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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The correction of metabolic acidosis is one of the treatment goals for chronic kidney disease&#46; To achieve so in patients who are undergoing haemodialysis&#44; bicarbonate is added during the sessions&#46; The optimal bicarbonate concentration these patients should maintain is not accurately known&#46; The KDOQI guidelines recommend maintaining a predialysis bicarbonate of 22 mEq&#47;L in all patients<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a>&#44; while the UK Renal Association suggests different targets for patients undergoing peritoneal dialysis &#40;25-29 mmol&#47;L&#41; and haemodialysis &#40;HD&#41; &#40;20-26 mmol&#47;L&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We could define the optimal bicarbonate concentration of DF as that which prevents interdialysis metabolic acidosis and avoids intradialysis and postdialysis alkalosis&#46; Achieving this goal is not an easy task&#44; as patients who are undergoing haemodialysis have progressive bicarbonate depletion in the interdialysis period and a sudden bicarbonate overload takes place during dialysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">From a technical point of view&#44; in order to avoid precipitation of calcium carbonate and magnesium carbonate that takes place in the DF when adding bicarbonate&#44; it is necessary to add an acid&#46; Thus&#44; a DF generation system is used with 2 concentrates&#58; one with bicarbonate and the other with acid&#46; Acetic acid is most generally used&#44; at concentrations ranging from 3 to 10 mmol&#47;L&#46; This small amount causes an acetate transfer to the patient during HD&#44; increasing its blood concentration&#44; since the DF has concentrations which are 30 to 40 times greater than the normal blood values &#40;0&#46;1 mmol&#47;L&#41;&#46; This exposure to acetate increases in online haemodiafiltration &#40;HDF&#41; techniques<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; due to the higher amount of infused fluid&#46; Among the side effects described with acetate&#44; hemodynamic instability caused by vasodilation mediated by nitric oxide release<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and the activation of proinflammatory cytokines by hypoxia<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> are worth mentioning due to their importance dur ing HD&#46; Even compared to a DF w ith low concentrations of acetate &#40;3 mmol&#47;L&#41;&#44; a lower risk of haemodynamic complications has been described when patients undergo dialysis with an acetate-free DF<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; other acids have been researched for years as DF stabilisers&#46; The first acetate substitution attempts involved hydrochloric acid&#46; With this acetate-free DF&#44; it was possible to observe that the usual increase in acetatemia shown by patients undergoing dialysis with DF containing bicarbonate and 4 mmol&#47;L of acetate could be corrected by using a concentrate containing hydrochloric acid<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; The problem with this DF with high chlorine content is that it modifies the sodium concentration-conductivity correlation&#44; thus producing changes in serum ions so that it is necessary to change the total and partial conductivities of bicarbonate&#44; despite the fact that its use has not been clearly standardised&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At present&#44; we have a DF containing citrate&#44; which appears as an alternative to acidification without using acetate&#46; Citrate is a calcium &#40;Ca&#41; chelating agent that is used due to its anticoagulant effect by reducing ionic calcium &#40;Ca<span class="elsevierStyleInf">i</span>&#41;&#46; It is estimated to cause a 10&#37; decrease in Ca<span class="elsevierStyleInf">i</span>&#59; therefore&#44; most authors recommend supplementing calcium contained in the DF when citrate is used as an acid to correct these differences&#46; As shown by Steckiph et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; per each citrate mmol&#44; the calcium concentration has to be increased 0&#46;15 mmol&#47;L to maintain the calcium balance during treatment and to prevent hypocalcaemia&#46; Several long-term beneficial effects related to citrate have been described&#44; such as a lower thrombogenicity<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; improvement in clearance<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; inflammation<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; nutrition<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; tolerance<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> and acid-base control with a lower predialysis acidosis<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Objective</span><p id="par0030" class="elsevierStylePara elsevierViewall">To assess the acute effect on acid-base balance and calcium-phosphorus metabolism parameters with the use of a DF containing citrate instead of acetate in patients with chronic HD&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study followed a prospective&#44; crossover design and was conducted at single hospital dialysis site&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">Twenty-four clinically stable patients were enrolled &#40;15 male and 9 female subjects&#41;&#46; The inclusion criteria were age older than 18&#44; having received dialysis treatment for more than three months&#44; being clinically stable and giving an informed consent&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">A prospective&#44; crossover study was used to compare a single dialysis session with DF containing acetate to another dialysis session with citrate&#46; All patients underwent dialysis with AK-200-Ultra-S monitor with SoftPac&#174; dialysis fluid&#44; made with 3 mmol&#47;L of acetate and with SelectBag Citrate&#174;&#44; with 1 mmol&#47;L of citrate and free of acetate&#46; The composition of the used dialysis fluids is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Each patient was his&#47;her own control&#44; and no modifications were made in the dialysis schedule or pharmacological treatment during the study&#59; the standard work schedule was followed&#46; The fluid calcium concentration used was higher in the DF containing citrate&#58; 1&#46;5 mmol&#47;L in acetate fluid and 1&#46;65 mmol&#47;L