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y anemia asociada &#40;niveles de hemoglobina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en varones y<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>11 en mujeres&#41; y necesidad de aportes de hierro &#40;&#237;ndice de saturaci&#243;n de transferrina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37; y&#47;o ferritina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#46; Se administr&#243; CMF iv &#40;Ferinject<span class="elsevierStyleSup">&#174;</span>&#44; Vifor Pharma Inc&#46;&#41; en dosis &#250;nica&#44; diluida en 250<span class="elsevierStyleHsp" style=""></span>cc de ClNa al 0&#44;9&#37;&#44; durante 15<span class="elsevierStyleHsp" style=""></span>min&#46; La dosis habitual era de 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#44; sin superar 15<span class="elsevierStyleHsp" style=""></span>mg de hierro por kilogramo de peso corporal&#46; Los resultados a los 6 meses se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Ning&#250;n paciente present&#243; reacciones adversas en el momento de la administraci&#243;n ni en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La CMF es una mol&#233;cula nueva&#44; eficaz y con pocos efectos secundarios asociados<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; En nuestro caso esta eficacia se mantuvo a los 6 meses&#44; sin necesidad de dosis suplementarias &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La informaci&#243;n acerca del tratamiento con CMF en pacientes con ERC es escasa<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6&#8211;9</span></a>&#46; Qunibi et al&#46; evidenciaron una mayor eficacia de la CMF iv que una pauta est&#225;ndar de ferroterapia oral<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Charytan et al&#46; concluyeron que la administraci&#243;n de CMF a pacientes con ERC era al menos tan eficaz como otras formulaciones iv&#44; con muy pocos efectos secundarios<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; En nuestra serie no se observaron efectos destacables&#46; Algunos trabajos han descrito tendencia a hipofosforemia&#44; pero nosotros no lo evidenciamos&#44; pudiendo tratarse de un efecto transitorio<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; La administraci&#243;n &#250;nica de ferroterapia iv supone una serie de ventajas sobre otras formulaciones iv&#46; En primer lugar disminuye las visitas al centro &#40;una dosis de CMF iv equivale a 10 sesiones con hierro dextrano&#44; 8 sesiones con gluconato f&#233;rrico y 5 con hierro sacarosa&#41; y se alcanza antes una correcta repleci&#243;n f&#233;rrica&#46; Adem&#225;s&#44; la CMF iv conlleva un menor tiempo de administraci&#243;n y&#44; por tanto&#44; ahorro de tiempo del profesional sanitario&#46; Otro aspecto relevante en pacientes con ERC es la conservaci&#243;n del &#225;rbol vascular&#44; minimizando las venopunciones&#46; A todas estas ventajas se a&#241;ade la ausencia de efectos secundarios sin modificaci&#243;n de los marcadores inflamatorios<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Por tanto&#44; el balance coste-efectividad puede ser mayor&#44; por encima del del valor neto &#40;1 vial &#61; 96 &#8364;&#41;&#46; En suma&#44; la administraci&#243;n de CMF en dosis &#250;nica iv a pacientes con ERC parece segura y eficaz&#44; permitiendo una posolog&#237;a sencilla&#44; con buena tolerancia que asegura el cumplimiento terap&#233;utico&#46; La eficiencia de la CMF iv&#44; comparada con otras formulaciones de hierro parenteral&#44; es importante en otras enfermedades que aconsejen esta forma de repleci&#243;n de los dep&#243;sitos de hierro&#46; Los enfermos renales tambi&#233;n pueden beneficiarse de esta posibilidad terap&#233;utica&#46;</p></span>"
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Carboximaltosa férrica intravenosa en el tratamiento de la anemia en enfermedad renal crónica
Intravenous ferric carboxymaltose for the treatment of anemia in chronic renal disease
J.L. Merinoa,
Autor para correspondencia
jluis.merino@salud.madrid.org

Autor para correspondencia.
