Optimisation of dialysate flow in on-line hemodiafiltration

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Diffusive clearance is related to blood flow (Qb), dialysate flow (Qd), and the mass transfer-area coefficient (KoA). In one in vitro study, Leypoldt et al.<a class="elsevierStyleCrossRef" href="#bib0135">3</a> showed that an increase in Qd from 500mL/min to 800mL/min conferred a 14% increase in urea KoA, due to improved distribution of dialysate and reduced mass transfer resistance across the membrane. These results were subsequently demonstrated in clinical practice, with a 5.7%<a class="elsevierStyleCrossRef" href="#bib0140">4</a> increase in KoA and an 8.5% increase in K and Kt/V when Qd was changed from 500mL/min to 750mL/min.<a class="elsevierStyleCrossRef" href="#bib0145">5</a> Through modifications in the manufacturing of dialyzers, the pharmaceutical industry has improved dialysate distribution in capillaries.<a class="elsevierStyleCrossRefs" href="#bib0150">6–8</a> It has been observed that an increase in Qd to beyond 600mL/min does not correlate with better dialysis outcomes, as determined by Kt/V<a class="elsevierStyleCrossRef" href="#bib0165">9</a> or clearance of molecules such as phosphorus and β2-microglobulin.<a class="elsevierStyleCrossRef" href="#bib0170">10</a>Haemodiafiltration is a dialysis technique that combines diffusion and convection, both processes having similar clearance capacities. Post-dilution on-line HDF (OL-HDF) has been demonstrated to improve intradialysis tolerance<a class="elsevierStyleCrossRef" href="#bib0175">11</a>, increase survival<a class="elsevierStyleCrossRef" href="#bib0180">12</a> and more recently, several meta-analyses have confirmed reduced overall and cardiovascular mortality.<a class="elsevierStyleCrossRefs" href="#bib0180">12–15</a> Secondary analyses of the studies using death as a primary endpoint<a class="elsevierStyleCrossRefs" href="#bib0175">11,14,15</a> observed an association between convective volume and survival. Therefore, a minimum convective volume of 23L per session was recommended until more conclusive scientific evidence became available.<a class="elsevierStyleCrossRefs" href="#bib0200">16,17</a>Initially, OL-HDF was performed with a Qd of 800mL/min, because some of the dialysate was used as substitution solution.<a class="elsevierStyleCrossRefs" href="#bib0210">18,19</a> Later, newer monitors were able to differentiate dialysate destined for diffusion (usually 500mL/min) from that destined for substitution (60–150mL/min).<a class="elsevierStyleCrossRef" href="#bib0220">20</a> Now, with the aim of optimising the dialysate to the requirements of the dialyser, the 5008 monitors have a Qd autoflow system with an adjustable Qd/Qb ratio. The initial default setting recommended by the monitor for this factor was 1.2.<a class="elsevierStyleCrossRef" href="#bib0225">21</a> This recommendation has subsequently been changed to a factor of 1.0 if Qb is equal to or greater than 400mL/min, or 1.2 if Qb is less than 400mL/min.To assess and optimise the choice of dialysate, the aim of this study was to evaluate the effects of changes in Qd on the convective volume and clearance capacity in patients on OL-HDF treatment.Patients and methodsThis was a single-centre study in stable haemodialysis patients. Fifty-nine patients were included, 45 men and 14 women, with a mean age of 67.0±13 years (range 26–89 years), who were on a haemodialysis programme for a mean of 39.4±42 months. The aetiology of chronic renal failure was chronic glomerulonephritis in 8 cases (13.6%), diabetic nephropathy in 14 cases (23.7%), polycystic disease in 6 cases (10.2%), vascular nephropathy in 13 cases (22%), urological causes in 6 cases (10.2%), systemic disease in 1 (1.7%), tubulo-interstitial nephritis in 2 (3.4%), and unknown aetiology in 9 (15.3%). All patients were dialysed via an arteriovenous fistula, except one patient who had a tunnelled central line.Each patient received 5 different dialysis sessions, always mid-week, in which only Qd was changed, to either 300, 400, 500, 600, or 700mL/min. Other dialytic parameters were kept constant in all sessions studied: dialysis time, 293.4±15min (240–300min); Qb, 424±4mL/min (350–450mL/min). The dialyser was not changed (80% FX60Cordiax, 20% FX80Cordiax), 5008 Cordiax monitor, post-dilution OL-HDF with auto-substitution system was used. The order of sessions was randomised.The dialysis parameters collected at each session were: programmed time, actual duration of sessions; dialyser; Qb; initial and final weight; Kt, automatically measured by ionic dialysance; recirculation rate, measured by the temperature module; arterial pressure; venous pressure; transmembrane pressure; initial and final haemoglobin; volume of blood processed; and substitution volume.Serum concentrations of urea (60Da), creatinine (113Da), β2-microglobulin (11,800Da), myoglobin (17,200Da) and α1-microglobulin (33,000Da) were measured at the start and end of each session to calculate the percentage reduction of these solutes. The concentrations of urea and creatinine were measured using molecular absorption spectrometry on the ADVIA 2400 analyser (Chemistry System of Siemens Healthcare Diagnostics, Chicago, IL, USA). β2-Microglobulin (β2-m) and α1-microglobulin (α1-m) were measured by immunonephelometry with the BNII analyser (Siemens Healthcare Diagnostics). Myoglobin concentrations were measured by “sandwich” enzyme immunoassay with the Dimension EXL analyser (Siemens Healthcare Diagnostics). In all cases, dedicated reagents were used.To correct for haemoconcentration during dialysis, the percentage reductions pre- and post-treatment in plasma β2-m, myoglobin and α1-microglobulin were calculated using the Bergström and Wehle formula.<a class="elsevierStyleCrossRef" href="#bib0230">22</a>Statistical analysis was performed on the programme SPSS version 20.0 and results are expressed as mean±standard deviation. For analysis of the statistical significance of quantitative parameters, the Student's t-test was used for paired data, or ANOVA for repeated measures. A P-value <0.05 was considered statistically significant.ResultsAll dialysis sessions were carried out with no clinical incidents of note. The anticoagulation used was heparin sodium in 28.8%, low molecular weight heparin (tinzaparin) in 55.9%, and in the remaining 15.3%, no heparin was used.The volume of dialysate passed per session increased from 117.9±6.4L with a Qd of 300mL/min up to 232.4±12L with a Qd of 700mL/min (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no differences in the other dialysis parameters, Qb, total blood processed by the monitor, needle gauge, recirculation, actual duration of sessions, initial weight, final weight, weight gain, or dialysis monitor measurements of initial and final haematocrit (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The substitution volume was similar in all 5 Qd settings studied (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), demonstrating that Qd affected neither substitution volume nor convective volume (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that in all situations, there were no differences in arterial pressure, venous pressure, transmembrane pressure, Qi, ultrafiltration flow (QUF), or percentage of effective convective volume over total processed blood.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>When Qd was increased, the dialysis dose and clearance of small molecules also increased. Kt increased significantly, from 68.0±6.9L when Qd was 300mL/min, up to 75.5±7.3L when Qd was 700mL/min (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), P<0.001 in all situations. There was also a greater percentage reduction of urea with the increase in Qd, being significantly lower when Qd was 300mL/min than in the other 4 study situations (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>When we evaluated the percentage reduction of creatinine, β2-m, myoglobin and α1-microglobulin, no significant differences were observed among the different study situations (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).DiscussionThis study shows, in post-dilution OL-HDF, the comparison between different dialysis flow rates of 300mL/min, 400mL/min, 500mL/min, 600mL/min, and 700mL/min, observing that changes in Qd did not lead to changes in convective volume. In addition, a slight increase was observed in urea clearance, with no changes in the other molecules studied: creatinine, β2-m, myoglobin, and α1-microglobulin. Therefore, it seems reasonable to optimise Qd to values that guarantee an adequate dialysis dose, considering that every 100mL/min reduction in Qd equates to a 16% reduction in dialysate consumption: approximately 6L per hour of dialysis.On-line HDF is a safe technique that improves intradialytic tolerance<a class="elsevierStyleCrossRef" href="#bib0175">11</a> and increases survival.<a class="elsevierStyleCrossRefs" href="#bib0180">12–15</a> The EuDial group redefined HDF as a blood purification therapy combining diffusive and convective solute transport using a high-flux membrane with a KUF (ultrafiltration coefficient) greater than 20mL/h/mmHg/m2 and a sieving coefficient for β2-m greater than 0.6, with an effective convective volume greater than 20% of the total blood volume processed,<a class="elsevierStyleCrossRef" href="#bib0200">16</a> and no specification regarding Qd.The main limiting factors in achieving high convective volumes are Qb, duration of session, and haemoconcentration. One previous study<a class="elsevierStyleCrossRef" href="#bib0235">23</a> showed that increasing Qb was likely to be the best method to achieve a greater convective volume: for every 50mL/min increase in Qb, the convective volume increased more than half a litre per hour. One subsequent study<a class="elsevierStyleCrossRef" href="#bib0240">24</a> analysed the importance of dialyser surface area. The authors concluded that with the high flux dialysers currently available for OL-HDF modes, choice of dialyser surface area should be considered in the cost effectiveness; when KUF was greater than 45mL/h/mmHg, the differences in both convective volume and clearance capacity were minimal. Increasing the duration of sessions will always be beneficial in achieving a greater convective volume and greater clearance capacity. The present study confirms the null influence that Qd has on convective volume.Regarding clearance efficiency, only diffusion is affected by Qd. Clearance capacity for small molecules depends mainly on Qb, Qd, and the properties of the membrane (KoA). Clearance capacity for low molecular weight molecules can decrease with the increase in spaces not adequately reached by dialysate, because the yield worsens. Initially, increasing Qd was recommended to avoid this phenomenon, but in both in vitro and in vivo studies,<a class="elsevierStyleCrossRefs" href="#bib0135">3–5</a> only slight improvements in clearance were observed with an increase in Qd.In recent years, the pharmaceutical industry, after studying classic dialysers with magnetic resonance imaging and computed tomography and observing spaces to which dialysate was not adequately distributed, introduced changes in the manufacture of dialysers.