Asymmetric cellulose triacetate is a safe and effective alternative for online haemodiafiltration

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Diego Rodríguez Puyol, Guillermina Barril, Jose Antonio Sánchez Tomero, Martin Giorgi, Manuel Rafael Ramirez Chamond" "autores" => array:11 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Albalate Ramón" "email" => array:1 [ 0 => "malbalater@senefro.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Patricia" "apellidos" => "Martínez Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Lourdes" "apellidos" => "Bohorquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Patricia" "apellidos" => "de Sequera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Hanane" "apellidos" => "Bouarich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Rafael" "apellidos" => "Pérez-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Diego" "apellidos" => "Rodríguez Puyol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Guillermina" "apellidos" => "Barril" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 8 => array:3 [ "nombre" => "Jose Antonio" "apellidos" => "Sánchez Tomero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 9 => array:3 [ "nombre" => "Martin" "apellidos" => "Giorgi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 10 => array:3 [ "nombre" => "Manuel Rafael" "apellidos" => "Ramirez Chamond" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Laboratorio de Fisiología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital de La Princesa, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El triacetato de celulosa asimétrico es una alternativa segura y eficaz para la hemodiafiltración en línea" ] ] "textoCompleto" => "IntroductionOnline haemodiafiltration (OLHDF) is the most complete haemodialysis technique currently available, as it is capable of removing significant quantities of low-, medium- and high-molecular weight uraemic toxins, in direct relation with the convective transport volume obtained.<a class="elsevierStyleCrossRef" href="#bib0100">1</a> Post-dilution OLHDF is the most used form and has proven efficacy. It is known to be a safe technique which improves intradialytic haemodynamic tolerance and increases survival.<a class="elsevierStyleCrossRefs" href="#bib0105">2–4</a>OLHDF uses high-flux biocompatible dialysers, providing greater clearance per unit of surface by combining the processes of diffusion and convection. To date, the membranes used in this technique have been synthetic. In the study by Maduell et al.,<a class="elsevierStyleCrossRef" href="#bib0120">5</a> in which multiple dialysers for OLHDF were compared, they considered that cellulose triacetate had a low purification of β2-microglobulin and limited its use in OLHDF due to high transmembrane pressure (TMP). An asymmetric cellulose triacetate membrane (ATA®) was recently marketed in the Solacea® (Nipro) dialyser with a KUF of 72ml/mmHg/h/m2 and configured in order to perform OLHDF. In accordance with the manufacturer's data, the complement activation produced is similar to that of the synthetic membranes, demonstrating its biocompatibility. Its long-term biocompatibility through its effect on monocytes and interleukins (IL) is still to be determined. As yet, there is no publication on the convective volume (Vconv) obtained, the adaptation to different OLHDF systems, the clearance capacity for different types of molecules or biocompatibility in daily clinical practice. The recent description of various cases of hypersensitivity with biocompatible membranes, such as polysulfone,<a class="elsevierStyleCrossRef" href="#bib0125">6</a> in which cellulose triacetate is used as an alternative, has led to even greater interest in the study of this type of membrane.ObjectiveTo describe the features and the in vivo behaviour of the ATA® membrane in order to identify: its clearance efficacy, biocompatibility and ease of use in clinical practice.Material and methodsThis was a prospective, observational study in three hospital haemodialysis units (Hospital de La Princesa, Hospital Príncipe de Asturias and Hospital Infanta Leonor, Autonomous Community of Madrid, Spain) in which the normal synthetic dialyser that each patient had for OLHDF was replaced with an ATA® dialyser, with all other parameters remaining the same. The study (LIB 09/2015) was reviewed and approved by the Hospital Universitario Príncipe de Asturias IEC (Alcalá de Henares, Madrid).Inclusion and exclusion criteriaInclusion criteria: over 18 years of age, having undergone treatment with OLHDF for more than four weeks (with three weekly sessions) and having signed the informed consent form.Exclusion criteria: pregnancy and illness which means that death is predicted to occur in fewer than four weeks.Study designEach patient underwent 12 haemodialysis sessions (during one month) with his/her normal regimen of time, bathing, heparin dose, sodium and bicarbonate conductivity and also on his/her normal monitor: 5008-Fresenius® (n=14), AK 200-Gambro® (n=5), Artis-Gambro® (n=3) and the Nikkiso DBB-07 (n=1). All monitors were suitable for conducting OLHDF, although with different automated control systems for convective transport. The Qb used was the maximum facilitated vascular access, without allowing an arterial line the pressure below −220mmHg.In all cases, the nursing staff connected the automated OLHDF system to the system with which the patient's monitor operated. In the event that the system was Ultracontrol®, the warning systems were set at TMP>300 or pressure system (Psyst)>700mmHg. In the event that these warnings were shown and not resolved, Ultracontrol® would be withdrawn and the control-pressure system would be used, in which the TMP remains at values which ensure a Psyst<700mmHg and an appropriate infusion volume (Vinf).Dialyser featuresThe features of the dialyser are specified in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Data collectedDemographic and dialysis data<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Demographic data: gender, age, underlying disease, time on OLHDF, type of vascular access: fistula or catheter.</li><li class="elsevierStyleListItem" id="lsti0010">-General information related to the dialysis procedure: monitor, composition of dialysis fluid (calcium, potassium) sodium and bicarbonate conductivities, dialysis fluid flow (Qd, ml/min), fluid temperature, type and dose of heparin.</li><li class="elsevierStyleListItem" id="lsti0015">-In each dialysis session: effective time (min), blood flow (Qb, ml/min), volume ultrafiltrated to achieve dry weight (UF, l/session), Vinf (l/session), infusion rate (Qi, ml/min), Kt (l/session), maximum TMP and maximum Psyst in Ultracontrol® (mmHg) and the technical complications, warnings and system coagulation problems that could occur.</li></ul>The filtration fraction (FF) was calculated as the percentage of Qi relative to Qb. Following the definition of the EuDial group, the Vconv was defined as the total ultrafiltrate volume, which is the sum of Vinf and UF.<a class="elsevierStyleCrossRef" href="#bib0130">7</a>Blood tests<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">-Pre-dialysis samples were obtained on the first and last day to measure monocytes and IL-6 and IL-1β.</li><li class="elsevierStyleListItem" id="lsti0025">-On the mid day of the first week, three blood extractions were performed: the first, at the start (CI); the second, after 30min (CM), and the third, at the end of the dialysis session (CP). All from the arterial line: the first directly from the patient, before the connection, and the other two after reduction of Qb to 50ml/min. during one minute.</li></ul>The following were measured at CI and CP: blood count; proteins and albumin; small molecules (molecular weight less than 500Da): urea (60Da), phosphorus (95Da), creatinine (113Da) and uric acid (168Da); medium molecules (molecular weight greater than 500Da): β2-microglobulin (11,818Da) and myoglobin (17,200Da); and molecules bound to proteins: retinol-binding protein (21,200Da).Leukocytes, platelets, C3a and C5a were measured to study acute biocompatibility at CI and CM.Laboratory methodsGeneral biochemical data: blood count, proteins, albumin, urea, phosphorus, creatinine (113Da), uric acid, β2-microglobulin, myoglobin and retinol-binding protein were determined with each hospital's regular analyser.The determinations of monocytes, C3a, C5a, IL-6 and IL-1β were performed at the Universidad de Alcalá laboratory. C3a and C5a were measured with the ELISA Kit C3a Elabscience (Wuhan, PR China) and ELISA C5a RayBiotech (Norcross, GA, USA). The concentration of IL-6 and IL-1β was measured in frozen serum samples with Abcam kits (Cambridge, United Kingdom). The populations of monocytes were identified by flow cytometry (FACSCalibur™, Becton Dickinson, San Jose, CA, USA).CalculationsThe percent reduction ratios (RR) were calculated with the formula: RR (%)=[(Cpre−Cpos)/Cpre]×100, where Cpre and Cpos are the concentrations of the compounds analysed pre- and post-dialysis.For the substances bound