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Capacidad diagnóstica de las ecuaciones Chronic Kidney Disease Epidemiology Collaboration y Modification of Diet in Renal Disease-4 en la estimación del filtrado glomerular en pacientes pluripatológicos
Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients
José Luis Cabrerizo-Garcíaa,
Autor para correspondencia
j_cabrerizo@hotmail.com

Autor para correspondencia.
, Jesús Díez-Manglanob, Ernesto García-Arillac, Paz Revillo-Pinillad, José Ramón-Puertasa, Mariano Sebastián-Royoa, en representación de los investigadores del estudio PLUPAR
a Servicio de Medicina Interna, Hospital General de la Defensa, Zaragoza, España
b Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, España
c Servicio de Geriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
d Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065"><span class="elsevierStyleSmallCaps">I</span>ntroducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El aumento de la esperanza de vida en nuestra sociedad va acompa&#241;ado de un incremento de comorbilidad y de enfermedades cr&#243;nicas&#46; Se estima que el 31&#37; de la poblaci&#243;n tendr&#225; m&#225;s de 65 a&#241;os en el a&#241;o 2050<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La coexistencia de 2 o m&#225;s enfermedades cr&#243;nicas predispone a presentar fragilidad cl&#237;nica&#44; disminuci&#243;n de autonom&#237;a y capacidad funcional&#44; y conforma el concepto de paciente pluripatol&#243;gico &#40;PP&#41; seg&#250;n el Comit&#233; de Expertos de la Junta de Andaluc&#237;a de 2007<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Estos pacientes presentan una mortalidad y un consumo de recursos mayores&#44; constituyen el 1&#44;4&#37; de la poblaci&#243;n general y el 30&#37; de los pacientes ingresados en los servicios de medicina interna<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; El estudio de la funci&#243;n renal es relevante en pacientes que soportan una gran carga de comorbilidad&#44; nos ayuda en el ajuste del tratamiento y evita un da&#241;o renal sobrea&#241;adido en un colectivo frecuentemente polimedicado&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La forma m&#225;s exacta de calcular el filtrado glomerular &#40;FG&#41; pasa por medidas directas de inulina o m&#233;todos isot&#243;picos que resultan caros y poco pr&#225;cticos en la pr&#225;ctica cl&#237;nica habitual&#46; La determinaci&#243;n de la creatinina s&#233;rica o la recogida de orina de 24<span class="elsevierStyleHsp" style=""></span>h pueden ser muy variables debido a numerosas circunstancias ajenas a la propia funci&#243;n renal<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La estimaci&#243;n del FG mediante f&#243;rmulas es el mejor &#237;ndice&#44; en la pr&#225;ctica cl&#237;nica habitual&#44; para evaluar la funci&#243;n renal&#44; tanto en determinaciones aisladas<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> como en el diagn&#243;stico&#44; clasificaci&#243;n y pron&#243;stico de la enfermedad renal<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para simplificar el proceso se han dise&#241;ado diversas f&#243;rmulas como las de Cockcroft-Gault<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> o la <span class="elsevierStyleItalic">Modification of Diet in Renal Disease</span> &#40;MDRD&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; siendo esta &#250;ltima la recomendada por la mayor&#237;a de las sociedades cient&#237;ficas<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Sin embargo&#44; su utilizaci&#243;n sistem&#225;tica en la poblaci&#243;n general ha suscitado algunas cr&#237;ticas&#46; Fue creada a partir de pacientes afectos de insuficiencia renal con un FG medio de 40<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#59; parece tener escasa correlaci&#243;n con el FG en valores<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; infraestima los resultados cercanos a 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> y asigna la condici&#243;n de enfermedad renal a muchos pacientes sin otros datos de afectaci&#243;n renal&#46; Todo ello supone no solo limitar procedimientos diagn&#243;sticos y terap&#233;uticos&#44; sino tambi&#233;n un incremento no real del riesgo cardiovascular y una derivaci&#243;n injustificada a las consultas de nefrolog&#237;a&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Con la idea de mejorar los resultados de MDRD&#44; el grupo de investigaci&#243;n dependiente del <span class="elsevierStyleItalic">National Institute of Diabetes and Digestive and Kidney Disease</span>&#44; el <span class="elsevierStyleItalic">Chronic Kidney Disease Epidemiology Collaboration</span> &#40;CKD-EPI&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; ha publicado una nueva ecuaci&#243;n&#44; denominada CKD-EPI&#44; incluyendo a pacientes con y sin insuficiencia renal con un aclaramiento medio de