<a class="elsevierStyleCrossRefs" href="#bib0150">6–8</a> These structural modifications, aimed at changing the arrangement and packing of capillaries to make up the membrane, have optimised dialysate distribution across the membrane, thus improving yield. Following the introduction of these structural modifications, both in vitro<a class="elsevierStyleCrossRefs" href="#bib0150">6–8</a> and in vivo<a class="elsevierStyleCrossRefs" href="#bib0165">9,10</a> studies have demonstrated that an increase in Qd beyond 600mL/min does not lead to a better clearance capacity in terms of Kt/V,<a class="elsevierStyleCrossRef" href="#bib0165">9</a> KoA, phosphorus, or β2-microglobulin.<a class="elsevierStyleCrossRef" href="#bib0170">10</a> Therefore, the diffusive efficiency conferred by Qd has decreased with the modifications in the dialyser manufacturing process, and it cannot be claimed that an increase in Qd leads to improved clearance. Nonetheless, the prescribing doctor must always individualise the dialysis parameters, including Qd, to achieve a minimum dose of Kt.One limitation of this study is that it involved only one type of dialyser, with a helixone membrane. Therefore, further studies with different membranes and dialyser characteristics are needed to assess whether these results can be extrapolated or whether Qd should be individualised to each dialyser.Using previously published data, and after analysing the results of this study, it seems reasonable to dialyse with a Qd of 400mL/min or with a Qd/Qb autoflow of 1.0 when Qb is equal to or greater than 400mL/min. This Qd is sufficient to achieve an adequate clearance capacity, optimising the dialysate used in each session.ConclusionDialysate flow in OL-HDF does not affect convective volume. A higher Qd results in a slight increase in clearance capacity for urea (diffusion dependent), with no changes for medium and large molecules (convection dependent). It is recommended that Qd to be optimised to the minimum possible that guarantees an adequate dialysis dose (Kt or Kt/V) and allows rationalisation of water and dialysis concentrate consumption. Further studies are needed with different dialysers, to assess it these results can be extrapolated to all dialysers or if it is necessary to individualise Qd to each dialyser.Conflicts of interestFM has received fees from Amgen, Baxter, Bellco, and Fresenius. The other authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres604419" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec618574" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres604420" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec618575" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-24" "fechaAceptado" => "2015-03-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec618574" "palabras" => array:4 [ 0 => "Dialysate flow" 1 => "On-line hemodiafiltration" 2 => "Efficacy" 3 => "Convective volume" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec618575" "palabras" => array:4 [ 0 => "Flujo líquido diálisis" 1 => "Hemodiafiltración on-line" 2 => "Eficacia depurativa" 3 => "Volumen convectivo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionCurrently, on-line hemodiafiltration (OL-HDF) is the most effective technique. Several randomised studies and meta-analyses have shown a reduced mortality and a direct association with convective volume has been reported. At present, it has not been established if an increased dialysate flow (Qd) shows in improved results in terms of convective and depurative efficiency. We aim at assessing the effects of Qd variations on convective volume and its depurative capacity in patients on OL-HDF. Material and methodsA total of 59 patients (45 men and 14 women) from a OL-HDF programme in which a monitor 5008 Cordiax with auto-substitution was used, were enrolled. Patients were assessed in 5 sessions with post-dilutional OL-HDF, using helixone-based dialyzers, with only Qd being changed (300, 400, 500, 600 and 700mL/min). Serum levels of urea (60Da), creatinine (113Da), β2-microglobulin (11,800Da), myoglobin (17,200Da) and α1-microglobulin (33,000Da) were measured at the beginning and at the end of each session, in order to estimate the percent reduction of such solutes. ResultsAn increased dialysate volume per session was observed, from 117.9±6.4L with Qd 300mL/min to 232.4±12L with Qd 700mL/min. No changes were found in replacement volume or convective volume. Regarding diffusion, Qd increase was associated to a significantly increased dialysis dose, with an increased Kt from 68±6.9L with Qd 300mL/min to 75.5±7.3L with Qd 700mL/min (P<0.001), and a gradually increased percent reduction in urea associated to increased Qd with significantly lower levels being found with Qd 300mL/min. No changes were found in other measured substances. ConclusionQd variations in OL-HDF do not change convective volume. A higher Qd was associated to a slightly increased urea clearance with no change being observed for medium and large molecules. Qd optimisation to the minimal level assuring an adequate dialysis dose and allowing water and dialysate use to be rationalised should be recommended." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa hemodiafiltración on-line (HDF-OL) es actualmente la técnica más efectiva. Varios estudios aleatorizados y metaanálisis han observado una reducción de la mortalidad, con una asociación en relación directa con el volumen convectivo. En el momento presente no está bien establecido si el aumento del flujo del líquido de diálisis (Qd) puede suponer mejores resultados en términos de eficacia convectiva y depurativa. El objetivo del estudio fue valorar, en pacientes en tratamiento con HDF-OL, el efecto de la variación del Qd sobre el volumen convectivo y su capacidad depurativa. Material y métodosSe incluyeron 59 pacientes, 45 varones y 14 mujeres que se encontraban en programa de HDF-OL con monitor 5008 Cordiax con autosustitución. Cada paciente fue analizado en 5 sesiones con HDF-OL posdilucional, con dializadores de helixona, en las que solo se varió el Qd (300, 400, 500, 600 y 700ml/min). En cada sesión se determinaron concentración de urea (60Da), creatinina (113 Da), β2-microglobulina (11.800Da), mioglobina (17.200Da) y α1-microglobulina (33.000Da) en suero al inicio y al final de cada sesión, para calcular el porcentaje de reducción de estos solutos. ResultadosSe objetivó un aumento de litros de Qd por sesión, desde 117,9±6,4 L con Qd de 300ml/min hasta 232,4±12 L con Qd 700ml/min. No se determinaron cambios en el volumen de sustitución ni en el volumen convectivo. En términos de difusión, el incremento del Qd mostró un aumento significativo de la dosis de diálisis, con un aumento de Kt de 68±6,9 L con Qd 300ml/min hasta 75,5±7,3 L con Qd 700ml/min (p<0,001), y un aumento progresivo del porcentaje de reducción de urea con el incremento del Qd, que era significativamente inferior con Qd 300ml/min. No se objetivaron cambios en el resto de moléculas estudiadas. ConclusiónLa variación del Qd en HDF-OL no modifica el volumen convectivo. Un mayor Qd mostró un discreto incremento de la depuración de la urea, sin variaciones en las medianas ni en las grandes moléculas. Es recomendable optimizar el Qd al mínimo posible que garantice una adecuada dosis de diálisis y permita racionalizar el consumo de agua y concentrado de diálisis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Maduell F, Ojeda R, Arias-Guillén M, Fontseré N, Vera M, Massó E, et al. Optimización del flujo del líquido de diálisis en la hemodiafiltración on-line. Nefrologia. 2015;35:473–478." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1231 "Ancho" => 1589 "Tamanyo" => 79771 ] ] "descripcion" => array:1 [ "en" => "Changes in dialysate volume according to Qd; n=59; ANOVA for repeated measures." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1253 "Ancho" => 1590 "Tamanyo" => 84096 ] ] "descripcion" => array:1 [ "en" => "Changes in convective volume according to Qd; n=59; ANOVA for repeated measures." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "NS, not significant; Qb, blood flow; Qd, dialysate flow; Td, dialysis time." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Qd (mL/min) \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">300 \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">400 \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">500 \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">600 \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">700 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Qb (mL/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">423.72±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">423.72±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">423.72±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">423.72±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">423.72±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Processed blood volume (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">121.65±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">122.04±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">121.71±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">121.49±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">121.41±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Needle gauge 15/16 (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6/91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6/91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6/91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6/91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6/91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Recirculation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.17±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.24±4.