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Cumplimiento de las recomendaciones de ajuste de la dosis de inhibidores DPP4 según la función renal en una base de datos poblacional
Compliance with the DPP-4 inhibitors dose adjustment recommendations based on renal function in a population database
Josep Franch-Nadala,b,c, Jordi Reala, Manel Mata-Casesa,b,d, Emilio Ortegaa,e,f, Joan Antoni Vallèsa,g, Bogdan Vlachoa,
Autor para correspondencia
bogdan.vlacho@gmail.com

Autor para correspondencia.
, Dídac Mauricioa,b,h
a DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
b CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
c Centre d’Atenció Primària Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
d Centre d’Atenció Primària La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, España
e Servei d’endocrinologia i nutrició, Institut d’Investigacions Biomèdiques August Pi i Suñer, Hospital Clinic, Barcelona, España
f CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
g Gerència del Medicament, Gerència d’Atenció Primaria, Institut Català de la Salut, Barcelona, España
h Servei d’Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sobredosificaci&#243;n del global de los iDPP4 y de los iDPP4 no-linaglipt&#237;nicos&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DDD-aj&#58; dosis diaria definida ajustada a la funci&#243;n renal&#59; DDP&#58; dosis diaria prescrita&#46;</p>"
        ]
      ]
    ]
    "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">Los inhibidores de la dipeptidil-peptidasa 4 &#40;iDPP4&#41; son unos f&#225;rmacos ampliamente utilizados en el tratamiento de la diabetes mellitus tipo 2 &#40;DM2&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; En nuestro medio&#44; se prescriben aproximadamente a un 16&#37; de los pacientes con DM2&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En Espa&#241;a la prescripci&#243;n y la financiaci&#243;n de un f&#225;rmaco por el sistema p&#250;blico de salud viene condicionada por las recomendaciones de la ficha t&#233;cnica de la Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;AEMPS&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los iDPP4 son antidiab&#233;ticos con un buen perfil de seguridad<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#44; pudiendo utilizarse incluso en todos los grados de insuficiencia renal<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&#46; De los f&#225;rmacos iDPP4 comercializados en Espa&#241;a&#44; solo la linagliptina &#40;con una excreci&#243;n predominante por la v&#237;a biliar&#41; puede utilizarse a dosis plenas independientemente del grado de insuficiencia renal<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; En los dem&#225;s casos las recomendaciones de las fichas t&#233;cnicas son ajustar la dosis al valor del filtrado glomerular &#40;FG&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46; As&#237;&#44; salvo la linagliptina&#44; funcionalmente en el estadio IIIb &#40;FG&#58; 30-44<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; todos los iDPP4 deben dosificarse al 50&#37;&#59; en los estadios IV &#40;FG&#58; 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 V &#40;FG<span class="elsevierStyleHsp" style=""></span>&#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; la sitagliptina y la alogliptina deben reducirse a un 25&#37; de la dosis habitual<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Seg&#250;n datos poblacionales&#44; la insuficiencia renal cr&#243;nica est&#225; presente en el 28&#37; de los pacientes con DM2&#46; Las prevalencias de los estadios IIIb&#44; IV y V son del 8&#44;6&#44; 3&#44;3 y 0&#44;7&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En general&#44; los peligros de la sobredosificaci&#243;n de los f&#225;rmacos pueden llegar a ser muy importantes<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a>&#44; pero en el caso de los iDPP4 los datos son limitados y no parecen ser muy graves&#46; En un estudio norteamericano el 98&#44;3&#37; de los pacientes con sobredosificaci&#243;n por iDPP4 fueron asintom&#225;ticos&#44; y el principal problema fue la hipoglucemia entre los que los usaban asociado otro antidiab&#233;tico<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#46; Hay dudas sobre un discreto alargamiento QTC<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> con la sobredosificaci&#243;n de sitagliptina&#44; pero en general el riesgo es bajo&#46; Sin embargo&#44; en un estudio coreano<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> retrospectivo de 82&#46;332 pacientes&#44; la sobredosificaci&#243;n de iDPP4 se asoci&#243; con un mayor riesgo de ingreso en urgencias hospitalarias &#40;HR&#58; 1&#44;07&#41;&#44; hipoglucemias graves &#40;HR&#58; 1&#44;19&#41; y mortalidad &#40;HR&#58; 1&#44;12&#41; despu&#233;s de un ajuste multivariante&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Por otro lado&#44; en la pr&#225;ctica habitual de la consulta diaria&#44; frecuentemente no se siguen estrictamente las recomendaciones de las gu&#237;as de pr&#225;ctica cl&#237;nica ni de prescripci&#243;n seg&#250;n la ficha t&#233;cnica de los medicamentos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Por ello&#44; consideramos necesario examinar el patr&#243;n de prescripci&#243;n de los distintos f&#225;rmacos iDPP4 en funci&#243;n del filtrado glomerular en condiciones de pr&#225;ctica cl&#237;nica real&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio retrospectivo descriptivo a partir de una base de datos poblacional de registros cl&#237;nicos anonimizada &#40;Sistema de Informaci&#243;n para el Desarrollo de la Investigaci&#243;n en Atenci&#243;n Primaria &#91;SIDIAP&#93;&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Fuente de datos</span><p id="par0045" class="elsevierStylePara elsevierViewall">La base de datos SIDIAP incluye informaci&#243;n cl&#237;nica de los usuarios del Institut Catal&#224; de la Salut &#40;ICS&#41; de un total de 288 equipos de Atenci&#243;n Primaria de toda Catalunya&#46; SIDIAP contiene informaci&#243;n sobre datos demogr&#225;ficos&#44; diagn&#243;sticos&#44; variables cl&#237;nicas&#44; prescripciones&#44; dispensaciones en oficinas de farmacia&#44; anal&#237;ticas y datos de las altas hospitalarias obtenidas del Conjunto M&#237;nimo de Datos B&#225;sicos &#40;CMBD&#41;&#44; y se ha utilizado previamente para llevar a cabo numerosos estudios de utilidad cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; El 31&#47;12&#47;2017 constaban en SIDIAP un total de 389&#46;178 pacientes diagnosticados de DM2&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Periodo del estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">El periodo de reclutamiento e identificaci&#243;n de sujetos fue el comprendido entre el 1&#47;1&#47;2008 y el 31&#47;12&#47;2017&#59; el periodo de observaci&#243;n fue entre la fecha de inclusi&#243;n&#44; definida