array:25 [
  "pii" => "S2174204917302349"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2017.08.003"
  "estado" => "S300"
  "fechaPublicacion" => "2017-09-01"
  "aid" => "1051"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2017;36:605-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1752
    "formatos" => array:3 [
      "EPUB" => 129
      "HTML" => 1285
      "PDF" => 338
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S087025511730567X"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2017.07.006"
      "estado" => "S300"
      "fechaPublicacion" => "2017-09-01"
      "aid" => "1051"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2017;36:605-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2254
        "formatos" => array:3 [
          "EPUB" => 161
          "HTML" => 1665
          "PDF" => 428
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio editorial</span>"
        "titulo" => "Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "605"
            "paginaFinal" => "607"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "What is the meaning and importance of cardiovascular risk in peritoneal dialysis&#63; Many issues remain to be clarified"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rui Alves"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Alves"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204917302349"
          "doi" => "10.1016/j.repce.2017.08.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302349?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730567X?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000009/v1_201709150927/S087025511730567X/v1_201709150927/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204917302325"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.11.016"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "995"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:609-16"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3297
      "formatos" => array:3 [
        "EPUB" => 160
        "HTML" => 2689
        "PDF" => 448
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "The postoperative venous thromboembolism &#40;TREVO&#41; study &#8211; Risk and case mortality by surgical specialty"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "609"
          "paginaFinal" => "616"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Estudo TRomboEmbolismo Venoso p&#243;s-Operat&#243;rio &#40;TREVO&#41; &#8211; risco e mortalidade por especialidade cir&#250;rgica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 948
              "Ancho" => 1645
              "Tamanyo" => 53874
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Annual changes in overall risk of venous thromboembolism&#44; 2008-2012&#46; VTE&#58; venous thromboembolism&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Amaral, Lu&#237;s Guimar&#227;es Pereira, Ana Moreto, Ana Carolina S&#225;, Ana Azevedo"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Amaral"
            ]
            1 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Guimar&#227;es Pereira"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Moreto"
            ]
            3 => array:2 [
              "nombre" => "Ana Carolina"
              "apellidos" => "S&#225;"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Azevedo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255117302858"
        "doi" => "10.1016/j.repc.2016.11.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117302858?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302325?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302325/v1_201709220127/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204917302398"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.12.021"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1050"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:599-604"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1825
      "formatos" => array:3 [
        "EPUB" => 131
        "HTML" => 1385
        "PDF" => 309
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Hypervolemia&#44; hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "599"
          "paginaFinal" => "604"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Hipervolemia&#44; hipoalbuminemia e calcifica&#231;&#227;o mitral como marcadores de risco cardiovascular nos doentes em di&#225;lise peritoneal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1059
              "Ancho" => 1567
              "Tamanyo" => 96918
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curves relating occurrence of a non-fatal or fatal cardiovascular event to mitral calcification &#40;p&#60;0&#46;001&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sara Querido, Patr&#237;cia Quadros Branco, Henrique Silva Sousa, Teresa Adrag&#227;o, Pedro Ara&#250;jo Gon&#231;alves, Maria Augusta Gaspar, Jos&#233; Diogo Barata"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Sara"
              "apellidos" => "Querido"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Quadros Branco"
            ]
            2 => array:2 [
              "nombre" => "Henrique"
              "apellidos" => "Silva Sousa"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Adrag&#227;o"
            ]
            4 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Ara&#250;jo Gon&#231;alves"
            ]
            5 => array:2 [
              "nombre" => "Maria Augusta"
              "apellidos" => "Gaspar"
            ]
            6 => array:2 [
              "nombre" => "Jos&#233; Diogo"
              "apellidos" => "Barata"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255117305668"
        "doi" => "10.1016/j.repc.2016.12.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305668?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302398?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302398/v1_201709220127/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "What is the meaning and importance of cardiovascular risk in peritoneal dialysis&#63; Many issues remain to be clarified"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "605"