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.36±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.56±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.1±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Prescribed Td (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">293.4±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">293.4±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">293.4±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">293.4±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">293.4±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Delivered Td (min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">288.1±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">288.8±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">288.1±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">287.6±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">287.1±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Initial weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.46±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.30±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.39±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71.14±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70.71±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Final weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.39±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.31±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.35±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.00±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68.53±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight gain (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.07±0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.00±1.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.05±1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.15±0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.10±1.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Initial haematocrit (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.9±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.1±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.3±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.3±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.9±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Final haematocrit (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.2±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.9±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.4±5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.4±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.1±5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989874.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of dialysis parameters for the 5 different Qd settings (n=59)." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "NS, not significant; P, probability; Qi, infusion flow; QUF, ultrafiltration flow; TMP, transmembrane pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><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">Qd \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">300 \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">400 \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">500 \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">600 \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">700 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Arterial pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−225±23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−222±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−224±28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−225±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−222±23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Venous pressure (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217±33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">218±26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">216±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">213±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">216±31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">TMP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185.2±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">188.9±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185.1±23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185.5±22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">185.3±18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Substitution volume (L/session) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.39±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.92±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.61±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.79±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.28±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Convective volume (L/session) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.47±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.90±2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.66±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.94±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.44±3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Qi (mL/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.2±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110.4±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.8±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110.6±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.2±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">QUF (mL/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.2±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117.5±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.9±11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118.0±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.7±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Percentage of convective volume over processed blood (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6±2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.3±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.0±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.6±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989873.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of substitution volume, total convective volume, infusion flow, ultrafiltration flow, and processed blood volume at different dialysate flow rates (n=59)." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Qd \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">300 \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">400 \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">500 \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">600 \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">700 \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">Kt (L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.0±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.3±6.9<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.2±6.6<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.1±7.7<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.5±7.3<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0020">d</a> \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">% reduction urea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.5±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.6±5.1<a class="elsevierStyleCrossRef" href="#tblfn0025">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.0±4.8<a class="elsevierStyleCrossRef" href="#tblfn0030">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.5±5.4<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.1±4.8<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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">% reduction Cr \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.5±4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.0±5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.6±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.4±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.0±5.2 \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">% reduction β2-m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.5±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.8±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.6±4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.9±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.2±4.1 \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">% reduction myoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.1±7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.4±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.8±8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.1±8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.2±7.3 \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">% reduction α1-microglobulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.9±9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.5±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.6±9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.8±9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7±8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab989872.png" ] ] ] "notaPie" => array:6 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "P<0.001 compared with 300." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "P<0.001 compared with 400." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "P=0.003 compared with 500." ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "P<0.001 compared with 500." ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "P=0.018 compared with 300." ] 5 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "f" "nota" => "P=0.004 compared with 300." ] ] ] 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Original article

