Editorial
Acute kidney injury in Latin America in “big data” era
Lesión renal aguda en Latinoamérica en la era del big data
Fernando Lombia,1,2,
, Carlos Federico Varelab,1,2, Ricardo Martinezc,1,2, Gustavo Grelonib,1,2, Vicente Campolo Girardd,1, Guillermo Rosa-Diezb,1,2
Corresponding author
a Servicio de Nefrología, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
b Servicio de Nefrología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
c Servicio de Nefrología, Hospital Churruca Visca Buenos Aires, Buenos Aires, Argentina
d Servicio de Terapia Intensiva, Clínica Pasteur, Neuquén, Argentina
Read
9755
Timeswas read the article
3277
Total PDF
6478
Total HTML
Share statistics
array:24 [ "pii" => "S2013251417301591" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.09.004" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "362" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Nefrologia (English Version). 2017;37:461-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4270 "formatos" => array:3 [ "EPUB" => 301 "HTML" => 3330 "PDF" => 639 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699517300681" "issn" => "02116995" "doi" => "10.1016/j.nefro.2017.03.010" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "362" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Nefrologia. 2017;37:461-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4625 "formatos" => array:3 [ "EPUB" => 290 "HTML" => 3474 "PDF" => 861 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Lesión renal aguda en Latinoamérica en la era del <span class="elsevierStyleItalic">big data</span>" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "464" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute kidney injury in Latin America in “big data” era" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Lombi, Carlos Federico Varela, Ricardo Martinez, Gustavo Greloni, Vicente Campolo Girard, Guillermo Rosa Diez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Lombi" ] 1 => array:2 [ "nombre" => "Carlos Federico" "apellidos" => "Varela" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Martinez" ] 3 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Greloni" ] 4 => array:2 [ "nombre" => "Vicente" "apellidos" => "Campolo Girard" ] 5 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Rosa Diez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251417301591" "doi" => "10.1016/j.nefroe.2017.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301591?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517300681?idApp=UINPBA000064" "url" => "/02116995/0000003700000005/v2_201709270247/S0211699517300681/v2_201709270247/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417301578" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.09.002" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "364" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Nefrologia (English Version). 2017;37:465-77" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7230 "formatos" => array:3 [ "EPUB" => 293 "HTML" => 5790 "PDF" => 1147 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Monoclonal gammopathies of renal significance" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "477" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gammapatías monoclonales de significado renal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Caravaca-Fontán, Eduardo Gutiérrez, Ramón Delgado Lillo, Manuel Praga" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Caravaca-Fontán" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Gutiérrez" ] 2 => array:2 [ "nombre" => "Ramón" "apellidos" => "Delgado Lillo" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Praga" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021169951730070X" "doi" => "10.1016/j.nefro.2017.03.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951730070X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301578?idApp=UINPBA000064" "url" => "/20132514/0000003700000005/v2_201710131456/S2013251417301578/v2_201710131456/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Acute kidney injury in Latin America in “big data” era" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "461" "paginaFinal" => "464" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fernando Lombi, Carlos Federico Varela, Ricardo Martinez, Gustavo Greloni, Vicente Campolo Girard, Guillermo Rosa-Diez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Fernando" "apellidos" => "Lombi" "email" => array:1 [ 0 => "fernandolombi@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn0010" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlos Federico" "apellidos" => "Varela" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn0010" ] ] ] 2 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Martinez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn0010" ] ] ] 3 => array:3 [ "nombre" => "Gustavo" "apellidos" => "Greloni" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn0010" ] ] ] 4 => array:3 [ "nombre" => "Vicente" "apellidos" => "Campolo Girard" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 5 => array:3 [ "nombre" => "Guillermo" "apellidos" => "Rosa-Diez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "fn0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Británico de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Churruca Visca Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Terapia Intensiva, Clínica Pasteur, Neuquén, Argentina" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesión renal aguda en Latinoamérica en la era del <span class="elsevierStyleItalic">big data</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Latin America includes 20 countries, with an estimated population of 625 million according to data from the Economic Commission for Latin America and the Caribbean region (CEPAL).