        "paginaFinal" => "607"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Rui Alves"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Rui"
            "apellidos" => "Alves"
            "email" => array:1 [
              0 => "ruimbalves&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Faculdade de Medicina da Universidade de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Nefrologia&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular risk has been demonstrated to be substantially increased in patients with end-stage renal disease &#40;ESRD&#41; under dialysis&#46; In both the US and Europe&#44; cardiovascular mortality is around 40&#37;&#44; and is particularly high within three months of beginning treatment&#46; This implies that long before beginning dialysis&#44; progressive renal failure and uremia create a pathogenic environment that is especially conducive to atherogenesis&#44; whatever the etiology of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This in turn means that when considering the problem of cardiovascular disease in patients undergoing dialysis&#44; it is necessary to distinguish between the contributions of traditional cardiovascular risk factors&#44; those related to the causes of renal disease&#44; and risk factors related to renal replacement therapy&#44; whether peritoneal dialysis &#40;PD&#41;&#44; hemodialysis &#40;HD&#41;&#44; or kidney transplantation&#46; Which of these dialysis techniques is used can influence the atherogenic process&#44; depending on characteristics of the procedure such as the dialyzer or the peritoneal membrane&#44; but the most important parameters are the clearance rate and correction of the hydroelectrolyte&#44; acid&#47;base&#44; endocrine and metabolic and inflammatory imbalances that characterize renal failure&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies comparing cardiovascular risk in patients undergoing HD or PD are generally inconclusive&#59; study populations frequently vary enormously in age&#44; treatment duration and comorbidities&#44; besides the variety of factors affecting the pathophysiology of atherosclerotic disease&#46; However&#44; objective and replicable data indicate the importance of extracellular water accumulation and hypervolemia&#44; malnutrition and hypoalbuminemia associated with protein-energy wasting &#40;PEW&#41;&#44; and vascular calcification as factors in cardiovascular morbidity and mortality in ESRD patients&#46; All these may be present to varying degrees in both PD and HD and it is difficult to ascertain which of the techniques carries less risk&#46; Although there are specific characteristics that can increase the pathogenicity of these factors&#44; the crucial parameter is residual renal function&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The article by Querido et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> in this issue of the <span class="elsevierStyleItalic">Journal</span> does not set out to compare the two techniques in terms of cardiovascular risk&#44; but rather to identify cardiovascular risk markers in patients beginning PD&#46; The authors studied a large number of incident PD patients for a significant period of time&#44; which is notable given the scarcity of such studies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The discussion and conclusions of this article prompt the following considerations&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding hypervolemia&#44; extracellular volume in PD tends to increase&#44; due to its limited ability to remove sodium and the variable degree of ultrafiltration across the peritoneum&#44; which contributes to hypertension and left ventricular hypertrophy&#46; At the same time&#44; the presence of solute in the peritoneal cavity increases intra-abdominal pressure and also systemic blood pressure&#44; due to raised peripheral resistance&#46; These alterations act to increase myocardial production of natriuretic peptides&#44; which are indicators of overall mortality in patients undergoing dialysis and particularly PD&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> PD may thus be less effective than HD in reducing volume and controlling hypertension&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To correct hypervolemia and water retention&#44; the solute must contain an osmotic agent&#44; usually glucose&#44; which exposes the peritoneum to high concentrations of advanced glycation end-products &#40;AGEs&#41;&#46; These compounds are implicated in inflammation&#44; oxidative stress and structural changes in collagen&#46; However&#44; according to some authors the elevation of AGE levels in PD is also seen in HD&#44; and it is unlikely that AGE production in PD has systemic vascular effects&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> When it is deemed necessary to increase peritoneal ultrafiltration rate without using hypertonic glucose&#44; one option is icodextrin solution&#44; which was used by Querido et al&#46; to identify patients with volume overload&#46; The use of more biocompatible alternatives to glucose such as bicarbonate is controversial&#44; although some studies concluded that it improved survival and preserved residual renal function&#46; These solutes do appear to reduce peritoneal neoangiogenesis and thus loss of ultrafiltration&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Concerning hypoalbuminemia&#44; as pointed out by Querido et al&#46;&#44; a strong association has been demonstrated between malnutrition&#44; inflammation &#40;reflected in elevated C-reactive protein&#41;&#44; and atherosclerosis &#40;MIA syndrome&#41;&#44; and this is linked to increased cardiovascular mortality&#46; Although low serum albumin levels in dialysis patients show a strong inverse relationship with mortality&#44; this is generally taken to reflect disease severity rather than nutritional status&#46; Some authors therefore argue that a more accurate term would be