Optimización del flujo del líquido de diálisis en la hemodiafiltración on-line

Francisco Maduella,

Corresponding author

fmaduell@clinic.ub.es

Corresponding author.

, Raquel Ojedaa, Marta Arias-Guilléna, Néstor Fontseréa, Manel Veraa, Elisabeth Massóa, Miquel Gómeza, Lida Rodasa, Giannina Bazána, Mario Jiménez-Hernándeza, Gastón Piñeiroa, Nayra Ricob

a Departamento de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain

b Departamento de Bioquímica, Hospital Clínic de Barcelona, Barcelona, Spain

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Changes in convective volume according to Qd&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#59; ANOVA for repeated measures&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">National<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> and international<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> clinical practice guidelines recommend to provide at least a minimum dose of haemodialysis as determined by a Kt&#47;V of 1&#46;3 and a urea reduction ratio of 70&#37;&#46; Diffusive clearance is related to blood flow &#40;Qb&#41;&#44; dialysate flow &#40;Qd&#41;&#44; and the mass transfer-area coefficient &#40;KoA&#41;&#46; In one in vitro study&#44; Leypoldt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> showed that an increase in Qd from 500<span class="elsevierStyleHsp" style=""></span>mL&#47;min to 800<span class="elsevierStyleHsp" style=""></span>mL&#47;min conferred a 14&#37; increase in urea KoA&#44; due to improved distribution of dialysate and reduced mass transfer resistance across the membrane&#46; These results were subsequently demonstrated in clinical practice&#44; with a 5&#46;7&#37;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> increase in KoA and an 8&#46;5&#37; increase in K and Kt&#47;V when Qd was changed from 500<span class="elsevierStyleHsp" style=""></span>mL&#47;min to 750<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a> Through modifications in the manufacturing of dialyzers&#44; the pharmaceutical industry has improved dialysate distribution in capillaries&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#8211;8</span></a> It has been observed that an increase in Qd to beyond 600<span class="elsevierStyleHsp" style=""></span>mL&#47;min does not correlate with better dialysis outcomes&#44; as determined by Kt&#47;V<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> or clearance of molecules such as phosphorus and &#946;<span class="elsevierStyleInf">2</span>-microglobulin&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Haemodiafiltration is a dialysis technique that combines diffusion and convection&#44; both processes having similar clearance capacities&#46; Post-dilution on-line HDF &#40;OL-HDF&#41; has been demonstrated to improve intradialysis tolerance<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#44; increase survival<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> and more recently&#44; several meta-analyses have confirmed reduced overall and cardiovascular mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">12&#8211;15</span></a> Secondary analyses of the studies using death as a primary endpoint<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">11&#44;14&#44;15</span></a> observed an association between convective volume and survival&#46; Therefore&#44; a minimum convective volume of 23<span class="elsevierStyleHsp" style=""></span>L per session was recommended until more conclusive scientific evidence became available&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Initially&#44; OL-HDF was performed with a Qd of 800<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; because some of the dialysate was used as substitution solution&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18&#44;19</span></a> Later&#44; newer monitors were able to differentiate dialysate destined for diffusion &#40;usually 500<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41; from that destined for substitution &#40;60&#8211;150<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> Now&#44; with the aim of optimising the dialysate to the requirements of the dialyser&#44; the 5008 monitors have a Qd autoflow system with an adjustable Qd&#47;Qb ratio&#46; The initial default setting recommended by the monitor for this factor was 1&#46;2&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> This recommendation has subsequently been changed to a factor of 1&#46;0 if Qb is equal to or greater than 400<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; or 1&#46;2 if Qb is less than 400<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To assess and optimise the choice of dialysate&#44; the aim of this study was to evaluate the effects of changes in Qd on the convective volume and clearance capacity in patients on OL-HDF treatment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a single-centre study in stable haemodialysis patients&#46; Fifty-nine patients were included&#44; 45 men and 14 women&#44; with a mean age of 67&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years &#40;range 26&#8211;89 years&#41;&#44; who were on a haemodialysis programme for a mean of 39&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42 months&#46; The aetiology of chronic renal failure was chronic glomerulonephritis in 8 cases &#40;13&#46;6&#37;&#41;&#44; diabetic nephropathy in 14 cases &#40;23&#46;7&#37;&#41;&#44; polycystic disease in 6 cases &#40;10&#46;2&#37;&#41;&#44; vascular nephropathy in 13 cases &#40;22&#37;&#41;&#44; urological causes in 6 cases &#40;10&#46;2&#37;&#41;&#44; systemic disease in 1 &#40;1&#46;7&#37;&#41;&#44; tubulo-interstitial nephritis in 2 &#40;3&#46;4&#37;&#41;&#44; and unknown aetiology in 9 &#40;15&#46;3&#37;&#41;&#46; All patients were dialysed via an arteriovenous fistula&#44; except one patient who had a tunnelled central line&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Each patient received 5 different dialysis sessions&#44; always mid-week&#44; in which only Qd was changed&#44; to either 300&#44; 400&#44; 500&#44; 600&#44; or 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; Other dialytic parameters were kept constant in all sessions studied&#58; dialysis time&#44; 293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>min &#40;240&#8211;300<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; Qb&#44; 424<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mL&#47;min &#40;350&#8211;450<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41;&#46; The dialyser was not changed &#40;80&#37; FX60Cordiax&#44; 20&#37; FX80Cordiax&#41;&#44; 5008 Cordiax monitor&#44; post-dilution OL-HDF with auto-substitution system was used&#46; The order of sessions was randomised&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The dialysis parameters collected at each session were&#58; programmed time&#44; actual duration of sessions&#59; dialyser&#59; Qb&#59; initial and final weight&#59; Kt&#44; automatically measured by ionic dialysance&#59; recirculation rate&#44; measured by the temperature module&#59; arterial pressure&#59; venous pressure&#59; transmembrane pressure&#59; initial and final haemoglobin&#59; volume of blood processed&#59; and substitution volume&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Serum concentrations of urea &#40;60<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; creatinine &#40;113<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; &#946;<span class="elsevierStyleInf">2</span>-microglobulin &#40;11&#44;800<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; myoglobin &#40;17&#44;200<span class="elsevierStyleHsp" style=""></span>Da&#41; and &#945;<span class="elsevierStyleInf">1</span>-microglobulin &#40;33&#44;000<span class="elsevierStyleHsp" style=""></span>Da&#41; were measured at the start and end of each session to calculate the percentage reduction of these solutes&#46; The concentrations of urea and creatinine were measured using molecular absorption spectrometry on the ADVIA 2400 analyser &#40;Chemistry System of Siemens Healthcare Diagnostics&#44; Chicago&#44; IL&#44; USA&#41;&#46; &#946;<span class="elsevierStyleInf">2</span>-Microglobulin &#40;&#946;<span class="elsevierStyleInf">2</span>-m&#41; and &#945;<span class="elsevierStyleInf">1</span>-microglobulin &#40;&#945;<span class="elsevierStyleInf">1</span>-m&#41; were measured by immunonephelometry with the BNII analyser &#40;Siemens Healthcare Diagnostics&#41;&#46; Myoglobin concentrations were measured by &#8220;sandwich&#8221; enzyme immunoassay