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">One of the main stigmas is the prevailing social inequity: Latin America has the world's second highest level of inequality (Gini coefficient 52.9), just below that of sub-Saharan Africa (56.5).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The inequalities are mainly based on gender, ethnicity, per capita income, geographic areas (rural vs urban area), heterogeneity in terms of infrastructure and asymmetry in technological development. These social inequalities determine the evolution of these populations in terms of health.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a few years, an ageing population will be the predominant in our society. If no changes are made, this ageing population will be exposed to the prevailing inequality phenomenon in the region, with a disproportionate high risk of developing acute and chronic diseases (especially kidney diseases).</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is estimated that population growth rates for Latin America will reach 680 million by 2025 and 779 million by 2050.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> Some organisations warn that a inversion of the ratio between individuals aged over 65 years and children younger than 5 years will be reached by 2047.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this situation, everything concerning healthcare costs is of particular importance as they will have a huge impact on national budgets. In this regard, the consulting firm Ernst & Young<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> warns about the levels of unsustainability generated by this emerging situation, which must be addressed by the healthcare systems.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In addition to inequality</span>, an <span class="elsevierStyleItalic">ageing population</span> and <span class="elsevierStyleItalic">unsustainability of healthcare cost, the</span> heterogeneity of the population in the region complicates the situation. Population heterogeneity forces the states to attend a very different healthcare demands, given the geographic dispersion and high vulnerability, with large deficits in logistics and infrastructure in some areas.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this context, acute kidney injury (AKI) in Latin America is important by itself, given the major impact that it generates in terms of <span class="elsevierStyleItalic">morbidity</span>, <span class="elsevierStyleItalic">mortality</span> and <span class="elsevierStyleItalic">costs.</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> Nowadays, AKI is the most common reason for consultations in nephrology departments<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a>: according to different publications, the incidence varies between 2000<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> and 15,000<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> patients per million inhabitants per year. In addition, the incidence of AKI requiring renal replacement therapy is 533 patients per million inhabitants per year.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> This figure increases significantly if those patients requiring renal support therapy are taken into account (in the context of situations such as refractory septic shock, permissive hypercapnia, parenteral nutrition, volume overload >10% of body weight, etc.). The purpose of applying these technologies designed to treat kidney failure with support therapies is to regulate volume status, electrolyte balance or acid-base balance, without AKI necessarily being present.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">As stated in previous publications by Lombardi et al.,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> currently it is very difficult to establish accurately the incidence of AKI in Latin America, given the lack of data which makes very difficult to approach this condition. The first part of the AKI 0by25<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> initiative demonstrated that the figures on AKI incidence come mostly from epidemiological studies carried out in developed countries with little participation of countries in the region. This means that these data should be interpreted with caution, as the epidemiology of AKI is different in these developed countries, where it is predominantly present in urban environments, with national epidemiological records available and a specific coding system.</p><p id="par0050" class="elsevierStylePara elsevierViewall">It is t speculated that the incidence of AKI is significantly higher in developing countries, such as Latin America. The epidemiological situation of the countries in the region makes AKI be present in predominantly suburban and rural environments without national epidemiological records, and with a vast majority of published papers concerning single-centre studies in critical care areas, and with no uniformity in definitions.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The lack of data on the incidence of AKI in Latin America makes the planning of regional healthcare policies very difficult. Thus, scientific societies face the challenge of providing a response to the pressing demand of the generation of regional coded record of AKI.