in the citrate fluid&#46; Three K concentrations were used in the DF containing acetate &#40;1&#46;5&#44; 2 and 3 mmol&#47;L&#41;&#44; which were the same the patients had before their enrolment in the study&#44; and 2 mmol&#47;L of K in the DF containing citrate&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Collected dialysis and demographic parameters</span><p id="par0055" class="elsevierStylePara elsevierViewall">A set of demographic parameters were collected&#58; age&#44; underlying condition&#44; weight&#44; dialysis technique &#40;HD or HDF&#41;&#44; the type of vascular access &#40;fistula &#91;AVF&#93; or catheter &#91;CT&#93;&#41;&#44; and residual renal function &#40;RRF&#41;&#44; measured as mean urea and creatinine clearance &#40;&#40;CCr&#43;CU&#41;&#47;2&#41; in 24-hour urine &#40;if this was &#60; 1<span class="elsevierStyleHsp" style=""></span>mL&#47;min or diuresis &#60; 100<span class="elsevierStyleHsp" style=""></span>mL&#47;day&#44; absence of RRF was considered&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Dialysis parameters included&#58; time&#44; blood flow &#40;Qb&#41;&#44; dialysis fluid flow &#40;Qd&#41;&#44; sodium and bicarbonate conductivities&#44; fluid temperature&#44; dialyser&#44; heparin type and dose&#44; HDF infusion volumes&#44; Kt automatically measured by the Diascan&#174; biosensor&#44; ultrafiltration &#40;UF&#41; per session&#44; and blood pressure &#40;BP&#41; before and after HD&#46; The number of hypotensive episodes was also recorded&#44; which was defined as every acute decrease in blood pressure perceived by the patient which required the intervention of nursing personnel&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Laboratory tests</span><p id="par0065" class="elsevierStylePara elsevierViewall">All blood samples were collected through the arterial line of the vascular access&#46; The predialysis samples were collected immediately before starting the technique&#44; and postdialysis samples were taken after reducing the Qb to 50<span class="elsevierStyleHsp" style=""></span>mL&#47;min for 60<span class="elsevierStyleHsp" style=""></span>seconds upon finishing the session&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Blood tests included</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Acid-base parameters by means of venous blood gas monitoring that included pH&#44; partial pressure of carbon dioxide &#40;PCO2&#41;&#44; partial pressure of oxygen &#40;PO2&#41;&#44; bicarbonate&#44; base excess of the extracellular fluid &#40;BEecf&#41;&#44; measured oxygen saturation &#40;sO<span class="elsevierStyleInf">2</span>m&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Biochemical parameters&#58; sodium &#40;Na&#41;&#44; potassium &#40;K&#41;&#44; magnesium &#40;Mg&#41;&#44; Ca&#44; Ca<span class="elsevierStyleInf">i</span>&#44; phosphorus &#40;P&#41;&#44; and parathyroid hormone &#40;PTH&#41;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">The pH was determined by potentiometry&#44; pCO2 by Severinghaus electrode&#44; pO2 by amperometry and Ca<span class="elsevierStyleInf">i</span> by ion-selective electrode &#40;ISE&#41;&#46; Biochemical determinations were made with an autoanalyser &#40;ADVIA&#174; 2400 Chemistry System&#44; Bayer&#41;&#46; PTH determinations were made by chemiluminescence with the Bayer ADVIA CENTAUR system&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ca concentration was corrected for pH &#40;Cac&#41; using the following formula&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted via the SPSS 15&#46;0 programme &#40;SPSS INC&#46;&#44; Chicago IL&#44; USA&#41;&#46; Descriptive data were expressed as arithmetic mean and standard deviation &#40;SD&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">For the comparison of two independent continuous variables&#44; the Student&#39;s t-test was used for paired samples&#46; For the comparison of more than two quantitative variables&#44; the ANOVA test was used&#46; A <span class="elsevierStyleItalic">p</span> &#60;0&#46;05 was considered statistically significant&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">Mean age of the twenty-four patients was 68&#46;13 &#40;19&#46;2&#41; &#40;range 19-92&#41; years&#46; Dry weight was 72&#46;7 &#40;20&#46;5&#41; Kg&#46; Renal failure aetiologies were as follows&#58; glomerulonephritis &#40;n &#61; 8&#41;&#44; interstitial nephritis &#40;n &#61; 3&#41;&#44; polycystosis &#40;n &#61; 1&#41;&#44; vascular &#40;n &#61; 3&#41;&#44; diabetes mellitus &#40;n &#61; 2&#41;&#44; and unknown &#40;n &#61; 7&#41;&#46; Ten &#40;41&#46;7&#37;&#41; patients had RRF&#44; with &#40;CCr&#43;CU&#41;&#47;2 of 6&#46;5 &#40;3&#46;2&#41; &#91;2&#46;7-14&#46;4&#93; mL&#47;min&#46; Six of them underwent dialysis twice weekly &#40;25&#37;&#41;&#46; This is the frequency with which we usually administer dialysis if the patient meets the following requirements&#58; &#40;CCr&#43;CU&#41;&#47;2 &#8805; 5<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; normal blood pressure&#44; adequate P and volume control&#46; Eighteen &#40;75&#37;&#41; patients underwent dialysis through an arteriovenous fistula and 6 &#40;25&#37;&#41; by catheter&#46; Thirteen &#40;54&#46;2&#37;&#41; patients underwent dialysis with high-flow HD and 11 &#40;45&#46;8&#37;&#41; with HDF&#46; Mean dialysis time was 250 &#40;16&#41; &#91;210-270&#93; minutes&#46; All patients had individualised bicarbonate concentrations&#58; 30&#46;8 &#40;2&#46;4&#41; &#91;26-34&#93; mmol&#47;L&#44; sodium conductivity&#58; 13&#46;8 &#40;0&#46;1&#41; &#91;13&#46;7-14&#46;1&#93; mS&#47;cm and DF temperature&#58; 35&#46;8 &#40;0&#46;4&#41; &#91;35-36&#46;5&#93; &#176;C&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">All patients were informed about the study characteristics and gave their consent to participate in the study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dialysers were the same and were distributed as follows&#58; 5 &#40;21&#37;&#41; polyethersulfone of 1&#46;8 m<span class="elsevierStyleSup">2</span> &#40;Xenium&#174;&#41;&#44; 8 &#40;33&#37;&#41; helixone of 1&#46;8 m<span class="elsevierStyleSup">2</span> &#40;&#91;FX-class&#93;&#174; 80 and 800&#41; and 11 &#40;46&#37;&#41; polyamide of 2&#46;1 m<span class="elsevierStyleSup">2</span> &#40;Poliflux&#174; 210H&#41;&#46; The HDF technique was implemented in 11 &#40;45&#46;8&#37;&#41; patients&#44; with a mean infusion volume of 27&#46;7 &#40;3&#46;8&#41; &#91;20&#46;8-33&#46;9&#93; litres&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Potassium concentrations used in DF containing acetate were 1&#46;5&#44; 2 and 3 mmol&#47;L in 9 &#40;37&#46;5&#37;&#41;&#44; 12 &#40;50&#37;&#41; and 3 &#40;12&#46;5&#37;&#41; patients&#44; respectively&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Anticoagulation therapy was performed with heparin sodium at 1&#37; in all patients except for one who used enoxaparin&#44; with a mean heparin dose of 51&#46;6 &#40;18&#46;5&#41; &#91;20-90&#93; units&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The mean values of the analysed parameters are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Statistically significant differences were found when using the citrate bath compared to acetate in the following postdialysis values&#58; pH&#44; bicarbonate&#44; BEef&#44; K&#44; Ca<span class="elsevierStyleInf">c</span> and Ca<span class="elsevierStyleInf">i</span>&#46; No differences were found in any of the predialysis values&#44; or in the rest of the analysed postdialysis values&#46; Despite increasing Ca concentration in the bath&#44; the postHD Ca<span class="elsevierStyleInf">i</span> values were lower in patients who underwent dialysis with citrate&#44; with no changes in PTH&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Results were also analysed according to technique &#40;HD vs&#46; HDF&#41;&#44; and no statistically significant differences were found in the analysed parameters&#46; No differences were found when we compared patients on HDF with infusion volumes higher or lower than 27 L either&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding K&#44; the concentration used was only the same with both DF in 12 &#40;50&#37;&#41; patients &#40;2 mmol&#47;L&#41;&#44; and no differences were found in postdialysis K concentrations&#58; 3&#46;2 &#40;0&#46;2&#41; and 3&#46;4 &#40;0&#46;3&#41; mmol&#47;L for acetate and citrate&#44; respectively&#46; Differences were found&#44; however&#44; in postdialysis potassium concentrations in total patients &#40;Table 3&#41; and&#44; as expected&#44; between the DF containing acetate with 1&#46;5 mmol&#47;L of K and the DF containing citrate with 2 mmol&#47;L of K&#58; 3&#46;05 &#40;0&#46;1&#41; vs&#46; 3&#46;48 &#40;0&#46;1&#41;&#44; respectively&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As far as efficacy is concerned&#44; no differences were found with DF containing citrate and acetate&#44; respectively&#58; Kt 58&#46;8 &#40;9&#46;2&#41; vs&#46; 61&#46;6 &#40;6&#46;8&#41; L&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; although no differences were found in postdialysis systolic and diastolic BP values with either DF &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; there were differences in the number of symptomatic hypotension episodes&#46; There were three symptomatic hypotension cases &#40;6&#46;2&#37;&#41; out of the total of sessions &#40;48&#41;&#44; and in the three cases a DF containing acetate was being used &#40;12&#46;5&#37;&#41;&#46; No hypotension episode was observed in the 24 sessions performed with citrate &#40;0&#37;&#41;&#46; There were no differences in mean ultrafiltration rates in either group&#58; 1849 &#40;884&#41; vs&#46; 1904 &#40;847&#41; mL for citrate and acetate&#44; respectively&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The main result from our study is that dialysis with citrate provides better control of postdialysis acid-base balance than acetate by decreasing&#47;avoiding postdialysis alkalaemia&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Acute alkalaemia induced by the addition of bicarbonate during dialysis is an issue which has considerable clinical significance&#46; It has been related to important adverse effects&#44; such as hemodynamic instability<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a>&#44; cardiac arrhythmia&#44; paraesthesia&#47;cramps<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; reduced cerebral blood flow&#44; respiratory distress&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> headache&#44; and a procalcifying effect&#46; Finally&#44; a higher bicarbonate concentration in the dialysis fluid has also been associated with increased mortality<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The greater cardiac excitability is explained by several mechanisms&#44; among which we could mention the effect metabolic alkalosis has on transcellular potassium redistribution&#46; The increase in bicarbonate concentration favours potassium redistribution to the intracellular space&#44; which may cause a more sudden decrease in the potassium levels during dialysis and precipitate cardiac arrhythmias<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; The bicarbonate conductivity of DF and plasma bicarbonatemia have been associated with an increase in QT interval in postdialysis electrocardiographies&#44; an effect which may probably be mediated by the sudden decrease in both K and Ca<span class="elsevierStyleInf">i</span>&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The acid-base balance also plays a relevant role in the regulation of calcium deposits in blood vessels&#44; so alkalosis favours calcification<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; The article by Solis et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> analyses the pH effect on calcification through two experimental approaches&#58; the <span class="elsevierStyleItalic">in vitro</span> effect of uremic serum on plain muscle cell calcification at different pH levels&#44; and the <span class="elsevierStyleItalic">in vivo</span> effect of treatment with bicarbonate on nephrectomised rats&#46; Its results suggest that extracellular alkalinisation promotes vascular calcification while acidification prevents it&#44; both in cell cultures and uremic rats&#46; The authors of this study have reproduced the situation faced by our dialysis patients&#44; who usually have moderate metabolic acidosis and experience repeated episodes of sudden alkalinisation in dialysis sessions&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">There are certain situations in which preventing intradialysis and postdialysis alkalosis is of special interest&#46; Examples of these instances include patients with advanced chronic liver disease<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44; respiratory failure with extreme carbon dioxide retention&#44; or those with clinical events