&#243;n del estudio SIMETAP &#40;C&#243;digo Beca&#58; 05&#47;2010RS&#41; fue aprobada seg&#250;n la Orden 472&#47;2010&#44; de 16 de septiembre&#44; de la Consejer&#237;a de Sanidad&#44; por la que se aprueban las bases reguladoras y la convocatoria de ayudas para el a&#241;o 2010 de la Agencia &#171;Pedro La&#237;n Entralgo&#187; de Formaci&#243;n&#44; Investigaci&#243;n y Estudios Sanitarios de la Comunidad de Madrid&#44; para la realizaci&#243;n de proyectos de investigaci&#243;n en el campo de resultados en salud en atenci&#243;n primaria&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Comit&#233; &#201;tico de Investigaci&#243;n</span><p id="par0170" class="elsevierStylePara elsevierViewall">Comisi&#243;n de Investigaci&#243;n de la Gerencia Adjunta de Planificaci&#243;n y Calidad&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Gerencia de Atenci&#243;n Primaria&#46; Servicio Madrile&#241;o de Salud &#40;SERMAS&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0180" class="elsevierStylePara elsevierViewall">Los autores no tienen conflictos de intereses para esta publicaci&#243;n&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad renal cr&#243;nica &#40;ERC&#41; constituye un importante problema de salud que contribuye al desarrollo de alteraciones cardiovasculares como la insuficiencia card&#237;aca y la enfermedad cardiovascular arterioscler&#243;tica &#40;ECVA&#41;&#46; Los objetivos de este estudio fueron determinar la prevalencia de ERC y evaluar su asociaci&#243;n con factores de riesgo cardiometab&#243;licos y la ECVA&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal realizado en el &#225;mbito de atenci&#243;n primaria&#46; Muestra aleatoria de base poblacional&#58; 6&#46;588 personas entre 18 y 102 a&#241;os &#40;tasa de respuesta&#58; 66&#37;&#41;&#46; Se determinaron las tasas de prevalencia brutas y ajustadas por sexo y edad de ERC seg&#250;n KDIGO valorando albuminuria y filtrado glomerular estimado seg&#250;n CKD-EPI&#44; y sus asociaciones con factores cardiometab&#243;licos y ECVA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La prevalencia cruda de ERC fue 11&#44;48&#37; &#40;IC95&#37;&#58; 10&#44;72&#8211;12&#44;27&#37;&#41;&#44; sin diferencia significativa entre hombres &#40;11&#44;64&#37; &#91;IC95&#37;&#58; 10&#44;49&#8211;12&#44;86&#37;&#93;&#41; y mujeres &#40;11&#44;35&#37; &#91;IC95&#37;&#58; 10&#44;34&#8211;12&#44;41&#37;&#93;&#41;&#46; La tasa de prevalencia ajustada por edad y sexo de ERC fue 9&#44;16&#37; &#40;hombres&#58; 8&#44;61&#37;&#59; mujeres&#58; 9&#44;69&#37;&#41;&#46; La prevalencia del filtrado glomerular estimado reducido &#40;&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; y de albuminuria &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; fueron 7&#44;95&#37; &#40;IC95&#37;&#58; 7&#44;30&#8211;8&#44;61&#41; y 5&#44;98&#37; &#40;IC95&#37;&#58; 5&#44;41&#8211;6&#44;55&#41;&#44; respectivamente&#46; Hipertensi&#243;n&#44; diabetes&#44; prediabetes&#44; &#237;ndice cintura-talla aumentado&#44; insuficiencia card&#237;aca&#44; fibrilaci&#243;n auricular y ECVA se asociaban independientemente con ERC &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El 77&#44;51&#37; &#40;IC95&#37;&#58; 74&#44;54&#8211;80&#44;49&#41; de la poblaci&#243;n con ERC ten&#237;a un riesgo cardiovascular muy alto seg&#250;n SCORE&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia ajustada de ERC era del 9&#44;2&#37; &#40;filtrado glomerular estimado reducido&#58; 8&#37;&#59; albuminuria&#58; 6&#37;&#41;&#46; La mayor&#237;a de los pacientes con ERC ten&#237;a riesgo cardiovascular muy alto&#46; Hipertensi&#243;n&#44; diabetes&#44; prediabetes&#44; &#237;ndice cintura-talla aumentado y ECVA se asociaban independientemente con la ERC&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chronic kidney disease &#40;CKD&#41; is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease &#40;ACVD&#41;&#46; The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional observational study conducted in primary care setting&#46; Population-based random sample&#58; 6&#44;588 people between 18 and 102 years old &#40;response rate&#58; 66&#37;&#41;&#46; Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI&#44; and their associations with cardiometabolic factors and ACVD were