Letter to the Editor
Acute renal failure in patients with myeloma: Experience with extended high cut-off hemodialysis
Fracaso renal agudo en pacientes con mieloma: Nuestra experiencia con hemodiálisis extendidas con dializadores de alto poro
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class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Vanesa" "apellidos" => "Camarero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Rosales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Badawi" "apellidos" => "Hijazi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "María Jesus" "apellidos" => "Izquierdo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Jorge" "apellidos" => "Labrador" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Rodolfo" "apellidos" => "Alvárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "Julio" "apellidos" => "Hermida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Verónica" "apellidos" => "Mercado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "María Dolores" "apellidos" => "Badía" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 10 => array:3 [ "nombre" => "Raquel" "apellidos" => "de Toro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 11 => array:3 [ "nombre" => "Basilia" "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 12 => array:3 [ "nombre" => "Pedro" "apellidos" => "Abaigar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Análisis Clínico, Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracaso renal agudo en pacientes con mieloma: Nuestra experiencia con hemodiálisis extendidas con dializadores de alto poro" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The aim of this study was to share our experience and add further evidence to those studies already published in the literature proposing haemodialysis (HD) with high-cut-off (HCO) dialysers as a promising option in the treatment of myeloma kidney.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a prospective study from November 2012 to February 2015 and evaluated eight patients with multiple myeloma and acute renal failure requiring dialysis, with serum free light chain (FLC) levels >500<span class="elsevierStyleHsp" style=""></span>mg/L (measured by nephelometry; FREELITE<span class="elsevierStyleSup">®</span>, The Binding Site, Birmingham, United Kingdom).</p><p id="par0015" class="elsevierStylePara elsevierViewall">All patients received treatment with bortezomib-based regimens.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients signed a consent form after being informed about the technique.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two patients had renal biopsy, with a histopathology diagnosis of cast nephropathy. Renal biopsy was not performed in the remaining cases because of hemathologic abnormalities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patients had a 8-h HD sessions with a HCO 2100 dialyser (Theralite<span class="elsevierStyleSup">®</span>, 2.1<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, Gambro, Deerfield, Illinois, USA), using the HD monitors routinely used in our unit (5008 CorDiax<span class="elsevierStyleSup">®</span>, Fresenius Medical Care, Bad Homburg, Germany), with blood flows of 250–300<span class="elsevierStyleHsp" style=""></span>mL/min and ultrapure dialysis fluid flow of 500<span class="elsevierStyleHsp" style=""></span>mL/min.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Heparinisation was achieved with hourly doses of unfractionated sodium heparin (initial dose of 0.5<span class="elsevierStyleHsp" style=""></span>mg/kg in the first hour and 10<span class="elsevierStyleHsp" style=""></span>mg/h with adjustment according to aPTT after 4<span class="elsevierStyleHsp" style=""></span>h).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Replacement fluid after each session was albumin 20% (100<span class="elsevierStyleHsp" style=""></span>mL), monosodium phosphate (10<span class="elsevierStyleHsp" style=""></span>mL), 1<span class="elsevierStyleHsp" style=""></span>M magnesium sulphate (10<span class="elsevierStyleHsp" style=""></span>mL) and calcium gluconate. These supplements were adjusted according to the needs of each patient.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The treatment regimen included 5 sessions in consecutive days, 6 sessions on alternate days and then 3 weekly sessions until recovery of renal function and/or a reduction in FLC <500<span class="elsevierStyleHsp" style=""></span>mg/L and/or after 6 weeks had elapsed, at which time an assessment was made of whether or not to continue treatment according to the patient's clinical evolution and response to chemotherapy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Data analysis was performed using SPSS 15.0.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Eight patients were analysed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Three were male (37%) and five female (62%), with mean age 67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 years. Six patients (75%) had <span class="elsevierStyleItalic">de novo</span> multiple myeloma and two (25%) had relapses. One patient (12%) had a history of chronic kidney disease as a result of nephroangiosclerosis (eGFR by CDK-EPI: 49<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>). The FLC were <span class="elsevierStyleItalic">lambda</span> in five patients (62%). Seven patients (87%) had renal involvement at the time of diagnosis and all required HD at the start of treatment. The median number of FLC at baseline was 3415<span class="elsevierStyleHsp" style=""></span>mg/L (2740–11,975). In 3 patients (37%), HD with HCO was delayed ≥7 days from the time of diagnosis of acute renal failure.