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as&#237; como un riesgo aumentado de osteoporosis<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico y el tratamiento de la HBC suelen ser tard&#237;os<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a>&#59; de esta manera&#44; en la actualidad&#44; la edad de los pacientes con HBC es mayor y presentan m&#225;s comorbilidades que dificultan el manejo cl&#237;nico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La enfermedad renal cr&#243;nica &#40;ERC&#41; es un problema mundial de salud p&#250;blica y muestra numerosos factores de riesgo&#44; algunos de ellos de naturaleza convencional y otros no convencionales&#46; Las infecciones por virus de la hepatitis C y virus de la inmunodeficiencia humana se han incluido en este &#250;ltimo grupo&#59; de hecho&#44; estudios llevados a cabo en la &#250;ltima d&#233;cada han asociado la infecci&#243;n por virus de la hepatitis C con la ERC en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> y entre los sujetos infectados por el virus de la inmunodeficiencia humana<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a>&#46; Adem&#225;s&#44; se ha observado una relaci&#243;n entre la infecci&#243;n por VHB y un mayor riesgo de desarrollar una disminuci&#243;n en la tasa de filtraci&#243;n glomerular &#40;TFG&#41;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Hasta en un 20&#37; de los pacientes infectados por el VHB&#44; tanto en infecciones agudas como cr&#243;nicas&#44; se han observado manifestaciones extrahep&#225;ticas de HBC&#46; Distintos investigadores ya han evidenciado la asociaci&#243;n entre la infecci&#243;n por VHB y la enfermedad glomerular<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La reciente publicaci&#243;n de numerosas y grandes encuestas sobre la relaci&#243;n entre la infecci&#243;n por VHB y la frecuencia de la ERC &#40;TFG estimada baja y&#47;o proteinuria detectable&#41; nos lleva a revisar de nuevo la evidencia sobre este punto&#46; Con el fin de comprobar si las personas infectadas por el VHB presentan un mayor riesgo de desarrollo y progresi&#243;n de ERC en la poblaci&#243;n general adulta&#44; hemos llevado a cabo una revisi&#243;n sistem&#225;tica de la literatura m&#233;dica con metaan&#225;lisis de estudios cl&#237;nicos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">La presente revisi&#243;n cumple con la declaraci&#243;n <span class="elsevierStyleItalic">Preferred Reporting Items for Systematic reviews and Meta-Analyses&#44;</span> conocida como PRISMA &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fuentes de datos y b&#250;squedas</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dos autores &#40;FF y RC&#41; revisaron de forma independiente las citas en ingl&#233;s de la base de datos Medline de la Biblioteca Nacional de Medicina desde 1970 hasta el 28 de febrero de 2019&#46; Antes de 1970 no se dispon&#237;a de datos sobre el ant&#237;geno del core del VHB &#40;HBcAg&#41;&#44; a&#241;o en el que se desarroll&#243; la primera prueba para su detecci&#243;n&#46; Llevamos a cabo nuestra b&#250;squeda en 4 motores de bases de datos Medline &#40;Embase&#44; Grateful Med&#44; Ovid y PubMed&#41;&#46; La b&#250;squeda Medline se limit&#243; a los estudios en humanos publicados en la literatura inglesa&#46; Aplicamos el siguiente algoritmo en encabezamientos de temas m&#233;dicos y en palabras de texto libre&#58; &#40;&#171;HEPATITIS B&#187; o &#171;HEPATITIS B VIRUS INFECTION&#187; o &#171;HBsAg POSITIVE STATUS&#187; o &#171;HBc ANTIBODY POSITIVE STATUS&#187;&#41; y &#40;&#171;CHRONIC KIDNEY DISEASE&#187; o &#171;CKD&#187; o &#171;END-STAGE KIDNEY DISEASE&#187; or &#171;ESKD&#187; o &#171;END-STAGE RENAL DISEASE&#187; o &#171;ESRD&#187; o &#171;LOW GLOMERULAR FILTRATION RATE&#187; o &#171;RENAL IMPAIRMENT&#187; o &#171;RENAL INSUFFICIENCY&#187; o &#171;RENAL FAILURE&#187; o &#171;PROTEINURIA&#187;&#41; y &#40;&#171;RELATIVE RISK&#187; o &#171;RISK RATIO&#187; o &#171;RR&#187; o &#171;ODDS RATIO&#187; o &#171;OR&#187; o &#171;HAZARD RATIO&#187; o &#171;HR&#187; o &#171;INCIDENCE&#187;&#41;&#46; Adem&#225;s&#44; se realiz&#243; una investigaci&#243;n m&#225;s con b&#250;squedas electr&#243;nicas en la Biblioteca Cochrane&#59; a fin de identificar toda la literatura pertinente se efectuaron b&#250;squedas manuales de revistas especializadas seleccionadas&#46; Tambi&#233;n se analizaron las listas de referencias de las revisiones cualitativas y de los estudios cl&#237;nicos publicados&#46; Previamente se demostr&#243; que la b&#250;squeda centrada exclusivamente en Medline pod&#237;a no ser lo suficientemente sensible<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">11</span></a>&#46; Se extrajeron los datos referidos al dise&#241;o del estudio&#44; el per&#237;odo de estudio&#44; las caracter&#237;sticas de los pacientes&#44; la prevalencia del VHB y los resultados de la enfermedad renal&#46; Nos pusimos en contacto con los autores de los art&#237;culos seleccionados con el objeto de obtener los datos perdidos&#44; de forma que &#250;nicamente se incluyeron los datos procedentes de aquellos individuos de los que se conoc&#237;a el estatus del VHB&#46; Se alcanz&#243; el consenso para todos los datos&#46; Se compararon los estudios para eliminar las informaciones duplicadas para los mismos pacientes&#44; contactando con los investigadores cuando fue necesario&#46; Se especificaron previamente los criterios de elegibilidad y de exclusi&#243;n&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Selecci&#243;n de estudios</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron los estudios que cumpl&#237;an los siguientes criterios de inclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Presentaban datos originales de estudios de cohorte&#44; casos y controles y transversales&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">El resultado de inter&#233;s se defini&#243; claramente como incidencia o prevalencia de ERC&#44; es decir&#44; TFG reducida y&#47;o proteinuria detectable en adultos en la poblaci&#243;n general&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Proporcionaban las estimaciones de riesgo ajustadas &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93;&#44; <span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#41; y sus intervalos de confianza &#40;IC&#41; o los datos eran suficientes para poder calcularlos&#46;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Se incluy&#243; en el an&#225;lisis el estudio m&#225;s reciente en aquellos casos en los que los datos precedentes de la misma poblaci&#243;n estaban duplicados en m&#225;s de un estudio&#46; Incluimos los estudios en los que el diagn&#243;stico de infecci&#243;n por VHB fue llevado a cabo mediante la prueba de HBcAg en suero y&#47;o anticuerpos HBc&#46; En el momento de la inscripci&#243;n se recopil&#243; la informaci&#243;n sobre el estatus serol&#243;gico VHB&#46; Tambi&#233;n se tuvieron en cuenta las encuestas basadas en c&#243;digos administrativos &#40;por ejemplo&#44; el ICD-9&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Estudios no aptos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se excluyeron los estudios que proporcionaban datos inadecuados sobre la asociaci&#243;n entre la ERC y el estatus seropositivo VHB &#40;por ejemplo&#44; informaci&#243;n incompleta sobre el estatus VHB o resultados renales&#41;&#46; Se excluyeron los estudios no publicados&#44; aquellos publicados exclusivamente en formato resumen y los informes provisionales&#59; para esta revisi&#243;n sistem&#225;tica no se tuvieron en cuenta ni las cartas ni los art&#237;culos de revisi&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Evaluaci&#243;n de la calidad</span><p id="par0060" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de la calidad se realiz&#243; utilizando una escala binaria de 5 puntos desarrollada espec&#237;ficamente para este estudio&#46; Esta escala se basa en la Escala de Newcastle-Ottawa con modificaciones de acuerdo con las directrices est&#225;ndar y a nuestro propio criterio<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a>&#46; La Escala de Newcastle-Ottawa es un sistema de puntuaci&#243;n que valora&#44; desde un punto de vista metodol&#243;gico&#44; cada aspecto de un estudio epidemiol&#243;gico observacional&#46; Para este metaan&#225;lisis&#44; adoptamos aquellos elementos que son comunes a todos los dise&#241;os epidemiol&#243;gicos&#44; con lo que reduc&#237;amos la escala de manera considerable&#46; Adoptamos los siguientes criterios etiquetados como &#171;s&#237;&#187; &#40;1&#41; o &#171;no&#187; &#40;2&#41;&#58; 1&#41; si la evaluaci&#243;n de la infecci&#243;n por VHB se bas&#243; en datos de laboratorio &#40;s&#237;&#41; o en c&#243;digos administrativos o en otros &#40;no&#41;&#59; 2&#41; si el diagn&#243;stico de ERC se alcanz&#243; mediante la valoraci&#243;n de la TFG o de la proteinuria a partir de datos de laboratorio &#40;s&#237;&#41; o mediante c&#243;digos administrativos u otros &#40;no&#41;&#59; 3&#41; si el an&#225;lisis de los factores de confusi&#243;n se ajust&#243;&#44; por lo menos&#44; por edad y sexo&#44; ya fuera en la fase de dise&#241;o o en el an&#225;lisis &#40;s&#237;&#41;&#44; o no &#40;no&#41;&#59; 4&#41; si la muestra no expuesta se obtuvo de la misma poblaci&#243;n que la expuesta &#40;s&#237;&#41; o no &#40;no&#41;&#59; 5&#41; si la poblaci&#243;n diana estaba claramente definida &#40;s&#237;&#41; o&#44; por el contrario&#44; se basaba en un muestreo de conveniencia&#44; como por ejemplo pacientes procedentes de una &#250;nica consulta o voluntarios&#44; o no explicado &#40;no&#41;&#46; Mediante esta evaluaci&#243;n&#44; consideramos un &#237;tem como &#171;no&#187; cuando los autores no proporcionaron la informaci&#243;n sobre dicho punto&#46; Dos revisores &#40;FF y FMD&#41;&#44; de forma independiente&#44; realizaron la extracci&#243;n de los datos y la puntuaci&#243;n de la calidad y los resultados se fusionaron por consenso&#46; El protocolo completo para la puntuaci&#243;n de calidad est&#225; disponible on-line &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 2</a>&#41;&#46; Llevamos a cabo un an&#225;lisis combinado de aquellos estudios que cumpl&#237;an con al menos 3 de los criterios y los comparamos con aquellos que puntuaron en menos de 3&#46; La evaluaci&#243;n del estudio de calidad no incluy&#243; la valoraci&#243;n de la calidad de los estudios incluidos en el metaan&#225;lisis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Medidas de resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Realizamos metaan&#225;lisis por separado dependiendo del resultado&#46; Un metaan&#225;lisis incluy&#243; los estudios de cohorte que abordaban la incidencia de la ERC o de la enfermedad renal terminal&#59; otro metaan&#225;lisis contemplaba los estudios transversales &#40;o casos y controles&#41; que valoraban la prevalencia de la ERC&#46; Para la evaluaci&#243;n de la prevalencia de la proteinuria se realiz&#243; un metaan&#225;lisis m&#225;s&#46; La clasificaci&#243;n de la ERC se llev&#243; a cabo conforme a la definici&#243;n de la iniciativa <span class="elsevierStyleItalic">Kidney Disease Outcomes Quality Initiative</span> &#40;KDIGO&#41;&#44; y se adopt&#243; la ecuaci&#243;n MDRD de 4 variables u otras f&#243;rmulas dise&#241;adas para estimar la TFG sobre la base de los niveles de creatinina s&#233;rica<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">13</span></a>&#46; El punto de corte primario fue la estimaci&#243;n ajustada del riesgo &#40;y unos IC del 95&#37;&#41; de la incidencia &#40;o prevalencia&#41; de la ERC en la poblaci&#243;n general de acuerdo con el estatus serol&#243;gico&#46; Se realiz&#243; un an&#225;lisis multivariante para estimar el efecto independiente del estado seropositivo del VHB sobre la frecuencia de la ERC despu&#233;s del ajuste de elementos de distorsi&#243;n potenciales &#40;covariables&#59; por ejemplo&#58; edad&#44; sexo&#44; raza&#47;etnia&#44; diabetes mellitus y otras&#41;&#46; Para evaluar los predictores de incidencia de la ERC&#44; los estudios de cohorte adoptaron el an&#225;lisis de regresi&#243;n de Cox&#59; en los estudios transversales se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica m&#250;ltiple&#46; Un punto de corte m&#225;s fue la estimaci&#243;n ajustada del riesgo &#40;IC 95&#37;&#41; de la prevalencia de la proteinuria en adultos de la poblaci&#243;n general de acuerdo con el estado serol&#243;gico del VHB&#46; Para evaluar el efecto del estado seropositivo <span class="elsevierStyleItalic">per se</span> sobre la incidencia de la ERC despu&#233;s del ajuste por tiempo de seguimiento diferencial y la distribuci&#243;n de posibles factores de confusi&#243;n se realiz&#243; un an&#225;lisis siguiendo el modelo de regresi&#243;n de Cox de riesgos proporcionales&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">S&#237;ntesis de datos y an&#225;lisis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Ponderamos los logaritmos de la proporci&#243;n de OR espec&#237;ficos del estudio para los estudios casos y controles y los transversales&#44; y los logaritmos de la hazard ratio para los estudios de cohorte por el inverso de su varianza para obtener una estimaci&#243;n del efecto agrupado y sus IC del 95&#37;&#46; Asumimos para cada estudio&#44; el efecto de la medida que se ajustaba a un mayor n&#250;mero de factores de confusi&#243;n&#46; Presentamos las estimaciones agrupadas de los efectos fijos y aleatorios&#44; aunque estas &#250;ltimas fueron empleadas e informadas cuando se produc&#237;a heterogeneidad&#46; Utilizamos la aproximaci&#243;n de los efectos aleatorios&#44; tal y como describen DerSimonian y Laird<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a>&#46; Para cuantificar la heterogeneidad se us&#243; la prueba Q de Cochrane<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">15</span></a>&#46; Tambi&#233;n se calcul&#243; el estad&#237;stico I<span class="elsevierStyleSup">2</span>&#44; que mide el porcentaje de variaci&#243;n a trav&#233;s de los estudios debido m&#225;s a la heterogeneidad que al error<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a>&#46; La hip&#243;tesis nula de esta prueba es la ausencia de heterogeneidad&#46; Exploramos el origen de la heterogeneidad al restringir el an&#225;lisis a subgrupos de estudios definidos por sus caracter&#237;sticas&#44; como el pa&#237;s de origen&#44; la etapa de ERC y otras&#46; Tambi&#233;n se evalu&#243; la heterogeneidad mediante