en la pen&#250;ltima determinaci&#243;n del filtrado glomerular estimado &#40;CKD-EPI&#41; y un m&#225;ximo de 6 meses posteriores o muerte&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Criterios de inclusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sujetos mayores de 18 a&#241;os incluidos en la base de datos SIDIAP&#44; con diagn&#243;stico de DM2 &#40;Clasificaci&#243;n internacional de enfermedades versi&#243;n 10&#58; E11&#46;0-E11&#46;9&#44; E14 o E14&#46;0-E14&#46;9&#41; con 2 o m&#225;s determinaciones de FGe por CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> y cualquier tratamiento prescrito activo del grupo iDPP4 &#40;c&#243;digos Anatomical Therapeutic Chemical classification system &#91;ATC&#93;&#58; A10BH&#41;&#44; tanto en monoterapia como en combinaci&#243;n&#46; Los iDPP4 incluidos en el estudio son&#58; alogliptina &#40;A10BH04&#41;&#44; linagliptina &#40;A10BH05&#41;&#44; saxagliptina &#40;A10BH03&#41;&#44; sitagliptina &#40;A10BH01&#41; y vildagliptina &#40;A10BH02&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables del estudio</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Principales</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Funci&#243;n renal&#58;</span> FGe por CKD-EPI&#44; cociente albumina&#47;creatinina en el momento de inclusi&#243;n y clasificaci&#243;n en estadios de la funci&#243;n renal seg&#250;n KDIGO<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; Seg&#250;n ficha t&#233;cnica&#44; las dosis de sitagliptina y de vildagliptina deben ajustarse al 50&#37; con valores de filtrado glomerular entre 49 y 30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; que no se corresponde exactamente con ning&#250;n estadio KDIGO&#46; Por consenso de los investigadores se homolog&#243; con el estadio IIIb&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">DDP&#58;</span> Para cada sujeto se calcul&#243; de forma individual la dosis diaria prescrita &#40;DDP&#41; por su m&#233;dico como resultado del promedio diario seg&#250;n la posolog&#237;a y frecuencia que constaba en su historia cl&#237;nica durante el tiempo de observaci&#243;n&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">DDD-aj&#58;</span> Se estim&#243; la dosis diarias definidas &#40;DDD&#41; de cada f&#225;rmaco ajustada al valor del filtrado glomerular estimado de cada paciente seg&#250;n recomendaciones de la ficha t&#233;cnica &#40;DDD-aj&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46; En los casos con una buena funci&#243;n renal&#44; las DDD recomendadas<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> para sitagliptina y vildagliptina son de 100<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; para alogliptina de 25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a y para linagliptina y saxagliptina de 5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En los casos de insuficiencia renal&#44; se aplicaron las siguientes DDD-aj&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Alogliptina&#58; 12&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGe entre 45-30&#41; y 6&#44;25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Linagliptina&#58; sin modificaciones</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Saxagliptina&#58; 2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45&#41;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Sitagliptina&#58; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGE entre 45-30&#41; y 25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#41;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Vildagliptina&#58; 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a &#40;si FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45&#41;</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ratio &#40;RDP&#41;&#58;</span> Aplicando la ecuaci&#243;n propuesta por la Universidad de Manitoba&#44; para cada paciente se calcul&#243; el ratio DDP&#47;DDD-aj<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sobretratamiento&#58;</span> Si su ratio RDP es igual a uno corresponder&#237;a una prescripci&#243;n adecuada a la su funci&#243;n renal&#44; ya que la dosis prescrita por su m&#233;dico corresponder&#237;a a la dosis te&#243;rica recomendada&#59; si el RDP es inferior a uno corresponder&#237;a a un paciente infratratado y consecuentemente si el ratio RDP es superior a uno corresponder&#237;a a un sujeto sobretratado&#46; Por consenso de los investigadores siguiendo las recomendaciones de Kale et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a>&#44; y los protocolos de prescripci&#243;n electr&#243;nica del ICS&#44; se consider&#243; como &#171;sobretratamiento&#187; cuando el ratio era superior a 1&#44;2 &#40;m&#225;s del 20&#37; de la dosis adecuada&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tipo de iDPP4&#58;</span> El grupo farmacol&#243;gico de iDPP4 antidiab&#233;tico activo prescrito por el m&#233;dico de cabecera&#46; Esto tambi&#233;n incluy&#243; cambios de f&#225;rmacos y de dosis&#44; y adici&#243;n de otros grupos farmacol&#243;gicos&#44; por lo que la suma global no tiene que corresponder a la suma de cada familia &#40;en algunos casos un mismo paciente estar&#225; contado en 2 familias de iDPP4 distintas o habr&#225; iniciado una terapia combinada con adici&#243;n de otro f&#225;rmaco no iDPP4&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Variables secundarias</span><p id="par0120" class="elsevierStylePara elsevierViewall">Variables sociodemogr&#225;ficas &#40;edad y g&#233;nero&#41;&#44; las cl&#237;nicas relacionadas con la DM2&#44; tiempo de evoluci&#243;n de la DM2&#44; HbA1c&#44; coexistencia de factores de riesgo y comorbilidades como antecedentes en el momento de inclusi&#243;n&#46; Las determinaciones cl&#237;nicas registradas en el momento de inclusi&#243;n o la m&#225;s reciente durante el a&#241;o previo a la fecha de inclusi&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0125" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se bas&#243; en resumir de forma descriptiva los principales indicadores de inter&#233;s para cada familia de iDPP4 y seg&#250;n estadio de su funci&#243;n renal&#46; Las variables cuantitativas se resumieron con la media y la desviaci&#243;n est&#225;ndar &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41; y las categ&#243;ricas se expresan con la frecuencia y su porcentaje&#46; Se realiz&#243; una comparativa de las caracter&#237;sticas basales por estadios de funci&#243;n renal para cada familia de iDPP4&#44; todas las familias agrupadas a excepci&#243;n de la linagliptina&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">El proceso de manejo de datos se realiz&#243; mediante el paquete estad&#237;stico R versi&#243;n 3&#46;6&#46;1 por el equipo de bioestad&#237;sticos del grupo DAP&#46;cat&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El estudio se ha llevado a