to proteins and the β2-microglobulin, the concentrations at the end of the session were corrected for haemoconcentration by a correction factor based on the change in plasma protein concentration:Correction factor=TPpre/TPpos,<a class="elsevierStyleCrossRef" href="#bib0135">8</a>where TPpre and TPpos are the concentrations of total proteins pre- and post-dialysis.Statistical analysisAll the information was collected in a database file to be analysed using SPPS vs .15. Each value was the mean of the values obtained from the different sessions or blood determinations.For the statistical analysis, descriptive statistics included means (standard deviation), median with quartiles or percentages, as appropriate. Paired Student's t-test was used to compare paired measurements from continuous variables. p<0.05 was considered to be statistically significant.ResultsThe study included 23 patients (15 males, 8 females) with a median age of 65 (41–85). The causes of kidney disease were: diabetic nephropathy in seven cases, glomerular disease in six cases, nephroangiosclerosis in two cases, reduced kidney mass in two cases, hepatorenal polycystic disease in two cases, chronic pyelonephritis in one case and unknown origin in three cases. The median time on renal replacement therapy was 98 (17–315) months. Sixteen patients had arteriovenous fistula and seven had a catheter. The mean dry weight was 73.4 (16.7) kg.A total of 287 sessions were performed, and 264 complete sessions were collected (sessions excluded were those in which the effective time differed by more than 15min from the scheduled time, or if the monitor had been changed). One patient was lost to follow-up due to vascular disease requiring hospital admission .The results of dialysis parameters and molecule clearance are shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>, respectively. The FF obtained with the different monitors was: 5008® 28.9 (3.9)%, AK 200® 31.8 (1.8)%, Artis® 32.6 (4)% and DBB-07® 27%. There was a negative correlation between the initial Hb and the Vconv (r=−0.5, p>.01) and the Kt (r=−0.5, p<0.01). There were no complications reported and there were no warnings issued by the dialyser and it was not necessary to make changes to the Ultracontrol® system. As coagulation problems did not occur the dose of heparin was not changed.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Finally, <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the acute biocompatibility data while <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows details on inflammation parameters. Both tables show that there is no complement activation when using a cellulose membrane, and there is not worsening in inflammatory molecules after one month of treatment. There was no significant correlation between CRP and the other inflammatory parameters studied.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>DiscussionOur results show that the membrane studied has the necessary characteristics to perform OLHDF; it obtains a suitable Vconv, Kt and RR for different substances, it does not cause technical problems and nursing work is not affected beyond daily clinical practice. Also, the membrane is biocompatible (it does not activate the complement in the short-term or induce changes in the inflammatory profile in the medium term, based on the data obtained on activation of IL and monocytes).The two clinical parameters used on a day-to-day basis to assess OLHDF's suitability are Kt and Vconv.<a class="elsevierStyleCrossRefs" href="#bib0140">9,10</a> The mean Kt reached was 56l, this value is greater than the target suggested in the guidelines, and, although the optimal Vconv remains to be decided, a recent study<a class="elsevierStyleCrossRef" href="#bib0150">11</a> showed that increasing Vconv improves survival linearly between ∼55 and 75l/week; our results indicate that the maximum volume was achieved. The clearance capacity obtained as assessed by RRs for substances of different sizes were also similar to those presented in other studies which feature high-permeability dialysers to perform OLHDF,<a class="elsevierStyleCrossRefs" href="#bib0155">12,13</a> taking into account the differences which may be found depending on the dialysis time and the surface used.According to the EUDIAL group, the dialyser used to perform OLHDF must have the following features: high flux, ultrafiltration coefficient greater than 20ml/mmHg/h/m2, permeability coefficient for β2-microglobulin greater than 0.6, and obtain an effective convective transport greater than 20% of the total processed blood.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> Given that each monitor uses different methods to optimise the FF,<a class="elsevierStyleCrossRef" href="#bib0165">14</a> the results obtained were different depending on which monitor we used, but the results were greater than 27% in all monitors. The classic description of cellulose membranes is that they are thinner than synthetic membranes and have a capillary wall that is uniform and symmetric in composition, without having the necessary resistance to support the high pressures generated in OLHDF.<a class="elsevierStyleCrossRef" href="#bib0170">15</a> However, the ATA® membrane is asymmetrical, which allows to have a low TMP and, therefore, to perform OLHDF achieving adequate clearance, in accordance with the measurement parameters used.Regarding clinical aspects, there were no significant problems in the daily practice, we observed a well adaptation to the different systems which the monitors use to achieve an adequate Vconv, as reflected in the different FFs obtained. This is important fact, since the absence of alarm warnings improves the nurse's work load and means that the dialyser adapts well to the technique.The idea persists that the contact of these cellulose membranes with blood causes a major inflammatory response, classifying them as non-biocompatible membranes. This inflammatory response could be acute, with complement activation and leukopaenia after 30min of the session, or have consequences in the longer term through activation of monocytes and cytokines. The severity of this response is due to the hydroxyl groups (OH) within the cellulose molecule. The replacement of these groups with acetate has resulted in modified cellulose triacetate membranes which reduce these responses and make them similar to synthetic dialysers. To determine the membrane's acute biocompatibility, complement activation and leukocytes were measured at 30min, and we found reductions similar to the published with synthetic dialysers. This led us to consider this membrane to be biocompatible and the concept that assumes that cellulose as bioincompatible was dismissed.<a class="elsevierStyleCrossRef" href="#bib0170">15</a>There is a great heterogeneity of circulating monocytes in humans. Circulating monocytes which can be summarised as classical and non-classical according to whether they express greater or lower levels of CD14 and CD16 markers. Classical monocytes are most of the monocytes seen in healthy individuals. Non-classical monocyte populations tend are observed in certain pathological situations, such as cardiovascular disease<a class="elsevierStyleCrossRef" href="#bib0175">16</a> or inflammatory processes.<a class="elsevierStyleCrossRef" href="#bib0180">17</a> Several studies show a reduction in the percentage of non-classical monocytes and of markers of endothelial damage with OLHDF compared to conventional high-flux haemodialysis.<a class="elsevierStyleCrossRef" href="#bib0185">18</a> Elevated levels of proinflammatory cytokines have been associated with greater mortality. Our results reveal that these membranes do not induce changes in these inflammatory markers after one month of treatment, as we have not found significant changes in the percentage of non-classical monocytes or in ILs levels. We therefore believe that this substituted cellulose membrane does not induce inflammatory changes different from those of normal synthetic membranes.Our study has some limitations, although the number of patients is small, but we believe that the number of sessions performed is high and, therefore, the outcome is representative. The objective was not to compare this membrane with other membranes, but instead to describe the membrane it self. Therefore, the design is suitable. Although the number of sessions performed with some monitors, for example the Nikkiso monitor, was lower, we believe that the results are quite conclusive in terms of good adaptation of the filter to all systems. It is yet to be established if there is loss of albumin, which means that there is a question to be answered, however, we do not have the necessary resources to analyse this. We have found one report in which the loss of Albumin is quantified, and it is less than 2g per session.