PEW&#44; since the precise role of malnutrition and inflammation in the mortality risk of these patients remains to be clarified&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In the case of PD&#44; protein losses through the peritoneum and in urine&#44; as well as variations in protein intake&#44; make it particularly difficult to use albumin levels as indicators of inflammation and&#47;or malnutrition&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to mitral calcification&#44; in dialysis patients&#44; as in the general population&#44; arterial calcification is an important risk factor for cardiovascular mortality&#46; Such calcification occurs in both vessel intima and media&#44; as well as in cardiac valves&#44; and causes hardening of the arterial wall that leads to hypertension and left ventricular hypertrophy&#46; The main pathophysiological factors involved are hyperphosphatemia and&#44; probably&#44; the FGF23&#47;Klotho axis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Studies on the prevalence of calcification in ESRD have focused mainly on HD patients&#44; but those on PD patients also reveal a significantly increased prevalence&#46; This suggests that PD is no worse than HD in terms of the main pathophysiological mechanisms leading to tissue calcification&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Observational studies have shown a positive correlation between calcification and inflammatory markers&#44; particularly C-reactive protein&#44; interleukin-6 and adhesion molecules&#46; On the other hand&#44; considering the factors that affect the calcification process&#44; higher levels of fetuin-A&#44; an inhibitor of calcium deposition&#44; appear to be inversely related to cardiovascular mortality&#44; and since they are elevated in PD patients&#44; may confer a protective effect&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the absence of observational or randomized studies comparing PD with HD &#40;which would be impractical to perform&#41;&#44; the study by Querido et al&#46; contributes the experience of a single center in identifying markers of cardiovascular risk in patients treated by PD&#46; As outlined above&#44; cardiovascular risk in these patients is multifactorial and difficult to analyze&#44; and the methodology used runs the risk of incurring bias that could obscure its true causes&#46; Hypervolemia&#44; hypoalbuminemia and mitral calcification are in fact present in patients with chronic kidney disease before dialysis as well as in those undergoing HD&#44; and so it cannot be inferred from this study that they are related to the technique itself&#46; Furthermore&#44; the fact that valve calcification was diagnosed at the beginning of the study means that a link cannot be established with PD&#46; It thus remains to be seen to what extent PD contributes to the development or worsening of mitral calcification&#44; independently of its contribution to the increased incidence of cardiovascular events and mortality in this population&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alves R&#46; Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer&#46; Rev Port Cardiol&#46; 2017&#59;36&#58;605&#8211;607&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of cardiovascular risk in patients with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Locatelli"
                            1 => "P&#46; Pozzoni"
                            2 => "F&#46; Tentori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2003"
                        "volumen" => "18"
                        "numero" => "Suppl&#46; 7"
                        "paginaInicial" => "vii2"
                        "paginaFinal" => "vii9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12953023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypervolemia&#44; hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Querido"
                            1 => "P&#46;Q&#46; Branco"
                            2 => "H&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2016.12.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2017"
                        "volumen" => "36"
                        "paginaInicial" => "599"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28843932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is brain natriuretic peptide a reliable biomarker of hydration status in all peritoneal dialysis patients&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Crepaldi"
                            1 => "M&#46; Rosner"
                            2 => "C&#46; Teixeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000362155"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Purif"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "238"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24943906"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of changes in pulse wave velocity in patients on continuous ambulatory peritoneal dialysis and hemodialysis one year after introduction of dialysis therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Mimura"
                            1 => "T&#46; Takenaka"
                            2 => "Y&#46; Kanno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Perit Dial"
                        "fecha" => "2005"
                        "volumen" => "21"
                        "paginaInicial" => "139"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16686305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Fouque"
                            1 => "K&#46; Kalantar-Zadeh"
                            2 => "J&#46; Kopple"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002585"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2008"
                        "volumen" => "73"
                        "paginaInicial" => "391"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18094682"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mineral metabolism&#44; mortality&#44; and morbidity in maintenance hemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Block"