cabo de acuerdo con las indicaciones del protocolo y fue clasificado por la AEMPS como EPA-OD&#46; El tratamiento&#44; la comunicaci&#243;n y la cesi&#243;n de los datos de car&#225;cter personal de todos los sujetos participantes se ajusta a lo dispuesto en Ley Org&#225;nica 3&#47;2018&#44; de 5 de diciembre&#44; de protecci&#243;n de datos de car&#225;cter personal&#46; Al ser un estudio anonimizado no es preciso el consentimiento informado de los pacientes&#46; El estudio fue aprobado el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica IDIAP Jordi Gol &#40;c&#243;digo 19&#47;029-P&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se identificaron 70&#46;209 pacientes que cumpl&#237;an los criterios de inclusi&#243;n para este estudio&#46; Se registraron 1&#46;926 situaciones en las que durante el seguimiento se registr&#243; un cambio de tratamiento con otro iDPP4 o se hab&#237;a iniciado terapia combinada con alg&#250;n f&#225;rmaco no IDPP4&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las caracter&#237;sticas basales de los pacientes incluidos en el estudio en funci&#243;n del tipo de iDPP4 que utilizaron&#46; Globalmente la edad al inicio del tratamiento fue de 69&#44;7 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;6&#41; a&#241;os con un promedio de 10&#44;3 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;0&#41; a&#241;os de evoluci&#243;n de la DM2&#46; La HbA1c media al inicio del tratamiento fue del 7&#44;7&#37; &#40;&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;47&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">La funci&#243;n renal mostr&#243; un FGe medio de 71&#44;2 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>20&#44;1&#41; ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; con un 27&#44;8&#37; de pacientes en situaci&#243;n de insuficiencia renal&#44; y en 13&#44;7&#37; pacientes se observ&#243; insuficiencia renal grave &#40;FG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46; A destacar que entre los tratados con linagliptina el porcentaje de pacientes en estadios IIIb&#44; IV y V era claramente superior al de los otros iDPP4 &#40;42&#44;7&#37;&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra el uso de iDPP4 en monoterapia &#40;45&#44;6&#37;&#41; o en tratamiento combinado &#40;54&#44;4&#37;&#41; en funci&#243;n de los estadios de la funci&#243;n renal&#46; El iDPP4 m&#225;s utilizado fue la sitagliptina tanto en monoterapia &#40;53&#44;0&#37;&#41; como en tratamiento combinado &#40;64&#44;1&#37;&#41;&#44; seguido por la vildagliptina &#40;28&#44;4 y 23&#37;&#44; respectivamente&#41;&#46; En los estadios m&#225;s avanzados de insuficiencia renal &#40;estadios IV y V&#41; la linagliptina fue el m&#225;s prescrito &#40;en el 53&#44;5&#37; de los casos&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Respecto a la prescripci&#243;n por su m&#233;dico de cabecera&#44; hay que destacar que las medias de las dosis diarias prescritas &#40;DDP&#41; fueron inferiores a las dosis diarias definidas &#40;DDD&#41; te&#243;ricas para cada tipo de iDPP4 seg&#250;n la AEMPS en los estadios de la funci&#243;n renal que no precisan ajuste de dosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Globalmente la DDP media para alogliptina fue de 14&#44;5 &#40;DDD&#58; 25&#41;&#44; para linagliptina de 4&#44;01 &#40;DDD&#58; 5&#41;&#44; para saxagliptina de 3&#44;23 &#40;DDD&#58; 5&#41;&#44; para sitagliptina de 70&#44;8 &#40;DDD&#58; 100&#41; y para vildagliptina de 77&#44;8 &#40;DDD&#58; 100&#41;&#46; En los estadios m&#225;s avanzados &#40;IV y V&#41; las medias fueron&#58; alogliptina DDP&#58; 12&#44;6 &#40;DDD-aj&#58; 6&#44;25&#41;&#59; saxagliptina DDP&#58; 2&#44;82 &#40;DDD-aj&#58; 2&#44;5&#41;&#59; sitagliptina DDP&#58; 53&#44;0 &#40;DDD-aj&#58; 25&#41;&#59; vildagliptina DDP&#58; 53&#44;2 &#40;DDD-aj&#58; 50&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Cuando a nivel individual se calcul&#243; el ratio DDP&#47;DDD-aj de los iDPP4 para medir la adecuaci&#243;n de la posolog&#237;a seg&#250;n el estadio de la insuficiencia renal se obtienen los datos de la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; En los estadios I&#44; II y IIIa el ratio es inferior a 1uno demostrando la tendencia a la infradosificaci&#243;n&#46; En el estadio IIIb &#40;FGe&#58; 44-30&#41; se observa sobredosificaci&#243;n con la saxagliptina&#44; la sitagliptina y la vildagliptina &#40;ratios de 1&#44;16&#44; 1&#44;24 y 1&#44;34&#44; respectivamente&#46; Y en los estadios IV y V la media del ratio de sobredosificaci&#243;n asciende hasta alcanzar 2&#46;16&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se muestra el porcentaje de pacientes con sobredosificaci&#243;n de los distintos iDPP4 en los diferentes estadios de insuficiencia renal&#46; A destacar que globalmente la sobredosificaci&#243;n de los iDPP4 ocurre en el 7&#44;15&#37; de los tratamientos y que se incrementa en los estadios m&#225;s avanzados de la enfermedad renal &#40;el 36&#44;8&#37; de los pacientes con FG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45&#41; &#40;estadios IIIB&#44; IV y V&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Si de este an&#225;lisis excluimos los iDPP4 linaglipt&#237;nicos&#44; los valores de sobredosificaci&#243;n ascienden&#58; globalmente se observa en el 7&#44;93&#37; y en los estadios avanzados en el 58&#44;7&#37; de los casos &#40;58&#44;4&#37; en IIIb&#44; 60&#44;2&#37; en IV y 52&#44;7&#37; en V&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los datos de este estudio demuestran que&#44; en condiciones de pr&#225;ctica cl&#237;nica real&#44; un porcentaje muy importante de pacientes con DM2 e insuficiencia renal avanzada &#40;estadios IIIb&#44; IV y V&#41; presentan una sobredosificaci&#243;n de los iDPP4 no-linagliptina&#46; La recomendaci&#243;n de las fichas t&#233;cnicas de la AEMPS es ajustar la dosis de esta familia farmacol&#243;gica al grado del filtrado glomerular de cada paciente y esto se cumple escasamente en nuestro medio&#46; En los pacientes con insuficiencia renal avanzada &#40;FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; la sobredosificaci&#243;n de los IDPP4 ocurre en el 36&#44;8&#37; de los tratamientos &#40;en un 58&#44;7&#37; si excluimos la linagliptina&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Respecto a las caracter&#237;sticas generales de nuestro estudio&#44; al igual que ha sido observado por otros autores<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a>&#44; globalmente no parecen existir grandes diferencias en el perfil cl&#237;nico de los pacientes ni en la adherencia al tratamiento entre las diferentes familias de iDPP4&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">El presente estudio analiz&#243; la prescripci&#243;n por parte del m&#233;dico y no la actitud del paciente en cuanto a la dispensaci&#243;n en la administraci&#243;n de farmacia y por