metarregresi&#243;n a fin de observar el efecto de las covariables potenciales y continuas en el resultado de inter&#233;s&#46; Se especificaron con anterioridad los an&#225;lisis de subgrupos o estratificados y de metarregresi&#243;n&#46; Realizamos una metarregresi&#243;n de efectos aleatorios utilizando el m&#233;todo de momentos o enfoques de m&#225;xima verosimilitud&#44; cuando correspond&#237;a&#44; permitiendo un solo predictor en cada modelo &#40;metarregresi&#243;n simple&#41;&#46; Los sesgos de la publicaci&#243;n se calcularon mediante la prueba de regresi&#243;n lineal de Egger para el an&#225;lisis de la asimetr&#237;a del gr&#225;fico de embudo <span class="elsevierStyleItalic">&#40;funnel-plot&#41;&#46;</span> Todos los an&#225;lisis se hicieron con el paquete estad&#237;stico <span class="elsevierStyleItalic">Comprehensive Meta-Analysis</span>&#44; versi&#243;n 2&#46;0 &#40;BioStat Inc&#46;&#44; Estados Unidos&#44; 2005&#41;&#46; El nivel de significaci&#243;n para riesgo fue del 5&#37;&#46; Se proporciona cada estimaci&#243;n con su correspondiente IC 95&#37;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Revisi&#243;n de la literatura</span><p id="par0075" class="elsevierStylePara elsevierViewall">Tal y como se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; de los 722 art&#237;culos recopilados&#44; se evaluaron para su elecci&#243;n 152 art&#237;culos completos&#46; Es posible obtener una lista completa de los art&#237;culos solicit&#225;ndosela a uno de los autores &#40;FF&#41;&#46; Treinta y tres estudios cumplieron los criterios de inclusi&#243;n&#44; fueron publicados en 26 art&#237;culos &#40;4&#46;604&#46;406 pacientes &#250;nicos&#41; y llevados a cabo en 2 continentes<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">17&#8211;42</span></a>&#46; Identificamos estudios de casos y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; de cohorte &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41; y transversales &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41; que proporcionaban informaci&#243;n sobre el riesgo de ERC en una misma poblaci&#243;n&#46; As&#237;&#44; algunos estudios suministraron datos sobre el resultado de m&#225;s de una enfermedad renal&#44; pero cada cohorte estuvo representada una vez en cada metaan&#225;lisis&#46; Con respecto a la inclusi&#243;n y exclusi&#243;n final de los estudios revisados&#44; seg&#250;n los criterios predefinidos de inclusi&#243;n y exclusi&#243;n&#44; la concordancia entre revisores fue de un 100&#37;&#46; El diagn&#243;stico de la infecci&#243;n por VHB se realiz&#243; mediante la detecci&#243;n en suero del ant&#237;geno de superficie del virus de la hepatitis B &#40;HBsAg&#41;&#59; en unos pocos informes&#44; el diagn&#243;stico de la infecci&#243;n por VHB se hizo mediante bases de datos administrativos &#40;c&#243;digos ICD-9&#41;&#46; En uno de los estudios&#44; la tasa de infecci&#243;n del VHB se averigu&#243; mediante la detecci&#243;n de anticuerpos frente al ant&#237;geno de superficie en otro estudio la infecci&#243;n fue identificada a partir de la historia cl&#237;nica&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Caracter&#237;sticas del estudio y de los pacientes</span><p id="par0080" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1-4</a> y las tablas complementarias 1 y 2 &#40;<a class="elsevierStyleCrossRef" href="#sec0100">ver material adicional</a>&#41; recogen las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas m&#225;s destacadas de los sujetos participantes en los estudios incluidos en esta revisi&#243;n&#46; La media de edad de las cohortes de pacientes oscila entre los 18&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5 y los 72 a&#241;os&#46; La distribuci&#243;n por sexos fluct&#250;a entre el 17&#44;5 y el 67&#44;6&#37; de varones&#46; Once informes proced&#237;an de Taiw&#225;n&#44; 8 de China&#44; 2 de Corea&#44; Hong Kong y Estados Unidos&#44; respectivamente&#44; y uno de Jap&#243;n&#46; En cuanto a los estudios de cohorte&#44; el tiempo medio de seguimiento oscil&#243; entre los 2 y los 9&#44;1 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n de calidad est&#225; entre el 3 y el 5 &#40;estudios de cohorte&#41;&#44; y el 4 y el 5 &#40;estudios transversales&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 3</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Estimaci&#243;n resumida del resultado&#46; Incidencia de la ERC</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cuando se analizaron juntos todos los estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41; &#40;la OR agrupada se expres&#243; como HR&#41;&#44; se demostr&#243; que&#44; en la poblaci&#243;n general&#44; exist&#237;a una relaci&#243;n significativa entre el VHB y el riesgo de padecer ERC &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Se observ&#243; una heterogeneidad significativa &#40;valor Q por la prueba de Chi-cuadrado 227&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Once estudios de cohorte &#40;1&#46;056&#46;645 pacientes &#250;nicos&#41; abordaron la incidencia de la ERC &#40;o enfermedad renal terminal&#41; entre los pacientes VHB positivos&#46; La relaci&#243;n entre el estado VHB seropositivo y el aumento de la incidencia de la ERC fue significativo&#59; la HR ajustada por VHB en todas las encuestas fue de 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Hubo heterogeneidad en todos los estudios &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Ni el <span class="elsevierStyleItalic">funnel-plot</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; ni los correspondientes resultados de la prueba de Egger mostraron evidencias de la existencia de sesgos en las publicaciones &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;127&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#44; la asociaci&#243;n entre el estado VHB seropositivo y el mayor riesgo de ERC persist&#237;a &#40;OR ajustada expresada como HR&#41; cuando los estudios de casos y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;315&#46;277 pacientes&#41; eran considerados por separado y cuando los estudios de casos y controles y de cohorte eran analizados conjuntamente &#40;HR ajustada de 1&#44;39&#59; IC 95&#37; 1&#44;21-1&#44;59&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Estimaci&#243;n resumida del resultado&#46; Prevalencia de la ERC</span><p id="par0105" class="elsevierStylePara elsevierViewall">Diez estudios transversales &#40;3&#46;222&#46;545 pacientes&#41; abordaron la prevalencia de la ERC &#40;o la TFG disminuida&#41; en los pacientes infectados por VHB&#46; La asociaci&#243;n entre el estado VHB seropositivo y la prevalencia de ERC no fue significativa &#40;OR ajustada por VHB en todos los estudios 1&#44;04&#59; IC 95&#37; 0&#44;90-1&#44;21&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;055&#41;&#46; Se observ&#243; heterogeneidad &#40;valor de Q por la prueba de Chi-cuadrado 68&#44;09&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Estimaci&#243;n resumida del resultado&#46; Prevalencia de la proteinuria</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ocho estudios &#40;3&#46;205&#46;142 pacientes &#250;nicos&#41; analizaron la prevalencia de la proteinuria de acuerdo con el estado VHB seropositivo&#46; La mayor&#237;a de los estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; eran transversales &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; No hubo conexi&#243;n entre la infecci&#243;n por VHB y la proteinuria observada &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Cuatro estudios definieron la proteinuria mediante an&#225;lisis semicuantitativo &#40;tira reactiva para prote&#237;nas en orina&#41; y otros 4 midieron la albuminuria a trav&#233;s de la proporci&#243;n de alb&#250;mina&#47;creatinina en orina &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">An&#225;lisis de la sensibilidad</span><p id="par0120" class="elsevierStylePara elsevierViewall">Para evaluar m&#225;s a fondo la posibilidad de la presencia de sesgos en nuestros estudios&#44; asumimos que&#44; en el caso de que los resultados fueran nulos&#44; las revistas rechazaban con mayor probabilidad los estudios transversales&#46; Recalculamos nuestras estimaciones ajustadas bajo las siguientes premisas extremas&#58; 1&#41; los estudios transversales que eval&#250;an el impacto del VHB sobre el riesgo de ERC en adultos en la poblaci&#243;n general son solo la mitad de los estudios publicados sobre este punto&#59; 2&#41; todos los estudios no publicados encontraron una OR de 1&#44; y 3&#41; los estudios no publicados y los publicados obtuvieron una misma prevalencia de ERC&#46; Bajo estas premisas extremas&#44; la estimaci&#243;n ajustada de los efectos aleatorios mostr&#243; un riesgo aumentado &#40;OR agrupadas expresadas como riesgos relativos&#41;&#44; riesgo relativo ajustado de 1&#44;08 &#40;IC 95&#37; 1&#44;02-1&#44;15&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lisis de metarregresi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#44; la metarregresi&#243;n demostr&#243; un impacto positivo del HBsAg seropositivo sobre el resultado de inter&#233;s &#40;HR ajustada de la incidencia de ERC entre los pacientes VHB-positivos&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; No se observ&#243; nexo de uni&#243;n entre el resultado de inter&#233;s y el n&#250;mero de variables continuas &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">En 1971 Combes et al&#46; informaron por primera vez de la asociaci&#243;n entre la infecci&#243;n por VHB y el da&#241;o glomerular en un paciente con s&#237;ndrome nefr&#243;tico por nefropat&#237;a membranosa y HBC<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a>&#46; Desde entonces&#44; otras enfermedades glomerulares &#40;enfermedad de cambios m&#237;nimos&#44; nefropat&#237;a por IgA&#44; glomerulonefritis membranoproliferativa y nefritis mesangial&#41; se han asociado con la enfermedad hep&#225;tica cr&#243;nica y algunos ant&#237;genos&#44; como el HBsAg&#44; el HBeAg y el HBcAg&#46; Estos trastornos son frecuentes en los pa&#237;ses asi&#225;ticos y raros en Europa<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a>&#46; Con anterioridad&#44; una revisi&#243;n sistem&#225;tica y un metaan&#225;lisis de estudios observacionales llevados a cabo por nuestro equipo demostraron la existencia de un impacto positivo del estado HBsAg seropositivo sobre la incidencia de la ERC en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a>&#46; Posteriormente se han ido publicando numerosos y extensos estudios sobre esta materia&#46; En consecuencia&#44; de nuevo resumimos la evidencia cient&#237;fica y llevamos a cabo un metaan&#225;lisis sobre la exposici&#243;n a la infecci&#243;n por VHB y el riesgo de padecer ERC en los adultos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El presente metaan&#225;lisis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44; 7&#46;849&#46;849 pacientes&#41; incluye m&#225;s del doble de estudios que nuestro metaan&#225;lisis anterior y destaca la asociaci&#243;n existente entre el estado seropositivo por infecci&#243;n con VHB y la mayor incidencia de ERC&#59; los resultados agrupados de 11 estudios de cohorte proporcionaron una HR de 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; La aparici&#243;n de heterogeneidad significativa impidi&#243; claramente alcanzar conclusiones m&#225;s definitivas&#44; incluso si nuestro an&#225;lisis estratificado mostraba resultados homog&#233;neos en algunas comparaciones&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre la infecci&#243;n por VHB y la ERC parece compleja y de naturaleza bidireccional&#58; algunas formas de enfermedades renales est&#225;n inducidas por la infecci&#243;n con VHB y los pacientes con ERC tienen un mayor riesgo de adquirir el VHB&#46; Numerosos hallazgos evidencian un papel crucial del VHB en la adquisici&#243;n y la progresi&#243;n de la ERC&#46; En la encuesta HARPE &#40;260 pacientes&#41; se encontr&#243; que un 64&#44;6&#37; de los pacientes presentaban enfermedad renal&#59; la prevalencia de la proteinuria y la hematuria era del 38&#44;1 y el 20&#44;6&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a>&#46; De acuerdo con una cohorte retrospectiva&#44; llevada a cabo en Estados Unidos&#44; de 815 pacientes sometidos a un seguimiento medio de 4 meses&#44; los pacientes que no recibieron terapia antiviral experimentaron una disminuci&#243;n de la TFG estimada relacionada con la edad a un ritmo comparable al de la poblaci&#243;n general&#46; Sin embargo&#44; la funci&#243;n renal se deterior&#243; m&#225;s r&#225;pido de lo esperado en aquellos pacientes infectados por VHB tratados no pudi&#233;ndose atribuir toda la p&#233;rdida a los agentes antivirales <span class="elsevierStyleItalic">per se</span><a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a>&#46; Los estudios llevados a cabo en receptores de trasplante hep&#225;tico o pacientes con funci&#243;n normal concluyeron que la telbivudina &#40;sola o junto con terapia de adefovir complementaria&#41; pod&#237;a mejorar la funci&#243;n renal durante el tratamiento de la HBC y este resultado se ha asociado a su actividad antiviral&#46; La mejor&#237;a de la TFG estimada debida a la telbivudina fue duradera&#44; &#250;nica y no relacionada con los t&#237;tulos de ADN del VHB<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">45&#44;46</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La ERC es un problema mundial de salud p&#250;blica<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a>&#46; En los Estados Unidos se estim&#243; que alrededor del 10&#37; de los adultos no institucionalizados tienen ERC&#59; las consecuencias de la ERC no solo incluyen progresi&#243;n del fallo renal&#44; sino tambi&#233;n complicaciones derivadas de la funci&#243;n renal reducida y un riesgo aumentado de padecer enfermedad cardiovascular&#46; Los pacientes con ERC son m&#225;s propensos a morir&#44; que a desarrollar fallo renal&#46; La HBC es un proceso inflamatorio y se ha publicado que varios procesos que cursan con inflamaci&#243;n cr&#243;nica de bajo grado aumentan el riesgo de arterioesclerosis<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a>&#46; Algunas pruebas apoyan la relaci&#243;n entre el VHB y la enfermedad arterioescler&#243;tica en humanos<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">49&#44;50</span></a>&#46; Los pacientes con HBC muestran mayores niveles de insulina en ayunas e &#237;ndice HOMA-IR&#44; y un &#237;ndice QUICKI menor<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a>&#46; Autores coreanos publicaron un caso cl&#237;nico de un hombre de 34 a&#241;os con HBC y estenosis vasculares cerebrales m&#250;ltiples que no presentaba ning&#250;n factor de riego de arterioesclerosis<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">52</span></a>&#46; Otro estudio&#44; realizado en Turqu&#237;a&#44; mostr&#243; que los portadores de HBsAg ten&#237;an un volumen medio plaquetario mayor de lo que se considera como un factor de riesgo emergente de enfermedad aterotromb&#243;tica<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">53</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El presente metaan&#225;lisis tiene numerosas limitaciones&#46; En primer lugar&#44; la mayor&#237;a de los estudios proceden de Asia&#44; por lo que son necesarios estudios realizados en otros continentes&#46; La baja prevalencia del VHB en la poblaci&#243;n general europea dificulta claramente la realizaci&#243;n de dichas encuestas&#46; En segundo lugar&#44; un n&#250;mero de estudios incluidos en esta revisi&#243;n sistem&#225;tica eran transversales&#59; estos estudios no mostraban un nexo significativo entre la exposici&#243;n al VHB y la ERC&#46; Por consiguiente&#44; existe el riesgo de que nuestros hallazgos se vean afectados por el dise&#241;o del estudio&#46; En tercer lugar&#44; nuestro estudio es una revisi&#243;n sistem&#225;tica de estudios observacionales &#40;como los estudios de cohorte y los de casos y controles&#41;&#44; ya que las limitaciones &#233;ticas y presupuestarias a menudo dificultan el desarrollo de estudios experimentales&#46; Debido a la ausencia de aleatorizaci&#243;n&#44; las asociaciones estimadas entre el resultado y la exposici&#243;n pueden verse afectadas por factores de confusi&#243;n que sesgan las estimaciones de sus valores verdaderos&#46; Por ejemplo&#44; en los estudios recopilados para nuestro metaan&#225;lisis&#44; la informaci&#243;n de las caracter&#237;sticas v&#237;ricas del VHB &#40;por ejemplo&#44; ADN del VHB o genotipos de VHB&#41; o del uso de drogas recreativas&#44; que son confusores potenciales&#44; era incompleta&#46; La significaci&#243;n del efecto confusor residual en los estudios observacionales &#40;y en los metaan&#225;lisis&#41; sigue siendo un tema de discusi&#243;n entre los estad&#237;sticos y metaanalistas&#59; aunque se han desarrollado enfoques de simulaci&#243;n para solventar este punto&#44; los resultados siguen sin ser concluyentes<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a>&#46; Se est&#225;n desarrollando nuevos m&#233;todos que permitan manejar los efectos confusores<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el presente metaan&#225;lisis de estudios observacionales parece evidenciar la existencia de una relaci&#243;n entre la exposici&#243;n al VHB y una mayor incidencia de una baja TFG estimada y&#47;o enfermedad renal terminal en la poblaci&#243;n general&#46; Son necesarios nuevos estudios que permitan confirmar estos resultados &#40;dichos estudios deben minimizar el error de la medici&#243;n en la exposici&#243;n y el sesgo de clasificaci&#243;n err&#243;nea en el resultado&#41;&#46; Adem&#225;s&#44; se debe evitar el dise&#241;o transversal&#46; Recomendamos una valoraci&#243;n de la funci&#243;n del ri&#241;&#243;n y una prueba de orina al inicio y durante el seguimiento en todos los pacientes HBsAg positivos&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Estimaci&#243;n resumida del resultado&#46; Incidencia de la ERC"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El papel del virus de la hepatitis B &#40;VHB&#41; como factor de riesgo en la incidencia y progresi&#243;n de la enfermedad renal cr&#243;nica &#40;ERC&#41; no ha sido clarificado&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos el impacto producido por la infecci&#243;n con el VHB sobre el riesgo de la ERC en la poblaci&#243;n general&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Llevamos a cabo una revisi&#243;n sistem&#225;tica de la literatura m&#233;dica publicada a fin de evaluar si existe&#44; en la poblaci&#243;n adulta general&#44; una relaci&#243;n entre la infecci&#243;n por el VHB y un aumento del riesgo de ERC&#46; Adoptamos el modelo de efectos aleatorios de DerSimonian y Laird para proporcionar una estimaci&#243;n resumida del riesgo de ERC &#40;definida por una tasa de filtraci&#243;n glomerular reducida y&#47;o una proteinuria detectable&#41; por infecci&#243;n con el VHB en los estudios publicados&#46; Tambi&#233;n se realizaron metarregresiones y an&#225;lisis estratificados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Recogimos 33 estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;849&#46;849 pacientes&#41; publicados en 26 art&#237;culos y se realiz&#243; un metaan&#225;lisis por separado conforme a los resultados&#46; La agrupaci&#243;n de los resultados de los estudios de cohortes &#40;11 estudios&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;056&#46;645 pacientes&#41; demostr&#243; una relaci&#243;n entre un estatus serol&#243;gico VHB positivo y el aumento de la incidencia de la ERC&#44; con una estimaci&#243;n resumida para la HR ajustada con VHB en todas las encuestas del 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Se observ&#243; heterogeneidad entre estudios &#40;valor <span class="elsevierStyleItalic">Q&#58;</span> 49&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; En el subconjunto de estudios transversales no se detect&#243; relaci&#243;n entre el VHB y la prevalencia de la ERC &#40;10 estudios&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;222&#46;545 pacientes&#59; OR ajustada 1&#44;04&#59; IC 95&#37; 0&#44;90-1&#44;218&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41;&#46; Los an&#225;lisis de metarregresi&#243;n informaron de una relaci&#243;n entre el estatus HBcAg positivo y la incidencia de ERC en la poblaci&#243;n general &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Parece que la exposici&#243;n a la infecci&#243;n por VHB est&#225; asociada con un aumento en el riesgo de desarrollar ERC en la poblaci&#243;n adulta general&#46; Se est&#225;n realizando estudios destinados a comprender los mecanismos responsables de dicha asociaci&#243;n&#46;</p></span>"
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            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The activity of hepatitis B virus &#40;HBV&#41; as a risk factor for the incidence and progression of chronic kidney disease &#40;CKD&#41; has not been clarified&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We evaluated the impact of infection with HBV on the risk of CKD in the general population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We carried out a systematic review of the published medical literature to assess whether a relationship between hepatitis B infection and an increased risk of CKD in the adult general population occurs&#46; We adopted the random effects model of DerSimonian and Laird to provide a summary estimate of the risk of chronic kidney disease &#40;defined by lowered glomerular filtration rate and&#47;or detectable proteinuria&#41; with HBV infection across the published studies&#46; Meta-regression and stratified analyses were also performed&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We retrieved 33 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;849&#44;849 patients&#41; published in 26 different articles&#44; and separate meta-analyses were performed according to the outcome&#46; Pooling results from cohort studies &#40;11 studies&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;056&#44;645 patients&#41; demonstrated a relationship between positive HBV serologic status and increased incidence of CKD&#44; the summary estimate for adjusted HR with HBV across the surveys&#44; 1&#46;40 &#40;95&#37; CI&#44; 1&#46;16-1&#46;69&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Between-study heterogeneity was noted &#40;<span class="elsevierStyleItalic">Q</span> value&#44; 49&#46;5&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; No relationship between HBV and prevalence of CKD was noted in the subset of cross-sectional studies &#40;10 studies&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;222&#44;545 patients&#41;&#44; adjusted OR&#44; 1&#46;04 &#40;95&#37; IC 0&#46;90-1&#46;218&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;5&#41;&#46; Meta-regression analysis reported a relationship between positive HBsAg status and incidence of CKD in the general population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">It appears that exposure to HBV infection seems to be associated with an increased risk of developing CKD in the adult general population&#46; Studies aimed to understand the mechanisms responsible of such association are under way&#46;</p></span>"
        "secciones" => array:5 [
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            "identificador" => "abst0030"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0035"
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          2 => array:2 [
            "identificador" => "abst0040"
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            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo de la selecci&#243;n de estudios&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Funnel-plot</span> de precisi&#243;n&#58; exposici&#243;n al virus de la hepatitis B e incidencia de la enfermedad renal cr&#243;nica &#40;estudios de cohorte&#41;&#46;</p>"
        ]
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de metarregresi&#243;n&#58; tasa positiva de HBsAg e incidencia de la enfermedad renal cr&#243;nica&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Lo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a>&#58; HR ajustada para sexo&#44; estado de <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; creatinina s&#233;rica&#44; hemoglobina en sangre&#44; tratamiento con IECA y BRA&#44; presi&#243;n sangu&#237;nea sist&#243;lica&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Cheng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a>&#58; HR ajustada a edad&#44; sexo&#44; diabetes&#44; tabaquismo&#44; presi&#243;n sangu&#237;nea&#44; &#237;ndice de masa corporal&#44; glucosa&#44; triglic&#233;ridos&#44; colesterol&#44; hemoglobina&#44; TFGe&#44; recuento leucocitario&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a>&#58; HR ajustada a sexo&#44; estado marital&#44; estado educativo&#44; consumo de hierbas&#44; comorbilidad &#40;enfermedad hep&#225;tica leve&#44; diabetes mellitus&#44; enfermedad hep&#225;tica grave&#44; hipertensi&#243;n&#44; enfermedad cardiovascular&#41;&#44; &#237;ndice de masa corporal&#44; hemoglobina&#44; plaquetas&#44; alb&#250;mina&#44; alanina aminotransferasa&#44; colesterol&#44; &#225;cido &#250;rico&#44; glucosa&#44; estadio de la ERC&#44; tasa urinaria prote&#237;na&#47;creatinina&#44; VHC&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; glomerulonefritis&#44; pielonefritis&#44; nefrolitiasis&#44; cirrosis&#44; tumor renal y del tracto urinario&#44; zona geogr&#225;fica&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#44; visitas m&#233;dicas &#40;n&#250;mero&#41;&#44; puntuaci&#243;n de propensi&#243;n&#44; puntuaci&#243;n del &#237;ndice de comorbilidad de Charlson&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">29</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; cirrosis&#44; hiperlipidemia&#44; enfermedad coronaria&#44; uso de hierbas que contienen &#225;cido aristol&#243;quico&#44; &#225;rea geogr&#225;fica&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#44; n&#250;mero de visitas m&#233;dicas&#184; puntuaci&#243;n del &#237;ndice de comorbilidad de Charlson&#44; puntuaci&#243;n de propensi&#243;n&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Su et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">30</span></a>&#58; OR ajustada a sexo&#44; edad&#44; obesidad&#44; renta&#44; VHC&#44; uremia&#44; anemia&#44; hiperlipidemia&#44; tabaquismo&#44; ingesta de alcohol&#44; chicle de nuez de betel&#44; h&#225;bitos de ejercicio&#44; consumo de aguas subterr&#225;neas&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Hwang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a>&#58; HR ajustada a edad&#44; VHC&#44; sexo&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; gota&#44; VHB&#44; cirrosis&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Kong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a>&#58; HR ajustada a edad&#44; sexo&#44; hipertensi&#243;n&#44; diabetes&#44; &#237;ndice de masa corporal&#44; colesterol total&#44; triglic&#233;ridos&#44; &#225;cido &#250;rico&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; cirrosis&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Nguyen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a>&#58; OR ajustada a edad&#44; sexo&#44; seguro m&#233;dico&#44; a&#241;os de seguimiento&#44; VHC&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad cardiovascular&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a>&#58; OR ajustada a edad&#44; sexo&#44; &#237;ndice de masa corporal&#44; prote&#237;nas totales&#44; alb&#250;mina s&#233;rica&#44; bilirrubina total&#44; anemia&#44; recuento plaquetario&#44; colesterol&#44; hemoglobina glucosilada&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Si et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a>&#58; HR ajustada a edad&#44; sexo&#44; cirrosis&#44; nivel educativo&#44; estado marital&#44; consumo de alcohol&#44; tabaquismo&#44; &#237;ndice de masa corporal&#44; actividad f&#237;sica&#44; ingesta de alimentos&#44; estado menop&#225;usico&#44; diabetes&#44; hipertensi&#243;n&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Hong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a>&#58; HR ajustada a edad&#44; sexo&#44; TFGe basal&#44; tabaquismo&#44; ingesta de alcohol&#44; nivel educativo&#44; actividad f&#237;sica&#44; &#237;ndice de masa corporal&#44; hipertensi&#243;n&#44; diabetes&#44; enfermedad de h&#237;gado graso&#46;</p><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Fang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a>&#58; HR ajustada a sexo&#44; tipo de inmunosupresi&#243;n&#44; nefritis l&#250;pica &#40;clase&#41;&#44; duraci&#243;n de terapia inmunosupresora&#46;</p><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Tartof et al&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a>&#58; HR ajustada a