Letter to the Editor
Role of sustained low-efficiency dialysis in the intensive care unit
Papel de la diálisis sostenida de baja eficiencia en las unidades de cuidados intensivos
Alícia Molina-Andújar
, Miquel Blasco, Esteban Poch
Corresponding author
Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
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A propósito de un caso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1567 "Ancho" => 2157 "Tamanyo" => 349216 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathophysiology of cyanotic nephropathy.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">FF: filtration fraction; RBF: renal blood flow; FSGE: focal and segmental glomerulosclerosis; GLM: glomerulus; MCGN: minimal change glomerulonephritis; GHF: glomerular hyperfiltration; HT: hypertrophy; PDGF: platelet derived growth factor; PCT: proximal convoluted tubule; TGFβ: tumor growth factor β; AA VSD: arteriolar afferent vasodilation.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Continuous line: pathway of vascular damage; broken line: path of proliferative damage; double grid: path of final damage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mayra Ortega-Díaz, Marta Puerta Carretero, Elena Corchete, Juan A. 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However, the clinical experience is that approximately two-thirds of IHD sessions in critically ill patients are not well tolerated,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> requiring the use of continuous techniques.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the experience of using SLED in a tertiary hospital where both modalities are available, and in which the prescription of both continuous and intermittent techniques depends on the Nephrology Department.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of our study was to describe the characteristics of patients who received SLED-type renal replacement therapy in intensive care units due to a non-standardised indication by the Nephrology specialist. As secondary objectives, we proposed to assess complications in relation to haemodynamic tolerance and electrolytes abnormalities.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective study was therefore conducted using the registry of patients in intensive care units treated with SLED between 2014 and 2016, including those who received it as the first therapeutic option, immediately after receiving CRRT or after IHD. The technique included a QB 100–150<span class="elsevierStyleHsp" style=""></span>ml/min, QD 200–250<span class="elsevierStyleHsp" style=""></span>ml/min and a dialysis time of 7–8<span class="elsevierStyleHsp" style=""></span>h. The presence of haemodynamic instability in a session was defined as the need to start or increase vasoactive drugs during the session according to the nursing record, a fall in systolic blood pressure <90<span class="elsevierStyleHsp" style=""></span>mmHg when values were greater than 90<span class="elsevierStyleHsp" style=""></span>mmHg at the start of the session or a decrease of >25% in systolic or diastolic blood pressure during the session. Mortality was defined as deaths which occurred during hospital admission.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 54 patients were analysed, of which 26 received the technique after IHD, 11 as the first therapeutic option and 17 as a first option after CRRT. The characteristics of the three groups, and the complications, are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to those related to haemodynamic tolerance, other complications that should be highlighted include hypokalemia related to the session, which was detected in 29.6% of cases. Severe hypoglycemia, chest pain and bleeding were also reported. In one isolated case, all of the above complications were reported.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the recovery of kidney function, excluding patients who received dialysis as chronic treatment or those who died during admission (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21), 66.6% recovered full kidney function and 19% required haemodialysis upon discharge. Of the total number of patients, 29% did not require IHD after SLED sessions.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore, according to our registry, the majority of treatments with SLED are indicated after poorly-tolerated IHD; secondly, as a step between CRRT and IHD, and, less frequently, as first-line treatment in critically ill patients. The patients are usually on vasoactive drugs, most of them intubated when using the technique after CRRT. Regarding haemodynamic tolerance, more than 70% of the sessions were well tolerated, with the rate falling to 63% when performed after IHD, although none of the sessions had to be discontinued due to poor haemodynamic tolerance. An interesting point is that among all patients in whom SLED was indicated after poorly-tolerated IHD, only 11.5% subsequently received CRRT, which seems to indicate that the technique has fulfilled its objective of maintaining the intermittent modality.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We therefore believe that SLED is an intermittent renal replacement technique which is not widely used as a first treatment modality in intensive care units and is more frequently used as an intermediate step between CRRT and IHD. One of the possible reasons for its limited use as a first therapeutic option is the availability of the technique due to its long duration,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> as it depends on dialysis nursing staff for its application. We believe that if knowledge of this technique is expanded, it may have an important role as it is well tolerated in critically ill patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Molina-Andújar A, Blasco M, Poch E. Papel de la diálisis sostenida de baja eficiencia en las unidades de cuidados intensivos. Nefrologia. 2019;39:98–99.</p>" ] ] "multimedia" => array:1 [ 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" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In the first column, after conventional intermittent haemodialysis, in the second, as the first therapeutic option, and, in the third, as the first option after CRRT.