<a class="elsevierStyleCrossRef" href="#bib0190">19</a>ConclusionsThe new ATA® membrane obtains adequate Kt and Vconv values, without technical problems. We did not find the classic problems attributed to this type of membrane in the biocompatibility parameters studied, making it possible to perform OLHDF, and finding it to be most useful in patients who are allergic to synthetic membranes.FundingThe study was funded by Nipro, with a financial contribution of €5000. This was allocated entirely to laboratory expenditure. None of the investigators received payment for the study.Conflicts of interestThe authors declare potential conflicts of interest.Dr P. de Sequera, Dr M. Albalate and Dr R. Pérez García have participated as speakers at meetings organised by Gambro and Fresenius, and Dr G. Barril has participated at meetings organised by Nikkiso. They charged fees for these talks." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1026169" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec983881" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1026170" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec983880" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Material and methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Inclusion and exclusion criteria" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Dialyser features" ] 3 => array:3 [ "identificador" => "sec0035" "titulo" => "Data collected" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Demographic and dialysis data" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Blood tests" ] ] ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Laboratory methods" ] 5 => array:2 [ "identificador" => "sec0055" "titulo" => "Calculations" ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack346537" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-27" "fechaAceptado" => "2017-11-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec983881" "palabras" => array:5 [ 0 => "Online haemodiafiltration" 1 => "Cellulose triacetate" 2 => "Suitability" 3 => "Biocompatibility" 4 => "Inflammation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec983880" "palabras" => array:5 [ 0 => "Hemodiafiltración en línea" 1 => "Triacetato de celulosa" 2 => "Adecuación" 3 => "Biocompatibilidad" 4 => "Inflamación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundIn post-dilution haemodiafiltration only synthetic membranes have been used to date. Asymmetric cellulose triacetate (ATA™) is now available, whose characteristics are suitable for this technique. ObjectivesTo describe the in vivo performance and behaviour of this membrane, to identify its depurative effectiveness, use in clinical practice and its biocompatibility, both acute and after one month of treatment. MethodsObservational prospective study of 23 patients who were dialysed for 4 weeks using an ATA™ membrane and who maintained their prior regimen. ResultsA total of 287 sessions were performed and 264 complete sessions were collected. With an effective time of 243.7 (17.6) min and a mean blood flow of 371.7 (23) ml/min, an average Kt of 56.3 (5.3) l was observed, as well as a convection volume of 27.1 (4.2) l, a filtration fraction of 29.9 (3.7) %, a urea reduction ratio (RR) of 81 (5.2) %, a creatinine RR of 74.7 (4.6) %, a β2-microglobulin RR of 76.5 (4.8) % and a retinol binding protein RR of 18.6 (7.6) %. There were no technical problems or alarms. Changing the heparin dosage was not necessary. No increases in C3a or C5a concentrations or leukopenia were observed in the first 30min of the session. Neither the monocyte subpopulations nor IL-β1 or IL-6 were significantly altered after one month of treatment. ConclusionsThe new ATA™ membrane achieves adequate Kt and convection volume, without technical problems and with good biocompatibility and inflammatory profiles. It is therefore a valid option for post-dilution haemodiafiltration, particularly in patients allergic to synthetic membranes." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesEn la hemodiafiltración posdilucional se han usado solo membranas sintéticas. Ahora contamos con un triacetato de celulosa asimétrico (ATA®) cuyas características lo hacen apto para esta técnica. ObjetivosDescribir las prestaciones y el comportamiento in vivo de esta membrana estudiando la eficacia depurativa y el uso clínico, además de su biocompatibilidad aguda tras un mes de tratamiento. MétodosEstudio prospectivo observacional en el que se incluyeron 23 pacientes que se dializaron durante 4 semanas con ATA® manteniendo su pauta previa. ResultadosSe realizaron 287 sesiones y se recogieron 264 sesiones completas. Con un tiempo efectivo de 243,7 (17,6) min y un flujo medio de sangre de 371,7 (23) ml/min, se obtuvo un Kt medio de 56,3 (5,3) l, un volumen convectivo de 27,1 (4,2) l, con una fracción de filtración del 29,9 (3,7) %, un porcentaje de reducción (RR) de urea de 81 (5,2) %, un RR de creatinina de 74,7 (4,6) %, un RR de β2-microglobulina de 76,5 (4,8) % y un RR de proteína transportadora de retinol de 18,6 (7,6) %. No se produjeron problemas técnicos ni alarmas. No fue preciso cambiar la dosificación de heparina. A los 30min de la sesión no se produjo ningún aumento de C3a, C5a ni leucopenia. Tampoco se modificaron de forma significativa las poblaciones monocitarias ni la IL-β1 ni IL-6 tras un mes de tratamiento. ConclusionesATA® logra un Kt y un volumen convectivo adecuados, sin problemas técnicos y con buen perfil de biocompatibilidad e inflamatorio, lo que lo convierte en una posibilidad más de tratamiento para hemodiafiltración posdilucional, máxime en pacientes alérgicos a membranas sintéticas." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Albalate Ramón M, Martínez Miguel P, Bohorquez L, de Sequera P, Bouarich H, Pérez-García R, et al. El triacetato de celulosa asimétrico es una alternativa segura y eficaz para la hemodiafiltración en línea. Nefrologia. 2018;38:315–320." ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "KUF: ultrafiltration coefficient; Qb: blood flow; Qd: dialysis flow; TMP: transmembrane pressure." "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Membrane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ATA® \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sterilisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gamma rays \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bisphenol A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">KUF (ml/h/mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Effective surface area (m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">108 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thickness of membrane (μ) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">245 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal diameter (μ) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum TMP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">500 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pressure drop (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Qb/Qd (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200/500 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood/fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47/16 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1745878.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Technical features of the Solacea® 19H dialyser." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "FF: filtration fraction; Max.TMP: maximum transmembrane pressure; Psyst: system pressure in AK-200; Qb: blood flow; Qd: dialysis flow; Qi: mean infusion rate; SD: standard deviation; T: time; UF: ultrafiltration; VB: blood volume; Vconv: convective volume; Vinf: infusion volume." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean (SD) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scheduled T (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">248.7 (17.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Effective T (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243.7 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qb (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">371.7 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qd (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">553 (128.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VB (l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.6 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UF (l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.7 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vinf (l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.4 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vconv (l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qi (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111.1 (14.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FF (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.9 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kt (l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.3 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psyst (mmHg) (n=5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">520.6 (58.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Max.TMP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">188.9 (54) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1745880.