enfermedad hep&#225;tica en fase terminal&#44; diabetes&#44; hipertensi&#243;n&#44; VIH&#44; TFGe basal&#44; raza&#44; sexo&#44; edad&#44; VHC&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del estudio&#44; n &#40;tipo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del efecto ajustado&#44; estimaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de casos y controles</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;980 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 2&#44;58 &#40;1&#44;95-3&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Su et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;463 &#40;NA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;25 &#40;1&#44;03-1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kim et al&#46;Corea&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;240 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;23 &#40;1&#44;04-1&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nguyen et al&#46;EE&#46; UU&#46;&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165&#46;594 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;09 &#40;1&#44;02-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de cohorte</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lo et al&#46;Hong Kong&#44; 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;0 &#40;0&#44;5-1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cheng et al&#46;Hong Kong&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;838 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 4&#44;53 &#40;1&#44;11-18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;790 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 3&#44;85 &#40;2&#44;36-6&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lee et al&#46;Taiw&#225;n&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;185 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;10 &#40;0&#44;89-1&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kong et al&#46;China&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;329 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;12 &#40;0&#44;65-1&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hwang et al&#46;Taiw&#225;n&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;574 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;23 &#40;0&#44;68-2&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;580 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;67 &#40;1&#44;40-1&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Si et al&#46;China&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">469&#46;459 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;37 &#40;1&#44;18-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hong et al&#46;Corea&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">299&#46;913 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;11 &#40;1&#44;03-1&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fang et al&#46;China&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 4&#44;03 &#40;0&#44;97-13&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tartof et al&#46;EE&#46; UU&#46;&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&#46;708 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERCFT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;17 &#40;0&#44;78-1&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudios de casos y controles y de cohorte que abordan la relaci&#243;n entre el VHB y la ERC &#40;resultado&#58; frecuencia de la enfermedad renal en fase terminal o de enfermedad renal cr&#243;nica&#41; &#40;estimaciones demogr&#225;ficas y de efectos&#41;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes&#44; n &#40;edad media en a&#241;os<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes mellitus&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti-VHC positivo&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tasa HBsAg&#44; N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hipertensi&#243;n arterial&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#46;&#44; Taiw&#225;n&#44; 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;934 &#40;55&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&#37; &#40;1&#46;241&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&#37; &#40;646&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;1&#37; &#40;1&#46;301&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&#37; &#40;3&#46;317&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ishizaka et al&#46;&#44; Jap&#243;n&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;535 &#40;53&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&#37; &#40;72&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#37; &#40;130&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&#44; China&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;925 &#40;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3&#37; &#40;878&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&#37; &#40;153&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;2&#37; &#40;4&#46;205&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&#44; Taiw&#225;n&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;966 &#40;60&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&#37; &#40;5&#46;302&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&#37; &#40;5&#46;189&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;9&#37; &#40;5&#46;424&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;9&#37; &#40;17&#46;002&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cai et al&#46;&#44; China&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;854 &#40;50&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;9&#37; &#40;613&#47;6&#46;584&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&#37; &#40;328&#47;6&#46;584&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#44;2&#37; &#40;3&#46;440&#47;6&#46;584&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lin et al&#46;&#44; Taiw&#225;n&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;352 &#40;47&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;7&#37; &#40;191&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6&#37; &#40;188&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4&#37; &#40;415&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;2&#37; &#40;509&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Senghore et al&#46;&#44; Taiw&#225;n&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;745 &#40;18&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&#37; &#40;54&#47;7&#46;745&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;3&#37; &#40;570&#47;7&#46;745&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zeng et al&#46;&#44; China&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;549 &#40;49&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&#37; &#40;1&#46;508&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&#37; &#40;94&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37; &#40;785&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;8&#37; &#40;2&#46;605&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Du et al&#46;&#44; China&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;091&#46;379 &#40;27&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&#37; &#40;22&#46;807&#47;3&#46;091&#46;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6&#37; &#40;173&#46;860&#47;3&#46;091&#46;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&#37; &#40;125&#46;600&#47;3&#46;091&#46;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lai et al&#46;&#44; Taiw&#225;n&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;805 &#40;47&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;4&#37; &#40;335&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&#37; &#40;431&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;8&#37; &#40;2&#46;318&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; &#40;821&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&#44; China&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;435 &#40;50&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37; &#40;197&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;1&#46;002&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;7&#37; &#40;187&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Estudios transversales que estudian la relaci&#243;n entre el VHB y la ERC o la proteinuria &#40;caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#41;</p>"
        ]
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      5 => array:8 [
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        "tipo" => "MULTIMEDIATABLA"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Var&#243;n&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto ajustado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;1&#37; &#40;4&#46;291&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94 &#40;0&#44;75-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ishizaka et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#44;2&#37; &#40;8&#46;054&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51 &#40;0&#44;28-0&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;4&#37; &#40;7&#46;589&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;87-1&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;2&#37; &#40;17&#46;168&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;07 &#40;0&#44;95-1&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cai et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37; &#40;3&#46;425&#47;6&#46;854&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;37-2&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lin et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;6&#37; &#40;1&#46;629&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;03-1&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Senghore et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;1&#37; &#40;3&#46;265&#47;7&#46;745&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;10 &#40;0&#44;77&#59; 1&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zeng et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;6&#37; &#40;10&#46;509&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86 &#40;0&#44;26-2&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Du et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;3&#37; &#40;1&#46;493&#46;136&#47;3&#46;091&#46;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;29-1&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lai et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;8&#37; &#40;6&#46;601&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95 &#40;0&#44;72-1&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;5&#37; &#40;1&#46;156&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73 &#40;0&#44;44-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2756493.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Estudios transversales que analizan la relaci&#243;n entre el VHB y la ERC &#40;resultado&#58; solo frecuencia de enfermedad renal cr&#243;nica o de TFGe baja&#41; &#40;estimaci&#243;n del efecto&#41;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0020"
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto ajustado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de casos y controles</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kim et al&#46;&#44; Corea&#44; 2018&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">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;41 &#40;1&#44;32-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios transversales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Huang et al&#46;&#44; Taiw&#225;n&#44; 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94 &#40;0&#44;75-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ishizaka et al&#46;&#44; Jap&#243;n&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;50 &#40;0&#44;23-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Zhang et al&#46;&#44; China&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;99-1&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lee et al&#46;&#44; Taiw&#225;n&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;91-1&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cai et al&#46;&#44; China&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;79 &#40;0&#44;53-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Zeng et al&#46;&#44; China&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;27 &#40;0&#44;85-1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Du et al&#46;&#44; China&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;24 &#40;1&#44;18-1&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estudios&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;19 &#40;1&#44;11-1&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">227&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado&#58; ERC &#40;incidencia&#41;&#44; HRa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de casos y controles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;40 &#40;1&#44;06-1&#44;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Casos y controles<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>estudios de cohorte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;resultado&#58; ERC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;resultado&#58; enfermedad renal terminal&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;solo prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;ajustado por el riesgo competitivo de mortalidad&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;63 &#40;1&#44;08-2&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte puntuaci&#243;n de calidad 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte puntuaci&#243;n de calidad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado&#58; ERC &#40;prevalencia&#41;&#44; ORa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Todos los estudios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios basados &#250;nicamente en TFGe baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios con una puntuaci&#243;n de calidad 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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REVISIÓN
La infección por VHB es un factor de riesgo de enfermedad renal crónica: revisión sistemática y metaanálisis
HBV infection is a risk factor for chronic kidney disease: Systematic review and meta-analysis
F. Fabrizia,
Autor para correspondencia
fabrizio.fabrizi@policlinico.mi.it

Autor para correspondencia.