with the Dimension EXL analyser &#40;Siemens Healthcare Diagnostics&#41;&#46; In all cases&#44; dedicated reagents were used&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">To correct for haemoconcentration during dialysis&#44; the percentage reductions pre- and post-treatment in plasma &#946;<span class="elsevierStyleInf">2</span>-m&#44; myoglobin and &#945;<span class="elsevierStyleInf">1</span>-microglobulin were calculated using the Bergstr&#246;m and Wehle formula&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Statistical analysis was performed on the programme SPSS version 20&#46;0 and results are expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; For analysis of the statistical significance of quantitative parameters&#44; the Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used for paired data&#44; or ANOVA for repeated measures&#46; A <span class="elsevierStyleItalic">P</span>-value &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">All dialysis sessions were carried out with no clinical incidents of note&#46; The anticoagulation used was heparin sodium in 28&#46;8&#37;&#44; low molecular weight heparin &#40;tinzaparin&#41; in 55&#46;9&#37;&#44; and in the remaining 15&#46;3&#37;&#44; no heparin was used&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The volume of dialysate passed per session increased from 117&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4<span class="elsevierStyleHsp" style=""></span>L with a Qd of 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min up to 232&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>L with a Qd of 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There were no differences in the other dialysis parameters&#44; Qb&#44; total blood processed by the monitor&#44; needle gauge&#44; recirculation&#44; actual duration of sessions&#44; initial weight&#44; final weight&#44; weight gain&#44; or dialysis monitor measurements of initial and final haematocrit &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The substitution volume was similar in all 5 Qd settings studied &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; demonstrating that Qd affected neither substitution volume nor convective volume &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that in all situations&#44; there were no differences in arterial pressure&#44; venous pressure&#44; transmembrane pressure&#44; Qi&#44; ultrafiltration flow &#40;QUF&#41;&#44; or percentage of effective convective volume over total processed blood&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">When Qd was increased&#44; the dialysis dose and clearance of small molecules also increased&#46; Kt increased significantly&#44; from 68&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9<span class="elsevierStyleHsp" style=""></span>L when Qd was 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; up to 75&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3<span class="elsevierStyleHsp" style=""></span>L when Qd was 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 in all situations&#46; There was also a greater percentage reduction of urea with the increase in Qd&#44; being significantly lower when Qd was 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min than in the other 4 study situations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">When we evaluated the percentage reduction of creatinine&#44; &#946;<span class="elsevierStyleInf">2</span>-m&#44; myoglobin and &#945;<span class="elsevierStyleInf">1</span>-microglobulin&#44; no significant differences were observed among the different study situations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">This study shows&#44; in post-dilution OL-HDF&#44; the comparison between different dialysis flow rates of 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; 400<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; 500<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; 600<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; and 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#44; observing that changes in Qd did not lead to changes in convective volume&#46; In addition&#44; a slight increase was observed in urea clearance&#44; with no changes in the other molecules studied&#58; creatinine&#44; &#946;<span class="elsevierStyleInf">2</span>-m&#44; myoglobin&#44; and &#945;<span class="elsevierStyleInf">1</span>-microglobulin&#46; Therefore&#44; it seems reasonable to optimise Qd to values that guarantee an adequate dialysis dose&#44; considering that every 100<span class="elsevierStyleHsp" style=""></span>mL&#47;min reduction in Qd equates to a 16&#37; reduction in dialysate consumption&#58; approximately 6<span class="elsevierStyleHsp" style=""></span>L per hour of dialysis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">On-line HDF is a safe technique that improves intradialytic tolerance<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> and increases survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">12&#8211;15</span></a> The EuDial group redefined HDF as a blood purification therapy combining diffusive and convective solute transport using a high-flux membrane with a KUF &#40;ultrafiltration coefficient&#41; greater than 20<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#47;mmHg&#47;m<span class="elsevierStyleSup">2</span> and a sieving coefficient for &#946;<span class="elsevierStyleInf">2</span>-m greater than 0&#46;6&#44; with an effective convective volume greater than 20&#37; of the total blood volume processed&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">16</span></a> and no specification regarding Qd&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The main limiting factors in achieving high convective volumes are Qb&#44; duration of session&#44; and haemoconcentration&#46; One previous study<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> showed that increasing Qb was likely to be the best method to achieve a greater convective volume&#58; for every 50<span class="elsevierStyleHsp" style=""></span>mL&#47;min increase in Qb&#44; the convective volume increased more than half a litre per hour&#46; One subsequent study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a> analysed the importance of dialyser surface area&#46; The authors concluded that with the high flux dialysers currently available for OL-HDF modes&#44; choice of dialyser surface area should be considered in the cost effectiveness&#59; when KUF was greater than 45<span class="elsevierStyleHsp" style=""></span>mL&#47;h&#47;mmHg&#44; the differences in both convective volume and clearance capacity were minimal&#46; Increasing the duration of sessions will always be beneficial in achieving a greater convective volume and greater clearance capacity&#46; The present study confirms the null influence that Qd has on convective volume&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding clearance efficiency&#44; only diffusion is affected by Qd&#46; Clearance capacity for small molecules depends mainly on Qb&#44; Qd&#44; and the properties of the membrane &#40;KoA&#41;&#46; Clearance capacity for low molecular weight molecules can decrease with the increase in spaces not adequately reached by dialysate&#44; because the yield worsens&#46; Initially&#44; increasing Qd was recommended to avoid this phenomenon&#44; but in both in vitro and in vivo studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;5</span></a> only slight improvements in clearance were observed with an increase in Qd&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In recent years&#44; the pharmaceutical industry&#44; after studying classic dialysers with magnetic resonance imaging and computed tomography and observing spaces to which dialysate was not adequately distributed&#44; introduced changes in the manufacture of dialysers&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#8211;8</span></a> These structural modifications&#44; aimed at changing the arrangement and packing of capillaries to make up the membrane&#44; have optimised dialysate distribution across the membrane&#44; thus improving yield&#46; Following the introduction of these structural modifications&#44; both in vitro<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#8211;8</span></a> and in vivo<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">9&#44;10</span></a> studies have demonstrated that an increase in Qd beyond 600<span class="elsevierStyleHsp" style=""></span>mL&#47;min does not lead to a better clearance capacity in terms