that may worsen due to small modifications in acid-base balance occurring during dialysis and may even be life-threatening for the patient&#46; The increase in pH may precipitate hepatic encephalopathy with severe liver failure&#44; both acute and chronic&#44; since it increases the NH3&#47;NH4<span class="elsevierStyleSup">&#43;</span> ratio and the NH3 passes through the blood-brain barrier more easily <a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; Respiratory failure and CO2 retention may worsen upon inducing metabolic alkalosis since respiratory compensation reduces the respiratory centre stimulation &#40;lower respiratory amplitude and rate&#41;&#46; These complications may be prevented by reducing bicarbonate concentration in the DF<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and&#47;or using a DF such as citrate which produces less alkalinisation&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">We have found only one publication that analyses the acute effect of citrate on acid-base balance&#46; Higher alkalinisation was found during dialysis with citrate compared to acetate &#40;7&#46;38 to 7&#46;50 and 21 to 29&#46;2 mmol&#47;L vs&#46; 7&#46;39 to 7&#46;45 and 22&#46;4 to 24&#46;3 for values of pH and bicarbonate with DF containing citrate and acetate&#44; respectively&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Our study shows that DF containing citrate produces less alkalaemia than acetate&#44; shown by the differences in postdialysis gasometric parameters &#40;pH&#44; HCO3-and BE&#41;&#46; It is important to consider that sodium and bicarbonate conductivities were kept stable&#46; In addition&#44; bicarbonate conductivity is individualised in our unit&#44; and our goal is to achieve predialysis bicarbonate values &#62; 18 mmol&#47;L and postdialysis bicarbonate values &#60; 28 mmol&#47;L&#46; We believe that the difference found may be even higher in units where bicarbonate does not meet each patient&#39;s needs&#46; Therefore&#44; in our study&#44; where the bicarbonate conductivity range is between 26 and 34 mmol&#47;L&#44; patients on dialysis with acetate showed a slight postdialysis alkalaemia&#44; only three &#40;12&#46;5&#37;&#41; patients showed HCO3-levels greater than 30 mmol&#47;L and no alkalaemia was observed with DF containing citrate &#40;mean values of pH 7&#46;43&#44; HCO3-24&#46;7 mmol&#47;L and BE 0&#46;4&#41;&#46; No patients showed HCO3-values greater than 30 mmol&#47;L&#46; Differences were kept in all used conductivity ranges&#44; with no differences among them &#40;results not shown&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The second result we would like to highlight is related to postdialysis calcaemia&#46; Most studies analysing the effect of citrate on calcium-phosphorus metabolism have observed a reduction in Ca<span class="elsevierStyleInf">i</span> levels and an increase in PTH<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; With the calcium concentration used in the DF containing citrate&#44; which was 0&#46;15 mmol&#47;L greater than that of acetate&#44; we observed no clinical or analytical hypocalcaemia and postdialysis values of both Cac and Ca<span class="elsevierStyleInf">i</span> were significantly lower using the DF containing citrate compared to acetate&#46; Furthermore&#44; with both DF at the used calcium concentrations&#44; postdialysis values of Cac and Ca<span class="elsevierStyleInf">i</span> were greater than those obtained before dialysis&#46; This result is even more important if we consider how changes in pH modify Ca<span class="elsevierStyleInf">i</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; Hydrogen ions displace Ca from albumin&#44; so a reduction of 0&#46;1 in pH increases the Ca<span class="elsevierStyleInf">i</span> concentration by 0&#46;1 mEq&#47;L&#44; approximately&#44; while alkalosis reduces free Ca and increases Ca binding to albumin&#46; In our case&#44; the postdialysis pH was higher in the dialysis conducted with acetate&#59; had this not been true&#44; the difference would have been even higher&#46; In fact&#44; no differences were found in postdialysis non-corrected Ca values&#44; but there were differences in the corrected ones &#40;9&#46;8 and 10&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL with citrate and acetate&#44; respectively&#41;&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">We have not found higher clearance with the DF containing citrate&#44; although other authors have<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; This finding has been related to the local anticoagulant effect of citrate&#44; which would imply a lower thrombogenicity and&#44; therefore&#44; a lower loss of useful surface area of the dialyser and&#44; as a result&#44; of dialysis efficacy&#46; We have analysed the effect of both DF on coagulation in 12 patients by means of a visual classification of the status of the lines&#44; chambers and dialyser &#40;results not shown&#41;&#44; and no differences were found either&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Finally&#44; based on the higher hemodynamic stability described with citrate<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#44; we have found no differences in blood pressure &#40;BP&#41;&#44; but we have found differences in the incidence of symptomatic hypotension episodes&#46; Although the number of hypotension cases found was very low &#40;in only 3 out of the 48 sessions was there hypotension &#91;6&#46;2&#37;&#93;&#41;&#44; in the three cases it occurred using a DF containing acetate&#46; No hypotensive episodes were observed in the 24 sessions performed with citrate &#40;12&#46;5 vs&#46; 0&#37;&#41;&#46; It is worth mentioning that our incidence of hypotension is much lower than that reported in literature&#44; ranging from 15 to 60&#37;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;34</span></a>&#46; This result may also be explained by the known vasodilator effect of acetate&#44; due to a lower bicarbonatemia found with citrate&#44; since a direct relationship between bicarbonate concentration in DF and hemodynamic stability has been described<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; The higher hemodynamic stability may also be the result of higher sodium &#91;Na&#93; concentration in the DF at an equal conductivity due to a modification in the relationship between the two &#40;Na and conductivity&#41;&#46; We have undisclosed data supporting