, R. Ceruttia, F.M. Donatob, P. Messaa,c
a División de Nefrología, Diálisis y Transplante Renal, Hospital Policlínico Maggiore, Fundación IRCCS, Milán, Italia
b División de Gastroenterología y Hepatología, Hospital Policlínico Maggiore, Fundación IRCCS, Milán, Italia
c Escuela Universitaria de Medicina, Milán, Italia
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as&#237; como un riesgo aumentado de osteoporosis<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico y el tratamiento de la HBC suelen ser tard&#237;os<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a>&#59; de esta manera&#44; en la actualidad&#44; la edad de los pacientes con HBC es mayor y presentan m&#225;s comorbilidades que dificultan el manejo cl&#237;nico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La enfermedad renal cr&#243;nica &#40;ERC&#41; es un problema mundial de salud p&#250;blica y muestra numerosos factores de riesgo&#44; algunos de ellos de naturaleza convencional y otros no convencionales&#46; Las infecciones por virus de la hepatitis C y virus de la inmunodeficiencia humana se han incluido en este &#250;ltimo grupo&#59; de hecho&#44; estudios llevados a cabo en la &#250;ltima d&#233;cada han asociado la infecci&#243;n por virus de la hepatitis C con la ERC en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a> y entre los sujetos infectados por el virus de la inmunodeficiencia humana<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">7</span></a>&#46; Adem&#225;s&#44; se ha observado una relaci&#243;n entre la infecci&#243;n por VHB y un mayor riesgo de desarrollar una disminuci&#243;n en la tasa de filtraci&#243;n glomerular &#40;TFG&#41;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Hasta en un 20&#37; de los pacientes infectados por el VHB&#44; tanto en infecciones agudas como cr&#243;nicas&#44; se han observado manifestaciones extrahep&#225;ticas de HBC&#46; Distintos investigadores ya han evidenciado la asociaci&#243;n entre la infecci&#243;n por VHB y la enfermedad glomerular<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La reciente publicaci&#243;n de numerosas y grandes encuestas sobre la relaci&#243;n entre la infecci&#243;n por VHB y la frecuencia de la ERC &#40;TFG estimada baja y&#47;o proteinuria detectable&#41; nos lleva a revisar de nuevo la evidencia sobre este punto&#46; Con el fin de comprobar si las personas infectadas por el VHB presentan un mayor riesgo de desarrollo y progresi&#243;n de ERC en la poblaci&#243;n general adulta&#44; hemos llevado a cabo una revisi&#243;n sistem&#225;tica de la literatura m&#233;dica con metaan&#225;lisis de estudios cl&#237;nicos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">La presente revisi&#243;n cumple con la declaraci&#243;n <span class="elsevierStyleItalic">Preferred Reporting Items for Systematic reviews and Meta-Analyses&#44;</span> conocida como PRISMA &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">10</span></a>&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Fuentes de datos y b&#250;squedas</span><p id="par0025" class="elsevierStylePara elsevierViewall">Dos autores &#40;FF y RC&#41; revisaron de forma independiente las citas en ingl&#233;s de la base de datos Medline de la Biblioteca Nacional de Medicina desde 1970 hasta el 28 de febrero de 2019&#46; Antes de 1970 no se dispon&#237;a de datos sobre el ant&#237;geno del core del VHB &#40;HBcAg&#41;&#44; a&#241;o en el que se desarroll&#243; la primera prueba para su detecci&#243;n&#46; Llevamos a cabo nuestra b&#250;squeda en 4 motores de bases de datos Medline &#40;Embase&#44; Grateful Med&#44; Ovid y PubMed&#41;&#46; La b&#250;squeda Medline se limit&#243; a los estudios en humanos publicados en la literatura inglesa&#46; Aplicamos el siguiente algoritmo en encabezamientos de temas m&#233;dicos y en palabras de texto libre&#58; &#40;&#171;HEPATITIS B&#187; o &#171;HEPATITIS B VIRUS INFECTION&#187; o &#171;HBsAg POSITIVE STATUS&#187; o &#171;HBc ANTIBODY POSITIVE STATUS&#187;&#41; y &#40;&#171;CHRONIC KIDNEY DISEASE&#187; o &#171;CKD&#187; o &#171;END-STAGE KIDNEY DISEASE&#187; or &#171;ESKD&#187; o &#171;END-STAGE RENAL DISEASE&#187; o &#171;ESRD&#187; o &#171;LOW GLOMERULAR FILTRATION RATE&#187; o &#171;RENAL IMPAIRMENT&#187; o &#171;RENAL INSUFFICIENCY&#187; o &#171;RENAL FAILURE&#187; o &#171;PROTEINURIA&#187;&#41; y &#40;&#171;RELATIVE RISK&#187; o &#171;RISK RATIO&#187; o &#171;RR&#187; o &#171;ODDS RATIO&#187; o &#171;OR&#187; o &#171;HAZARD RATIO&#187; o &#171;HR&#187; o &#171;INCIDENCE&#187;&#41;&#46; Adem&#225;s&#44; se realiz&#243; una investigaci&#243;n m&#225;s con b&#250;squedas electr&#243;nicas en la Biblioteca Cochrane&#59; a fin de identificar toda la literatura pertinente se efectuaron b&#250;squedas manuales de revistas especializadas seleccionadas&#46; Tambi&#233;n se analizaron las listas de referencias de las revisiones cualitativas y de los estudios cl&#237;nicos publicados&#46; Previamente se demostr&#243; que la b&#250;squeda centrada exclusivamente en Medline pod&#237;a no ser lo suficientemente sensible<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">11</span></a>&#46; Se extrajeron los datos referidos al dise&#241;o del estudio&#44; el per&#237;odo de estudio&#44; las caracter&#237;sticas de los pacientes&#44; la prevalencia del VHB y los resultados de la enfermedad renal&#46; Nos pusimos en contacto con los autores de los art&#237;culos seleccionados con el objeto de obtener los datos perdidos&#44; de forma que &#250;nicamente se incluyeron los datos procedentes de aquellos individuos de los que se conoc&#237;a el estatus del VHB&#46; Se alcanz&#243; el consenso para todos los datos&#46; Se compararon los estudios para eliminar las informaciones duplicadas para los mismos pacientes&#44; contactando con los investigadores cuando fue necesario&#46; Se especificaron previamente los criterios de elegibilidad y de exclusi&#243;n&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Selecci&#243;n de estudios</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron los estudios que cumpl&#237;an los siguientes criterios de inclusi&#243;n&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Presentaban datos originales de estudios de cohorte&#44; casos y controles y transversales&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">El resultado de inter&#233;s se defini&#243; claramente como incidencia o prevalencia de ERC&#44; es decir&#44; TFG reducida y&#47;o proteinuria detectable en adultos en la poblaci&#243;n general&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Proporcionaban las estimaciones de riesgo ajustadas &#40;<span class="elsevierStyleItalic">hazard ratio</span> &#91;HR&#93;&#44; <span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#41; y sus intervalos de confianza &#40;IC&#41; o los datos eran suficientes para poder calcularlos&#46;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Se incluy&#243; en el an&#225;lisis el estudio m&#225;s reciente en aquellos casos en los que los datos precedentes de la misma poblaci&#243;n estaban duplicados en m&#225;s de un estudio&#46; Incluimos los estudios en los que el diagn&#243;stico de infecci&#243;n por VHB fue llevado a cabo mediante la prueba de HBcAg en suero y&#47;o anticuerpos HBc&#46; En el momento de la inscripci&#243;n se recopil&#243; la informaci&#243;n sobre el estatus serol&#243;gico VHB&#46; Tambi&#233;n se tuvieron en cuenta las encuestas basadas en c&#243;digos administrativos &#40;por ejemplo&#44; el ICD-9&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Estudios no aptos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se excluyeron los estudios que proporcionaban datos inadecuados sobre la asociaci&#243;n entre la ERC y el estatus seropositivo VHB &#40;por ejemplo&#44; informaci&#243;n incompleta sobre el estatus VHB o resultados renales&#41;&#46; Se excluyeron los estudios no publicados&#44; aquellos publicados exclusivamente en formato resumen y los informes provisionales&#59; para esta revisi&#243;n sistem&#225;tica no se tuvieron en cuenta ni las cartas ni los art&#237;culos de revisi&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Evaluaci&#243;n de la calidad</span><p id="par0060" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de la calidad se realiz&#243; utilizando una escala binaria de 5 puntos desarrollada espec&#237;ficamente para este estudio&#46; Esta escala se basa en la Escala de Newcastle-Ottawa con modificaciones de acuerdo con las directrices est&#225;ndar y a nuestro propio criterio<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">12</span></a>&#46; La Escala de Newcastle-Ottawa es un sistema de puntuaci&#243;n que valora&#44; desde un punto de vista metodol&#243;gico&#44; cada aspecto de un estudio epidemiol&#243;gico observacional&#46; Para este metaan&#225;lisis&#44; adoptamos aquellos elementos que son comunes a todos los dise&#241;os epidemiol&#243;gicos&#44; con lo que reduc&#237;amos la escala de manera considerable&#46; Adoptamos los siguientes criterios etiquetados como &#171;s&#237;&#187; &#40;1&#41; o &#171;no&#187; &#40;2&#41;&#58; 1&#41; si la evaluaci&#243;n de la infecci&#243;n por VHB se bas&#243; en datos de laboratorio &#40;s&#237;&#41; o en c&#243;digos administrativos o en otros &#40;no&#41;&#59; 2&#41; si el diagn&#243;stico de ERC se alcanz&#243; mediante la valoraci&#243;n de la TFG o de la proteinuria a partir de datos de laboratorio &#40;s&#237;&#41; o mediante c&#243;digos administrativos u otros &#40;no&#41;&#59; 3&#41; si el an&#225;lisis de los factores de confusi&#243;n se ajust&#243;&#44; por lo menos&#44; por edad y sexo&#44; ya fuera en la fase de dise&#241;o o en el an&#225;lisis &#40;s&#237;&#41;&#44; o no &#40;no&#41;&#59; 4&#41; si la muestra no expuesta se obtuvo de la misma poblaci&#243;n que la expuesta &#40;s&#237;&#41; o no &#40;no&#41;&#59; 5&#41; si la poblaci&#243;n diana estaba claramente definida &#40;s&#237;&#41; o&#44; por el contrario&#44; se basaba en un muestreo de conveniencia&#44; como por ejemplo pacientes procedentes de una &#250;nica consulta o voluntarios&#44; o no explicado &#40;no&#41;&#46; Mediante esta evaluaci&#243;n&#44; consideramos un &#237;tem como &#171;no&#187; cuando los autores no proporcionaron la informaci&#243;n sobre dicho punto&#46; Dos revisores &#40;FF y FMD&#41;&#44; de forma independiente&#44; realizaron la extracci&#243;n de los datos y la puntuaci&#243;n de la calidad y los resultados se fusionaron por consenso&#46; El protocolo completo para la puntuaci&#243;n de calidad est&#225; disponible on-line &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 2</a>&#41;&#46; Llevamos a cabo un an&#225;lisis combinado de aquellos estudios que cumpl&#237;an con al menos 3 de los criterios y los comparamos con aquellos que puntuaron en menos de 3&#46; La evaluaci&#243;n del estudio de calidad no incluy&#243; la valoraci&#243;n de la calidad de los estudios incluidos en el metaan&#225;lisis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Medidas de resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Realizamos metaan&#225;lisis por separado dependiendo del resultado&#46; Un metaan&#225;lisis incluy&#243; los estudios de cohorte que abordaban la incidencia de la ERC o de la enfermedad renal terminal&#59; otro metaan&#225;lisis contemplaba los estudios transversales &#40;o casos y controles&#41; que valoraban la prevalencia de la ERC&#46; Para la evaluaci&#243;n de la prevalencia de la proteinuria se realiz&#243; un metaan&#225;lisis m&#225;s&#46; La clasificaci&#243;n de la ERC se llev&#243; a cabo conforme a la definici&#243;n de la iniciativa <span class="elsevierStyleItalic">Kidney Disease Outcomes Quality Initiative</span> &#40;KDIGO&#41;&#44; y se adopt&#243; la ecuaci&#243;n MDRD de 4 variables u otras f&#243;rmulas dise&#241;adas para estimar la TFG sobre la base de los niveles de creatinina s&#233;rica<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">13</span></a>&#46; El punto de corte primario fue la estimaci&#243;n ajustada del riesgo &#40;y unos IC del 95&#37;&#41; de la incidencia &#40;o prevalencia&#41; de la ERC en la poblaci&#243;n general de acuerdo con el estatus serol&#243;gico&#46; Se realiz&#243; un an&#225;lisis multivariante para estimar el efecto independiente del estado seropositivo del VHB sobre la frecuencia de la ERC despu&#233;s del ajuste de elementos de distorsi&#243;n potenciales &#40;covariables&#59; por ejemplo&#58; edad&#44; sexo&#44; raza&#47;etnia&#44; diabetes mellitus y otras&#41;&#46; Para evaluar los predictores de incidencia de la ERC&#44; los estudios de cohorte adoptaron el an&#225;lisis de regresi&#243;n de Cox&#59; en los estudios transversales se realiz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica m&#250;ltiple&#46; Un punto de corte m&#225;s fue la estimaci&#243;n ajustada del riesgo &#40;IC 95&#37;&#41; de la prevalencia de la proteinuria en adultos de la poblaci&#243;n general de acuerdo con el estado serol&#243;gico del VHB&#46; Para evaluar el efecto del estado seropositivo <span class="elsevierStyleItalic">per se</span> sobre la incidencia de la ERC despu&#233;s del ajuste por tiempo de seguimiento diferencial y la distribuci&#243;n de posibles factores de confusi&#243;n se realiz&#243; un an&#225;lisis siguiendo el modelo de regresi&#243;n de Cox de riesgos proporcionales&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">S&#237;ntesis de datos y an&#225;lisis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Ponderamos los logaritmos de la proporci&#243;n de OR espec&#237;ficos del estudio para los estudios casos y controles y los transversales&#44; y los logaritmos de la hazard ratio para los estudios de cohorte por el inverso de su varianza para obtener una estimaci&#243;n del efecto agrupado y sus IC del 95&#37;&#46; Asumimos para cada estudio&#44; el efecto de la medida que se ajustaba a un mayor n&#250;mero de factores de confusi&#243;n&#46; Presentamos las estimaciones agrupadas de los efectos fijos y aleatorios&#44; aunque estas &#250;ltimas fueron empleadas e informadas cuando se produc&#237;a heterogeneidad&#46; Utilizamos la aproximaci&#243;n de los efectos aleatorios&#44; tal y como describen DerSimonian y Laird<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">14</span></a>&#46; Para cuantificar la heterogeneidad se us&#243; la prueba Q de Cochrane<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">15</span></a>&#46; Tambi&#233;n se calcul&#243; el estad&#237;stico I<span class="elsevierStyleSup">2</span>&#44; que mide el porcentaje de variaci&#243;n a trav&#233;s de los estudios debido m&#225;s a la heterogeneidad que al