</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"> \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">Post intermittent haemodialysis (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26) \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">From the start (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \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">Post-CRRT (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17) \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">Mean age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">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">Reasons for ICU admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock 53%<br>Hypovolaemic shock 15%<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Septic shock 27%<br>Severe heart failure 18%<br>Post-surgery 18% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Post-surgery 59%<br>Septic shock 35% \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">Mean SOFA score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \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">Intubation, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 \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">Vasoactive drugs, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \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">Haemodynamic instability, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 \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">Number of sessions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.1 \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">Conventional haemodialysis change, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 \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">CRRT change, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \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">Death, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 \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">Previous CKD, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.8 \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><td class="td" title="table-entry " align="left" valign="top">58.8 \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">Previous CKD in haemodialysis, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1978553.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients treated with sustained low-efficiency dialysis distributed according to the time it was performed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.A. Kumar" 1 => "M. Craig" 2 => "T.A. Depner" 3 => "J.Y. Yeun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/ajkd.2000.8973" "Revista" => array:5 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2000" "volumen" => "36" "paginaInicial" => "294" "paginaFinal" => "300" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuous versus intermittent renal replacement therapy for critically ill patients with acute kidney injury: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.M. Bagshaw" 1 => "L.R. Berthiaume" 2 => "A. Delaney" 3 => "R. Bellomo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0B013E3181611F552" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2008" "volumen" => "36" "paginaInicial" => "610" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18216610" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of continuous renal replacement therapy and intermittent haemodialysis in management of patients with acute renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Ghahramani" 1 => "S. Shadrou" 2 => "C. Hollenbeak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1797.2008.00966.x" "Revista" => array:5 [ "tituloSerie" => "Nephrology (Carlton)" "fecha" => "2008" "volumen" => "13" "paginaInicial" => "570" "paginaFinal" => "578" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practical guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Schortgen" 1 => "N. Soubrier" 2 => "C. Delclaux" 3 => "M. Thuong" 4 => "E. Girou" 5 => "C. Brun-Buisson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.162.1.9907098" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2000" "volumen" => "162" "paginaInicial" => "197" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10903241" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.E. Fieghen" 1 => "J.O. Friedrich" 2 => "K.E. Burns" 3 => "R. Nisenbaum" 4 => "N.K. Adhikari" 5 => "M.A. Hladunewich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2369-11-32" "Revista" => array:5 [ "tituloSerie" => "BMC Nephrol" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21106112" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003900000001/v1_201903030617/S2013251419300197/v1_201903030617/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003900000001/v1_201903030617/S2013251419300197/v1_201903030617/en/main.pdf?idApp=UINPBA000064&text.app=https://www.revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251419300197?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 2790 | 52 | 2842 |
| 2024 September | 2399 | 70 | 2469 |
| 2024 August | 2154 | 92 | 2246 |
| 2024 July | 2726 | 53 | 2779 |
| 2024 June | 2300 | 61 | 2361 |
| 2024 May | 2674 | 50 | 2724 |
| 2024 April | 2309 | 59 | 2368 |
| 2024 March | 2424 | 43 | 2467 |
| 2024 February | 2867 | 59 | 2926 |
| 2024 January | 4693 | 50 | 4743 |
| 2023 December | 2892 | 70 | 2962 |
| 2023 November | 2849 | 76 | 2925 |
| 2023 October | 2689 | 64 | 2753 |
| 2023 September | 2191 | 63 | 2254 |
| 2023 August | 2375 | 61 | 2436 |
| 2023 July | 1235 | 51 | 1286 |
| 2023 June | 1187 | 64 | 1251 |
| 2023 May | 1233 | 83 | 1316 |
| 2023 April | 766 | 24 | 790 |
| 2023 March | 1036 | 49 | 1085 |
| 2023 February | 732 | 37 | 769 |
| 2023 January | 479 | 63 | 542 |
| 2022 December | 331 | 54 | 385 |
| 2022 November | 571 | 73 | 644 |
| 2022 October | 584 | 87 | 671 |
| 2022 September | 495 | 45 | 540 |
| 2022 August | 414 | 73 | 487 |
| 2022 July | 341 | 81 | 422 |
| 2022 June | 316 | 83 | 399 |
| 2022 May | 389 | 47 | 436 |
| 2022 April | 383 | 64 | 447 |
| 2022 March | 398 | 59 | 457 |
| 2022 February | 469 | 79 | 548 |
| 2022 January | 587 | 54 | 641 |
| 2021 December | 422 | 58 | 480 |
| 2021 November | 535 | 50 | 585 |
| 2021 October | 927 | 86 | 1013 |
| 2021 September | 542 | 58 | 600 |
| 2021 August | 622 | 61 | 683 |
| 2021 July | 595 | 67 | 662 |
| 2021 June | 497 | 78 | 575 |
| 2021 May | 462 | 76 | 538 |
| 2021 April | 1040 | 104 | 1144 |
| 2021 March | 604 | 68 | 672 |
| 2021 February | 566 | 31 | 597 |
| 2021 January | 554 | 31 | 585 |
| 2020 December | 478 | 45 | 523 |
| 2020 November | 447 | 33 | 480 |
| 2020 October | 396 | 49 | 445 |
| 2020 September | 461 | 44 | 505 |
| 2020 August | 469 | 38 | 507 |
| 2020 July | 508 | 32 | 540 |
| 2020 June | 406 | 51 | 457 |
| 2020 May | 463 | 49 | 512 |
| 2020 April | 715 | 67 | 782 |
| 2020 March | 1061 | 58 | 1119 |
| 2020 February | 525 | 64 | 589 |
| 2020 January | 479 | 60 | 539 |
| 2019 December | 344 | 67 | 411 |
| 2019 November | 352 | 41 | 393 |
| 2019 October | 274 | 41 | 315 |
| 2019 September | 371 | 76 | 447 |
| 2019 August | 246 | 46 | 292 |
| 2019 July | 249 | 71 | 320 |
| 2019 June | 186 | 43 | 229 |
| 2019 May | 147 | 46 | 193 |
| 2019 April | 178 | 51 | 229 |
| 2019 March | 46 | 26 | 72 |
| 2019 February | 22 | 16 | 38 |
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