this hypothesis&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">There is no doubt that individualisation of the dialysis therapy should also include the bicarbonate concentration in the bath<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46; But&#44; considering the results obtained in our study&#44; should such individualisation be extended to the type of acid used&#63; We should first consider that the bicarbonate concentration we set underestimates the actual concentration&#44; since part of the acetate or citrate contained in the DF will then convert into bicarbonate&#46; Both citrate and acetate transfer to plasma depend on the type of dialysis&#44; clearance and treatment time&#44; among other factors&#46; As a result&#44; the plasma citrate level increases &#60;0&#46;1 mmol&#47;L at 0&#46;2 to 0&#46;3 mmol&#47;L<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> during dialysis with DF containing 1 mmol&#47;L of citrate&#44; while the acetate level increases from 0&#46;2 to 0&#46;5 mmol&#47;L with a DF containing 4 mmol&#47;L of acetate<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Once metabolised&#44; acetate and citrate contribute to the increase in plasma bicarbonate concentration between 2 and 8 mEq&#47;L&#44; which may contribute to the development of postdialysis alkalosis&#46; This fact led the Food and Drug Administration to write a communication warning physicians about the impact both acetate and other alkali sources have on bicarbonate prescription in dialysis<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#44; and the risks of alkalosis induced by it&#46; The way and period of time in which these acids are metabolised will have an impact on postdialysis acid-base balance values&#46; The citrate-acetate concentration ratio we have used in the DF is 3&#47;1 &#40;3 mmol of acetate and 1 mmol of citrate per litre&#41;&#46; Although it may be considered that this could partially explain the results&#44; this is not the case because each metabolised citrate molecule is equivalent to the generation of three bicarbonate molecules&#46; Meanwhile&#44; in acetate metabolism there is a stoichiometric generation of bicarbonate&#44; due to equimolar consumption of a proton when it is activated by the Acetyl CoA synthetase to make Acetyl CoA&#46; Therefore&#44; 1 mmol&#47;L of citrate and 3 mmol&#47;L of acetate&#44; upon being metabolised by the body&#44; should theoretically generate a similar amount of bicarbonate&#46; For this reason&#44; it is not considered necessary to modify the bicarbonate level prescribed when changing from a DF with 3-4 mmol&#47;L to a DF with 1 mmol&#47;L of citrate&#46; So&#44; we should resort to chemistry to explain this&#58; citrate is the base of citric acid&#44; a weak organic acid&#44; whose dominating form at physiological pH is trivalent citrate C3H5 &#40;COO&#41;<span class="elsevierStyleSup">3</span>-&#44; of MW 189 D and a half-life of 30 to 60<span class="elsevierStyleHsp" style=""></span>minutes&#46; Its metabolism is mainly hepatic and also muscular&#58; citrate enters the cell through transport proteins&#44; then it moves into the mitochondrion&#44; where it is converted into isocitrate during the Krebs cycle and&#44; subsequently&#44; into alpha-ketoglutarate&#44; which is metabolised to generate bicarbonate and energy&#46; Therefore&#44; a fast conversion from citrate to bicarbonate takes place&#44; but the main difference with acetate lies in the fact that this metabolism is incomplete during dialysis&#44; since hepatic and muscular metabolism partly occurs after the technique is completed&#46; Moreover&#44; there are patients with fast metabolisms and others with slow metabolisms&#44; depending on their liver function and muscle mass&#44; which are factors that should also be taken into account&#46; In patients who receive a citrate infusion as regional anticoagulant therapy&#44; the plasma citrate levels are of 1 mmol&#47;L&#44; and patients on HD show similar levels to those having a normal renal function<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a>&#46; This is unlike patients with liver failure&#44; in whom citrate clearance is reduced by 50&#37;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; Another possible explanation for the lower alkalosis with citrate may be due to the different composition of both DF &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; with components showing a different ionic strength&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Thus&#44; to answer the foregoing question&#44; the ideal bicarbonate conductivity with which patients should undergo dialysis has not been precisely determined&#46; This value will depend on patient-related factors &#40;predialysis bicarbonate concentration&#44; hydrogen ion generation&#44; bicarbonate distribution space&#44; etc&#46;&#41; and dialysis-related factors &#40;bath bicarbonate concentration&#44; type of technique&#44; frequency&#44; ultrafiltration&#44; blood flow and bath f low&#44; etc&#46;&#41;&#44; among others&#46; In light of our results&#44; we should probably also add to these the type and concentration of acid used in the DF&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The main restriction of our study is that the number of patients included is small&#44; but the crossover design enables the comparison between each patient and himself&#47;herself&#44; thus reinforcing the results&#46; A second restriction is that the order of use of each acid in the DF has not been randomised&#46; Even so&#44; by analysing its acute effect&#44; we think the impact of this randomisation would be minimal&#46; Finally&#44; the study has been conducted at a single hospital&#44; but we believe the results may be valid for other centres with similar dialysis conditions&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">It would have been interesting to measure citrate concentrations and acid-base balance parameters&#44; not only postdialysis but also in the interdialysis period&#44; in order to elaborate more on the metabolism mechanisms of both acids&#46; This study opens the doors to future research analysing the clinically significant differences in patients with long-term treatment with DF containing citrate&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">The results of this article show that dialysis with citrate provides better control of postdialysis acid-base balance and decreases&#47;avoids postdialysis alkalaemia&#46; The lower postdialysis alkalaemia&#44; together with a lower increase in calcaemia&#44; support a less calcifying profile of the DF containing citrate&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">This finding is of special interest in patients with factors predisposing to arrhythmia and those with respiratory failure&#44; carbon dioxide retention&#44; calcifications and advanced liver disease&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "titulo" => "Keywords"