iotalamato de 68<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#46; Seg&#250;n el estudio&#44; al compararla con MDRD ofrece mejores resultados&#44; con mayor precisi&#243;n y exactitud&#44; en especial para valores de FG<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#46; Los creadores de la ecuaci&#243;n sugieren que deber&#237;a sustituir a MDRD de forma generalizada en los laboratorios y en la pr&#225;ctica cl&#237;nica habitual&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hasta ahora&#44; la nueva ecuaci&#243;n de CKD-EPI ofrece&#44; de forma general&#44; valores superiores de FG con respecto a MDRD y reclasifica a los pacientes asignados por MDRD hacia estadios con mejor funci&#243;n renal&#46; Reduce la prevalencia de los pacientes que pertenecen al estadio 3&#44; redirigi&#233;ndolos hacia el estadio 2 y&#44; por tanto&#44; disminuye los posibles falsos positivos de enfermedad renal cr&#243;nica &#40;ERC&#41;&#46; Sin embargo&#44; el empleo de la ecuaci&#243;n CKD-EPI en PP es escasa y a&#250;n no ha quedado suficientemente confirmado si estos resultados se mantienen en poblaciones con caracter&#237;sticas espec&#237;ficas&#44; como lo es la de los PP&#46; Por ello&#44; nos planteamos como objetivo del trabajo comparar los valores de FG estimado &#40;FGe&#41; de la nueva ecuaci&#243;n CKD-EPI frente a la ecuaci&#243;n cl&#225;sica MDRD-4 en un grupo de PP ingresados en los servicios de medicina interna y geriatr&#237;a&#46; Hemos analizado la concordancia de ambas f&#243;rmulas&#44; la asignaci&#243;n de pacientes a diferentes grupos seg&#250;n su FGe&#44; as&#237; como la reclasificaci&#243;n de los casos discordante realizada por CKD-EPI en pacientes previamente clasificados por MDRD-4&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudio multic&#233;ntrico&#44; observacional&#44; descriptivo y transversal&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se recogieron datos de 425 pacientes con criterios de pluripatolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> entre el 1 de marzo y el 30 de junio de 2011&#44; ingresados en las unidades de medicina interna o geriatr&#237;a de agudos en 13 hospitales de Arag&#243;n cuyos participantes pertenecen al grupo de investigaci&#243;n del estudio Paciente PLUriPatol&#243;gico ingresado en medicina interna de Arag&#243;n &#40;PLUPAR&#41;&#46; Se excluyeron los reingresos&#44; los pacientes fallecidos durante el ingreso y aquellos que no contaban con las variables necesarias o no aceptaban la participaci&#243;n en el estudio&#46; Los datos fueron recogidos por personal m&#233;dico cualificado de cada servicio adiestrado para la ocasi&#243;n&#46; El estudio fue evaluado y aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n de la Comunidad Aut&#243;noma de Arag&#243;n&#46; Los pacientes que participaron en el estudio firmaron un consentimiento informado&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables del estudio</span><p id="par0050" class="elsevierStylePara elsevierViewall">Variables cl&#237;nicas&#46; Edad&#44; sexo&#44; antecedentes recogidos seg&#250;n las 8 categor&#237;as utilizadas en la definici&#243;n de enfermo PP<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#58; enfermedades card&#237;acas&#44; autoinmunes o renales&#44; respiratorias&#44; digestivas&#44; neurol&#243;gicas&#44; arteriopat&#237;a perif&#233;rica sintom&#225;tica o diabetes&#44; enfermedades oncohematol&#243;gicas y del aparato locomotor&#46; Presencia de polifarmacia &#40;consumo previo de 5-9 f&#225;rmacos&#41; o polifarmacia extrema &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>10 f&#225;rmacos&#41;&#46; Al ingreso se realiz&#243; una valoraci&#243;n mediante los siguientes &#237;ndices&#58; Barthel<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; cuestionario de Pfeiffer<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> e &#237;ndice de PROFUND<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; El &#237;ndice de Barthel valora las actividades b&#225;sicas de la vida diaria y el &#237;ndice de Charlson la comorbilidad&#46; El cuestionario de Pfeiffer eval&#250;a las funciones cognitivas y el &#237;ndice de PROFUND la probabilidad de muerte al cabo de un a&#241;o en PP&#46; Se registraron los reingresos y mortalidad durante un a&#241;o de seguimiento&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Variables anal&#237;ticas&#46; En el momento del ingreso se registr&#243; la concentraci&#243;n de hemoglobina &#40;g&#47;dl&#41;&#44; creatinina s&#233;rica &#40;mg&#47;dl&#41; y la estimaci&#243;n de FG mediante las f&#243;rmulas MDRD-4<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> y CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#41;&#46; El c&#225;lculo del FGe con ambas ecuaciones se realiz&#243; de forma independiente sin que el resultado de una pudiera influir en el de la otra&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Las