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In this context, and taking into account the latest estimations of the United Nations (UN) on the world's population (7 billion),<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> 9% of which live in Latin America (625 million). A merely speculative exercise based on these data, would indicate that the projected figures of AKI incidence in Latin America will reach 1,250,000<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> to 9,375,000<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> people per year. Of these people, 333,125 to 2,498,437 patients would require some type of renal replacement therapy.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> This figure would also be much higher if we consider the indications for renal support therapy.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Being aware of this situation, the International Society of Nephrology (ISN) has sponsored global campaigns, such as those mentioned, to address this scourge. Perhaps the most representative is the 0by25 Initiative for AKI. This recognises the medical care of AKI as a human right and sets out the challenge of eliminating all preventable deaths due to AKI by 2025.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">However, in the design of this campaign, different countries were classified according to their level of development, as defined by gross national income (GNI) per capita stipulated by the World Bank in 2014.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Based on this, the countries were divided up according to their level of development:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">High level of development (HLD) if GNI <span class="elsevierStyleItalic">per capita</span> >US$ 12,476.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">High/medium level of development (HMLD) if GNI <span class="elsevierStyleItalic">per capita</span> is between US$ 4035 and 12,476.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Medium/low level of development (LMLD) if GNI <span class="elsevierStyleItalic">per capita</span> is between US$ 1045 and 4035.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Low level of development (LLD) if GNI <span class="elsevierStyleItalic">per capita</span></p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">According to this concept, Latin American countries would be classified as follows:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">HLD: Argentina, Chile, Uruguay.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">HMLD: Brazil, Colombia, Costa Rica, Ecuador, Mexico, Granada, Jamaica, Panama, Peru, Dominican Rep. Paraguay, Suriname.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">LMLD: Bolivia, Ecuador, Guatemala, Guyana, Honduras, Nicaragua.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">LLD: Haiti.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">No data available: Cuba, French Guiana, Puerto Rico, Venezuela.</p></li></ul></p><p id="par0125" class="elsevierStylePara elsevierViewall">The GNI per capita refers to economic growth on its own, based on the value of all goods and services produced by the residents of a country during a specified period of time (generally one year) divided by the number of inhabitants. From this perspective, Latin American countries such as Argentina, Chile and Uruguay would share the same weighting as countries such as Germany, Australia and Sweden. However, if the healthcare costs per capita for 2014, according to the World Bank, are taken into account, the figures are very diverse for these Latin American countries: Argentina US$ 605, Chile US$ 1137, and Uruguay US$ 1442 in contrast with Germany US$ 5411, Australia US$ 6031 and Sweden US$ 6808.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> This generates an unrealistic assessment of this GNI weighting. Furthermore, the GNI does not reveal any information on how this income is invested, or whether it is used to improve health, education or other outcomes in terms of human development.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In order to avoid this bias, it is perhaps more appropriate to use the human development index (HDI),<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> a statistical social indicator based on people and their capabilities which weighs up three parameters (<span class="elsevierStyleItalic">a long and healthy life, being knowledgeable and having a decent standard of living</span>). This is due to the fact that there is a risk of not fulfilling the premise of the initiative regarding medical care for AKI that is considered a human right, due to the loss of universality of this right.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Irrespective of the data, there are several circumstances that would explain the adverse development of AKI in these countries, which are more closely related to the weighting contained in the HDI. These include: lack of or inadequate training of healthcare personnel, lack of awareness of the consequences, limited access to healthcare services, limited diagnostic tools, lack of clinical practice guidelines and limitations in terms of the treatment offered.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In this regard, the current innovative process is hugely disruptive, focussed mainly on the collection and analysis of data, a phenomenon known as “big data”, from which more accurate and effective strategies to tackle AKI can be designed.