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptive results of the dialysis sessions (n=264 sessions)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "β2m: β2-microglobulin; RBP: retinol-binding protein; RR: reduction ratio.The results are expressed as a mean (standard deviation)." "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-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Urea RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">Creatinine RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">Myoglobin RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">β2m RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">RBP RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">Phosphorus RR \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">81 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.7 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.5 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.6 (7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.1 (45.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1745877.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptive results of molecule clearance (%) (n=22 sessions)." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ns: not significant.The results are expressed as a mean (standard deviation)." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Start \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">30min \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukocytes (×109/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6280 (2552) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6324 (2342) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neutrophils (×109/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3990 (2208) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4210 (2309) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets (×109/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">191.4 (49.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">176 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C3a (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1160.1 (755.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1511.7 (451.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C5a (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31,260.5 (15,591.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31,524 (13,860.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1745876.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results on acute biocompatibility with blood samples obtained at the start and after 30min of dialysis (n=22 sessions)." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IL-6: interleukin-6; IL-1β: interleukin-1 beta; ns: not significant." "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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Classical (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-classical (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IL-β1 (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IL-6 (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Start \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.3 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.6 (6.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.2 (22.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.5 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1745879.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results on monocytes and inflammatory molecules after one month of use (samples obtained before the first session with Solacea® and at the start of the last session) (n=21 patients)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effective removal of protein-bound uraemic solutes by different convective strategies: a prospective trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Meert" 1 => "S. Eloot" 2 => "M. Waterloos" 3 => "M. van Landschoot" 4 => "A. Dhondt" 5 => "G. Glorieux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfn522" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "562" "paginaFinal" => "570" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18809977" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Maduell" 1 => "F. Moreso" 2 => "M. Pons" 3 => "R. Ramos" 4 => "J. Mora-Macià" 5 => "J. Carreras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2012080875" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "487" "paginaFinal" => "497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411788" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from DOPPS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Canaud" 1 => "J.L. Bragg-Gresham" 2 => "M.R. Marshall" 3 => "S. Desmeules" 4 => "B.W. Gillespie" 5 => "T. 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El triacetato de celulosa asimétrico es una alternativa segura y eficaz para la hemodiafiltración en línea

Marta Albalate Ramóna,

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malbalater@senefro.org

Corresponding author.

, Patricia Martínez Miguelb, Lourdes Bohorquezc, Patricia de Sequeraa, Hanane Bouarichb, Rafael Pérez-Garcíaa, Diego Rodríguez Puyolb, Guillermina Barrild, Jose Antonio Sánchez Tomerod, Martin Giorgid, Manuel Rafael Ramirez Chamondc

a Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain

b Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain

c Laboratorio de Fisiología, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain

d Servicio de Nefrología, Hospital de La Princesa, Madrid, Spain

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providing greater clearance per unit of surface by combining the processes of diffusion and convection&#46; To date&#44; the membranes used in this technique have been synthetic&#46; In the study by Maduell et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> in which multiple dialysers for OLHDF were compared&#44; they considered that cellulose triacetate had a low purification of &#946;<span class="elsevierStyleInf">2</span>-microglobulin and limited its use in OLHDF due to high transmembrane pressure &#40;TMP&#41;&#46; An asymmetric cellulose triacetate membrane &#40;ATA<span class="elsevierStyleSup">&#174;</span>&#41; was recently marketed in the Solacea<span class="elsevierStyleSup">&#174;</span> &#40;Nipro&#41; dialyser with a KUF of 72<span class="elsevierStyleHsp" style=""></span>ml&#47;mmHg&#47;h&#47;m<span class="elsevierStyleSup">2</span> and configured in order to perform OLHDF&#46; In accordance with the manufacturer&#39;s data&#44; the complement activation produced is similar to that of the synthetic membranes&#44; demonstrating its biocompatibility&#46; Its long-term biocompatibility through its effect on monocytes and interleukins &#40;IL&#41; is still to be determined&#46; As yet&#44; there is no publication on the convective volume &#40;Vconv&#41; obtained&#44; the adaptation to different OLHDF systems&#44; the clearance capacity for different types of molecules or biocompatibility in daily clinical practice&#46; The recent description of various cases of hypersensitivity with biocompatible membranes&#44; such as polysulfone&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> in which cellulose triacetate is used as an alternative&#44; has led to even greater interest in the study of this type of membrane&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objective</span><p id="par0015" class="elsevierStylePara elsevierViewall">To describe the features and the <span class="elsevierStyleItalic">in vivo</span> behaviour of the ATA<span class="elsevierStyleSup">&#174;</span> membrane in order to identify&#58; 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the nursing staff connected the automated OLHDF system to the system with which the patient&#39;s monitor operated&#46; In the event that the system was Ultracontrol<span class="elsevierStyleSup">&#174;</span>&#44; the warning systems were set at TMP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>300 or pressure system &#40;Psyst&#41;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>mmHg&#46; In the event that these warnings were shown and not resolved&#44; Ultracontrol<span class="elsevierStyleSup">&#174;</span> would be withdrawn and the control-pressure system would be used&#44; in which the TMP remains at values which ensure a Psyst<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>700<span class="elsevierStyleHsp" style=""></span>mmHg and an appropriate infusion volume &#40;Vinf&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Dialyser features</span><p id="par0045" class="elsevierStylePara elsevierViewall">The features of the dialyser are specified in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Data collected</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Demographic and dialysis data</span><p id="par0050" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Demographic data&#58; gender&#44; age&#44; underlying disease&#44; time on OLHDF&#44; type of vascular access&#58; fistula or