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          "identificador" => "xres551186"
          "titulo" => "Resumen"
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              "titulo" => "Introducci&#243;n"
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          "titulo" => "Palabras clave"
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          "titulo" => "Introduction"
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          "titulo" => "Patients"
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          "titulo" => "Methods"
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            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Collected dialysis and demographic parameters"
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              "titulo" => "Laboratory tests"
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              "titulo" => "Blood tests included"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2014-09-17"
    "fechaAceptado" => "2014-10-21"
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          "palabras" => array:7 [
            0 => "Haemodialysis"
            1 => "Haemodiafiltration"
            2 => "Bicarbonate"
            3 => "Acetate"
            4 => "Citrate"
            5 => "Metabolic acidosis"
            6 => "Metabolic alkalosis"
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          "palabras" => array:7 [
            0 => "Hemodi&#225;lisis"
            1 => "Hemodiafiltraci&#243;n"
            2 => "Bicarbonato"
            3 => "Acetato"
            4 => "Citrato"
            5 => "Acidosis metab&#243;lica"
            6 => "Alcalosis metab&#243;lica"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The correction of metabolic acidosis caused by renal failure is achieved by adding bicarbonate during dialysis&#46; In order to avoid the precipitation of calcium carbonate and magnesium carbonate that takes place in the dialysis fluid &#40;DF&#41; when adding bicarbonate&#44; it is necessary to add an acid&#44; usually acetate&#44; which is not free of side effects&#46; Thus&#44; citrate appears as an advantageous alternative to acetate&#44; despite the fact that its acute effects are not accurately known&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the acute effect of a dialysis fluid containing citrate instead of acetate on acid-base balance and calcium-phosphorus metabolism parameters&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A prospective crossover study was conducted with twenty-four patients &#40;15 male subjects and 9 female subjects&#41;&#46; All patients underwent dialysis with AK-200-Ultra-S monitor with SoftPac&#174; dialysis fluid&#44; made with 3 mmol&#47;L of acetate and SelectBag Citrate&#174;&#44; with 1 mmol&#47;L of citrate and free of acetate&#46; The following were measured before and after dialysis&#58; venous blood gas monitoring&#44; calcium &#40;Ca&#41;&#44; ionic calcium &#40;Ca<span class="elsevierStyleInf">i</span>&#41;&#44; phosphorus &#40;P&#41; and parathyroid hormone &#40;PTH&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Differences &#40;p&#60;0&#46;05&#41; were found when using the citrate bath &#40;C&#41; compared to acetate &#40;A&#41; in the postdialysis values of&#58; pH&#44; C&#58; 7&#46;43 &#40;0&#46;04&#41; vs&#46; A&#58; 7&#46;47 &#40;0&#46;05&#41;&#59; bicarbonate&#44; C&#58; 24&#46;7 &#40;2&#46;7&#41; vs&#46; A&#58; 27&#46;3 &#40;2&#46;1&#41; mmol&#47;L&#59; base excess &#40;BEecf&#41;&#44; C&#58; 0&#46;4 &#40;3&#46;1&#41; vs&#46; A&#58; 3&#46;7 &#40;2&#46;4&#41; mmol&#47;L&#59; corrected calcium &#40;Cac&#41;&#44; C&#58; 9&#46;8 &#40;0&#46;8&#41; vs&#46; A&#58; 10&#46;1 &#40;0&#46;7&#41; mg&#47;dL&#59; and Ca<span class="elsevierStyleInf">i</span>&#44; C&#58; 1&#46;16 &#40;0&#46;05&#41; vs&#46; A&#58; 1&#46;27 &#40;0&#46;06&#41; mmol&#47;L&#46; No differences were found in either of the parameters measured before dialysis&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Dialysis with citrate provides better control of postdialysis acid-base balance&#44; decreases&#47;avoids postdialysis alkalaemia&#44; and lowers the increase in Cac and Ca<span class="elsevierStyleInf">i</span>&#46; This finding is of special interest in patients with predisposing factors for arrhythmia and patients with respiratory failure&#44; carbon dioxide retention&#44; calcifications and advanced liver disease&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Introduction"
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            "titulo" => "Objective"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La correcci&#243;n de la acidosis metab&#243;lica provocada por la insuficiencia renal se consigue aportando bicarbonato durante la di&#225;lisis&#46; Para evitar la precipitaci&#243;n de carbonato c&#225;lcico y magn&#233;sico que se produce en el l&#237;quido de di&#225;lisis &#40;LD&#41; al a&#241;adir bicarbonato&#44; es necesario a&#241;adir un &#225;cido&#44; habitualmente acetato&#44; que no est&#225; exento de efectos secundarios&#46; As&#237;&#44; el citrato se presenta como una alternativa ventajosa al acetato&#44; aunque sus efectos agudos no se conocen con precisi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar el efecto agudo sobre los par&#225;metros del equilibrio &#225;cido base y del metabolismo calcio-f&#243;sforo con la utilizaci&#243;n de un l&#237;quido de di&#225;lisis con citrato en lugar de acetato&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo y cruzado realizado en veinticuatro pacientes &#40;15 hombres y 9 mujeres&#41;&#46; Todos los pacientes se dializaron con monitor AK-200-Ultra-S con l&#237;quido de di&#225;lisis SoftPac<span class="elsevierStyleSup">&#174;</span>&#44; elaborado con 3 mmol&#47;l de acetato y con SelectBag Citrate<span class="elsevierStyleSup">&#174;</span>&#44; con 1 mmol&#47;l de citrato&#44; libre de acetato&#46; Se extrajeron pre y post-di&#225;lisis&#58; gasometr&#237;a