determined&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The crude prevalence of CKD was 11&#46;48&#37; &#40;95&#37;CI&#58; 10&#46;72&#8211;12&#46;27&#37;&#41;&#44; without significant difference between men &#40;11&#46;64&#37; &#91;95&#37;CI&#58; 10&#46;49&#8211;12&#46;86&#37;&#93;&#41; and women &#40;11&#46;35&#37; &#91;95&#37;CI&#58; 10&#46;34&#8211;12&#46;41&#37;&#93;&#41;&#46; The age- and sex-adjusted prevalence rate of CKD was 9&#46;16&#37; &#40;men&#58; 8&#46;61&#37;&#59; women&#58; 9&#46;69&#37;&#41;&#46; The prevalence of low estimated glomerular filtration rate &#40;&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; and albuminuria &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#41; were 7&#46;95&#37; &#40;95&#37;CI&#58; 7&#46;30&#8211;8&#46;61&#41; and 5&#46;98&#37; &#40;95&#37;CI&#58; 5&#46;41&#8211;6&#46;55&#41;&#44; respectively&#46; Hypertension&#44; diabetes&#44; prediabetes&#44; increased waist-to-height ratio&#44; heart failure&#44; atrial fibrillation&#44; and ACVD were independently associated with CKD &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Very high cardiovascular risk according to SCORE was found in 77&#46;51&#37; &#40;95&#37;CI&#58; 74&#46;54&#8211;80&#46;49&#41; of the population with CKD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The adjusted prevalence of CKD was 9&#46;2&#37; &#40;low estimated glomerular filtration rate&#58; 8&#46;0&#37;&#59; albuminuria&#58; 6&#46;0&#37;&#41;&#46; Most of the patients with CKD had very high cardiovascular risk&#46; Hypertension&#44; diabetes&#44; prediabetes&#44; increased waist-to-height ratio and ACVD were independently associated with CKD&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Antonio Ruiz-Garc&#237;a y Ezequiel Arranz-Mart&#237;nez comparten primer autor e igual contribuci&#243;n&#46;</p>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tasas de prevalencia de ERC por grupos etarios y sexo&#46; ERC&#58; enfermedad renal cr&#243;nica&#59; H&#58; hombres&#59; M&#58; mujeres&#59; n&#58; n&#250;mero de casos&#59; N&#58; tama&#241;o muestral&#59; p&#58; p-valor de la diferencia &#40;H&#8211;M&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ERC&#58; enfermedad renal cr&#243;nica&#59; ERT&#58; enfermedad renal en etapa terminal&#59; FGe&#58; tasas de filtrado glomerular estimado seg&#250;n CDK-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#59; KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#58; Kidney Disease&#58; Improving Global Outcomes&#59; &#931; &#40;A&#41;&#58; sumatorio de porcentajes de las categor&#237;as de albuminuria&#59;&#931; &#40;G&#41;&#58; sumatorio de porcentajes de las categor&#237;as de FGe&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Escalas de riesgo seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#58; verde &#40;riesgo bajo&#41;&#59; amarillo &#40;riesgo moderadamente aumentado&#41;&#59; naranja &#40;riesgo alto&#41;&#59; rojo &#40;riesgo muy alto&#41;&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Porcentajes de las categor&#237;as de ERC seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a></p>"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A1&#58; cociente alb&#250;mina-creatinina en orina &#40;CAC&#41;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; A2&#58; CAC entre 30 y 300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; A3&#58; CAC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mg&#47;g&#59; FGe&#58; tasas de filtrado glomerular estimado seg&#250;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a>&#59; G&#58; categor&#237;as de FGe seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a>&#59; &#931; &#40;A&#41;&#58; sumatorio de porcentajes de las categor&#237;as de albuminuria&#59; &#931; &#40;G&#41;&#58; sumatorio de porcentajes de las categor&#237;as de FGe&#59; Dif&#46; &#931; &#40;A&#41;&#58; diferencia de los &#931; &#40;A&#41; entre hombres y mujeres&#59; Dif&#46; &#931; &#40;G&#41;&#58; diferencia de los &#931; &#40;G&#41; entre hombres y mujeres&#59; p&#58; p-valor de la diferencia de porcentajes&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Diferencia de medias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media &#40;&#177;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;832&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Per&#237;metro