catheter&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">General information related to the dialysis procedure&#58; monitor&#44; composition of dialysis fluid &#40;calcium&#44; potassium&#41; sodium and bicarbonate conductivities&#44; dialysis fluid flow &#40;Qd&#44; ml&#47;min&#41;&#44; fluid temperature&#44; type and dose of heparin&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">In each dialysis session&#58; effective time &#40;min&#41;&#44; blood flow &#40;Qb&#44; ml&#47;min&#41;&#44; volume ultrafiltrated to achieve dry weight &#40;UF&#44; l&#47;session&#41;&#44; Vinf &#40;l&#47;session&#41;&#44; infusion rate &#40;Qi&#44; ml&#47;min&#41;&#44; Kt &#40;l&#47;session&#41;&#44; maximum TMP and maximum Psyst in Ultracontrol<span class="elsevierStyleSup">&#174;</span> &#40;mmHg&#41; and the technical complications&#44; warnings and system coagulation problems that could occur&#46;</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">The filtration fraction &#40;FF&#41; was calculated as the percentage of Qi relative to Qb&#46; Following the definition of the EuDial group&#44; the Vconv was defined as the total ultrafiltrate volume&#44; which is the sum of Vinf and UF&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Blood tests</span><p id="par0075" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Pre-dialysis samples were obtained on the first and last day to measure monocytes and IL-6 and IL-1&#946;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">On the mid day of the first week&#44; three blood extractions were performed&#58; the first&#44; at the start &#40;CI&#41;&#59; the second&#44; after 30<span class="elsevierStyleHsp" style=""></span>min &#40;CM&#41;&#44; and the third&#44; at the end of the dialysis session &#40;CP&#41;&#46; All from the arterial line&#58; the first directly from the patient&#44; before the connection&#44; and the other two after reduction of Qb to 50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; during one minute&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">The following were measured at CI and CP&#58; blood count&#59; proteins and albumin&#59; small molecules &#40;molecular weight less than 500<span class="elsevierStyleHsp" style=""></span>Da&#41;&#58; urea &#40;60<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; phosphorus &#40;95<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; creatinine &#40;113<span class="elsevierStyleHsp" style=""></span>Da&#41; and uric acid &#40;168<span class="elsevierStyleHsp" style=""></span>Da&#41;&#59; medium molecules &#40;molecular weight greater than 500<span class="elsevierStyleHsp" style=""></span>Da&#41;&#58; &#946;<span class="elsevierStyleInf">2</span>-microglobulin &#40;11&#44;818<span class="elsevierStyleHsp" style=""></span>Da&#41; and myoglobin &#40;17&#44;200<span class="elsevierStyleHsp" style=""></span>Da&#41;&#59; and molecules bound to proteins&#58; retinol-binding protein &#40;21&#44;200<span class="elsevierStyleHsp" style=""></span>Da&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Leukocytes&#44; platelets&#44; C3a and C5a were measured to study acute biocompatibility at CI and CM&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Laboratory methods</span><p id="par0100" class="elsevierStylePara elsevierViewall">General biochemical data&#58; blood count&#44; proteins&#44; albumin&#44; urea&#44; phosphorus&#44; creatinine &#40;113<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; uric acid&#44; &#946;<span class="elsevierStyleInf">2</span>-microglobulin&#44; myoglobin and retinol-binding protein were determined with each hospital&#39;s regular analyser&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The determinations of monocytes&#44; C3a&#44; C5a&#44; IL-6 and IL-1&#946; were performed at the Universidad de Alcal&#225; laboratory&#46; C3a and C5a were measured with the ELISA Kit C3a Elabscience &#40;Wuhan&#44; PR China&#41; and ELISA C5a RayBiotech &#40;Norcross&#44; GA&#44; USA&#41;&#46; The concentration of IL-6 and IL-1&#946; was measured in frozen serum samples with Abcam kits &#40;Cambridge&#44; United Kingdom&#41;&#46; The populations of monocytes were identified by flow cytometry &#40;FACSCalibur&#8482;&#44; Becton Dickinson&#44; San Jose&#44; CA&#44; USA&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Calculations</span><p id="par0110" class="elsevierStylePara elsevierViewall">The percent reduction ratios &#40;RR&#41; were calculated with the formula&#58; RR &#40;&#37;&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#91;&#40;Cpre<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>Cpos&#41;&#47;Cpre&#93;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#44; where Cpre and Cpos are the concentrations of the compounds analysed pre- and post-dialysis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">For the substances bound to proteins and the &#946;<span class="elsevierStyleInf">2</span>-microglobulin&#44; the concentrations at the end of the session were corrected for haemoconcentration by a correction factor based on the change in plasma protein concentration&#58;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Correction factor<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>TPpre&#47;TPpos&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a>where TPpre and TPpos are the concentrations of total proteins pre- and post-dialysis&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">All the information was collected in a database file to be analysed using SPPS <span class="elsevierStyleItalic">vs</span> &#46;15&#46; Each value was the mean of the values obtained from the different sessions or blood determinations&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">For the statistical analysis&#44; descriptive statistics included means &#40;standard deviation&#41;&#44; median with quartiles or percentages&#44; as appropriate&#46; Paired Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used to compare paired measurements from continuous variables&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered to be statistically significant&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0135" class="elsevierStylePara elsevierViewall">The study included 23 patients &#40;15 males&#44; 8 females&#41; with a median age of 65 &#40;41&#8211;85&#41;&#46; The causes of kidney disease were&#58; diabetic nephropathy in seven cases&#44; glomerular disease in six cases&#44; nephroangiosclerosis in two cases&#44; reduced kidney mass in two cases&#44; hepatorenal polycystic disease in two cases&#44; chronic pyelonephritis in one case and unknown origin in three cases&#46; The median time on renal replacement therapy was 98 &#40;17&#8211;315&#41; months&#46; Sixteen patients had arteriovenous fistula and seven had a catheter&#46; The mean dry weight was 73&#46;4 &#40;16&#46;7&#41; kg&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">A total of 287 sessions were performed&#44; and 264 complete sessions were collected &#40;sessions excluded were those in which the effective time differed by more than 15<span class="elsevierStyleHsp" style=""></span>min from the scheduled time&#44; or if the monitor had been changed&#41;&#46; One patient was lost to follow-up due to vascular disease requiring hospital admission &#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The results of dialysis parameters and molecule clearance are shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#44; respectively&#46; The FF obtained with the different monitors was&#58; 5008<span class="elsevierStyleSup">&#174;</span> 28&#46;9 &#40;3&#46;9&#41;&#37;&#44; AK 200<span class="elsevierStyleSup">&#174;</span> 31&#46;8 &#40;1&#46;8&#41;&#37;&#44; Artis<span class="elsevierStyleSup">&#174;</span> 32&#46;6 &#40;4&#41;&#37; and DBB-07<span class="elsevierStyleSup">&#174;</span> 27&#37;&#46; There was a negative correlation between the initial Hb and the Vconv &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;5&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; and the Kt &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;5&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; There were no complications reported and there were no warnings issued by the dialyser and it was not necessary to make changes to the Ultracontrol<span class="elsevierStyleSup">&#174;</span> system&#46; As coagulation problems did not occur the dose of heparin was not changed&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> lists the acute biocompatibility data while <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows details on inflammation parameters&#46; Both tables show that there is no complement activation when using a cellulose membrane&#44; and there is not worsening in inflammatory molecules after one month of treatment&#46; There was no significant correlation between CRP and the other inflammatory parameters studied&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">Our results show that the membrane studied has the necessary characteristics to perform OLHDF&#59; it obtains a suitable