                            1 => "P&#46; Klassen"
                            2 => "J&#46;M&#46; Lazarus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ASN.0000133041.27682.A2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2004"
                        "volumen" => "15"
                        "paginaInicial" => "2208"
                        "paginaFinal" => "2218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15284307"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of serum fetuin-A levels with mortality in dialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;M&#46;H&#46; Hermans"
                            1 => "V&#46; Brandenburg"
                            2 => "M&#46; Ketteler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002178"
                      "Revista" => array:7 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2007"
                        "volumen" => "72"
                        "paginaInicial" => "202"
                        "paginaFinal" => "207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17342178"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274614003681"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302349/v1_201709220127/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000009/v1_201709220127/S2174204917302349/v1_201709220127/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302349?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial comment
What is the meaning and importance of cardiovascular risk in peritoneal dialysis? Many issues remain to be clarified
Qual é o significado e a importância do risco cardiovascular em diálise peritoneal? – Muitas questões ainda por esclarecer
Rui Alvesa,b
a Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
b Serviço de Nefrologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Read
4540
Times
was read the article
1612
Total PDF
2928
Total HTML
Share statistics
 array:25 [
  "pii" => "S2174204917302349"
  "issn" => "21742049"
  "doi" => "10.1016/j.repce.2017.08.003"
  "estado" => "S300"
  "fechaPublicacion" => "2017-09-01"
  "aid" => "1051"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2017;36:605-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1752
    "formatos" => array:3 [
      "EPUB" => 129
      "HTML" => 1285
      "PDF" => 338
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S087025511730567X"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2017.07.006"
      "estado" => "S300"
      "fechaPublicacion" => "2017-09-01"
      "aid" => "1051"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2017;36:605-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2254
        "formatos" => array:3 [
          "EPUB" => 161
          "HTML" => 1665
          "PDF" => 428
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Coment&#225;rio editorial</span>"
        "titulo" => "Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "605"
            "paginaFinal" => "607"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "What is the meaning and importance of cardiovascular risk in peritoneal dialysis&#63; Many issues remain to be clarified"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rui Alves"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Rui"
                "apellidos" => "Alves"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204917302349"
          "doi" => "10.1016/j.repce.2017.08.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302349?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730567X?idApp=UINPBA00004E"
      "url" => "/08702551/0000003600000009/v1_201709150927/S087025511730567X/v1_201709150927/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2174204917302325"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.11.016"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "995"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:609-16"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3297
      "formatos" => array:3 [
        "EPUB" => 160
        "HTML" => 2689
        "PDF" => 448
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "The postoperative venous thromboembolism &#40;TREVO&#41; study &#8211; Risk and case mortality by surgical specialty"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "609"
          "paginaFinal" => "616"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Estudo TRomboEmbolismo Venoso p&#243;s-Operat&#243;rio &#40;TREVO&#41; &#8211; risco e mortalidade por especialidade cir&#250;rgica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 948
              "Ancho" => 1645
              "Tamanyo" => 53874
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Annual changes in overall risk of venous thromboembolism&#44; 2008-2012&#46; VTE&#58; venous thromboembolism&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cristina Amaral, Lu&#237;s Guimar&#227;es Pereira, Ana Moreto, Ana Carolina S&#225;, Ana Azevedo"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Amaral"
            ]
            1 => array:2 [
              "nombre" => "Lu&#237;s"
              "apellidos" => "Guimar&#227;es Pereira"
            ]
            2 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Moreto"
            ]
            3 => array:2 [
              "nombre" => "Ana Carolina"
              "apellidos" => "S&#225;"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Azevedo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255117302858"
        "doi" => "10.1016/j.repc.2016.11.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117302858?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302325?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302325/v1_201709220127/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2174204917302398"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.12.021"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1050"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2017;36:599-604"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1825
      "formatos" => array:3 [
        "EPUB" => 131
        "HTML" => 1385
        "PDF" => 309