abdominal &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#44;56 &#40;13&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&#205;ndice cintura-talla&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;832&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;56 &#40;0&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adiposidad &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;79 &#40;7&#44;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;832&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;22 &#40;8&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PAS &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;832&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">121&#44;09 &#40;15&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PAD &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">756&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;832&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">73&#44;28 &#40;9&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ADA&#58; prediabetes seg&#250;n Asociaci&#243;n Americana de Diabetes<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a>&#59; c-HDL bajo&#58; colesterol unido a lipoprote&#237;nas de alta densidad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;hombres&#41;&#44; &#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;mujeres&#41;&#59; CUN-BAE-obesidad<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">17</span></a>&#58; adiposidad o &#237;ndice de grasa corporal &#40;Cl&#237;nica Universitaria de Navarra&#8211;Body Adiposity Estimator&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#37; &#40;hombres&#41;&#44; &#62;<span class="elsevierStyleHsp" style=""></span>35&#37; &#40;mujeres&#41;&#59; Dislipidemia aterog&#233;nica&#58; hipertrigliceridemia y c-HDL bajo&#59; EAP&#58; enfermedad arterial perif&#233;rica&#59; ECVA&#58; enfermedad cardiovascular arterioscler&#243;tica&#59; ERC&#58; enfermedad renal cr&#243;nica&#59; FRCV&#58; factores de riesgo cardiovascular&#59; Hipercolesterolemia&#58; colesterol total<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; Hipertrigliceridemia&#58; triglic&#233;ridos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; ICT aumentado&#58; &#237;ndice cintura-talla<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;55&#59; Inactividad f&#237;sica&#58; actividad f&#237;sica<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>min&#47;semana&#59; N&#58; tama&#241;o muestral&#59; Obesidad&#58; &#237;ndice de masa corporal<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; Obesidad abdominal&#58; per&#237;metro abdominal<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>102<span class="elsevierStyleHsp" style=""></span>cm &#40;hombres&#41;&#44; &#8805;<span class="elsevierStyleHsp" style=""></span>88<span class="elsevierStyleHsp" style=""></span>cm &#40;mujeres&#41;&#59; OR&#58; odds ratio entre ambas poblaciones &#40;intervalo de confianza 95&#37;&#41;&#59; SED&#58; prediabetes seg&#250;n Sociedad Espa&#241;ola de Diabetes<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a>&#59; Sobrepeso&#58; IMC 25&#44;0&#8211;29&#44;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#59; Tabaquismo&#58; consumo de cigarrillos o tabaco durante el &#250;ltimo a&#241;o&#46;</p>"
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                  \t\t\t\t">1&#46;325 &#40;22&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8211;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">396 &#40;52&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;683 &#40;46&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;1&#44;1&#8211;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;203 &#40;37&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;2 &#40;1&#44;0&#8211;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Obesidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">304 &#40;40&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;529 &#40;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;6&#8211;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CUN-BAE-obesidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">709 &#40;93&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;123 &#40;70&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3 &#40;4&#44;6&#8211;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Obesidad abdominal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">474 &#40;62&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;448 &#40;42&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#40;2&#44;0&#8211;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ICT aumentado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">602 &#40;79&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;094 &#40;53&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5 &#40;2&#44;9&#8211;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prediabetes &#40;SED&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89 &#40;11&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">434 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;3&#8211;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prediabetes &#40;ADA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;224 &#40;21&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8211;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">286 &#40;37&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">749 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1 &#40;3&#44;5&#8211;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertensi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">581 &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;966 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;5 &#40;5&#44;5&#8211;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipercolesterolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">586 &#40;77&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#46;515 &#40;60&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;7&#8211;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">c-HDL bajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">283 &#40;37&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;536 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;4&#8211;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipertrigliceridemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">317 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;630 &#40;27&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;6&#8211;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia aterog&#233;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173 &#40;22&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">768 &#40;13&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;6&#8211;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome metab&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">560 &#40;74&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#46;291 &#40;39&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;4 &#40;3&#44;7&#8211;5&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">196 &#40;25&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">419 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;5 &#40;3&#44;7&#8211;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad coronaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107 &#40;14&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">214 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3 &#40;3&#44;4&#8211;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ictus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">82 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">168 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;1 &#40;3&#44;1&#8211;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                            5 => "M&#46;M&#46; Sood"
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                  ]
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                      "doi" => "10.1053/j.ajkd.2013.12.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2014"
                        "volumen" => "63"
                        "paginaInicial" => "789"
                        "paginaFinal" => "797"
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        "identificador" => "xack667780"
        "titulo" => "Agradecimientos"