error<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">16</span></a>&#46; La hip&#243;tesis nula de esta prueba es la ausencia de heterogeneidad&#46; Exploramos el origen de la heterogeneidad al restringir el an&#225;lisis a subgrupos de estudios definidos por sus caracter&#237;sticas&#44; como el pa&#237;s de origen&#44; la etapa de ERC y otras&#46; Tambi&#233;n se evalu&#243; la heterogeneidad mediante metarregresi&#243;n a fin de observar el efecto de las covariables potenciales y continuas en el resultado de inter&#233;s&#46; Se especificaron con anterioridad los an&#225;lisis de subgrupos o estratificados y de metarregresi&#243;n&#46; Realizamos una metarregresi&#243;n de efectos aleatorios utilizando el m&#233;todo de momentos o enfoques de m&#225;xima verosimilitud&#44; cuando correspond&#237;a&#44; permitiendo un solo predictor en cada modelo &#40;metarregresi&#243;n simple&#41;&#46; Los sesgos de la publicaci&#243;n se calcularon mediante la prueba de regresi&#243;n lineal de Egger para el an&#225;lisis de la asimetr&#237;a del gr&#225;fico de embudo <span class="elsevierStyleItalic">&#40;funnel-plot&#41;&#46;</span> Todos los an&#225;lisis se hicieron con el paquete estad&#237;stico <span class="elsevierStyleItalic">Comprehensive Meta-Analysis</span>&#44; versi&#243;n 2&#46;0 &#40;BioStat Inc&#46;&#44; Estados Unidos&#44; 2005&#41;&#46; El nivel de significaci&#243;n para riesgo fue del 5&#37;&#46; Se proporciona cada estimaci&#243;n con su correspondiente IC 95&#37;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Revisi&#243;n de la literatura</span><p id="par0075" class="elsevierStylePara elsevierViewall">Tal y como se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; de los 722 art&#237;culos recopilados&#44; se evaluaron para su elecci&#243;n 152 art&#237;culos completos&#46; Es posible obtener una lista completa de los art&#237;culos solicit&#225;ndosela a uno de los autores &#40;FF&#41;&#46; Treinta y tres estudios cumplieron los criterios de inclusi&#243;n&#44; fueron publicados en 26 art&#237;culos &#40;4&#46;604&#46;406 pacientes &#250;nicos&#41; y llevados a cabo en 2 continentes<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">17&#8211;42</span></a>&#46; Identificamos estudios de casos y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; de cohorte &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41; y transversales &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41; que proporcionaban informaci&#243;n sobre el riesgo de ERC en una misma poblaci&#243;n&#46; As&#237;&#44; algunos estudios suministraron datos sobre el resultado de m&#225;s de una enfermedad renal&#44; pero cada cohorte estuvo representada una vez en cada metaan&#225;lisis&#46; Con respecto a la inclusi&#243;n y exclusi&#243;n final de los estudios revisados&#44; seg&#250;n los criterios predefinidos de inclusi&#243;n y exclusi&#243;n&#44; la concordancia entre revisores fue de un 100&#37;&#46; El diagn&#243;stico de la infecci&#243;n por VHB se realiz&#243; mediante la detecci&#243;n en suero del ant&#237;geno de superficie del virus de la hepatitis B &#40;HBsAg&#41;&#59; en unos pocos informes&#44; el diagn&#243;stico de la infecci&#243;n por VHB se hizo mediante bases de datos administrativos &#40;c&#243;digos ICD-9&#41;&#46; En uno de los estudios&#44; la tasa de infecci&#243;n del VHB se averigu&#243; mediante la detecci&#243;n de anticuerpos frente al ant&#237;geno de superficie en otro estudio la infecci&#243;n fue identificada a partir de la historia cl&#237;nica&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Caracter&#237;sticas del estudio y de los pacientes</span><p id="par0080" class="elsevierStylePara elsevierViewall">Las <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1-4</a> y las tablas complementarias 1 y 2 &#40;<a class="elsevierStyleCrossRef" href="#sec0100">ver material adicional</a>&#41; recogen las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas m&#225;s destacadas de los sujetos participantes en los estudios incluidos en esta revisi&#243;n&#46; La media de edad de las cohortes de pacientes oscila entre los 18&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5 y los 72 a&#241;os&#46; La distribuci&#243;n por sexos fluct&#250;a entre el 17&#44;5 y el 67&#44;6&#37; de varones&#46; Once informes proced&#237;an de Taiw&#225;n&#44; 8 de China&#44; 2 de Corea&#44; Hong Kong y Estados Unidos&#44; respectivamente&#44; y uno de Jap&#243;n&#46; En cuanto a los estudios de cohorte&#44; el tiempo medio de seguimiento oscil&#243; entre los 2 y los 9&#44;1 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n de calidad est&#225; entre el 3 y el 5 &#40;estudios de cohorte&#41;&#44; y el 4 y el 5 &#40;estudios transversales&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Anexo 3</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Estimaci&#243;n resumida del resultado&#46; Incidencia de la ERC</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cuando se analizaron juntos todos los estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41; &#40;la OR agrupada se expres&#243; como HR&#41;&#44; se demostr&#243; que&#44; en la poblaci&#243;n general&#44; exist&#237;a una relaci&#243;n significativa entre el VHB y el riesgo de padecer ERC &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Se observ&#243; una heterogeneidad significativa &#40;valor Q por la prueba de Chi-cuadrado 227&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Once estudios de cohorte &#40;1&#46;056&#46;645 pacientes &#250;nicos&#41; abordaron la incidencia de la ERC &#40;o enfermedad renal terminal&#41; entre los pacientes VHB positivos&#46; La relaci&#243;n entre el estado VHB seropositivo y el aumento de la incidencia de la ERC fue significativo&#59; la HR ajustada por VHB en todas las encuestas fue de 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Hubo heterogeneidad en todos los estudios &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Ni el <span class="elsevierStyleItalic">funnel-plot</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; ni los correspondientes resultados de la prueba de Egger mostraron evidencias de la existencia de sesgos en las publicaciones &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;127&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#44; la asociaci&#243;n entre el estado VHB seropositivo y el mayor riesgo de ERC persist&#237;a &#40;OR ajustada expresada como HR&#41; cuando los estudios de casos y controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;315&#46;277 pacientes&#41; eran considerados por separado y cuando los estudios de casos y controles y de cohorte eran analizados conjuntamente &#40;HR ajustada de 1&#44;39&#59; IC 95&#37; 1&#44;21-1&#44;59&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Estimaci&#243;n resumida del resultado&#46; Prevalencia de la ERC</span><p id="par0105" class="elsevierStylePara elsevierViewall">Diez estudios transversales &#40;3&#46;222&#46;545 pacientes&#41; abordaron la prevalencia de la ERC &#40;o la TFG disminuida&#41; en los pacientes infectados por VHB&#46; La asociaci&#243;n entre el estado VHB seropositivo y la prevalencia de ERC no fue significativa &#40;OR ajustada por VHB en todos los estudios 1&#44;04&#59; IC 95&#37; 0&#44;90-1&#44;21&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;055&#41;&#46; Se observ&#243; heterogeneidad &#40;valor de Q por la prueba de Chi-cuadrado 68&#44;09&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Estimaci&#243;n resumida del resultado&#46; Prevalencia de la proteinuria</span><p id="par0110" class="elsevierStylePara elsevierViewall">Ocho estudios &#40;3&#46;205&#46;142 pacientes &#250;nicos&#41; analizaron la prevalencia de la proteinuria de acuerdo con el estado VHB seropositivo&#46; La mayor&#237;a de los estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; eran transversales &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; No hubo conexi&#243;n entre la infecci&#243;n por VHB y la proteinuria observada &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Cuatro estudios definieron la proteinuria mediante an&#225;lisis semicuantitativo &#40;tira reactiva para prote&#237;nas en orina&#41; y otros 4 midieron la albuminuria a trav&#233;s de la proporci&#243;n de alb&#250;mina&#47;creatinina en orina &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">An&#225;lisis de la sensibilidad</span><p id="par0120" class="elsevierStylePara elsevierViewall">Para evaluar m&#225;s a fondo la posibilidad de la presencia de sesgos en nuestros estudios&#44; asumimos que&#44; en el caso de que los resultados fueran nulos&#44; las revistas rechazaban con mayor probabilidad los estudios transversales&#46; Recalculamos nuestras estimaciones ajustadas bajo las siguientes premisas extremas&#58; 1&#41; los estudios transversales que eval&#250;an el impacto del VHB sobre el riesgo de ERC en adultos en la poblaci&#243;n general son solo la mitad de los estudios publicados sobre este punto&#59; 2&#41; todos los estudios no publicados encontraron una OR de 1&#44; y 3&#41; los estudios no publicados y los publicados obtuvieron una misma prevalencia de ERC&#46; Bajo estas premisas extremas&#44; la estimaci&#243;n ajustada de los efectos aleatorios mostr&#243; un riesgo aumentado &#40;OR agrupadas expresadas como riesgos relativos&#41;&#44; riesgo relativo ajustado de 1&#44;08 &#40;IC 95&#37; 1&#44;02-1&#44;15&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;013&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">An&#225;lisis de metarregresi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">Como se muestra en la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#44; la metarregresi&#243;n demostr&#243; un impacto positivo del HBsAg seropositivo sobre el resultado de inter&#233;s &#40;HR ajustada de la incidencia de ERC entre los pacientes VHB-positivos&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; No se observ&#243; nexo de uni&#243;n entre el resultado de inter&#233;s y el n&#250;mero de variables continuas &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">En 1971 Combes et al&#46; informaron por primera vez de la asociaci&#243;n entre la infecci&#243;n por VHB y el da&#241;o glomerular en un paciente con s&#237;ndrome nefr&#243;tico por nefropat&#237;a membranosa y HBC<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">43</span></a>&#46; Desde entonces&#44; otras enfermedades glomerulares &#40;enfermedad de cambios m&#237;nimos&#44; nefropat&#237;a por IgA&#44; glomerulonefritis membranoproliferativa y nefritis mesangial&#41; se han asociado con la enfermedad hep&#225;tica cr&#243;nica y algunos ant&#237;genos&#44; como el HBsAg&#44; el HBeAg y el HBcAg&#46; Estos trastornos son frecuentes en los pa&#237;ses asi&#225;ticos y raros en Europa<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">9</span></a>&#46; Con anterioridad&#44; una revisi&#243;n sistem&#225;tica y un metaan&#225;lisis de estudios observacionales llevados a cabo por nuestro equipo demostraron la existencia de un impacto positivo del estado HBsAg seropositivo sobre la incidencia de la ERC en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">3</span></a>&#46; Posteriormente se han ido publicando numerosos y extensos estudios sobre esta materia&#46; En consecuencia&#44; de nuevo resumimos la evidencia cient&#237;fica y llevamos a cabo un metaan&#225;lisis sobre la exposici&#243;n a la infecci&#243;n por VHB y el riesgo de padecer ERC en los adultos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El presente metaan&#225;lisis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#44; 7&#46;849&#46;849 pacientes&#41; incluye m&#225;s del doble de estudios que nuestro metaan&#225;lisis anterior y destaca la asociaci&#243;n existente entre el estado seropositivo por infecci&#243;n con VHB y la mayor incidencia de ERC&#59; los resultados agrupados de 11 estudios de cohorte proporcionaron una HR de 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; La aparici&#243;n de heterogeneidad significativa impidi&#243; claramente alcanzar conclusiones m&#225;s definitivas&#44; incluso si nuestro an&#225;lisis estratificado mostraba resultados homog&#233;neos en algunas comparaciones&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">La relaci&#243;n entre la infecci&#243;n por VHB y la ERC parece compleja y de naturaleza bidireccional&#58; algunas formas de enfermedades renales est&#225;n inducidas por la infecci&#243;n con VHB y los pacientes con ERC tienen un mayor riesgo de adquirir el VHB&#46; Numerosos hallazgos evidencian un papel crucial del VHB en la adquisici&#243;n y la progresi&#243;n de la ERC&#46; En la encuesta HARPE &#40;260 pacientes&#41; se encontr&#243; que un 64&#44;6&#37; de los pacientes presentaban enfermedad renal&#59; la prevalencia de la proteinuria y la hematuria era del 38&#44;1 y el 20&#44;6&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">44</span></a>&#46; De acuerdo con una cohorte retrospectiva&#44; llevada a cabo en Estados Unidos&#44; de 815 pacientes sometidos a un seguimiento medio de 4 meses&#44; los pacientes que no recibieron terapia antiviral experimentaron una disminuci&#243;n de la TFG estimada relacionada con la edad a un ritmo comparable al de la poblaci&#243;n general&#46; Sin embargo&#44; la funci&#243;n renal se deterior&#243; m&#225;s r&#225;pido de lo esperado en aquellos pacientes infectados por VHB tratados no pudi&#233;ndose atribuir toda la p&#233;rdida a los agentes antivirales <span class="elsevierStyleItalic">per se</span><a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">45</span></a>&#46; Los estudios llevados a cabo en receptores de trasplante hep&#225;tico o pacientes con funci&#243;n normal concluyeron que la telbivudina &#40;sola o junto con terapia de adefovir complementaria&#41; pod&#237;a mejorar la funci&#243;n renal durante el tratamiento de la HBC y este resultado se ha asociado a su actividad antiviral&#46; La mejor&#237;a de la TFG estimada debida a la telbivudina fue duradera&#44; &#250;nica y no relacionada con los t&#237;tulos de ADN del VHB<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">45&#44;46</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La ERC es un problema mundial de salud p&#250;blica<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a>&#46; En los Estados Unidos se estim&#243; que alrededor del 10&#37; de los adultos no institucionalizados tienen ERC&#59; las consecuencias de la ERC no solo incluyen progresi&#243;n del fallo renal&#44; sino tambi&#233;n complicaciones derivadas de la funci&#243;n renal reducida y un riesgo aumentado de padecer enfermedad cardiovascular&#46; Los pacientes con ERC