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Hypervolemia&#44; hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "599"
          "paginaFinal" => "604"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Hipervolemia&#44; hipoalbuminemia e calcifica&#231;&#227;o mitral como marcadores de risco cardiovascular nos doentes em di&#225;lise peritoneal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1059
              "Ancho" => 1567
              "Tamanyo" => 96918
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier survival curves relating occurrence of a non-fatal or fatal cardiovascular event to mitral calcification &#40;p&#60;0&#46;001&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sara Querido, Patr&#237;cia Quadros Branco, Henrique Silva Sousa, Teresa Adrag&#227;o, Pedro Ara&#250;jo Gon&#231;alves, Maria Augusta Gaspar, Jos&#233; Diogo Barata"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Sara"
              "apellidos" => "Querido"
            ]
            1 => array:2 [
              "nombre" => "Patr&#237;cia"
              "apellidos" => "Quadros Branco"
            ]
            2 => array:2 [
              "nombre" => "Henrique"
              "apellidos" => "Silva Sousa"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Adrag&#227;o"
            ]
            4 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Ara&#250;jo Gon&#231;alves"
            ]
            5 => array:2 [
              "nombre" => "Maria Augusta"
              "apellidos" => "Gaspar"
            ]
            6 => array:2 [
              "nombre" => "Jos&#233; Diogo"
              "apellidos" => "Barata"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0870255117305668"
        "doi" => "10.1016/j.repc.2016.12.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305668?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302398?idApp=UINPBA00004E"
    "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302398/v1_201709220127/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "What is the meaning and importance of cardiovascular risk in peritoneal dialysis&#63; Many issues remain to be clarified"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "605"
        "paginaFinal" => "607"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Rui Alves"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Rui"
            "apellidos" => "Alves"
            "email" => array:1 [
              0 => "ruimbalves&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Faculdade de Medicina da Universidade de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Nefrologia&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular risk has been demonstrated to be substantially increased in patients with end-stage renal disease &#40;ESRD&#41; under dialysis&#46; In both the US and Europe&#44; cardiovascular mortality is around 40&#37;&#44; and is particularly high within three months of beginning treatment&#46; This implies that long before beginning dialysis&#44; progressive renal failure and uremia create a pathogenic environment that is especially conducive to atherogenesis&#44; whatever the etiology of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> This in turn means that when considering the problem of cardiovascular disease in patients undergoing dialysis&#44; it is necessary to distinguish between the contributions of traditional cardiovascular risk factors&#44; those related to the causes of renal disease&#44; and risk factors related to renal replacement therapy&#44; whether peritoneal dialysis &#40;PD&#41;&#44; hemodialysis &#40;HD&#41;&#44; or kidney transplantation&#46; Which of these dialysis techniques is used can influence the atherogenic process&#44; depending on characteristics of the procedure such as the dialyzer or the peritoneal membrane&#44; but the most important parameters are the clearance rate and correction of the hydroelectrolyte&#44; acid&#47;base&#44; endocrine and metabolic and inflammatory imbalances that characterize renal failure&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies comparing cardiovascular risk in patients undergoing HD or PD are generally inconclusive&#59; study populations frequently vary enormously in age&#44; treatment duration and comorbidities&#44; besides the variety of factors affecting the pathophysiology of atherosclerotic disease&#46; However&#44; objective and replicable data indicate the importance of extracellular water accumulation and hypervolemia&#44; malnutrition and hypoalbuminemia associated with protein-energy wasting &#40;PEW&#41;&#44; and vascular calcification as factors in cardiovascular morbidity and mortality in ESRD patients&#46; All these may be present to varying degrees in both PD and HD and it is difficult to ascertain which of the techniques carries less risk&#46; Although there are specific characteristics that can increase the pathogenicity of these factors&#44; the crucial parameter is residual renal function&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The article by Querido et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> in this issue of the <span class="elsevierStyleItalic">Journal</span> does not set out to compare the two techniques in terms of cardiovascular risk&#44; but rather to identify cardiovascular risk markers in patients beginning PD&#46; The authors studied a large number of incident PD patients for a significant period of time&#44; which is notable given the scarcity of such studies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The discussion and conclusions of this article prompt the following considerations&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding hypervolemia&#44; extracellular volume in PD tends to increase&#44; due to its limited ability to remove sodium and the variable degree of ultrafiltration across the peritoneum&#44; which contributes to hypertension and left ventricular hypertrophy&#46; At the same time&#44; the presence of solute in the peritoneal cavity increases intra-abdominal pressure and also systemic blood