variables continuas fueron expresadas como media y desviaci&#243;n est&#225;ndar &#40;DE&#41; y las variables cualitativas como valores absolutos y porcentajes&#46; Se establecieron 5 estadios seg&#250;n su FGe &#40;en ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#41; de acuerdo con los estadios correspondientes de ERC seg&#250;n las gu&#237;as de la <span class="elsevierStyleItalic">National Kidney Foundation</span>- <span class="elsevierStyleItalic">Kidney Disease Outcomes Quality Initiative</span> del 2002<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#58; 1&#44; valores del FGe<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#59; 2&#44; entre 60-89&#59; 3&#44; entre 30-59&#59; 4&#44; entre 15-29&#59; y 5&#44;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#46; La raz&#243;n para categorizar en estos 5 estadios&#44; de mayor a menor grado de FG&#44; fue para poder comparar mejor los resultados con la mayor&#237;a de los trabajos realizados sobre el tema&#44; los cuales dividen los valores del FG seg&#250;n los puntos de corte establecidos para la ERC&#46; A su vez&#44; cada uno de ellos se dividi&#243; seg&#250;n sexo y mediana de la edad muestral&#46; Para realizar las comparaciones hemos utilizado el an&#225;lisis de medias para muestras apareadas mediante los test t de Student o de Wilcoxon seg&#250;n su distribuci&#243;n fuera normal o no&#46; El grado de significaci&#243;n se estableci&#243; para valores de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; Se valor&#243; la fuerza de asociaci&#243;n entre las 2 ecuaciones&#44; para toda la muestra y cada uno de los grupos&#44; mediante el coeficiente de correlaci&#243;n Rho de Spearman&#46; Para el an&#225;lisis de concordancia&#44; es decir&#44; el grado de acuerdo entre los valores obtenidos con ambas f&#243;rmulas&#44; se utilizaron el coeficiente de concordancia de Lin y el gr&#225;fico de Bland-Altman&#46; Este procedimiento consiste en representar gr&#225;ficamente las diferencias entre 2 mediciones frente a su media&#44; permitiendo estimar la media de las diferencias y los l&#237;mites de concordancia acompa&#241;ados de un intervalo de confianza&#46; El c&#225;lculo del coeficiente de concordancia de Lin y la representaci&#243;n gr&#225;fica de Bland-Altman se realizaron con el programa estad&#237;stico MedCalc<span class="elsevierStyleSup">&#174;</span> versi&#243;n 12&#46;7&#46;0&#46;0 y el resto de los an&#225;lisis con el programa IBM SPSS Statistics<span class="elsevierStyleSup">&#174;</span> versi&#243;n 19&#46;0&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas basales de la poblaci&#243;n estudiada se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se trata de una muestra de 425 PP con una edad media &#40;DE&#41; de 81&#44;7 &#40;7&#44;9&#41; a&#241;os&#44; de los que el 55&#44;3&#37; eran mujeres&#46; El 72&#44;5&#37; proced&#237;an de servicios de medicina interna y el 27&#44;5&#37; de unidades de geriatr&#237;a de agudos&#46; Presentaban un deterioro cognitivo y una dependencia para actividades b&#225;sicas de la vida diaria moderados &#40;media seg&#250;n el cuestionario Pfeiffer de 4&#44;2 &#91;3&#44;4&#93; e &#237;ndice de Barthel de 55&#44;5 &#91;34&#44;9&#93;&#41;&#44; una probabilidad de mortalidad al a&#241;o del 45-50&#37; &#40;&#237;ndice de PROFUND medio de 8&#44;9 &#91;4&#44;8&#93;&#41; y una supervivencia media estimada a los 10 a&#241;os del 53&#44;39&#37; &#40;&#237;ndice de Charlson medio de 4 &#91;1&#44;2&#93;&#41;&#46; Entre las categor&#237;as diagn&#243;sticas destacaron las enfermedades card&#237;acas &#40;59&#44;8&#37;&#41; y neurol&#243;gicas &#40;46&#44;4&#37;&#41;&#46; El 33&#44;9&#37; presentaba insuficiencia renal cr&#243;nica&#46; M&#225;s de la mitad de los PP estaban polimedicados&#46; El 37&#44;4&#37; falleci&#243; en un a&#241;o y un 52&#44;5&#37; reingres&#243; en este periodo&#46; La media del FGe al ingreso fue de 58&#44;6 &#40;26&#44;3&#41; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> seg&#250;n MDRD-4 y de 52&#44;7 &#40;22&#44;9&#41; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> seg&#250;n CKD-EPI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">En las mujeres&#44; el FGe fue 5&#44;2<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; mayor con MDRD-4 que con CKD-EPI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y en los varones 6&#44;8<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; mayor con MDRD-4 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Tomando como referencia la mediana de la edad muestral&#44; 83 a&#241;os&#44; el FGe por MDRD-4 fue 6&#44;7<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; mayor que CKD-EPI en pacientes de 83 a&#241;os o mayores&#44; y de 5<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; mayor calculado por MDRD-4 en pacientes menores de83 a&#241;os &#40;ambos con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; con