son m&#225;s propensos a morir&#44; que a desarrollar fallo renal&#46; La HBC es un proceso inflamatorio y se ha publicado que varios procesos que cursan con inflamaci&#243;n cr&#243;nica de bajo grado aumentan el riesgo de arterioesclerosis<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">48</span></a>&#46; Algunas pruebas apoyan la relaci&#243;n entre el VHB y la enfermedad arterioescler&#243;tica en humanos<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">49&#44;50</span></a>&#46; Los pacientes con HBC muestran mayores niveles de insulina en ayunas e &#237;ndice HOMA-IR&#44; y un &#237;ndice QUICKI menor<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a>&#46; Autores coreanos publicaron un caso cl&#237;nico de un hombre de 34 a&#241;os con HBC y estenosis vasculares cerebrales m&#250;ltiples que no presentaba ning&#250;n factor de riego de arterioesclerosis<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">52</span></a>&#46; Otro estudio&#44; realizado en Turqu&#237;a&#44; mostr&#243; que los portadores de HBsAg ten&#237;an un volumen medio plaquetario mayor de lo que se considera como un factor de riesgo emergente de enfermedad aterotromb&#243;tica<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">53</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El presente metaan&#225;lisis tiene numerosas limitaciones&#46; En primer lugar&#44; la mayor&#237;a de los estudios proceden de Asia&#44; por lo que son necesarios estudios realizados en otros continentes&#46; La baja prevalencia del VHB en la poblaci&#243;n general europea dificulta claramente la realizaci&#243;n de dichas encuestas&#46; En segundo lugar&#44; un n&#250;mero de estudios incluidos en esta revisi&#243;n sistem&#225;tica eran transversales&#59; estos estudios no mostraban un nexo significativo entre la exposici&#243;n al VHB y la ERC&#46; Por consiguiente&#44; existe el riesgo de que nuestros hallazgos se vean afectados por el dise&#241;o del estudio&#46; En tercer lugar&#44; nuestro estudio es una revisi&#243;n sistem&#225;tica de estudios observacionales &#40;como los estudios de cohorte y los de casos y controles&#41;&#44; ya que las limitaciones &#233;ticas y presupuestarias a menudo dificultan el desarrollo de estudios experimentales&#46; Debido a la ausencia de aleatorizaci&#243;n&#44; las asociaciones estimadas entre el resultado y la exposici&#243;n pueden verse afectadas por factores de confusi&#243;n que sesgan las estimaciones de sus valores verdaderos&#46; Por ejemplo&#44; en los estudios recopilados para nuestro metaan&#225;lisis&#44; la informaci&#243;n de las caracter&#237;sticas v&#237;ricas del VHB &#40;por ejemplo&#44; ADN del VHB o genotipos de VHB&#41; o del uso de drogas recreativas&#44; que son confusores potenciales&#44; era incompleta&#46; La significaci&#243;n del efecto confusor residual en los estudios observacionales &#40;y en los metaan&#225;lisis&#41; sigue siendo un tema de discusi&#243;n entre los estad&#237;sticos y metaanalistas&#59; aunque se han desarrollado enfoques de simulaci&#243;n para solventar este punto&#44; los resultados siguen sin ser concluyentes<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a>&#46; Se est&#225;n desarrollando nuevos m&#233;todos que permitan manejar los efectos confusores<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el presente metaan&#225;lisis de estudios observacionales parece evidenciar la existencia de una relaci&#243;n entre la exposici&#243;n al VHB y una mayor incidencia de una baja TFG estimada y&#47;o enfermedad renal terminal en la poblaci&#243;n general&#46; Son necesarios nuevos estudios que permitan confirmar estos resultados &#40;dichos estudios deben minimizar el error de la medici&#243;n en la exposici&#243;n y el sesgo de clasificaci&#243;n err&#243;nea en el resultado&#41;&#46; Adem&#225;s&#44; se debe evitar el dise&#241;o transversal&#46; Recomendamos una valoraci&#243;n de la funci&#243;n del ri&#241;&#243;n y una prueba de orina al inicio y durante el seguimiento en todos los pacientes HBsAg positivos&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Evaluaci&#243;n de la calidad"
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              "titulo" => "Estimaci&#243;n resumida del resultado&#46; Incidencia de la ERC"
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              "titulo" => "Estimaci&#243;n resumida del resultado&#46; Prevalencia de la ERC"
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            1 => "End-stage renal disease"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El papel del virus de la hepatitis B &#40;VHB&#41; como factor de riesgo en la incidencia y progresi&#243;n de la enfermedad renal cr&#243;nica &#40;ERC&#41; no ha sido clarificado&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluamos el impacto producido por la infecci&#243;n con el VHB sobre el riesgo de la ERC en la poblaci&#243;n general&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Llevamos a cabo una revisi&#243;n sistem&#225;tica de la literatura m&#233;dica publicada a fin de evaluar si existe&#44; en la poblaci&#243;n adulta general&#44; una relaci&#243;n entre la infecci&#243;n por el VHB y un aumento del riesgo de ERC&#46; Adoptamos el modelo de efectos aleatorios de DerSimonian y Laird para proporcionar una estimaci&#243;n resumida del riesgo de ERC &#40;definida por una tasa de filtraci&#243;n glomerular reducida y&#47;o una proteinuria detectable&#41; por infecci&#243;n con el VHB en los estudios publicados&#46; Tambi&#233;n se realizaron metarregresiones y an&#225;lisis estratificados&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Recogimos 33 estudios &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;849&#46;849 pacientes&#41; publicados en 26 art&#237;culos y se realiz&#243; un metaan&#225;lisis por separado conforme a los resultados&#46; La agrupaci&#243;n de los resultados de los estudios de cohortes &#40;11 estudios&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;056&#46;645 pacientes&#41; demostr&#243; una relaci&#243;n entre un estatus serol&#243;gico VHB positivo y el aumento de la incidencia de la ERC&#44; con una estimaci&#243;n resumida para la HR ajustada con VHB en todas las encuestas del 1&#44;40 &#40;IC 95&#37; 1&#44;16-1&#44;69&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Se observ&#243; heterogeneidad entre estudios &#40;valor <span class="elsevierStyleItalic">Q&#58;</span> 49&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; En el subconjunto de estudios transversales no se detect&#243; relaci&#243;n entre el VHB y la prevalencia de la ERC &#40;10 estudios&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;222&#46;545 pacientes&#59; OR ajustada 1&#44;04&#59; IC 95&#37; 0&#44;90-1&#44;218&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;5&#41;&#46; Los an&#225;lisis de metarregresi&#243;n informaron de una relaci&#243;n entre el estatus HBcAg positivo y la incidencia de ERC en la poblaci&#243;n general &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Parece que la exposici&#243;n a la infecci&#243;n por VHB est&#225; asociada con un aumento en el riesgo de desarrollar ERC en la poblaci&#243;n adulta general&#46; Se est&#225;n realizando estudios destinados a comprender los mecanismos responsables de dicha asociaci&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The activity of hepatitis B virus &#40;HBV&#41; as a risk factor for the incidence and progression of chronic kidney disease &#40;CKD&#41; has not been clarified&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We evaluated the impact of infection with HBV on the risk of CKD in the general population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We carried out a systematic review of the published medical literature to assess whether a relationship between hepatitis B infection and an increased risk of CKD in the adult general population occurs&#46; We adopted the random effects model of DerSimonian and Laird to provide a summary estimate of the risk of chronic kidney disease &#40;defined by lowered glomerular filtration rate and&#47;or detectable proteinuria&#41; with HBV infection across the published studies&#46; Meta-regression and stratified analyses were also performed&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We retrieved 33 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#44;849&#44;849 patients&#41; published in 26 different articles&#44; and separate meta-analyses were performed according to the outcome&#46; Pooling results from cohort studies &#40;11 studies&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;056&#44;645 patients&#41; demonstrated a relationship between positive HBV serologic status and increased incidence of CKD&#44; the summary estimate for adjusted HR with HBV across the surveys&#44; 1&#46;40 &#40;95&#37; CI&#44; 1&#46;16-1&#46;69&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Between-study heterogeneity was noted &#40;<span class="elsevierStyleItalic">Q</span> value&#44; 49&#46;5&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; No relationship between HBV and prevalence of CKD was noted in the subset of cross-sectional studies &#40;10 studies&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;222&#44;545 patients&#41;&#44; adjusted OR&#44; 1&#46;04 &#40;95&#37; IC 0&#46;90-1&#46;218&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;5&#41;&#46; Meta-regression analysis reported a relationship between positive HBsAg status and incidence of CKD in the general population &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">It appears that exposure to HBV infection seems to be associated with an increased risk of developing CKD in the adult general population&#46; Studies aimed to understand the mechanisms responsible of such association are under way&#46;</p></span>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Lo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">17</span></a>&#58; HR ajustada para sexo&#44; estado de <span class="elsevierStyleItalic">H&#46; pylori</span>&#44; creatinina s&#233;rica&#44; hemoglobina en sangre&#44; tratamiento con IECA y BRA&#44; presi&#243;n sangu&#237;nea sist&#243;lica&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Cheng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">19</span></a>&#58; HR ajustada a edad&#44; sexo&#44; diabetes&#44; tabaquismo&#44; presi&#243;n sangu&#237;nea&#44; &#237;ndice de masa corporal&#44; glucosa&#44; triglic&#233;ridos&#44; colesterol&#44; hemoglobina&#44; TFGe&#44; recuento leucocitario&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">27</span></a>&#58; HR ajustada a sexo&#44; estado marital&#44; estado educativo&#44; consumo de hierbas&#44; comorbilidad &#40;enfermedad hep&#225;tica leve&#44; diabetes mellitus&#44; enfermedad hep&#225;tica grave&#44; hipertensi&#243;n&#44; enfermedad cardiovascular&#41;&#44; &#237;ndice de masa corporal&#44; hemoglobina&#44; plaquetas&#44; alb&#250;mina&#44; alanina aminotransferasa&#44; colesterol&#44; &#225;cido &#250;rico&#44; glucosa&#44; estadio de la ERC&#44; tasa urinaria prote&#237;na&#47;creatinina&#44; VHC&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; glomerulonefritis&#44; pielonefritis&#44; nefrolitiasis&#44; cirrosis&#44; tumor renal y del tracto urinario&#44; zona geogr&#225;fica&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#44; visitas m&#233;dicas &#40;n&#250;mero&#41;&#44; puntuaci&#243;n de propensi&#243;n&#44; puntuaci&#243;n del &#237;ndice de comorbilidad de Charlson&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">29</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; cirrosis&#44; hiperlipidemia&#44; enfermedad coronaria&#44; uso de hierbas que contienen &#225;cido aristol&#243;quico&#44; &#225;rea geogr&#225;fica&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#44; n&#250;mero de visitas m&#233;dicas&#184; puntuaci&#243;n del &#237;ndice de comorbilidad de Charlson&#44; puntuaci&#243;n de propensi&#243;n&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Su et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">30</span></a>&#58; OR ajustada a sexo&#44; edad&#44; obesidad&#44; renta&#44; VHC&#44; uremia&#44; anemia&#44; hiperlipidemia&#44; tabaquismo&#44; ingesta de alcohol&#44; chicle de nuez de betel&#44; h&#225;bitos de ejercicio&#44; consumo de aguas subterr&#225;neas&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Hwang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">31</span></a>&#58; HR ajustada a edad&#44; VHC&#44; sexo&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; gota&#44; VHB&#44; cirrosis&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Kong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">32</span></a>&#58; HR ajustada a edad&#44; sexo&#44; hipertensi&#243;n&#44; diabetes&#44; &#237;ndice de masa corporal&#44; colesterol total&#44; triglic&#233;ridos&#44; &#225;cido &#250;rico&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">35</span></a>&#58; HR ajustada a sexo&#44; edad&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad coronaria&#44; hiperlipidemia&#44; cirrosis&#44; nivel de urbanizaci&#243;n&#44; categor&#237;a de inscripci&#243;n&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Nguyen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">36</span></a>&#58; OR ajustada a edad&#44; sexo&#44; seguro m&#233;dico&#44; a&#241;os de seguimiento&#44; VHC&#44; diabetes&#44; hipertensi&#243;n&#44; enfermedad cardiovascular&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a>&#58; OR ajustada a edad&#44; sexo&#44; &#237;ndice de masa corporal&#44; prote&#237;nas totales&#44; alb&#250;mina s&#233;rica&#44; bilirrubina total&#44; anemia&#44; recuento plaquetario&#44; colesterol&#44; hemoglobina glucosilada&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Si et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">38</span></a>&#58; HR ajustada a edad&#44; sexo&#44; cirrosis&#44; nivel educativo&#44; estado marital&#44; consumo de alcohol&#44; tabaquismo&#44; &#237;ndice de masa corporal&#44; actividad f&#237;sica&#44; ingesta de alimentos&#44; estado menop&#225;usico&#44; diabetes&#44; hipertensi&#243;n&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Hong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a>&#58; HR ajustada a edad&#44; sexo&#44; TFGe basal&#44; tabaquismo&#44; ingesta de alcohol&#44; nivel educativo&#44; actividad f&#237;sica&#44; &#237;ndice de masa corporal&#44; hipertensi&#243;n&#44; diabetes&#44; enfermedad de h&#237;gado graso&#46;</p><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Fang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">40</span></a>&#58; HR