        "texto" => "<p id="par0185" class="elsevierStylePara elsevierViewall">Se agradece el esfuerzo&#44; dedicaci&#243;n y colaboraci&#243;n prestada de los siguientes m&#233;dicos que han participado en el Grupo de Investigaci&#243;n del Estudio SIMETAP&#58; Abad Schilling C&#46;&#44; Adri&#225;n Sanz M&#46;&#44; Aguilera Reija P&#46;&#44; Alcaraz Bethencourt A&#46;&#44; Alonso Roca R&#46;&#44; &#193;lvarez Benedicto R&#46;&#44; Arranz Mart&#237;nez E&#46;&#44; Arribas &#193;lvaro P&#46;&#44; Baltuille Aller M&#46;C&#46;&#44; Barrios Rueda E&#46;&#44; Benito Alonso E&#46;&#44; Berbil Bautista M&#46;L&#46;&#44; Blanco Canseco J&#46;M&#46;&#44; Caballero Ram&#237;rez N&#46;&#44; Cabello Igual P&#46;&#44; Cabrera V&#233;lez R&#46;&#44; Calder&#237;n Morales M&#46;P&#46;&#44; Capit&#225;n Caldas M&#46;&#44; Casaseca Calvo T&#46;F&#46;&#44; Cique Herr&#225;inz J&#46;A&#46;&#44; Ciria de Pablo C&#46;&#44; Chao Escuer P&#46;&#44; D&#225;vila Bl&#225;zquez G&#46;&#44; de la Pe&#241;a Ant&#243;n N&#46;&#44; de Prado Prieto L&#46;&#44; del Villar Redondo M&#46;J&#46;&#44; Delgado Rodr&#237;guez S&#46;&#44; D&#237;ez P&#233;rez M&#46;C&#46;&#44; Dur&#225;n Tejada M&#46;R&#46;&#44; Escamilla Guijarro N&#46;&#44; Escriv&#225; Ferrair&#243; R&#46;A&#46;&#44; Fern&#225;ndez Vicente T&#46;&#44; Fern&#225;ndez-Pacheco Vila D&#46;&#44; Fr&#237;as Vargas M&#46;J&#46;&#44; Garc&#237;a &#193;lvarez J&#46;C&#46;&#44; Garc&#237;a Fern&#225;ndez M&#46;E&#46;&#44; Garc&#237;a Garc&#237;a Alca&#241;iz M&#46;P&#46;&#44; Garc&#237;a Granado M&#46;D&#46;&#44; Garc&#237;a Pliego R&#46;A&#46;&#44; Garc&#237;a Redondo M&#46;R&#46;&#44; Garc&#237;a Villasur M&#46;P&#46;&#44; G&#243;mez D&#237;az E&#46;&#44; G&#243;mez Fern&#225;ndez O&#46;&#44; Gonz&#225;lez Escobar P&#46;&#44; Gonz&#225;lez-Posada Delgado J&#46;A&#46;&#44; Guti&#233;rrez S&#225;nchez I&#46;&#44; Hern&#225;ndez Beltr&#225;n M&#46;I&#46;&#44; Hern&#225;ndez de Luna M&#46;C&#46;&#44; Hern&#225;ndez L&#243;pez R&#46;M&#46;&#44; Hidalgo Calleja Y&#46;&#44; Holgado Catal&#225;n M&#46;S&#46;&#44; Hombrados Gonzalo M&#46;P&#46;&#44; Hueso Quesada R&#46;&#44; Ibarra S&#225;nchez A&#46;M&#46;&#44; Iglesias Quintana J&#46;R&#46;&#44; &#205;scar Valenzuela I&#46;&#44; Iturmendi Mart&#237;nez N&#46;&#44; Javierre Miranda A&#46;P&#46;&#44; L&#243;pez Uriarte B&#46;&#44; Lorenzo Borda M&#46;S&#46;&#44; Luna Ram&#237;rez S&#46;&#44; Macho del Barrio A&#46;I&#46;&#44; Mag&#225;n Tapia P&#46;&#44; Mara&#241;&#243;n Henrich N&#46;&#44; Mari&#241;o Su&#225;rez J&#46;E&#46;&#44; Mart&#237;n Calle M&#46;C&#46;&#44; Mart&#237;n Fern&#225;ndez A&#46;I&#46;&#44; Mart&#237;nez Cid de Rivera E&#46;&#44; Mart&#237;nez Irazusta J&#46;&#44; Miguel&#225;&#241;ez Valero A&#46;&#44; Minguela Puras M&#46;E&#46;&#44; Montero Costa A&#46;&#44; Mora Casado C&#46;&#44; Morales Cobos L&#46;E&#46;&#44; Morales Chico M&#46;R&#46;&#44; Moreno Fern&#225;ndez J&#46;C&#46;&#44; Moreno Mu&#241;oz M&#46;S&#46;&#44; Palacios Mart&#237;nez D&#46;&#44; Pascual Val T&#46;&#44; P&#233;rez Fern&#225;ndez M&#46;&#44; P&#233;rez Mu&#241;oz R&#46;&#44; Plata Barajas M&#46;T&#46;&#44; Pleite Raposo R&#46;&#44; Prieto Marcos M&#46;&#44; Quintana G&#243;mez J&#46;L&#46;&#44; Redondo de Pedro S&#46;&#44; Redondo S&#225;nchez M&#46;&#44; Reguillo D&#237;az J&#46;&#44; Rem&#243;n P&#233;rez B&#46;&#44; Revilla Pascual E&#46;&#44; Rey L&#243;pez A&#46;M&#46;&#44; Ribot Catal&#225; C&#46;&#44; Rico P&#233;rez M&#46;R&#46;&#44; Rivera Teijido M&#46;&#44; Rodr&#237;guez Cabanillas R&#46;&#44; Rodr&#237;guez de Coss&#237;o A&#46;&#44; Rodr&#237;guez de Mingo E&#46;&#44; Rodr&#237;guez Rodr&#237;guez A&#46;O&#46;&#44; Rosillo Gonz&#225;lez A&#46;&#44; Rubio Villar M&#46;&#44; Ruiz D&#237;az L&#46;&#44; Ruiz Garc&#237;a A&#46;&#44; S&#225;nchez Calso A&#46;&#44; S&#225;nchez Herr&#225;iz M&#46;&#44; S&#225;nchez Ramos M&#46;C&#46;&#44; Sanchidri&#225;n Fern&#225;ndez P&#46;L&#46;&#44; Sand&#237;n de Vega E&#46;&#44; Sanz Pozo B&#46;&#44; Sanz Velasco C&#46;&#44; Sarri&#225; S&#225;nchez M&#46;T&#46;&#44; Simonaggio Stancampiano P&#46;&#44; Tello Meco I&#46;&#44; Vargas-Machuca Caba&#241;ero C&#46;&#44; Velazco Zumarr&#225;n J&#46;L&#46;&#44; Vieira Pascual M&#46;C&#46;&#44; Zafra Urango C&#46;&#44; Zamora G&#243;mez M&#46;M&#46;&#44; Zarzuelo Mart&#237;n N&#46;</p>"
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Información del artículo
ISSN: 02149168
Idioma original: Español
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