pressure&#44; due to raised peripheral resistance&#46; These alterations act to increase myocardial production of natriuretic peptides&#44; which are indicators of overall mortality in patients undergoing dialysis and particularly PD&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> PD may thus be less effective than HD in reducing volume and controlling hypertension&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">To correct hypervolemia and water retention&#44; the solute must contain an osmotic agent&#44; usually glucose&#44; which exposes the peritoneum to high concentrations of advanced glycation end-products &#40;AGEs&#41;&#46; These compounds are implicated in inflammation&#44; oxidative stress and structural changes in collagen&#46; However&#44; according to some authors the elevation of AGE levels in PD is also seen in HD&#44; and it is unlikely that AGE production in PD has systemic vascular effects&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> When it is deemed necessary to increase peritoneal ultrafiltration rate without using hypertonic glucose&#44; one option is icodextrin solution&#44; which was used by Querido et al&#46; to identify patients with volume overload&#46; The use of more biocompatible alternatives to glucose such as bicarbonate is controversial&#44; although some studies concluded that it improved survival and preserved residual renal function&#46; These solutes do appear to reduce peritoneal neoangiogenesis and thus loss of ultrafiltration&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Concerning hypoalbuminemia&#44; as pointed out by Querido et al&#46;&#44; a strong association has been demonstrated between malnutrition&#44; inflammation &#40;reflected in elevated C-reactive protein&#41;&#44; and atherosclerosis &#40;MIA syndrome&#41;&#44; and this is linked to increased cardiovascular mortality&#46; Although low serum albumin levels in dialysis patients show a strong inverse relationship with mortality&#44; this is generally taken to reflect disease severity rather than nutritional status&#46; Some authors therefore argue that a more accurate term would be PEW&#44; since the precise role of malnutrition and inflammation in the mortality risk of these patients remains to be clarified&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In the case of PD&#44; protein losses through the peritoneum and in urine&#44; as well as variations in protein intake&#44; make it particularly difficult to use albumin levels as indicators of inflammation and&#47;or malnutrition&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to mitral calcification&#44; in dialysis patients&#44; as in the general population&#44; arterial calcification is an important risk factor for cardiovascular mortality&#46; Such calcification occurs in both vessel intima and media&#44; as well as in cardiac valves&#44; and causes hardening of the arterial wall that leads to hypertension and left ventricular hypertrophy&#46; The main pathophysiological factors involved are hyperphosphatemia and&#44; probably&#44; the FGF23&#47;Klotho axis&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Studies on the prevalence of calcification in ESRD have focused mainly on HD patients&#44; but those on PD patients also reveal a significantly increased prevalence&#46; This suggests that PD is no worse than HD in terms of the main pathophysiological mechanisms leading to tissue calcification&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Observational studies have shown a positive correlation between calcification and inflammatory markers&#44; particularly C-reactive protein&#44; interleukin-6 and adhesion molecules&#46; On the other hand&#44; considering the factors that affect the calcification process&#44; higher levels of fetuin-A&#44; an inhibitor of calcium deposition&#44; appear to be inversely related to cardiovascular mortality&#44; and since they are elevated in PD patients&#44; may confer a protective effect&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the absence of observational or randomized studies comparing PD with HD &#40;which would be impractical to perform&#41;&#44; the study by Querido et al&#46; contributes the experience of a single center in identifying markers of cardiovascular risk in patients treated by PD&#46; As outlined above&#44; cardiovascular risk in these patients is multifactorial and difficult to analyze&#44; and the methodology used runs the risk of incurring bias that could obscure its true causes&#46; Hypervolemia&#44; hypoalbuminemia and mitral calcification are in fact present in patients with chronic kidney disease before dialysis as well as in those undergoing HD&#44; and so it cannot be inferred from this study that they are related to the technique itself&#46; Furthermore&#44; the fact that valve calcification was diagnosed at the beginning of the study means that a link cannot be established with PD&#46; It thus remains to be seen to what extent PD contributes to the development or worsening of mitral calcification&#44; independently of its contribution to the increased incidence of cardiovascular events and mortality in this population&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Alves R&#46; Qual &#233; o significado e a import&#226;ncia do risco cardiovascular em di&#225;lise peritoneal&#63; &#8211; Muitas quest&#245;es ainda por esclarecer&#46; Rev Port Cardiol&#46; 2017&#59;36&#58;605&#8211;607&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of cardiovascular risk in patients with chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Locatelli"
                            1 => "P&#46; Pozzoni"
                            2 => "F&#46; Tentori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2003"
                        "volumen" => "18"
                        "numero" => "Suppl&#46; 7"
                        "paginaInicial" => "vii2"
                        "paginaFinal" => "vii9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12953023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypervolemia&#44; hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Querido"