ajustada a sexo&#44; tipo de inmunosupresi&#243;n&#44; nefritis l&#250;pica &#40;clase&#41;&#44; duraci&#243;n de terapia inmunosupresora&#46;</p><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">Tartof et al&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a>&#58; HR ajustada a enfermedad hep&#225;tica en fase terminal&#44; diabetes&#44; hipertensi&#243;n&#44; VIH&#44; TFGe basal&#44; raza&#44; sexo&#44; edad&#44; VHC&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del estudio&#44; n &#40;tipo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tama&#241;o del efecto ajustado&#44; estimaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de casos y controles</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;980 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 2&#44;58 &#40;1&#44;95-3&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Su et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;463 &#40;NA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;25 &#40;1&#44;03-1&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kim et al&#46;Corea&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;240 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;23 &#40;1&#44;04-1&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nguyen et al&#46;EE&#46; UU&#46;&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">165&#46;594 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;09 &#40;1&#44;02-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de cohorte</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lo et al&#46;Hong Kong&#44; 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;0 &#40;0&#44;5-1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cheng et al&#46;Hong Kong&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;838 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 4&#44;53 &#40;1&#44;11-18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;790 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 3&#44;85 &#40;2&#44;36-6&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lee et al&#46;Taiw&#225;n&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;185 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;10 &#40;0&#44;89-1&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kong et al&#46;China&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;329 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 1&#44;12 &#40;0&#44;65-1&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hwang et al&#46;Taiw&#225;n&#44; 2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;574 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;23 &#40;0&#44;68-2&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chen et al&#46;Taiw&#225;n&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;580 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfermedad renal terminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;67 &#40;1&#44;40-1&#44;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Si et al&#46;China&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">469&#46;459 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;37 &#40;1&#44;18-1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hong et al&#46;Corea&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">299&#46;913 &#40;prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;11 &#40;1&#44;03-1&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fang et al&#46;China&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">177 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERC estadio 1-5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR 4&#44;03 &#40;0&#44;97-13&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tartof et al&#46;EE&#46; UU&#46;&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152&#46;708 &#40;retrospectivo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ERCFT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HR 1&#44;17 &#40;0&#44;78-1&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudios de casos y controles y de cohorte que abordan la relaci&#243;n entre el VHB y la ERC &#40;resultado&#58; frecuencia de la enfermedad renal en fase terminal o de enfermedad renal cr&#243;nica&#41; &#40;estimaciones demogr&#225;ficas y de efectos&#41;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes&#44; n &#40;edad media en a&#241;os<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes mellitus&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti-VHC positivo&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tasa HBsAg&#44; N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hipertensi&#243;n arterial&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#46;&#44; Taiw&#225;n&#44; 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;934 &#40;55&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&#37; &#40;1&#46;241&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&#37; &#40;646&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;1&#37; &#40;1&#46;301&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&#37; &#40;3&#46;317&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ishizaka et al&#46;&#44; Jap&#243;n&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;535 &#40;53&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6&#37; &#40;72&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#37; &#40;130&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&#44; China&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;925 &#40;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3&#37; &#40;878&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;1&#37; &#40;153&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;2&#37; &#40;4&#46;205&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&#44; Taiw&#225;n&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;966 &#40;60&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&#37; &#40;5&#46;302&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;4&#37; &#40;5&#46;189&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;9&#37; &#40;5&#46;424&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;9&#37; &#40;17&#46;002&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cai et al&#46;&#44; China&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;854 &#40;50&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;9&#37; &#40;613&#47;6&#46;584&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;2&#37; &#40;3&#46;440&#47;6&#46;584&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lin et al&#46;&#44; Taiw&#225;n&#44; 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Senghore et al&#46;&#44; Taiw&#225;n&#44; 2013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;7&#37; &#40;54&#47;7&#46;745&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Zeng et al&#46;&#44; China&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Du et al&#46;&#44; China&#44; 2017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lai et al&#46;&#44; Taiw&#225;n&#44; 2018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;805 &#40;47&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&#37; &#40;431&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;8&#37; &#40;2&#46;318&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; &#40;821&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&#44; China&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;435 &#40;50&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#37; &#40;197&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;1&#46;002&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Estudios transversales que estudian la relaci&#243;n entre el VHB y la ERC o la proteinuria &#40;caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#41;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Var&#243;n&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto ajustado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;1&#37; &#40;4&#46;291&#47;9&#46;934&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;94 &#40;0&#44;75-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ishizaka et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#44;2&#37; &#40;8&#46;054&#47;12&#46;535&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51 &#40;0&#44;28-0&#44;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#44;4&#37; &#40;7&#46;589&#47;13&#46;925&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97 &#40;0&#44;87-1&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;2&#37; &#40;17&#46;168&#47;54&#46;966&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;07 &#40;0&#44;95-1&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cai et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#37; &#40;3&#46;425&#47;6&#46;854&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;37-2&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lin et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;6&#37; &#40;1&#46;629&#47;3&#46;352&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;03-1&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Senghore et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;1&#37; &#40;3&#46;265&#47;7&#46;745&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;10 &#40;0&#44;77&#59; 1&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zeng et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;6&#37; &#40;10&#46;509&#47;15&#46;549&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;86 &#40;0&#44;26-2&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Du et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#44;3&#37; &#40;1&#46;493&#46;136&#47;3&#46;091&#46;379&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> solo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;29-1&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lai et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;8&#37; &#40;6&#46;601&#47;13&#46;805&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span> 60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;95 &#40;0&#44;72-1&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44;5&#37; &#40;1&#46;156&#47;2&#46;435&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TFGe<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> o proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;73 &#40;0&#44;44-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Estudios transversales que analizan la relaci&#243;n entre el VHB y la ERC &#40;resultado&#58; solo frecuencia de enfermedad renal cr&#243;nica o de TFGe baja&#41; &#40;estimaci&#243;n del efecto&#41;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto ajustado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estimaci&#243;n del efecto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios de casos y controles</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kim et al&#46;&#44; Corea&#44; 2018&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">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;41 &#40;1&#44;32-1&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estudios transversales</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Huang et al&#46;&#44; Taiw&#225;n&#44; 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94 &#40;0&#44;75-1&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ishizaka et al&#46;&#44; Jap&#243;n&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;50 &#40;0&#44;23-1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Zhang et al&#46;&#44; China&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;99-1&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lee et al&#46;&#44; Taiw&#225;n&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&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">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;04 &#40;0&#44;91-1&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cai et al&#46;&#44; China&#44; 2012&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">Proteinuria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;79 &#40;0&#44;53-1&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Zeng et al&#46;&#44; China&#44; 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;27 &#40;0&#44;85-1&#44;89&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Du et al&#46;&#44; China&#44; 2017&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">Proteinuria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OR&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">1&#44;24 &#40;1&#44;18-1&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">79&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Casos y controles<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>estudios de cohorte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;resultado&#58; ERC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;resultado&#58; enfermedad renal terminal&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;51 &#40;1&#44;10-2&#44;09&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;solo prospectivo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;17 &#40;1&#44;02-1&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte &#40;ajustado por el riesgo competitivo de mortalidad&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;63 &#40;1&#44;08-2&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte puntuaci&#243;n de calidad 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de cohorte puntuaci&#243;n de calidad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado&#58; ERC &#40;prevalencia&#41;&#44; ORa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Todos los estudios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios basados &#250;nicamente en TFGe baja&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">90&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios con una puntuaci&#243;n de calidad 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios con una puntuaci&#243;n de calidad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado&#58; proteinuria &#40;prevalencia&#41;&#44; ORa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Todos los estudios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios transversales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios basados en an&#225;lisis est&#225;ndar de tira reactiva de orina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios con una puntuaci&#243;n de calidad<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios con una puntuaci&#243;n de calidad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37; &#40;l&#237;mites inferiores&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2019.10.010
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