, B. Buenoa, M.A. Camposb, Y. Amézquitaa
a Sección de Nefrología, Hospital Universitario del Henares, Coslada, Madrid, España
b Servicio de Farmacia, Hospital Universitario del Henares, Coslada, Madrid, España
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y anemia asociada &#40;niveles de hemoglobina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>mg&#47;dl en varones y<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>11 en mujeres&#41; y necesidad de aportes de hierro &#40;&#237;ndice de saturaci&#243;n de transferrina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37; y&#47;o ferritina<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&#46; Se administr&#243; CMF iv &#40;Ferinject<span class="elsevierStyleSup">&#174;</span>&#44; Vifor Pharma Inc&#46;&#41; en dosis &#250;nica&#44; diluida en 250<span class="elsevierStyleHsp" style=""></span>cc de ClNa al 0&#44;9&#37;&#44; durante 15<span class="elsevierStyleHsp" style=""></span>min&#46; La dosis habitual era de 1&#46;000<span class="elsevierStyleHsp" style=""></span>mg&#44; sin superar 15<span class="elsevierStyleHsp" style=""></span>mg de hierro por kilogramo de peso corporal&#46; Los resultados a los 6 meses se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Ning&#250;n paciente present&#243; reacciones adversas en el momento de la administraci&#243;n ni en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La CMF es una mol&#233;cula nueva&#44; eficaz y con pocos efectos secundarios asociados<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; En nuestro caso esta eficacia se mantuvo a los 6 meses&#44; sin necesidad de dosis suplementarias &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La informaci&#243;n acerca del tratamiento con CMF en pacientes con ERC es escasa<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;6&#8211;9</span></a>&#46; Qunibi et al&#46; evidenciaron una mayor eficacia de la CMF iv que una pauta est&#225;ndar de ferroterapia oral<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Charytan et al&#46; concluyeron que la administraci&#243;n de CMF a pacientes con ERC era al menos tan eficaz como otras formulaciones iv&#44; con muy pocos efectos secundarios<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; En nuestra serie no se observaron efectos destacables&#46; Algunos trabajos han descrito tendencia a hipofosforemia&#44; pero nosotros no lo evidenciamos&#44; pudiendo tratarse de un efecto transitorio<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; La administraci&#243;n &#250;nica de ferroterapia iv supone una serie de ventajas sobre otras formulaciones iv&#46; En primer lugar disminuye las visitas al centro &#40;una dosis de CMF iv equivale a 10 sesiones con hierro dextrano&#44; 8 sesiones con gluconato f&#233;rrico y 5 con hierro sacarosa&#41; y se alcanza antes una correcta repleci&#243;n f&#233;rrica&#46; Adem&#225;s&#44; la CMF iv conlleva un menor tiempo de administraci&#243;n y&#44; por tanto&#44; ahorro de tiempo del profesional sanitario&#46; Otro aspecto relevante en pacientes con ERC es la conservaci&#243;n del &#225;rbol vascular&#44; minimizando las venopunciones&#46; A todas estas ventajas se a&#241;ade la ausencia de efectos secundarios sin modificaci&#243;n de los marcadores inflamatorios<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Por tanto&#44; el balance coste-efectividad puede ser mayor&#44; por encima del del valor neto &#40;1 vial &#61; 96 &#8364;&#41;&#46; En suma&#44; la administraci&#243;n de CMF en dosis &#250;nica iv a pacientes con ERC parece segura y eficaz&#44; permitiendo una posolog&#237;a sencilla&#44; con buena tolerancia que asegura el cumplimiento terap&#233;utico&#46; La eficiencia de la CMF iv&#44; 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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones&#47;mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;21</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>Edad media &#40;a&#241;os&#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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12</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="elsevierStyleVsp" style="height:0.5px"></span></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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">5</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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4</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
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nefropat&#237;a tubulointersticial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No filiada&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">7</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IST &#40;&#37;&#41;&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">11&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&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">20&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;7&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">2&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&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"><span class="elsevierStyleHsp" style=""></span>FGE &#40;ml&#47;min&#44; MDRD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parathormona &#40;pg&#47;ml&#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">189<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>122&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">143<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dosis de eritropoyetina semanal &#40;&#956;g de darbepoetina alfa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                      "titulo" => "Clinical practice guidelines for anemia in chronic kidney disease&#58; Problems and solutions&#46; A position statement from Kidney Disease&#58; Improving Global Outcomes &#40;KDIGO&#41;"
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                            3 => "R&#46;G&#46; Walker"
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                        "volumen" => "74"
                        "paginaInicial" => "1237"
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                      "doi" => "10.2215/CJN.01670408"
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                        "tituloSerie" => "Clin J Am Soc Nephrol"
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                        "volumen" => "4"
                        "paginaInicial" => "57"
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ISSN: 00142565
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