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A median of 10 extended HD sessions with HCO were performed per patient (8–19), with a mean reduction in FLC per session of 73% (61–77). In the last HD with HCO session, we observed a mean concentration of FLC (pre-dialysis) of 972<span class="elsevierStyleHsp" style=""></span>mg/L (562–2815).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Six patients (75%) had an improvement in renal function, no longer requiring HD at the end of treatment. Two patients had no improvement in renal function and had to start long-term HD programmes. The start of treatment with HD with HCO had been delayed for more than seven days in both of these patients, one of whom was refractory to chemotherapy.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Among the patients who recovered renal function, we observed a median of 9 months free of HD (5–15). The mean follow-up time for each patient was 9 months (4–15). One patient died 11<span class="elsevierStyleHsp" style=""></span>months after starting HD with HCO because the development of sepsis with multiple organ failure, having maintained stable renal function up to that time.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mean albumin levels were 2.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4<span class="elsevierStyleHsp" style=""></span>g/dL, potassium 3.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4<span class="elsevierStyleHsp" style=""></span>mEquiv./L, phosphorus 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.6<span class="elsevierStyleHsp" style=""></span>mg/dL, calcium 8.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2<span class="elsevierStyleHsp" style=""></span>mg/dL and magnesium 1.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.3<span class="elsevierStyleHsp" style=""></span>mg/dL.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Patients tolerated the sessions satisfactorily from a haemodynamic point of view, and there were no incidents of note during the sessions.</p><p id="par0085" class="elsevierStylePara elsevierViewall">An increasing number of authors are proposing HD with HCO as effective adjuvant therapies in the treatment of myeloma kidney<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–8</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The advantage of these techniques is their high cut-off point, up to 60<span class="elsevierStyleHsp" style=""></span>kD, which obtains greater clearance of the FLC.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The main limitation of these techniques is the lack of controlled, randomised studies. There are currently two European multicentre studies underway, EuLITE<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and MYRE,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> the results of which will provide more evidence on the use of these techniques.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Sáez MI, Camarero V, Rosales A, Hijazi B, Izquierdo MJ, Labrador J, et al. Fracaso renal agudo en pacientes con mieloma: Nuestra experiencia con hemodiálisis extendidas con dializadores de alto poro. Nefrología. 2017;37:429–431.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">FLC: free light chains; ARF: acute renal failure; HCO: high-cut-off dialysers; HD: haemodialysis; MM: multiple myeloma.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Extended haemodialysis with Gambro HCO 2100 dialyser (Theralite<span class="elsevierStyleSup">®</span>) was used in all cases.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \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">Type MM \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">CRP<br>Initial (mg/dL) \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">CRP<br>Final (mg/dL) \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">FLC<br>Initial (mg/L) \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">FLC<br>Final (mg/L) \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">Reduction FLC/session (median) \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">No. sessions \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">HCO<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>7 days<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IgA lambda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9330 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1300 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78% (21–64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IgG kappa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21,200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">984 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40% (71–88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BJ lambda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Long-term HD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3960 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72% (58–84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IgA lambda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2290 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">519 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70% (63–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IgG