of Kt&#47;V&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> KoA&#44; phosphorus&#44; or &#946;<span class="elsevierStyleInf">2</span>-microglobulin&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a> Therefore&#44; the diffusive efficiency conferred by Qd has decreased with the modifications in the dialyser manufacturing process&#44; and it cannot be claimed that an increase in Qd leads to improved clearance&#46; Nonetheless&#44; the prescribing doctor must always individualise the dialysis parameters&#44; including Qd&#44; to achieve a minimum dose of Kt&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">One limitation of this study is that it involved only one type of dialyser&#44; with a helixone membrane&#46; Therefore&#44; further studies with different membranes and dialyser characteristics are needed to assess whether these results can be extrapolated or whether Qd should be individualised to each dialyser&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Using previously published data&#44; and after analysing the results of this study&#44; it seems reasonable to dialyse with a Qd of 400<span class="elsevierStyleHsp" style=""></span>mL&#47;min or with a Qd&#47;Qb autoflow of 1&#46;0 when Qb is equal to or greater than 400<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; This Qd is sufficient to achieve an adequate clearance capacity&#44; optimising the dialysate used in each session&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Dialysate flow in OL-HDF does not affect convective volume&#46; A higher Qd results in a slight increase in clearance capacity for urea &#40;diffusion dependent&#41;&#44; with no changes for medium and large molecules &#40;convection dependent&#41;&#46; It is recommended that Qd to be optimised to the minimum possible that guarantees an adequate dialysis dose &#40;Kt or Kt&#47;V&#41; and allows rationalisation of water and dialysis concentrate consumption&#46; Further studies are needed with different dialysers&#44; to assess it these results can be extrapolated to all dialysers or if it is necessary to individualise Qd to each dialyser&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">FM has received fees from Amgen&#44; Baxter&#44; Bellco&#44; and Fresenius&#46; The other authors declare no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2014-11-24"
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            0 => "Dialysate flow"
            1 => "On-line hemodiafiltration"
            2 => "Efficacy"
            3 => "Convective volume"
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          "palabras" => array:4 [
            0 => "Flujo l&#237;quido di&#225;lisis"
            1 => "Hemodiafiltraci&#243;n <span class="elsevierStyleItalic">on-line</span>"
            2 => "Eficacia depurativa"
            3 => "Volumen convectivo"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Currently&#44; on-line hemodiafiltration &#40;OL-HDF&#41; is the most effective technique&#46; Several randomised studies and meta-analyses have shown a reduced mortality and a direct association with convective volume has been reported&#46; At present&#44; it has not been established if an increased dialysate flow &#40;Qd&#41; shows in improved results in terms of convective and depurative efficiency&#46; We aim at assessing the effects of Qd variations on convective volume and its depurative capacity in patients on OL-HDF&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 59 patients &#40;45 men and 14 women&#41; from a OL-HDF programme in which a monitor 5008 Cordiax with auto-substitution was used&#44; were enrolled&#46; Patients were assessed in 5 sessions with post-dilutional OL-HDF&#44; using helixone-based dialyzers&#44; with only Qd being changed &#40;300&#44; 400&#44; 500&#44; 600 and 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#41;&#46; Serum levels of urea &#40;60<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; creatinine &#40;113<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; &#946;<span class="elsevierStyleInf">2</span>-microglobulin &#40;11&#44;800<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; myoglobin &#40;17&#44;200<span class="elsevierStyleHsp" style=""></span>Da&#41; and &#945;<span class="elsevierStyleInf">1</span>-microglobulin &#40;33&#44;000<span class="elsevierStyleHsp" style=""></span>Da&#41; were measured at the beginning and at the end of each session&#44; in order to estimate the percent reduction of such solutes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An increased dialysate volume per session was observed&#44; from 117&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;4<span class="elsevierStyleHsp" style=""></span>L with Qd 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min to 232&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>L with Qd 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; No changes were found in replacement volume or convective volume&#46; Regarding diffusion&#44; Qd increase was associated to a significantly increased dialysis dose&#44; with an increased Kt from 68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9<span class="elsevierStyleHsp" style=""></span>L with Qd 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min to 75&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3<span class="elsevierStyleHsp" style=""></span>L with Qd 700<span class="elsevierStyleHsp" style=""></span>mL&#47;min &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and a gradually increased percent reduction in urea associated to increased Qd with significantly lower levels being found with Qd 300<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#46; No changes were found in other measured substances&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Qd variations in OL-HDF do not change convective volume&#46; A higher Qd was associated to a slightly increased urea clearance with no change being observed for medium and large molecules&#46; Qd optimisation to the minimal level assuring an adequate dialysis dose and allowing water and dialysate use to be rationalised should be recommended&#46;</p></span>"
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            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La hemodiafiltraci&#243;n on-line &#40;HDF-OL&#41; es actualmente la t&#233;cnica m&#225;s efectiva&#46; Varios estudios aleatorizados y metaan&#225;lisis han observado una reducci&#243;n de la mortalidad&#44; con una asociaci&#243;n en relaci&#243;n directa con el volumen convectivo&#46; En el momento presente no est&#225; bien establecido si el aumento del flujo del l&#237;quido de di&#225;lisis &#40;Qd&#41; puede suponer mejores resultados en t&#233;rminos de eficacia convectiva y depurativa&#46; El objetivo del estudio fue valorar&#44; en pacientes en tratamiento con HDF-OL&#44; el efecto de la variaci&#243;n del Qd sobre el volumen convectivo y su capacidad depurativa&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 59 pacientes&#44; 45 varones y 14 mujeres que se encontraban en programa de HDF-OL con monitor 5008 Cordiax con autosustituci&#243;n&#46; Cada paciente fue analizado en 5 sesiones con HDF-OL posdilucional&#44; con dializadores de helixona&#44; en las que solo se vari&#243; el Qd &#40;300&#44; 400&#44; 500&#44; 600 y 700<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#41;&#46; En cada sesi&#243;n se determinaron concentraci&#243;n de urea &#40;60<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; creatinina &#40;113 Da&#41;&#44; &#946;<span class="elsevierStyleInf">2</span>-microglobulina &#40;11&#46;800<span class="elsevierStyleHsp" style=""></span>Da&#41;&#44; mioglobina &#40;17&#46;200<span class="elsevierStyleHsp" style=""></span>Da&#41; y &#945;<span class="elsevierStyleInf">1</span>-microglobulina &#40;33&#46;000<span class="elsevierStyleHsp" style=""></span>Da&#41; en suero al inicio y al final de cada sesi&#243;n&#44; para calcular el porcentaje de reducci&#243;n de estos solutos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se objetiv&#243; un aumento de litros de Qd por sesi&#243;n&#44; desde 117&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;4 L con Qd de 300<span class="elsevierStyleHsp" style=""></span>ml&#47;min hasta 232&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 L con Qd 700<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; No se determinaron cambios en el volumen de sustituci&#243;n ni en el volumen convectivo&#46; En t&#233;rminos de difusi&#243;n&#44; el incremento del Qd mostr&#243; un