respecto a CKD-EPI&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La prevalencia de cada estadio &#40;1&#44; 2&#44; 3&#44; 4 y 5&#41; seg&#250;n la ecuaci&#243;n MDRD-4 fue del 14&#44;6&#59; 31&#44;1&#59; 40&#44;5&#59; 11&#44;5&#59; y 2&#44;4&#37;&#44; respectivamente&#59; y para CKD-EPI del 3&#44;1&#59; 36&#44;2&#59; 41&#44;4&#59; 16&#44;5&#59; y 2&#44;8&#37;&#44; respectivamente&#46; Al considerar los 5 estadios&#44; el FGe medio calculado por ambas ecuaciones era diferente de forma significativa en los 5 estadios y en todos los subgrupos&#44; excepto en los varones del estadio 5 y en menores de 83 a&#241;os en el estadio 5&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El coeficiente de correlaci&#243;n Rho de Spearman para el FG calculado por MDRD-4 y CKD-EPI fue de 0&#44;993&#44; es decir&#44; la correlaci&#243;n era fuerte&#46; La correlaci&#243;n de ambas f&#243;rmulas era fuerte en todos los estadios y subgrupos&#44; salvo en el estadio 1 del total de la muestra y de cada uno de los subgrupos&#46; Destacar que en las mujeres del estadio 1 la correlaci&#243;n fue negativa o inversa&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La concordancia&#44; o la fuerza de acuerdo entre los valores de FGe de ambas ecuaciones para toda la muestra&#44; fue moderada &#40;coeficiente de concordancia de Lin de 0&#44;948&#41;&#46; La concordancia fue tambi&#233;n moderada en todos los subgrupos&#44; sin hacer divisiones de estadio&#46; Todos los subgrupos resultantes&#44; tras dividir la muestra seg&#250;n FGe &#40;estadio 1&#44; 2&#44; 3&#44; 4 y 5&#41;&#44; sexo y edad&#44; presentaban una concordancia pobre&#44; a excepci&#243;n del subgrupo de menores de 83 a&#241;os&#44; estadios 2 y 3&#44; cuya concordancia fue moderada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> representa el an&#225;lisis de Bland-Altman en los diferentes estadios de funci&#243;n renal&#46; En todos los grupos se observa un descenso del FGe cuando empleamos CKD-EPI&#44; porcentualmente mayor en los estadios 1&#44; 4 y 5&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra un an&#225;lisis m&#225;s detallado de concordancia para toda la muestra&#44; incluyendo a la vez las variables de edad y sexo&#46; Tomando como referencia la clasificaci&#243;n establecida por MDRD-4&#44; vemos a los pacientes reclasificados por CKD-EPI y&#44; en caso de discordancias&#44; hacia d&#243;nde son dirigidos&#46; Se observa&#44; en todos los casos&#44; un incremento de concordancia seg&#250;n empeora la funci&#243;n renal&#44; siendo los estadios 3&#44; 4 y 5 los m&#225;s concordantes&#44; si bien los resultados del estadio 5 han de interpretarse con reservas por la escasez de pacientes&#46; Los casos discordantes son reclasificados por CKD-EPI hacia FG inferiores&#44; excepto en un caso&#46; Tomando como referencia MDRD-4&#44; 102 pacientes &#40;el 24&#37;&#41; fueron reclasificados en toda la muestra por CKD-EPI&#44; casi la totalidad hacia FGe inferiores&#46; En los estadios 4 y 5 el grado de concordancia fue superior al 87&#37; y del 100&#37;&#44; respectivamente&#44; en todos los casos con independencia de la edad o sexo&#46; En el estadio 3 la concordancia oscil&#243; entre el 76&#44;9 y el 94&#44;7&#37;&#44; fue superior en los PP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>83 a&#241;os&#44; y todos&#44; excepto uno fueron reclasificados hacia el estadio 4&#46; En el estadio 2&#44; el 21&#44;2&#37; de los pacientes pasaban a tener un FGe de 30-59<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; siendo las mujeres de 83 a&#241;os o mayores el subgrupo m&#225;s frecuentemente reclasificado&#46; Finalmente&#44; en el estadio 1&#44; se observa igualmente un importante porcentaje de pacientes reclasificados en todos los subgrupos hacia el 2&#46; En conclusi&#243;n&#44; la nueva ecuaci&#243;n CKD-EPI empeora&#44; de forma general&#44; el grado de insuficiencia renal en PP independientemente de la edad y el sexo&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Para complementar el estudio de concordancia hemos realizado los gr&#225;ficos de Bland-Altman&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> podemos observar que los valores de FGe son 5&#44;9<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> menores de media con CKD-EPI que con MDRD-4 &#40;con unos intervalos de confianza de 5 a &#8722;16&#44;8&#41; y en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> observamos que la disminuci&#243;n del FGe es del 10&#44;5&#37; por CKD-EPI&#44; pudiendo llegar hasta el 21&#44;7&#37; &#40;intervalo de confianza de del 0&#44;7&#37; al &#8722;21&#44;7&#37;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Seg&#250;n nuestros resultados&#44; la concordancia global o la fuerza de acuerdo entre ambas ecuaciones es moderada para toda la muestra y tras dividirla por edad y sexo&#46; Sin embargo&#44; cuando dividimos la muestra por estadios&#44; y estos a su vez