lo tanto su cumplimiento&#46; Lo que fundamentalmente se quer&#237;a conocer era la intenci&#243;n de tratar de los profesionales sanitarios ante cada nueva prescripci&#243;n de un iDPP4 seg&#250;n el grado de funci&#243;n renal&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Cuando se intenta comparar los datos obtenidos con estudios previos&#44; sorprende la escasez de trabajos que analizan este aspecto&#46; No hemos encontrado ning&#250;n estudio similar en nuestro pa&#237;s&#46; Recientemente&#44; Spanopoulos D et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">26&#44;27</span></a> en un estudio tambi&#233;n en situaci&#243;n de pr&#225;ctica cl&#237;nica real en el Reino Unido analizaron la sobredosificaci&#243;n de iDPP4 en funci&#243;n de varias caracter&#237;sticas como la funci&#243;n renal&#46; Sus resultados indican que con FG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> existe una sobredosificaci&#243;n en el 16&#44;0&#37; de los tratamientos con alg&#250;n iDPP4 &#40;cifra que se eleva al 35&#44;2&#37; si se excluye la linagliptina&#41;&#46; Por diferentes f&#225;rmacos iDPP4&#44; se observa en el 38&#44;9&#37; de los tratamientos con alogliptina&#44; el 28&#44;1&#37; con saxagliptina&#44; 32&#44;7&#37; con sitagliptina y 18&#44;8&#37; con vildagliptina&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En 2017 en EE&#46; UU&#46;&#44; Huang H et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#44; estudiaron la sobredosificaci&#243;n solo en pacientes con estadios IIIb o superiores &#40;FG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45&#41; de insuficiencia renal y estima que existe un sobretratamiento de los iDPP4 en un 36&#44;2&#37; de los casos &#40;57&#44;9&#37; con saxagliptina y 44&#44;9&#37; con sitagliptina&#41;&#44; que son datos pr&#225;cticamente id&#233;nticos a los de nuestro estudio &#40;36&#44;8&#37;&#41;&#46; Analizan&#44; adem&#225;s&#44; el coste total derivado de la DM2&#44; observando que es superior en los pacientes sobredosificados &#40;304<span class="elsevierStyleHsp" style=""></span>&#36; anuales&#41;&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En Corea<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#44; un amplio estudio retrospectivo poblacional entre pacientes con DM2 y estadios IIIb y IV hallaron una sobredosificaci&#243;n de iDPP4 cercana al 40&#37; en el 2011 que se redujo al 24&#44;4&#37; 4 a&#241;os despu&#233;s&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Como limitaciones hay que se&#241;alar&#58; se trata de un estudio descriptivo retrospectivo con registros cl&#237;nicos con las limitaciones que hay impl&#237;citas como el riesgo de infraregistro y valores faltantes&#46; Sin embargo&#44; la receta electr&#243;nica est&#225; implantada hace muchos a&#241;os en nuestro sistema y en este estudio solamente se analizan pacientes con valores completos en las variables principales&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Exist&#237;a la posibilidad que durante el periodo de observaci&#243;n un sujeto pudiera experimentar cambios en la prescripci&#243;n&#44; tanto en la dosis&#44; como en el inicio de un tratamiento combinado con otro antidiab&#233;tico&#44; o incluso en el cambio de clase de iDPP4&#46; Se han analizado conjuntamente todas las situaciones posibles puesto que el objetivo del estudio era realizar un an&#225;lisis de la situaci&#243;n real y estudiar el patr&#243;n de prescripci&#243;n del m&#233;dico de atenci&#243;n primaria&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">No se han analizado los cambios temporales del patr&#243;n de tratamiento ni las repercusiones cl&#237;nicas que puede tener la sobredosificaci&#243;n de los iDPP4&#46; Esta puede ser una l&#237;nea de futuros estudios en pr&#225;ctica real&#44; especialmente en el terreno de los posibles efectos adversos que puedan presentarse&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Una revisi&#243;n bibliogr&#225;fica publicada recientemente ha concluido que el perfil de efectos adversos de los inhibidores de la DPP-4 en la insuficiencia renal no parece diferente al de las personas con funci&#243;n renal normal&#59; pero teniendo en cuenta los datos farmacocin&#233;ticos&#44; se recomiendan ajustes de dosis para aquellos iDPP-4 con excreci&#243;n renal significativa para evitar la acumulaci&#243;n de los f&#225;rmacos<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&#46; La acumulaci&#243;n en plasma de inhibidores de la DPP-4 se considera un riesgo potencial por la posibilidad que aparezcan alg&#250;n evento adverso desconocido<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> o poco frecuente pero potencialmente grave&#44; como la insuficiencia card&#237;aca o la pancreatitis<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&#46; El riesgo de provocar una hipoglucemia es menos probable&#46; Como principal fortaleza del estudio se&#241;alaremos la gran muestra y largo periodo de estudio&#46; Se ha podido describir en un entorno de pr&#225;ctica m&#233;dica real los h&#225;bitos de prescripci&#243;n del m&#233;dico de atenci&#243;n primaria en la prescripci&#243;n de los iDPP4&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">La reducci&#243;n de dosis&#44; adem&#225;s de las implicaciones que puede tener en la seguridad farmacol&#243;gica&#44; en ocasiones ha sido un argumento esgrimido para alegar un menor coste del tratamiento en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Nuestros datos y los de la bibliograf&#237;a muestran que&#44; ante la presencia de insuficiencia renal&#44; mayoritariamente no se ajusta la dosis de los iDPP4&#46; Aproximadamente un tercio de los pacientes con DM2 e insuficiencia renal avanzada &#40;FG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; tratados con iDPP4 est&#225;n sobredosificados&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">La principal recomendaci&#243;n que se puede establecer a partir del an&#225;lisis de los datos necesariamente debe orientarse a la necesidad de cumplir con las recomendaciones de la AEMPS y ajustar la dosis de los diferentes iDPP4 seg&#250;n el nivel del filtrado glomerular&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0240" class="elsevierStylePara elsevierViewall">El presente trabajo no ha recibido ninguna financiaci&#243;n externa&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Autor&#237;as</span><p id="par0245" class="elsevierStylePara elsevierViewall">J&#46;F-N&#44; M&#46;M-C&#44; J&#46;R&#44; D&#46;M&#44; E&#46;O&#44; J&#46;A&#46;V y B&#46;V&#44; participaron en el dise&#241;o de estudio&#46; J&#46;R realiz&#243; el an&#225;lisis estad&#237;stico&#46; J&#46;F&#46;-N redact&#243; el borrador inicial del manuscrito&#44; que lo editaron&#44; M&#46;M-C&#44; J&#46;R&#44; D&#46;M&#44; E&#46;O&#44; J&#46;A&#46;V y B&#46;V&#46; Todos los autores aprobaron el manuscrito