aumento significativo de la dosis de di&#225;lisis&#44; con un aumento de Kt de 68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;9 L con Qd 300<span class="elsevierStyleHsp" style=""></span>ml&#47;min hasta 75&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;3 L con Qd 700<span class="elsevierStyleHsp" style=""></span>ml&#47;min &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y un aumento progresivo del porcentaje de reducci&#243;n de urea con el incremento del Qd&#44; que era significativamente inferior con Qd 300<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#46; No se objetivaron cambios en el resto de mol&#233;culas estudiadas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La variaci&#243;n del Qd en HDF-OL no modifica el volumen convectivo&#46; Un mayor Qd mostr&#243; un discreto incremento de la depuraci&#243;n de la urea&#44; sin variaciones en las medianas ni en las grandes mol&#233;culas&#46; Es recomendable optimizar el Qd al m&#237;nimo posible que garantice una adecuada dosis de di&#225;lisis y permita racionalizar el consumo de agua y concentrado de di&#225;lisis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; Maduell F&#44; Ojeda R&#44; Arias-Guill&#233;n M&#44; Fontser&#233; N&#44; Vera M&#44; Mass&#243; E&#44; et al&#46; Optimizaci&#243;n del flujo del l&#237;quido de di&#225;lisis en la hemodiafiltraci&#243;n <span class="elsevierStyleItalic">on-line</span>&#46; Nefrologia&#46; 2015&#59;35&#58;473&#8211;478&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Changes in dialysate volume according to Qd&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#59; ANOVA for repeated measures&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Changes in convective volume according to Qd&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#59; ANOVA for repeated measures&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">NS&#44; not significant&#59; Qb&#44; blood flow&#59; Qd&#44; dialysate flow&#59; Td&#44; dialysis time&#46;</p>"
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                  \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">Qd &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Qb &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">423&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">423&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">423&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">423&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">423&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&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">Processed blood volume &#40;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">121&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&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">Needle gauge 15&#47;16 &#40;&#37;&#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&#47;91&#46;4&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&#47;91&#46;4&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&#47;91&#46;4&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&#47;91&#46;4&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&#47;91&#46;4&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">Recirculation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4&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">Prescribed Td &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">Delivered Td &#40;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">288&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">288&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">288&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">287&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">287&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&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">Initial weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&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">Final weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;53<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&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">Weight gain &#40;kg&#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;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;99&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;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;00&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;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;02&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;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;95&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;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;11&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">Initial haematocrit &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&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">Final haematocrit &#40;&#37;&#41;&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;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&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;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;5&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;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Comparison of dialysis parameters for the 5 different Qd settings &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NS&#44; not significant&#59; <span class="elsevierStyleItalic">P</span>&#44; probability&#59; Qi&#44; infusion flow&#59; QUF&#44; ultrafiltration flow&#59; TMP&#44; transmembrane pressure&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><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">Qd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Arterial pressure &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;225<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;222<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;224<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;225<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;222<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&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">Venous pressure &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">217<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">218<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&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">TMP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">188&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&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">Substitution volume &#40;L&#47;session&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&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">Convective volume &#40;L&#47;session&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;1&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">Qi &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&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">QUF &#40;mL&#47;min&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&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">Percentage of convective volume over processed blood &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of substitution volume&#44; total convective volume&#44; infusion flow&#44; ultrafiltration flow&#44; and processed blood volume at different dialysate flow rates &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41;&#46;</p>"
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                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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Qd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">600&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">700&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">Kt &#40;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&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">&#37; reduction urea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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">&#37; reduction Cr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;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">&#37; reduction &#946;<span class="elsevierStyleInf">2</span>-m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;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">&#37; reduction myoglobin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#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">&#37; reduction &#945;<span class="elsevierStyleInf">1</span>-microglobulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Article information