Vconv&#44; Kt and RR for different substances&#44; it does not cause technical problems and nursing work is not affected beyond daily clinical practice&#46; Also&#44; the membrane is biocompatible &#40;it does not activate the complement in the short-term or induce changes in the inflammatory profile in the medium term&#44; based on the data obtained on activation of IL and monocytes&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The two clinical parameters used on a day-to-day basis to assess OLHDF&#39;s suitability are Kt and Vconv&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a> The mean Kt reached was 56<span class="elsevierStyleHsp" style=""></span>l&#44; this value is greater than the target suggested in the guidelines&#44; and&#44; although the optimal Vconv remains to be decided&#44; a recent study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> showed that increasing Vconv improves survival linearly between &#8764;55 and 75<span class="elsevierStyleHsp" style=""></span>l&#47;week&#59; our results indicate that the maximum volume was achieved&#46; The clearance capacity obtained as assessed by RRs for substances of different sizes were also similar to those presented in other studies which feature high-permeability dialysers to perform OLHDF&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">12&#44;13</span></a> taking into account the differences which may be found depending on the dialysis time and the surface used&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">According to the EUDIAL group&#44; the dialyser used to perform OLHDF must have the following features&#58; high flux&#44; ultrafiltration coefficient greater than 20<span class="elsevierStyleHsp" style=""></span>ml&#47;mmHg&#47;h&#47;m<span class="elsevierStyleSup">2</span>&#44; permeability coefficient for &#946;<span class="elsevierStyleInf">2</span>-microglobulin greater than 0&#46;6&#44; and obtain an effective convective transport greater than 20&#37; of the total processed blood&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Given that each monitor uses different methods to optimise the FF&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> the results obtained were different depending on which monitor we used&#44; but the results were greater than 27&#37; in all monitors&#46; The classic description of cellulose membranes is that they are thinner than synthetic membranes and have a capillary wall that is uniform and symmetric in composition&#44; without having the necessary resistance to support the high pressures generated in OLHDF&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> However&#44; the ATA<span class="elsevierStyleSup">&#174;</span> membrane is asymmetrical&#44; which allows to have a low TMP and&#44; therefore&#44; to perform OLHDF achieving adequate clearance&#44; in accordance with the measurement parameters used&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Regarding clinical aspects&#44; there were no significant problems in the daily practice&#44; we observed a well adaptation to the different systems which the monitors use to achieve an adequate Vconv&#44; as reflected in the different FFs obtained&#46; This is important fact&#44; since the absence of alarm warnings improves the nurse&#39;s work load and means that the dialyser adapts well to the technique&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The idea persists that the contact of these cellulose membranes with blood causes a major inflammatory response&#44; classifying them as non-biocompatible membranes&#46; This inflammatory response could be acute&#44; with complement activation and leukopaenia after 30<span class="elsevierStyleHsp" style=""></span>min of the session&#44; or have consequences in the longer term through activation of monocytes and cytokines&#46; The severity of this response is due to the hydroxyl groups &#40;OH&#41; within the cellulose molecule&#46; The replacement of these groups with acetate has resulted in modified cellulose triacetate membranes which reduce these responses and make them similar to synthetic dialysers&#46; To determine the membrane&#39;s acute biocompatibility&#44; complement activation and leukocytes were measured at 30<span class="elsevierStyleHsp" style=""></span>min&#44; and we found reductions similar to the published with synthetic dialysers&#46; This led us to consider this membrane to be biocompatible and the concept that assumes that cellulose as bioincompatible was dismissed&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">There is a great heterogeneity of circulating monocytes in humans&#46; Circulating monocytes which can be summarised as classical and non-classical according to whether they express greater or lower levels of CD14 and CD16 markers&#46; Classical monocytes are most of the monocytes seen in healthy individuals&#46; Non-classical monocyte populations tend are observed in certain pathological situations&#44; such as cardiovascular disease<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> or inflammatory processes&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> Several studies show a reduction in the percentage of non-classical monocytes and of markers of endothelial damage with OLHDF compared to conventional high-flux haemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> Elevated levels of proinflammatory cytokines have been associated with greater mortality&#46; Our results reveal that these membranes do not induce changes in these inflammatory markers after one month of treatment&#44; as we have not found significant changes in the percentage of non-classical monocytes or in ILs levels&#46; We therefore believe that this substituted cellulose membrane does not induce inflammatory changes different from those of normal synthetic membranes&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Our study has some limitations&#44; although the number of patients is small&#44; but we believe that the number of sessions performed is high and&#44; therefore&#44; the outcome is representative&#46; The objective was not to compare this membrane with other membranes&#44; but instead to describe the membrane it self&#46; Therefore&#44; the design is suitable&#46; Although the number of sessions performed with some monitors&#44; for example the Nikkiso monitor&#44; was lower&#44; we believe that the results are quite conclusive in terms of good adaptation of the filter to all systems&#46; It is yet to be established if there is loss of albumin&#44; which means that there is a question to be answered&#44; however&#44; we do not have the necessary resources to analyse this&#46; We have found one report in which the loss of Albumin is quantified&#44; and it is less than 2<span class="elsevierStyleHsp" style=""></span>g per session&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">The new ATA<span class="elsevierStyleSup">&#174;</span> membrane obtains adequate Kt and Vconv values&#44; without technical problems&#46; We did not find the classic problems attributed to this type of membrane in the biocompatibility parameters studied&#44; making it possible to perform OLHDF&#44; and finding it to be most useful in patients who are allergic to synthetic membranes&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0195" class="elsevierStylePara elsevierViewall">The study was funded by <span class="elsevierStyleGrantSponsor" id="gs1">Nipro</span>&#44; with a financial contribution of &#8364;5000&#46; This was allocated entirely to laboratory expenditure&#46; None of the investigators received payment for the study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare potential conflicts of interest&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Dr P&#46; de Sequera&#44; Dr M&#46; Albalate and Dr R&#46; P&#233;rez Garc&#237;a have participated as speakers at meetings organised by Gambro and Fresenius&#44; and Dr G&#46; Barril has participated at meetings organised by Nikkiso&#46; They charged fees for these talks&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In post-dilution haemodiafiltration only synthetic membranes have been used to date&#46; Asymmetric cellulose triacetate &#40;ATA&#8482;&#41; is now available&#44; whose characteristics are suitable for this technique&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the <span class="elsevierStyleItalic">in vivo</span> performance and behaviour of this membrane&#44; to identify its depurative effectiveness&#44; use in clinical practice and its biocompatibility&#44; both acute and after one month of treatment&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Observational prospective study of 23 patients who were dialysed for 4 weeks using an ATA&#8482; membrane and who maintained their prior regimen&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 287 sessions were performed and 264 complete sessions were collected&#46; With an effective time of 243&#46;7 &#40;17&#46;6&#41; min and a mean blood flow of 371&#46;7 &#40;23&#41; ml&#47;min&#44; an average Kt of 56&#46;3 &#40;5&#46;3&#41; l