por edad y sexo&#44; los subgrupos presentan&#44; de forma general&#44; una concordancia pobre&#46; La variaci&#243;n en los valores de FG con ambas f&#243;rmulas no es despreciable y los intervalos de confianza del an&#225;lisis de Bland-Altman son&#44; desde el punto de vista cl&#237;nico&#44; demasiado amplios como para concluir que ambas f&#243;rmulas ofrecen resultados equivalentes en PP&#46; En el estadio 2&#44; hay un descenso del 7&#37; en los valores de FGe al emplear CKD-EPI&#44; por lo que algunos de estos pacientes pasar&#225;n al estadio 3 y podr&#237;an aumentar la prevalencia de insuficiencia renal&#46; Tras observar que CKD-EPI ofrece valores inferiores de forma sistem&#225;tica y con significaci&#243;n cl&#237;nica cuando la comparamos con MDRD-4&#44; construimos la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; En ella podemos observar qu&#233; proporci&#243;n de pacientes eran reclasificados y hacia qu&#233; direcci&#243;n&#46; Como cabr&#237;a esperar&#44; casi el 100&#37; de los pacientes reclasificados son trasladados a estadios de menor FGe&#44; es decir&#44; mayor disfunci&#243;n renal&#46; Tomando como referencia toda la muestra&#44; 27 pacientes netos eran reclasificados desde el estadio 2 al 3&#44; por lo tanto la prevalencia de insuficiencia renal se incrementar&#237;a en un 6&#44;4&#37; al emplear la ecuaci&#243;n CKD-EPI&#44; en caso de objetivarse lesi&#243;n renal o confirmarse los resultados en 3 meses&#46; Analizando los diferentes grupos tras dividir la muestra por edad y sexo&#44; en el grupo de mujeres de 83 a&#241;os o m&#225;s era donde hab&#237;a mayor proporci&#243;n de pacientes reclasificados hacia estadios de mayor disfunci&#243;n renal&#46; Hemos de tener presente que la comparaci&#243;n de la ecuaci&#243;n CKD-EPI se ha realizado sobre otra ecuaci&#243;n preexistente y no sobre un m&#233;todo preciso reconocido previamente como la inulina &#40;<span class="elsevierStyleItalic">gold-standard</span>&#41;&#44; mol&#233;culas marcadas con is&#243;topos radiactivos &#40;<span class="elsevierStyleSup">99Tm</span>Tc-DTPA&#44; <span class="elsevierStyleSup">51</span>Cr-EDTA&#44; <span class="elsevierStyleSup">125</span>I-iotalamato&#41; u otras no isot&#243;picas como iohexol&#44; o iotalamato<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Por lo tanto&#44; no podemos discutir sobre la precisi&#243;n o exactitud de una u otra&#44; sino sobre la concordancia que presentan en la estimaci&#243;n de FG&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Estos resultados contradicen&#44; en el grupo de PP&#44; los datos de la nueva ecuaci&#243;n CKD-EPI&#44; que de forma general disminuye la prevalencia de enfermedad renal&#44; sobre todo en mujeres&#44; reduciendo el n&#250;mero de falsos positivos del estadio 3 de MDRD al reclasificar parte de estos pacientes a estadios superiores&#46; En el estudio NHNES &#40;1999-2006&#41; se apreci&#243; un descenso de la prevalencia de la enfermedad renal del 1&#44;6&#37; debido a una disminuci&#243;n de los casos clasificados por MDRD en el estadio 3<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Monta&#241;&#233;s Berm&#250;dez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> observaron que CKD-EPI origina valores m&#225;s elevados de FGe que MDRD&#46; En su trabajo&#44; la reclasificaci&#243;n de pacientes se produce en el estadio 3B&#44; donde el 9&#44;8&#37; pasaron al 3A&#44; y en el 3A&#44; donde el 17&#37; pasaron al 2&#46; Los desplazamientos a subgrupos de mayor FGe eran m&#225;s llamativos en pacientes menores de 70 a&#241;os&#46; Algunos autores aportan resultados similares<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a>&#59; adem&#225;s los pacientes &#171;rescatados&#187; del estadio 3 al 2 por CKD-EPI parecen ser de riesgo cardiovascular bajo&#44; menor que los que permanecen en el grupo de FGe 30-59<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span><a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46; Estos resultados son contrarios a los que nosotros observamos&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nuestro estudio no confirma la disminuci&#243;n de falsos positivos de MDRD del estadio 3 por parte de CKD-EPI&#44; como tampoco lo han observado otros trabajos<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; La nueva ecuaci&#243;n aplicada a PP ofrece valores inferiores de FGe con respecto a MDRD-4&#46; Lejos de reducir el n&#250;mero de pacientes con FG 30-59<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#44; ampl&#237;a este grupo e incrementar&#237;a la prevalencia de insuficiencia renal&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Pensamos que una raz&#243;n sobre la discordancia de los resultados obtenidos con respecto a otros trabajos podr&#237;a ser la edad de los pacientes incluidos&#46; La edad media de nuestros pacientes fue de 81&#44;7 a&#241;os y el 91&#44;8&#37; ten&#237;an m&#225;s