ISSN: 20132514
Original language: English

DOI:10.1016/j.nefroe.2015.11.002

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Year/Month	Html	Pdf	Total

2024 November	4	7	11
2024 October	64	40	104
2024 September	83	37	120
2024 August	95	66	161
2024 July	57	30	87
2024 June	76	44	120
2024 May	85	38	123
2024 April	59	31	90
2024 March	47	38	85
2024 February	40	41	81
2024 January	36	45	81
2023 December	49	36	85
2023 November	42	38	80
2023 October	83	33	116
2023 September	36	21	57
2023 August	48	27	75
2023 July	62	29	91
2023 June	61	25	86
2023 May	53	30	83
2023 April	44	18	62
2023 March	59	21	80
2023 February	46	22	68
2023 January	60	24	84
2022 December	65	36	101
2022 November	72	25	97
2022 October	55	44	99
2022 September	64	35	99
2022 August	61	44	105
2022 July	45	46	91
2022 June	57	43	100
2022 May	51	41	92
2022 April	102	57	159
2022 March	86	52	138
2022 February	98	61	159
2022 January	128	37	165
2021 December	88	43	131
2021 November	60	41	101
2021 October	90	42	132
2021 September	83	47	130
2021 August	88	48	136
2021 July	68	46	114
2021 June	59	21	80
2021 May	79	43	122
2021 April	137	38	175
2021 March	74	26	100
2021 February	85	13	98
2021 January	52	14	66
2020 December	61	17	78
2020 November	48	13	61
2020 October	38	13	51
2020 September	67	17	84
2020 August	54	16	70
2020 July	55	19	74
2020 June	63	14	77
2020 May	76	15	91
2020 April	52	20	72
2020 March	60	21	81
2020 February	61	35	96
2020 January	66	24	90
2019 December	83	31	114
2019 November	85	39	124
2019 October	83	22	105
2019 September	102	27	129
2019 August	83	26	109
2019 July	53	26	79
2019 June	57	40	97
2019 May	85	33	118
2019 April	92	38	130
2019 March	50	20	70
2019 February	42	21	63
2019 January	52	30	82
2018 December	132	39	171
2018 November	243	21	264
2018 October	152	21	173
2018 September	117	15	132
2018 August	88	21	109
2018 July	92	22	114
2018 June	63	9	72
2018 May	50	14	64
2018 April	44	9	53
2018 March	48	7	55
2018 February	33	7	40
2018 January	33	4	37
2017 December	44	8	52
2017 November	47	12	59
2017 October	37	5	42
2017 September	40	10	50
2017 August	27	7	34
2017 July	35	9	44
2017 June	56	10	66
2017 May	61	9	70
2017 April	54	19	73
2017 March	26	7	33
2017 February	40	13	53
2017 January	20	5	25
2016 December	52	4	56
2016 November	69	21	90
2016 October	85	10	95
2016 September	145	6	151
2016 August	188	5	193
2016 July	195	20	215
2016 June	117	0	117
2016 May	202	0	202
2016 April	170	0	170
2016 March	161	0	161
2016 February	146	0	146
2016 January	126	0	126
2015 December	104	0	104

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