                            1 => "P&#46;Q&#46; Branco"
                            2 => "H&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2016.12.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2017"
                        "volumen" => "36"
                        "paginaInicial" => "599"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28843932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is brain natriuretic peptide a reliable biomarker of hydration status in all peritoneal dialysis patients&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Crepaldi"
                            1 => "M&#46; Rosner"
                            2 => "C&#46; Teixeira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000362155"
                      "Revista" => array:6 [
                        "tituloSerie" => "Blood Purif"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "238"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24943906"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of changes in pulse wave velocity in patients on continuous ambulatory peritoneal dialysis and hemodialysis one year after introduction of dialysis therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Mimura"
                            1 => "T&#46; Takenaka"
                            2 => "Y&#46; Kanno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Adv Perit Dial"
                        "fecha" => "2005"
                        "volumen" => "21"
                        "paginaInicial" => "139"
                        "paginaFinal" => "145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16686305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46; Fouque"
                            1 => "K&#46; Kalantar-Zadeh"
                            2 => "J&#46; Kopple"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002585"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2008"
                        "volumen" => "73"
                        "paginaInicial" => "391"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18094682"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mineral metabolism&#44; mortality&#44; and morbidity in maintenance hemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; Block"
                            1 => "P&#46; Klassen"
                            2 => "J&#46;M&#46; Lazarus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ASN.0000133041.27682.A2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2004"
                        "volumen" => "15"
                        "paginaInicial" => "2208"
                        "paginaFinal" => "2218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15284307"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of serum fetuin-A levels with mortality in dialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;M&#46;H&#46; Hermans"
                            1 => "V&#46; Brandenburg"
                            2 => "M&#46; Ketteler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002178"
                      "Revista" => array:7 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2007"
                        "volumen" => "72"
                        "paginaInicial" => "202"
                        "paginaFinal" => "207"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17342178"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1058274614003681"
                          "estado" => "S300"
                          "issn" => "10582746"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302349/v1_201709220127/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9917"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000009/v1_201709220127/S2174204917302349/v1_201709220127/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302349?idApp=UINPBA00004E"
]
Article information
ISSN: 21742049
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 12 4 16
2024 October 32 28 60
2024 September 46 25 71
2024 August 39 27 66
2024 July 28 31 59
2024 June 24 15 39
2024 May 26 18 44
2024 April 32 27 59
2024 March 25 24 49
2024 February 32 18 50
2024 January 22 25 47
2023 December 30 28 58
2023 November 33 26 59
2023 October 15 15 30
2023 September 18 9 27
2023 August 22 24 46
2023 July 31 8 39
2023 June 31 17 48
2023 May 40 25 65
2023 April 18 5 23
2023 March 40 23 63
2023 February 33 15 48
2023 January 20 17 37
2022 December 39 26 65
2022 November 52 28 80
2022 October 22 21 43
2022 September 25 33 58
2022 August 18 24 42
2022 July 25 39 64
2022 June 24 30 54
2022 May 18 33 51
2022 April 25 31 56
2022 March 24 36 60
2022 February 25 35 60
2022 January 26 25 51
2021 December 20 32 52
2021 November 26 33 59
2021 October 31 49 80
2021 September 20 28 48
2021 August 37 34 71
2021 July 16 19 35
2021 June 16 18 34
2021 May 28 40 68
2021 April 42 36 78
2021 March 71 19 90
2021 February 42 15 57
2021 January 26 14 40
2020 December 41 6 47
2020 November 17 15 32
2020 October 9 18 27
2020 September 48 16 64
2020 August 11 4 15
2020 July 45 13 58
2020 June 20 8 28
2020 May 26 9 35
2020 April 32 23 55
2020 March 28 8 36
2020 February 44 19 63
2020 January 27 5 32
2019 December 38 6 44
2019 November 21 4 25
2019 October 25 5 30
2019 September 21 9 30
2019 August 19 5 24
2019 July 21 10 31
2019 June 25 5 30
2019 May 36 8 44
2019 April 21 14 35
2019 March 78 7 85
2019 February 36 9 45
2019 January 49 4 53
2018 December 61 10 71
2018 November 76 7 83
2018 October 102 8 110
2018 September 51 16 67
2018 August 39 6 45
2018 July 22 3 25
2018 June 46 8 54
2018 May 32 4 36
2018 April 43 11 54
2018 March 59 11 70
2018 February 23 10 33
2018 January 26 10 36
2017 December 63 38 101
2017 November 63 30 93
2017 October 92 40 132
2017 September 45 18 63
Show all

Follow this link to access the full text of the article

Idiomas
Revista Portuguesa de Cardiologia (English edition)
en pt

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

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

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.