de 70 a&#241;os&#44; frente a la edad media de 47 a&#241;os del trabajo de Levey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; con solo un 3&#44;7&#37; mayores de 70 a&#241;os&#46; La escasa representaci&#243;n de pacientes con edad avanzada queda recogida en las limitaciones de su trabajo&#46; Esto podr&#237;a suscitar dudas sobre la concordancia de ambas f&#243;rmulas en pacientes a&#241;osos y con m&#225;s de una enfermedad grave&#46; Algunos autores han comenzado a evaluarla en pacientes longevos<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a>&#46; Creemos que han intervenido varias razones en la reclasificaci&#243;n de pacientes del grupo 1 al 2&#44; sobre todo en los m&#225;s ancianos&#46; En primer lugar&#44; la tendencia generalizada del total de PP a ser redirigidos hacia filtrados inferiores&#44; el reducido n&#250;mero de pacientes en este grupo o la existencia de valores excesivamente elevados de MDRD-4 en pacientes a&#241;osos con sarcopenia y concentraciones de creatinina frecuentemente disminuidas&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Independientemente de que algunos autores recomienden el empleo generalizado de la ecuaci&#243;n CKD-EPI<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#44; diferentes trabajos est&#225;n analizando su comportamiento en grupos de pacientes con caracter&#237;sticas espec&#237;ficas<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> y su aplicaci&#243;n en PP a&#250;n es escasa&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Para concluir&#44; seg&#250;n los resultados de nuestro trabajo&#44; podemos afirmar que&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los valores resultantes de la estimaci&#243;n del FG en PP var&#237;an de forma sustancial seg&#250;n empleemos CKD-EPI o MDRD-4&#46; Las discordancias son cl&#237;nicamente relevantes&#44; los resultados no pueden ser considerados equivalentes ni las f&#243;rmulas intercambiables&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los resultados en la estimaci&#243;n del FG obtenidos por CKD-EPI son&#44; en la mayor&#237;a de los casos&#44; inferiores a los obtenidos por MDRD-4 y reclasifican&#44; de forma general&#44; a los PP hacia estadios con mayor disfunci&#243;n renal&#44; especialmente en mujeres de 83 a&#241;os o m&#225;s&#46;</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuevos trabajos m&#225;s amplios que relacionen esta f&#243;rmula de reciente creaci&#243;n con PP podr&#237;an aportar informaci&#243;n &#250;til en el manejo de enfermos complejos con alta carga de comorbilidad&#44; cada vez m&#225;s frecuentes en los servicios de medicina interna y geriatr&#237;a&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; En primer lugar&#44; no disponemos de una segunda determinaci&#243;n de creatinina a los 3 meses para confirmar los valores de FGe&#46; Y en segundo lugar&#44; el reducido n&#250;mero de pacientes&#44; especialmente en los estadios extremos de FGe &#40;&#60;<span class="elsevierStyleHsp" style=""></span>15 y<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#41;&#46; Sin embargo&#44; en la pr&#225;ctica cl&#237;nica habitual&#44; el n&#250;mero de PP con filtrados aumentados es escaso y los pacientes con FGe m&#225;s reducido no suelen ser dializados debido a su alta carga de comorbilidad&#44; falleciendo m&#225;s r&#225;pidamente&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">No existen conflictos de inter&#233;s por parte de los autores&#46;</p></span></span>"
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            0 => "Comorbilidad"
            1 => "Filtrado glomerular"
            2 => "Insuficiencia renal"
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        0 => array:4 [
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            0 => "Comorbidity"
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            2 => "Renal insufficiency"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La f&#243;rmula <span class="elsevierStyleItalic">Modification of Diet in Renal Disease</span> &#40;MDRD&#41; es la recomendada por la mayor&#237;a de las sociedades cient&#237;ficas para el c&#225;lculo del filtrado glomerular estimado &#40;FGe&#41;&#46; Recientemente el grupo <span class="elsevierStyleItalic">Chronic Kidney Disease Epidemiology Collaboration</span> &#40;CKD-EPI&#41; ha publicado una nueva ecuaci&#243;n con mayor exactitud y precisi&#243;n&#46; Hemos analizado su comportamiento en un grupo de pacientes pluripatol&#243;gicos &#40;PP&#41; compar&#225;ndola con la versi&#243;n cl&#225;sica MDRD-4&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; observacional&#44; descriptivo y transversal&#46; Se calcul&#243; el FGe por MDRD-4 y CKD-EPI en 425 PP&#46; A cada uno se le asign&#243; un estadio seg&#250;n su FGe&#58; 1&#58;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#59; 2&#58; 60-89&#59; 3&#58; 30-59&#59; 4&#58; 15-29&#59; y 