venosa&#44; calcio &#40;Ca&#41;&#44; calcio i&#243;nico &#40;Cai&#41;&#44; f&#243;sforo &#40;P&#41; y hormona paratiroidea &#40;PTH&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Encontramos diferencias &#40;p &#60; 0&#44;05&#41; cuando utilizamos el ba&#241;o con citrato &#40;C&#41; frente a acetato &#40;A&#41; en los valores postdi&#225;lisis de&#58; pH &#40;C&#58; 7&#44;43 &#40;0&#44;04&#41; vs&#46; A&#58; 7&#44;47 &#40;0&#44;05&#41;&#41;&#44; bicarbonato &#40;C&#58; 24&#44;7 &#40;2&#44;7&#41; vs&#46; A&#58; 27&#44;3 &#40;2&#44;1&#41; mmol&#47;L&#41;&#44; exceso de base &#40;BEecf&#41; &#40;C&#58; 0&#44;4 &#40;3&#44;1&#41; vs A&#58; 3&#44;7 &#40;2&#44;4&#41; mmol&#47;L&#41;&#44; calcio corregido &#40;Cac&#41; &#40;C&#58; 9&#44;8 &#40;0&#44;8&#41; vs A&#58; 10&#44;1 &#40;0&#44;7&#41; mg&#47;dl&#41; y Cai &#40;C&#58; 1&#44;16 &#40;0&#44;05&#41; vs A&#58; 1&#44;27 &#40;0&#44;06&#41; mmol&#47;L&#41;&#46; No encontramos diferencias en ninguno de los par&#225;metros medidos predi&#225;lisis&#46; <span class="elsevierStyleItalic">Conclusi&#243;n</span> La di&#225;lisis con citrato consigue un mejor control de equilibrio &#225;cido base postdi&#225;lisis disminuyendo&#47;evitando la alcalemia postdi&#225;lisis y un menor aumento de Cac y Cai&#46; Este hallazgo es de especial inter&#233;s en pacientes con factores predisponentes a arritmias&#44; pacientes con insuficiencia respiratoria&#44; retenci&#243;n de carb&#243;nico&#44; calcificaciones y hepatopat&#237;a avanzada&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Na&#58; sodium&#59; K&#58; potassium&#59; Ca&#58; calcium&#59; Mg&#58; magnesium&#59; Cl&#58; chloride&#59; Glu&#58; glucose</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dialysis fluids &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Softpack G G 196<span class="elsevierStyleSup">a</span>&#44; G 295<span class="elsevierStyleSup">b</span>&#44; G 394<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Selectbag Citrate CX 265G&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" 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">G 196<span class="elsevierStyleSup">a</span>&#44; G 295<span class="elsevierStyleSup">b</span>&#44; G 394<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CX 265G&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="left" valign="top">Na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">140&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="left" valign="top">K&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;5<span class="elsevierStyleSup">a</span>&#44; 2<span class="elsevierStyleSup">b</span> y 3<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&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="left" valign="top">Ca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;5&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;65&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="left" valign="top">Mg&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;37<span class="elsevierStyleSup">a</span> y 0&#46;5<span class="elsevierStyleSup">b&#44;c</span>&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&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="left" valign="top">Acetato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&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="left" valign="top">Citrato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&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="left" valign="top">Cl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">108&#46;2<span class="elsevierStyleSup">a</span>&#44; 109<span class="elsevierStyleSup">b</span>&#44; 110<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109&#46;3&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="left" valign="top">Glu &#40;g&#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">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&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="left" valign="top">Bicarbonato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab889616.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Calculated Electrolyte Composition of DF containing Acetate and DF containing Citrate&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8211;</span>&#58; bicarbonate&#59; BE base excess&#59; pCO&#58; partial pressure of carbon dioxide&#59; pO2&#58; partial pressure of oxygen &#40;PO2&#41;&#44; sO<span class="elsevierStyleInf">2</span>&#58; oxygen saturation&#59; Na&#58; sodium&#59; K&#58; potassium&#59; Mg&#58; magnesium&#59; Ca&#58; calcium&#59; Cac&#58; corrected calcium&#59; Ca<span class="elsevierStyleInf">i</span>&#58; ionic calcium&#59; SBP&#58; systolic blood pressure&#59; DBP&#58; diastolic blood pressure</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#42; Mean of total patients where a DF containing acetate was used with three K concentrations &#40;1&#46;5&#44; 2 and 3 mmol&#47;L&#41; and DF containing citrate only 2 mmol&#47;L&#46; In the 12 &#40;50&#37;&#41; patients with the same concentration &#40;2 mmol&#47;L&#41;&#44; no differences were found in postdialysis K concentrations&#58; 3&#46;2 &#40;0&#46;2&#41; and 3&#46;4 &#40;0&#46;3&#41; for acetate and citrate&#44; respectively&#46; For DF containing acetate with 1&#46;5 and 3 mmol&#47;L of K&#44; there were differences&#58; 3&#46;02 &#40;0&#46;1&#41; vs&#46; 3&#46;4 &#40;0&#46;1&#41; and 3&#46;6 &#40;0&#46;1&#41; vs&#46; 3&#46;1 &#40;0&#46;1&#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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Citrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acetate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&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" title="table-entry  " align="left" valign="top">pH pre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;37 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;37 &#40;0&#46;06&#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" title="table-entry  " align="left" valign="top">HCO <span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8211;</span> pre mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;8 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;2 &#40;0&#46;3&#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" title="table-entry  " align="left" valign="top">BE pre mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;3&#46;1 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;2&#46;7 &#40;2&#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><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">pCO2 pre mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;4 &#40;4&#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">39&#46;1 &#40;5&#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">NS&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="left" valign="top">pO2 pre mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;7 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;8 &#40;23&#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" title="table-entry  " align="left" valign="top">sO<span class="elsevierStyleInf">2</span> pre &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&#46;3 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#46;8 &#40;2&#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><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Na pre mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;1 &#40;3&#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">138&#46;8 &#40;3&#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">NS&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="left" valign="top">K pre mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;1 &#40;0&#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">5&#46;1 &#40;0&#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">NS&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="left" valign="top">Mg pre mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#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">2&#46;1 &#40;0&#46;3&#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" title="table-entry  " align="left" valign="top">Ca pre mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;7 &#40;0&#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">8&#46;7 &#40;0&#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">NS&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="left" valign="top">Cac pre mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;6 &#40;0&#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">8&#46;6 &#40;0&#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">NS&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="left" valign="top">Ca<span class="elsevierStyleInf">i</span> pre mmol&#47;L&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;13 &#40;0&#46;09&#41;&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;15 &#40;0&#46;08&#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" title="table-entry  " align="left" valign="top">P pre mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;2 &#40;1&#46;17&#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&#46;03 &#40;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">NS&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="left" valign="top">PTH pre pg&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">435&#46;5 &#40;316&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">360&#46;1 &#40;252&#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" title="table-entry  " align="left" valign="top">pH post&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;43 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;47 &#40;0&#46;05&#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;001&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="left" valign="top">HCO <span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8211;</span> post mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;7 &#40;2&#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">27&#46;3 &#40;2&#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">0&#46;0001&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="left" valign="top">EB post mmol&#47;L&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;3&#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">3&#46;7 &#40;2&#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">0&#46;0001&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="left" valign="top">pCO2 post mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#46;7 &#40;5&#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">38&#46;4 &#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">NS&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="left" valign="top">pO2 post mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#46;6 &#40;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;5 &#40;29&#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" title="table-entry  " align="left" valign="top">sO<span class="elsevierStyleInf">2</span> post &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#46;1 &#40;17&#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">86&#46;5 &#40;18&#46;3&#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" title="table-entry  " align="left" valign="top">Na post mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136&#46;9 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136&#46;6 &#40;2&#46;5&#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" title="table-entry  " align="left" valign="top">K post&#42; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#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">3&#46;2 &#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">0&#46;016&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="left" valign="top">Mg post mg&#47;dl&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;8 &#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">1&#46;8 &#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">NS&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="left" valign="top">Ca post mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;6 &#40;0&#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">9&#46;8 &#40;0&#46;5&#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" title="table-entry  " align="left" valign="top">Cac post mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;8 &#40;0&#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">10&#46;1 &#40;0&#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" title="table-entry  " align="left" valign="top">Ca<span class="elsevierStyleInf">i</span> post mmol&#47;L&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;16 &#40;0&#46;05&#41;&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;27 &#40;0&#46;06&#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;000&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="left" valign="top">P post mg&#47;dl&nbsp;\t\t\t\t\t\t\n
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