final&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0250" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses en relaci&#243;n con este estudio&#44;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examinar el patr&#243;n de prescripci&#243;n de los distintos inhibidores de la dipeptidil-peptidasa 4 &#40;iDPP4&#41; en funci&#243;n del filtrado glomerular estimado &#40;FGe&#41; en condiciones de pr&#225;ctica cl&#237;nica real&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Metodolog&#237;a</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo observacional con base de datos poblacional &#40;SIDIAP Catalunya&#41;&#46; Se incluyeron sujetos diagnosticados de diabetes mellitus tipo 2 &#40;DM2&#41; con evaluaci&#243;n de su funci&#243;n renal y tratamiento activo con iDPP4&#46; Se incluyeron pacientes en el momento de la determinaci&#243;n del FGe &#40;CKD-EPI&#41;&#44; con un periodo de observaci&#243;n de 6 meses posterior a su inclusi&#243;n&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Para cada sujeto se estim&#243; la dosis diaria prescrita &#40;DDP&#41; de iDPP4&#44; su dosis te&#243;rica seg&#250;n su nivel de insuficiencia renal que establecen las recomendaciones de la ficha t&#233;cnica &#40;DDD-aj&#41; y el ratio RDP &#40;DDP&#47;DDD-aj&#41;&#46; Se consider&#243; que un sujeto estaba sobretratado si su RDP era superior a 1&#44;2 &#40;&#62;<span class="elsevierStyleHsp" style=""></span>20&#37;&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La muestra estudiada fue de 72&#46;135 sujetos con una edad media de 69&#44;7 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;6&#41; a&#241;os y un 55&#44;9&#37; de varones&#46; El porcentaje de pacientes con sobretratamiento var&#237;a seg&#250;n el tipo de f&#225;rmaco iDPP4 y el estadio de la funci&#243;n renal&#46; Globalmente la sobredosificaci&#243;n se registr&#243; en el 7&#44;15&#37; de todos los tratamientos con iDPP4&#46; En estadios avanzados &#40;IIIb&#44; IV y V&#41; la sobredosificaci&#243;n fue muy superior &#40;del 36&#44;8&#37; para todos los iDPP4 y si excluimos la linagliptina del 58&#44;7&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En condiciones de pr&#225;ctica cl&#237;nica real&#44; m&#225;s de un tercio de los pacientes con DM2 con insuficiencia renal avanzada presentaban una sobredosificaci&#243;n de los iDPP4&#44; puesto que no se ajustan correctamente las dosis al filtrado glomerular de cada paciente&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To examine the prescription pattern of the different dipeptidyl peptidase-4 inhibitors &#40;DPP4is&#41;&#44; depending on the estimated glomerular filtration rate &#40;eGFR&#41; under real-world clinical practice conditions&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This was a descriptive&#44; observational study using a population database &#40;SIDIAP Catalonia&#41;&#46; Subjects diagnosed with T2DM with kidney function assessed and on active treatment with DPP4is were enrolled&#46; Patients were included at the time of the measurement of eGFR &#40;CKD-EPI&#41; and were monitored for 6 months after enrolment&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">For each subject&#44; the prescribed daily dose &#40;PDD&#41; of DPP4i&#44; the theoretical dose according to the degree of renal failure established by the recommendations in the summary of product characteristics &#40;DDD-adj&#41;&#44; and the PDR ratio &#40;PDD&#47;DDD-adj&#41; were estimated&#46; A subject was considered overtreated if his&#47;her RDR was greater than 1&#46;2 &#40;&#62;20&#37;&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The study sample consisted of 72&#44;135 subjects with a mean age of 69&#46;7 &#40;&#177;11&#46;6&#41; years and 55&#46;9&#37; males&#46; The proportion of patients overtreated varied depending on the type of DPP4i and the renal function stage&#46; Overall&#44; overdosage was recorded in 7&#46;15&#37; of all DPP4i treatments&#46; In advanced stages &#40;IIIb&#44; IV and V&#41;&#44; overdosage was much higher &#40;36&#46;8&#37; for all DPP4is&#44; and 58&#46;7&#37; if linagliptin is excluded&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Under real-world clinical practice conditions&#44; more than one third of T2DM patients with advanced renal failure were overdosed with DPP4is because the doses were not adequately adjusted to the glomerular filtration rate of each patient&#46;</p></span>"
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        "etiqueta" => "Figura 1"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sobredosificaci&#243;n del global de los iDPP4 y de los iDPP4 no-linaglipt&#237;nicos&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DDD-aj&#58; dosis diaria definida ajustada a la funci&#243;n renal&#59; DDP&#58; dosis diaria prescrita&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio I y II&#59; FGe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio IIIa&#59; FG&#58; 45-59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio IIIb&#59; FG&#58; 30-45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio IV y V&#59; FGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes de HTA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedentes arteriopat&#237;a perif&#233;rica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">943 &#40;10&#44;0&#37;&#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">219 &#40;62&#44;6&#41;&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"><span class="elsevierStyleHsp" style=""></span>Saxagliptina&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">867 &#40;1&#44;20&#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">236 &#40;1&#44;14&#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">421 &#40;1&#44;35&#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">123 &#40;1&#44;21&#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">65 &#40;0&#44;93&#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">20 &#40;0&#44;74&#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 &#40;0&#44;57&#41;&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"><span class="elsevierStyleHsp" style=""></span>Sitagliptina&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">42&#46;571 &#40;59&#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">13&#46;305 &#40;64&#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">19&#46;548 &#40;62&#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">5&#46;787 &#40;56&#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">3&#46;033 &#40;43&#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">834 &#40;30&#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">64 &#40;18&#44;3&#41;&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"><span class="elsevierStyleHsp" style=""></span>Vildagliptina&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">18&#46;358 &#40;25&#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">5&#46;550 &#40;26&#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">8&#46;449 &#40;27&#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">2&#46;575 &#40;25&#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">1&#46;372 &#40;19&#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">365 &#40;13&#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">47 &#40;13&#44;4&#41;&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"><span class="elsevierStyleItalic">En monoterapia</span>&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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"><span class="elsevierStyleHsp" style=""></span>Todos iDPP4&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">32&#46;863&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">7&#46;881&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">13&#46;406&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&#46;981&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&#46;174&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&#46;109&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">312&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"><span class="elsevierStyleHsp" style=""></span>Alogliptina&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">424 &#40;1&#44;29&#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">87 &#40;1&#44;10&#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">140 &#40;1&#44;04&#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">50 &#40;1&#44;00&#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">68 &#40;1&#44;63&#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">62 &#40;2&#44;94&#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">17 &#40;5&#44;45&#41;&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"><span class="elsevierStyleHsp" style=""></span>Linagliptina&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;354 &#40;16&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">475 &#40;6&#44;03&#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;065 &#40;7&#44;94&#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">876 &#40;17&#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">1&#46;566 &#40;37&#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">1&#46;173 &#40;55&#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">199 &#40;63&#44;8&#41;&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"><span class="elsevierStyleHsp" style=""></span>Saxagliptina&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">348 &#40;1&#44;06&#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">82 &#40;1&#44;04&#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">163 &#40;1&#44;22&#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">58 &#40;1&#44;16&#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">33 &#40;0&#44;79&#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">10 &#40;0&#44;47&#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 &#40;0&#44;64&#41;&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"><span class="elsevierStyleHsp" style=""></span>Sitagliptina&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">17&#46;405 &#40;53&#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">4&#46;722 &#40;59&#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">7&#46;770 &#40;58&#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
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vildagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">En tratamiento combinado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alogliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Linagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2823176.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Pacientes tratados con iDPP4 en funci&#243;n del estadio de la funci&#243;n renal</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">En cada celda la media de la DDP y entre par&#233;ntesis la desviaci&#243;n est&#225;ndar&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">DDP&#58; dosis diaria prescrita&#59; FG&#58; filtrado glomerular&#59; iDPP4&#58; inhibidores de la dipeptidil peptidasa 4&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IFG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIFG&#58; 60-89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIa FG&#58; 45-59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIb FG&#58; 30-44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IVFG&#58; 15-29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio VFG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Alogliptina&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">14&#44;5 &#40;9&#44;08&#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">16&#44;2 &#40;8&#44;66&#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">15&#44;0 &#40;9&#44;88&#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">13&#44;0 &#40;8&#44;58&#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">12&#44;3 &#40;7&#44;90&#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">12&#44;6 &#40;7&#44;06&#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">12&#44;5 &#40;10&#44;3&#41;&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">Linagliptina&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;01 &#40;1&#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">3&#44;92 &#40;1&#44;87&#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;98 &#40;1&#44;91&#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;12 &#40;2&#44;04&#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;97 &#40;2&#44;00&#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;06 &#40;1&#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">4&#44;12 &#40;2&#44;25&#41;&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">Saxagliptina&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;23 &#40;1&#44;81&#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;26 &#40;1&#44;71&#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;27 &#40;1&#44;65&#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;29 &#40;1&#44;79&#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;89 &#40;2&#44;93&#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;64 &#40;1&#44;50&#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;56 &#40;0&#44;34&#41;&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">Sitagliptina&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">70&#44;8 &#40;34&#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">72&#44;6 &#40;33&#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">72&#44;2 &#40;35&#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">69&#44;6 &#40;35&#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">62&#44;2 &#40;35&#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">52&#44;9 &#40;34&#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">53&#44;9 &#40;27&#44;1&#41;&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">Vildagliptina&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">77&#44;8 &#40;40&#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">80&#44;3 &#40;33&#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">79&#44;6 &#40;43&#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">76&#44;0 &#40;36&#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">67&#44;2 &#40;44&#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">54&#44;4 &#40;42&#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">43&#44;9 &#40;31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2823177.png"