5&#58;<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#46; Se analiz&#243; la concordancia entre ambas y la reclasificaci&#243;n de pacientes por CKD-EPI&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad media &#40;DE&#41; fue de 81&#44;7 &#40;7&#44;9&#41; a&#241;os&#46; El 55&#44;3&#37; eran mujeres&#46; La media del FGe fue de 58&#44;6 &#40;26&#44;3&#41; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> seg&#250;n MDRD-4 y de 52&#44;7 &#40;23&#44;0&#41; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> seg&#250;n CKD-EPI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; coeficientes de correlaci&#243;n Rho de Spearman y de concordancia de Lin&#58; 0&#44;993 y 0&#44;948&#44; respectivamente&#41;&#46; Los gr&#225;ficos de Bland-Altman reflejaban valores inferiores de FGe para la ecuaci&#243;n CKD-EPI&#46; En el estadio 2&#44; el 21&#44;2&#37; eran reasignados por CKD-EPI al estadio 3&#44; siendo las mujeres mayores de 83 a&#241;os el subgrupo m&#225;s desfavorecido&#44; con el 27&#44;3&#37; de reclasificaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La CKD-EPI aplicada al c&#225;lculo del FGe en PP empeora los resultados de la estimaci&#243;n mediante MDRD-4&#46; Origina&#44; de forma general&#44; valores de FGe inferiores e incrementa el grado de insuficiencia renal&#44; en especial en mujeres m&#225;s a&#241;osas&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Modification of Diet in Renal Disease &#40;MDRD&#41; equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate &#40;GFR&#41;&#46; Recently the group Chronic Kidney Disease Epidemiology Collaboration &#40;CKP-EPI&#41; has published a new&#44; more precise and accurate equation&#46; We have analyzed its behavior in a group of polypathological patients &#40;PP&#41; and compared it with the classic MDRD-4&#46;version</p> <span class="elsevierStyleSectionTitle" id="sect0040">Patients and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicenter&#44; observational&#44; descriptive and transversal study&#46; We calculated GFR by MDRD-4 and CKD-EPI in 425 PP&#46; Each stage was assigned according to the GFR&#58; 1&#58;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#59; 2&#58; 60-89&#59; 3&#58; 30-59&#59; 4&#58; 15-29&#59; and 5<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#46; We analyzed the correlation between both and the patients reclassified by CKD-EPI&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mean age was &#40;mean &#91;SD&#93;&#41; 81&#46;7 &#40;7&#46;9&#41; years&#46; 55&#46;3&#37; were women&#46; The mean estimated GFR was 58&#46;6 &#40;26&#46;3&#41; ml&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span> by MDRD-4 and 52&#46;7 &#40;23&#46;0&#41; ml&#47;min&#47;1&#46;73m<span class="elsevierStyleSup">2</span> by CKD-EPI &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#59; Spearman&#39;s Rho correlation and Lin concordance coefficients&#58; 0&#46;993 and 0&#46;948&#41;&#46; The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation&#46; In the stage 2&#44; 21&#46;2&#37; were reclassified by CKD-EPI to the stage 3&#44; with women older than 83 years being the more disadvantaged subgroup with 27&#46;3&#37; or reclassification&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CKD-EPI equation applied to PP worsens the results of MDRD-4&#46; In general&#44; it originates low values of GFR and increases the degree of renal insufficiency&#44; especially in older women&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Los nombres de los investigadores del estudio PLUPAR est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0050">anexo 1</a>&#46;</p>"
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            "etiqueta" => "Anexo 1"
            "titulo" => "Grupo de investigadores del estudio PLUPAR"
            "identificador" => "sec0050"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;4 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;3 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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"><span class="elsevierStyleHsp" style=""></span>Correlaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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;993&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;301&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;963&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;987&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;969&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;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Concordancia<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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;948&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;074&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;838&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;882&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;761&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;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hombres &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">190&#41;</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">MDRD-4</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;9 &#40;27&#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">103&#44;4 &#40;8&#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">73&#44;8 &#40;8&#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">44&#44;1 &#40;8&#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">24&#44;4 &#40;3&#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">12&#44;2 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">CKD-EPI</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;1 &#40;23&#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">86&#44;8 &#40;5&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#44;6 &#40;8&#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">39&#44;8 &#40;8&#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">21&#44;5 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;1 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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;109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Correlaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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;991&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;454&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;970&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;988&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;979&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;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Concordancia<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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;939&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;110&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;821&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;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">0&#44;739&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;485&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mujeres &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">235&#41;</span></td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">MDRD-4</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;2 &#40;24&#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">101&#44;5 &#40;5&#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">73&#44;4 &#40;9&#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">43&#44;6 &#40;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;1 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">CKD-EPI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">68&#44;8 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;4 &#40;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Correlaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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;994&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;048&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;965&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;988&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;970&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</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Concordancia<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&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</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\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">83 a&#241;os &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">210&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">MDRD-4</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">61&#44;4 &#40;27&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">102&#44;7 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#44;6 &#40;8&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">24&#44;6 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FGe<span class="elsevierStyleInf">CKD-EPI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">56&#44;4 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Correlaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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</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</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;962&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</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</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;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Concordancia<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
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es en pt

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

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

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