was observed&#44; as well as a convection volume of 27&#46;1 &#40;4&#46;2&#41; l&#44; a filtration fraction of 29&#46;9 &#40;3&#46;7&#41; &#37;&#44; a urea reduction ratio &#40;RR&#41; of 81 &#40;5&#46;2&#41; &#37;&#44; a creatinine RR of 74&#46;7 &#40;4&#46;6&#41; &#37;&#44; a &#946;<span class="elsevierStyleInf">2</span>-microglobulin RR of 76&#46;5 &#40;4&#46;8&#41; &#37; and a retinol binding protein RR of 18&#46;6 &#40;7&#46;6&#41; &#37;&#46; There were no technical problems or alarms&#46; Changing the heparin dosage was not necessary&#46; No increases in C3a or C5a concentrations or leukopenia were observed in the first 30<span class="elsevierStyleHsp" style=""></span>min of the session&#46; Neither the monocyte subpopulations nor IL-&#946;1 or IL-6 were significantly altered after one month of treatment&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The new ATA&#8482; membrane achieves adequate Kt and convection volume&#44; without technical problems and with good biocompatibility and inflammatory profiles&#46; It is therefore a valid option for post-dilution haemodiafiltration&#44; particularly in patients allergic to synthetic membranes&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En la hemodiafiltraci&#243;n posdilucional se han usado solo membranas sint&#233;ticas&#46; Ahora contamos con un triacetato de celulosa asim&#233;trico &#40;ATA&#174;&#41; cuyas caracter&#237;sticas lo hacen apto para esta t&#233;cnica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir las prestaciones y el comportamiento <span class="elsevierStyleItalic">in vivo</span> de esta membrana estudiando la eficacia depurativa y el uso cl&#237;nico&#44; adem&#225;s de su biocompatibilidad aguda tras un mes de tratamiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo observacional en el que se incluyeron 23 pacientes que se dializaron durante 4 semanas con ATA&#174; manteniendo su pauta previa&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 287 sesiones y se recogieron 264 sesiones completas&#46; Con un tiempo efectivo de 243&#44;7 &#40;17&#44;6&#41; min y un flujo medio de sangre de 371&#44;7 &#40;23&#41; ml&#47;min&#44; se obtuvo un Kt medio de 56&#44;3 &#40;5&#44;3&#41; l&#44; un volumen convectivo de 27&#44;1 &#40;4&#44;2&#41; l&#44; con una fracci&#243;n de filtraci&#243;n del 29&#44;9 &#40;3&#44;7&#41; &#37;&#44; un porcentaje de reducci&#243;n &#40;RR&#41; de urea de 81 &#40;5&#44;2&#41; &#37;&#44; un RR de creatinina de 74&#44;7 &#40;4&#44;6&#41; &#37;&#44; un RR de &#946;<span class="elsevierStyleInf">2</span>-microglobulina de 76&#44;5 &#40;4&#44;8&#41; &#37; y un RR de prote&#237;na transportadora de retinol de 18&#44;6 &#40;7&#44;6&#41; &#37;&#46; No se produjeron problemas t&#233;cnicos ni alarmas&#46; No fue preciso cambiar la dosificaci&#243;n de heparina&#46; A los 30<span class="elsevierStyleHsp" style=""></span>min de la sesi&#243;n no se produjo ning&#250;n aumento de C3a&#44; C5a ni leucopenia&#46; Tampoco se modificaron de forma significativa las poblaciones monocitarias ni la IL-&#946;1 ni IL-6 tras un mes de tratamiento&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ATA&#174; logra un Kt y un volumen convectivo adecuados&#44; sin problemas t&#233;cnicos y con buen perfil de biocompatibilidad e inflamatorio&#44; lo que lo convierte en una posibilidad m&#225;s de tratamiento para hemodiafiltraci&#243;n posdilucional&#44; m&#225;xime en pacientes al&#233;rgicos a membranas sint&#233;ticas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Antecedentes"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Albalate Ram&#243;n M&#44; Mart&#237;nez Miguel P&#44; Bohorquez L&#44; de Sequera P&#44; Bouarich H&#44; P&#233;rez-Garc&#237;a R&#44; et al&#46; El triacetato de celulosa asim&#233;trico es una alternativa segura y eficaz para la hemodiafiltraci&#243;n en l&#237;nea&#46; Nefrologia&#46; 2018&#59;38&#58;315&#8211;320&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">KUF&#58; ultrafiltration coefficient&#59; Qb&#58; blood flow&#59; Qd&#58; dialysis flow&#59; TMP&#58; transmembrane pressure&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Membrane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ATA<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sterilisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gamma rays&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bisphenol A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">KUF &#40;ml&#47;h&#47;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Effective surface area &#40;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thickness of membrane &#40;&#956;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Internal diameter &#40;&#956;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum TMP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pressure drop &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Qb&#47;Qd &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200&#47;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Blood&#47;fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Technical features of the Solacea<span class="elsevierStyleSup">&#174;</span> 19H dialyser&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">FF&#58; filtration fraction&#59; Max&#46;TMP&#58; maximum transmembrane pressure&#59; Psyst&#58; system pressure in AK-200&#59; Qb&#58; blood flow&#59; Qd&#58; dialysis flow&#59; Qi&#58; mean infusion rate&#59; SD&#58; standard deviation&#59; <span class="elsevierStyleItalic">T</span>&#58; time&#59; UF&#58; ultrafiltration&#59; VB&#58; blood volume&#59; Vconv&#58; convective volume&#59; Vinf&#58; infusion volume&#46;</p>"
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              "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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scheduled <span class="elsevierStyleItalic">T</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">248&#46;7 &#40;17&#46;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Effective <span class="elsevierStyleItalic">T</span> &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243&#46;7 &#40;17&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qb &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">371&#46;7 &#40;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qd &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">553 &#40;128&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VB &#40;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;6 &#40;8&#46;2&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">UF &#40;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7 &#40;0&#46;9&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vinf &#40;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;4 &#40;4&#46;2&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vconv &#40;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1 &#40;4&#46;2&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Qi &#40;ml&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111&#46;1 &#40;14&#46;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">FF &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;9 &#40;3&#46;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kt &#40;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;3 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Psyst &#40;mmHg&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">520&#46;6 &#40;58&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Max&#46;TMP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">188&#46;9 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Descriptive results of the dialysis sessions &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>264 sessions&#41;&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#946;<span class="elsevierStyleInf">2</span>m&#58; &#946;<span class="elsevierStyleInf">2</span>-microglobulin&#59; RBP&#58; retinol-binding protein&#59; RR&#58; reduction ratio&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The results are expressed as a mean &#40;standard deviation&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Urea RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Creatinine RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Myoglobin RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">&#946;<span class="elsevierStyleInf">2</span>m RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">RBP RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Phosphorus RR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">81 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;7 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#46;5 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;6 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;1 &#40;45&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => "xTab1745877.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Descriptive results of molecule clearance &#40;&#37;&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22 sessions&#41;&#46;</p>"
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      3 => array:8 [