              ]
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Descriptiva de la dosis diaria prescrita de iDPP4 seg&#250;n el estadio de la insuficiencia renal</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">En cada celda la media del ratio DDP&#47;DDD-aj y entre par&#233;ntesis la desviaci&#243;n est&#225;ndar&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">DDD-aj&#58; dosis diaria definida ajustada a la funci&#243;n renal&#59; DDP&#58; dosis diaria prescrita&#59; FG&#58; filtrado glomerular&#59; iDPP4&#58; inhibidores de la dipeptidil peptidasa 4&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IFG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIFG&#58; 60-89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIa FG&#58; 45-59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIb FG&#58; 30-44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IVFG&#58; 15-29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio VFG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Alogliptina&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">0&#44;80 &#40;0&#44;70&#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">0&#44;65 &#40;0&#44;35&#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">0&#44;60 &#40;0&#44;40&#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">0&#44;52 &#40;0&#44;34&#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">0&#44;98 &#40;0&#44;63&#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;02 &#40;1&#44;13&#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;0 &#40;1&#44;64&#41;&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">Linagliptina&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">0&#44;80 &#40;0&#44;39&#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">0&#44;78 &#40;0&#44;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">0&#44;80 &#40;0&#44;38&#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">0&#44;82 &#40;0&#44;41&#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">0&#44;79 &#40;0&#44;40&#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">0&#44;81 &#40;0&#44;39&#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">0&#44;82 &#40;0&#44;45&#41;&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">Saxagliptina&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">0&#44;70 &#40;0&#44;48&#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">0&#44;65 &#40;0&#44;34&#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">0&#44;65 &#40;0&#44;33&#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">0&#44;66 &#40;0&#44;36&#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;16 &#40;1&#44;17&#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;06 &#40;0&#44;60&#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;42 &#40;0&#44;14&#41;&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">Sitagliptina&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">0&#44;79 &#40;0&#44;49&#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">0&#44;73 &#40;0&#44;34&#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">0&#44;72 &#40;0&#44;35&#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">0&#44;70 &#40;0&#44;35&#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;24 &#40;0&#44;70&#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;11 &#40;1&#44;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">2&#44;16 &#40;1&#44;08&#41;&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">Vildagliptina&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">0&#44;84 &#40;0&#44;49&#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">0&#44;80 &#40;0&#44;34&#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">0&#44;80 &#40;0&#44;43&#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">0&#44;76 &#40;0&#44;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">1&#44;34 &#40;0&#44;88&#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;09 &#40;0&#44;86&#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">0&#44;88 &#40;0&#44;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2823178.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Ratio DDP&#47;DDD-aj de los iDPP4 seg&#250;n el estadio de la insuficiencia renal</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IFG<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIFG&#58; 60-89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIa FG&#58; 45-59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IIIb FG&#58; 30-44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio IVFG&#58; 15-29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estadio VFG<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Conjunto iDPP4&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;156 &#40;7&#44;15&#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">447 &#40;2&#44;16&#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">768 &#40;2&#44;46&#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">309 &#40;3&#44;03&#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">2&#46;730 &#40;39&#44;2&#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">822 &#40;30&#44;2&#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">80 &#40;22&#44;9&#37;&#41;&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">Conjunto iDPP4 excepto linagliptina&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&#46;974 &#40;7&#44;93&#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">437 &#40;2&#44;26&#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">734 &#40;2&#44;55&#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">274 &#40;3&#44;19&#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">2&#46;680 &#40;58&#44;4&#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">780 &#40;60&#44;2&#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">69 &#40;52&#44;7&#37;&#41;&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">Alogliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Linagliptina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Saxagliptina&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">34 &#40;52&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \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">Sitagliptina&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">3&#46;747 &#40;8&#44;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">353 &#40;2&#44;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Vildagliptina&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;020 &#40;5&#44;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76 &#40;1&#44;37&#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