lambda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2800 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59% (67–80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BJ lambda \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10,400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1240 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78% (52–70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BJ kappa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Long-term HD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12,500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3820 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77% (67–84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IgG kappa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2720 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">694 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77% (48–85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1502165.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Start of haemodialysis with HCO<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>7 days after diagnosis with MM-related ARF.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical data of patients treated with HD with HCO.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ARF: acute renal failure; HD-HCO: extended haemodialysis with high-cut-off dialysers; HFR-SUPRA: haemodiafiltration with ultrafiltrate regeneration by adsorption in resin.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors \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">N</span> \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">Technique \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">Recovery of kidney function, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hutchison et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tan et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Martin Reyes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Buti et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Borrego-Hinojosa et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Khalafallah et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD-HCO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pendon-Ruiz et al. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HFR-SUPRA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (33) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1502166.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Experience of different authors with haemodialysis in ARF and myeloma.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: in-vitro and in-vivo studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 10 | 17 |
| 2024 October | 34 | 35 | 69 |
| 2024 September | 45 | 21 | 66 |
| 2024 August | 60 | 52 | 112 |
| 2024 July | 42 | 31 | 73 |
| 2024 June | 50 | 29 | 79 |
| 2024 May | 56 | 26 | 82 |
| 2024 April | 59 | 68 | 127 |
| 2024 March | 53 | 21 | 74 |
| 2024 February | 51 | 26 | 77 |
| 2024 January | 38 | 25 | 63 |
| 2023 December | 21 | 26 | 47 |
| 2023 November | 43 | 28 | 71 |
| 2023 October | 29 | 30 | 59 |
| 2023 September | 28 | 33 | 61 |
| 2023 August | 45 | 27 | 72 |
| 2023 July | 34 | 27 | 61 |
| 2023 June | 52 | 17 | 69 |
| 2023 May | 53 | 28 | 81 |
| 2023 April | 25 | 8 | 33 |
| 2023 March | 58 | 21 | 79 |
| 2023 February | 45 | 21 | 66 |
| 2023 January | 36 | 22 | 58 |
| 2022 December | 53 | 27 | 80 |
| 2022 November | 53 | 35 | 88 |
| 2022 October | 54 | 38 | 92 |
| 2022 September | 44 | 28 | 72 |
| 2022 August | 47 | 43 | 90 |
| 2022 July | 38 | 47 | 85 |
| 2022 June | 54 | 45 | 99 |
| 2022 May | 60 | 33 | 93 |
| 2022 April | 67 | 27 | 94 |
| 2022 March | 77 | 42 | 119 |
| 2022 February | 81 | 41 | 122 |
| 2022 January | 68 | 38 | 106 |
| 2021 December | 60 | 48 | 108 |
| 2021 November | 49 | 27 | 76 |
| 2021 October | 52 | 42 | 94 |
| 2021 September | 31 | 38 | 69 |
| 2021 August | 34 | 34 | 68 |
| 2021 July | 32 | 32 | 64 |
| 2021 June | 20 | 16 | 36 |
| 2021 May | 35 | 43 | 78 |
| 2021 April | 59 | 60 | 119 |
| 2021 March | 46 | 29 | 75 |
| 2021 February | 26 | 12 | 38 |
| 2021 January | 31 | 16 | 47 |
| 2020 December | 19 | 12 | 31 |
| 2020 November | 27 | 17 | 44 |
| 2020 October | 23 | 24 | 47 |
| 2020 September | 30 | 16 | 46 |
| 2020 August | 40 | 13 | 53 |
| 2020 July | 23 | 10 | 33 |
| 2020 June | 30 | 16 | 46 |
| 2020 May | 22 | 14 | 36 |
| 2020 April | 27 | 19 | 46 |
| 2020 March | 37 | 17 | 54 |
| 2020 February | 48 | 20 | 68 |
| 2020 January | 32 | 16 | 48 |
| 2019 December | 32 | 20 | 52 |
| 2019 November | 29 | 21 | 50 |
| 2019 October | 19 | 10 | 29 |
| 2019 September | 27 | 10 | 37 |
| 2019 August | 34 | 15 | 49 |
| 2019 July | 26 | 20 | 46 |
| 2019 June | 30 | 26 | 56 |
| 2019 May | 29 | 10 | 39 |
| 2019 April | 58 | 20 | 78 |
| 2019 March | 34 | 34 | 68 |
| 2019 February | 30 | 25 | 55 |
| 2019 January | 28 | 19 | 47 |
| 2018 December | 104 | 43 | 147 |
| 2018 November | 170 | 23 | 193 |
| 2018 October | 118 | 13 | 131 |
| 2018 September | 75 | 21 | 96 |
| 2018 August | 48 | 14 | 62 |
| 2018 July | 48 | 10 | 58 |
| 2018 June | 48 | 19 | 67 |
| 2018 May | 51 | 11 | 62 |
| 2018 April | 85 | 11 | 96 |
| 2018 March | 81 | 16 | 97 |
| 2018 February | 72 | 8 | 80 |
| 2018 January | 72 | 12 | 84 |
| 2017 December | 89 | 6 | 95 |
| 2017 November | 66 | 6 | 72 |
| 2017 October | 53 | 11 | 64 |
| 2017 September | 53 | 11 | 64 |
| 2017 August | 58 | 10 | 68 |
| 2017 July | 27 | 6 | 33 |
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