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        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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          0 => array:3 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">ns&#58; not significant&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The results are expressed as a mean &#40;standard deviation&#41;&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Start&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukocytes &#40;&#215;10<span class="elsevierStyleSup">9</span>&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6280 &#40;2552&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6324 &#40;2342&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3990 &#40;2208&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4210 &#40;2309&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets &#40;&#215;10<span class="elsevierStyleSup">9</span>&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">191&#46;4 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">176 &#40;44&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C3a &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1511&#46;7 &#40;451&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C5a &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;260&#46;5 &#40;15&#44;591&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#44;524 &#40;13&#44;860&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Results on acute biocompatibility with blood samples obtained at the start and after 30<span class="elsevierStyleHsp" style=""></span>min of dialysis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22 sessions&#41;&#46;</p>"
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        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">IL-6&#58; interleukin-6&#59; IL-1&#946;&#58; interleukin-1 beta&#59; ns&#58; not significant&#46;</p>"
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            0 => array:2 [
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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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Classical &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IL-&#946;1 &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IL-6 &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Start&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;3 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;6 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;4 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;2 &#40;22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;5 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Results on monocytes and inflammatory molecules after one month of use &#40;samples obtained before the first session with Solacea<span class="elsevierStyleSup">&#174;</span> and at the start of the last session&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21 patients&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effective removal of protein-bound uraemic solutes by different convective strategies&#58; a prospective trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Meert"
                            1 => "S&#46; Eloot"
                            2 => "M&#46; Waterloos"
                            3 => "M&#46; van Landschoot"
                            4 => "A&#46; Dhondt"
                            5 => "G&#46; Glorieux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfn522"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "562"
                        "paginaFinal" => "570"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18809977"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Maduell"
                            1 => "F&#46; Moreso"
                            2 => "M&#46; Pons"
                            3 => "R&#46; Ramos"
                            4 => "J&#46; Mora-Maci&#224;"
                            5 => "J&#46; Carreras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2012080875"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2013"
                        "volumen" => "24"
                        "paginaInicial" => "487"
                        "paginaFinal" => "497"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411788"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality risk for patients receiving hemodiafiltration versus hemodialysis&#58; European results from DOPPS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Canaud"
                            1 => "J&#46;L&#46; Bragg-Gresham"
                            2 => "M&#46;R&#46; Marshall"
                            3 => "S&#46; Desmeules"
                            4 => "B&#46;W&#46; Gillespie"
                            5 => "T&#46; Depner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5000447"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2006"
                        "volumen" => "69"
                        "paginaInicial" => "2087"
                        "paginaFinal" => "2093"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16641921"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality and cardiovascular events in online haemodiafiltration &#40;OL-HDF&#41; compared with high-flux dialysis&#58; results from the Turkish OL-HDF Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Ok"
                            1 => "G&#46; Asci"
                            2 => "H&#46; Toz"
                            3 => "E&#46;S&#46; Ok"
                            4 => "F&#46; Kircelli"
                            5 => "M&#46; Yilmaz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfs407"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "192"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23229932"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparaci&#243;n de dializadores en hemodiafiltraci&#243;n en l&#237;nea"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Maduell"
                            1 => "V&#46; Navarro"
                            2 => "J&#46; Hern&#225;ndez-Jaras"
                            3 => "C&#46; Calvo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2000"
                        "volumen" => "20"
                        "paginaInicial" => "269"
                        "paginaFinal" => "276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10917004"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypersensitivity reactions to synthetic haemodialysis membranes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;J&#46; S&#225;nchez-Villanueva"
                            1 => "E&#46; Gonz&#225;lez"
                            2 => "S&#46; Quirce"
                            3 => "R&#46; D&#237;az"
                            4 => "L&#46; &#193;lvarez"
                            5 => "D&#46; Men&#233;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2014.May.12552"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2014"
                        "volumen" => "34"
                        "paginaInicial" => "520"
                        "paginaFinal" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25036066"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2018.04.003

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Year/Month	Html	Pdf	Total

2024 October	50	28	78
2024 September	35	22	57
2024 August	74	56	130
2024 July	92	34	126
2024 June	52	39	91
2024 May	57	38	95
2024 April	62	38	100
2024 March	44	22	66
2024 February	51	36	87
2024 January	32	18	50
2023 December	31	29	60
2023 November	50	29	79
2023 October	36	29	65
2023 September	39	25	64
2023 August	39	19	58
2023 July	55	24	79
2023 June	53	25	78
2023 May	59	36	95
2023 April	33	25	58
2023 March	83	26	109
2023 February	61	24	85
2023 January	53	41	94
2022 December	75	30	105
2022 November	74	43	117
2022 October	138	43	181
2022 September	69	41	110
2022 August	107	53	160
2022 July	93	51	144
2022 June	82	59	141
2022 May	113	34	147
2022 April	182	54	236
2022 March	146	52	198
2022 February	142	45	187
2022 January	102	44	146
2021 December	94	38	132
2021 November	107	39	146
2021 October	117	57	174
2021 September	226	41	267
2021 August	46	49	95
2021 July	61	40	101
2021 June	65	37	102
2021 May	87	57	144
2021 April	152	82	234
2021 March	53	35	88
2021 February	46	21	67
2021 January	43	23	66
2020 December	55	12	67
2020 November	37	18	55
2020 October	54	24	78
2020 September	44	20	64
2020 August	60	28	88
2020 July	42	20	62
2020 June	43	26	69
2020 May	64	20	84
2020 April	37	18	55
2020 March	40	26	66
2020 February	79	19	98
2020 January	78	30	108
2019 December	80	16	96
2019 November	71	26	97
2019 October	62	28	90
2019 September	56	19	75
2019 August	28	22	50
2019 July	36	27	63
2019 June	49	25	74
2019 May	57	39	96
2019 April	72	41	113
2019 March	43	22	65
2019 February	28	15	43
2019 January	49	35	84
2018 December	170	41	211
2018 November	369	21	390
2018 October	263	26	289
2018 September	135	17	152
2018 August	47	15	62
2018 July	60	16	76
2018 June	94	10	104
2018 May	63	19	82
2018 April	12	3	15

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