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                  \t\t\t\t">134 &#40;1&#44;59&#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
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                  \t\t\t\t">38 &#40;1&#44;48&#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
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                  \t\t\t\t">670 &#40;48&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;26&#44;3&#37;&#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">6 &#40;12&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab2823179.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Ratio DPP&#47;DDD-aj<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;2&#46; Los porcentajes se corresponden con el total de casos sobredosificados respecto al total de casos que utilizan el iDPP4 dentro de cada estadio de funci&#243;n renal&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">DDD-aj&#58; dosis diaria definida ajustada a la funci&#243;n renal&#59; DPP&#58; dipeptidil peptidasa 4&#59; iDPP4&#58; inhibidores de la dipeptidil peptidasa 4&#46;</p>"
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          "es" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Frecuencia y porcentaje &#40;&#37;&#41; de sobredosificaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> de los iDPP4 seg&#250;n estadio de insuficiencia renal</p>"
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          "identificador" => "bibs0015"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of hyperglycaemia in type 2 diabetes&#44; 2018&#46; A consensus report by the american diabetes association &#40;ADA&#41; and the european association for the study of diabetes &#40;EASD&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Davies"
                            1 => "D&#46;A&#46; D&#8217;Alessio"
                            2 => "J&#46; Fradkin"
                            3 => "W&#46;N&#46; Kernan"
                            4 => "C&#46; Mathieu"
                            5 => "G&#46; Mingrone"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00125-018-4729-5"
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                        "tituloSerie" => "Diabetologia"
                        "fecha" => "2018"
                        "volumen" => "61"
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                        "paginaFinal" => "2498"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30288571"
                            "web" => "Medline"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "NICE&#46; Type 2 diabetes in adults&#58; management&#44; 2017 &#91;consultado 20 Nov 2018&#93; Disponible en&#58; http&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ng28&#47;resources&#47;type-2-diabetes-in-adults-management-pdf-1837338615493 &#40;page 22 - Algorithm for blood glucose lowering therapy in adults with type 2 diabetes&#41;"
                ]
              ]
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              "identificador" => "bib0305"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de Consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal cr&#243;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "R&#46; G&#243;mez-Huelgas"
                            1 => "A&#46; Mart&#237;nez-Castelao"
                            2 => "S&#46; Artola"
                            3 => "J&#46;L&#46; G&#243;rriz"
                            4 => "E&#46; Men&#233;ndez"
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nefrol&#46;"
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                        "volumen" => "34"
                        "paginaInicial" => "34"
                        "paginaFinal" => "45"
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                0 => array:1 [
                  "referenciaCompleta" => "Preguntas y Respuestas sobre la informaci&#243;n a incluir en Ficha T&#233;cnica&#44; Etiquetado y Prospecto&#46; Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;AEMPS&#41; website&#46; Updated July 13&#44; 2018 &#91;consultado 17 Nov 2020&#93; Disponible en&#58; https&#58;&#47;&#47;www&#46;aemps&#46;gob&#46;es&#47;industria-farmaceutica&#47;etiquetado-y-prospectos&#47;industria&#95;etiquetado&#95;preguntasrespuestas&#47;&#63;lang<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ca"
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                      "titulo" => "Efficacy and safety of dipeptidyl peptidase-4 inhibitors in type 2 diabetes&#58; Meta-analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            3 => "K&#46;L&#46; Rascati"
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                    0 => array:2 [
                      "doi" => "10.1345/aph.1R041"
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                        "tituloSerie" => "Ann Pharmacother"
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                        "volumen" => "46"
                        "paginaInicial" => "1453"
                        "paginaFinal" => "1469"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23136353"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de consenso sobre el tratamiento de la diabetes tipo 2 en el paciente con enfermedad renal cr&#243;nica"
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                        0 => array:2 [
                          "etal" => false
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                      "titulo" => "Pharmacokinetics and clinical use of incretin-based therapies in patients with chronic kidney disease and type 2 diabetes"
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                          "etal" => false
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                        "tituloSerie" => "Clin Pharmacokinet"
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                  "referenciaCompleta" => "Centro de informaci&#243;n online de medicamentos de la AEMPS &#8211; CIMA website&#46; Updated November&#44; 16 2020 &#91;consultado 17 Nov 2020&#93; Disponible en&#58; https&#58;&#47;&#47;cima&#46;aemps&#46;es&#47;cima&#47;publico&#47;home&#46;html"
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Información del artículo
ISSN: 25300164
Idioma original: Español
DOI:10.1016/j.endinu.2021.01.013
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Endocrinología, Diabetes y Nutrición
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Anteriormente publicada como Endocrinología y Nutrición
Endocrinología y Nutrición
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