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In order to take this campaign forward at a regional level, it is essential to make a significant investment in <span class="elsevierStyleItalic">technology</span>. The main obstacle to this objective is <span class="elsevierStyleItalic">funding</span>, which is a serious problem, particularly in Latin America, given the prevailing socio-economic crisis. The criterium of sustainability is therefore key when it comes to evaluating and defining the scenarios. One strategy for dealing with <span class="elsevierStyleItalic">funding</span> commits to innovative ways of purchasing, which include “shared risk” schemes between the hospital and the supplying company, with the double objective of providing access to complex technology therapies and reducing the financial risk; the refund of the product is conditioned on the results of planned outcomes and those agreed in the contract (health outcomes, saving, etc.).<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In this regard, the 15th Acute Dialysis Quality Initiative (ADQI) Conference focussed on the growth of data regarding AKI and the unprecedented opportunity to be able to address certain knowledge gaps and plan public health strategies, developing tangible strategies to reconfigure the infrastructure, in order to improve the quality of scientific studies and characterise the AKI phenotype.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Numerous virtual platforms have now been developed in order to promote and facilitate understanding of innovation in the field of healthcare technology. All agents involved in the innovation and marketing process are brought together in one single forum. An example of this is Medintech (Spain), or the National Innovation Centre of the NHS, recently transformed into The Knowledge and Information Zone (United Kingdom), etc. These types of platform appear to be a possible solution given that in a large part of Latin America the scientific and technological capabilities are concentrated in universities and frequently, the university agendas, their prevailing structures and policies and incentive schemes generate dynamics which are barely connected to the daily needs of the people. The connection of investigators and institutions with the community is not usually strong enough to promote the innovative circuits and interactive learning spaces that are required to solve such problems.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusion</span><p id="par0160" class="elsevierStylePara elsevierViewall">Technological and scientific advances are taking place at amazing speed, with a deep disruptive significance. It may be possible to exploit these to change the AKI paradigm in one of the world's most unequal regions.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The capitalisation of this opportunity should aim to integrate the AKI data on a regional basis, creating a coded base, in accordance with the guidelines of the 15th ADQI conference.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> The objective is to establish strategic plans of action that will benefit the most vulnerable populations, regardless of the place that the country occupies in terms of level of development as estimated by the GNI given that there is a risk of losing the universality of the right to healthcare. Perhaps the measurement of the HDI or the intensity of poverty could be used to focus the care.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Public/private consortiums, regulated by scientific societies and international bodies, could perhaps meet sustainability and funding.</p><p id="par0175" class="elsevierStylePara elsevierViewall">All efforts should be focussed on achieving the slogan of the 0by25<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> AKI campaign promoted by the ISN: medical care for AKI as a human right and eliminating all preventable deaths from AKI by 2025.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conclusion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lombi F, Varela CF, Martinez R, Greloni G, Campolo Girard V, Rosa Diez G. Lesión renal aguda en Latinoamérica en la era del <span class="elsevierStyleItalic">big data</span>. Nefrologia. 2017;37:461–464.</p>" ] 1 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Grupo de trabajo de IRA de la Sociedad Argentina de Nefrología (SAN).</p>" "identificador" => "fn0005" ] 2 => array:3 [ "etiqueta" => "2" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Consejo de nefrología crítica de la Asociación Nefrológica de Buenos Aires (ANBA).</p>" "identificador" => "fn0010" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Comisión Económica para América Latina y el Caribe. Naciones Unidas. Available from: <a href="http://www.cepal.org/es/estimaciones-proyecciones-poblacion-largo-plazo-1950-2100">http://www.cepal.org/es/estimaciones-proyecciones-poblacion-largo-plazo-1950-2100</a> [accessed 28.11.16]." ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Socio-Economic Database for Latin America and the Caribbean. Available from: <a href="http://sedlac.econo.unlp.edu.ar/esp/estadisticas-detalle.php?idE=52">http://sedlac.econo.unlp.edu.ar/esp/estadisticas-detalle.php?idE=52</a> [accessed 28.11.16]." ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Coalition on Aging. Available from: <a href="http://www.globalcoalitiononaging.com/index.php?id=aging-resources">http://www.globalcoalitiononaging.com/index.php?id=aging-resources</a> [accessed 22.10.16]." ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consultora Ernst & Young. Available from: <a href="http://www.ey.com/US/en/Industries/Health">http://www.ey.com/US/en/Industries/Health</a> [accessed 6.3.16]." ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury-epidemiology, outcomes and economics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Rewa" 1 => "S.M. Bagshaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrneph.2013.282" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Nephrol" "fecha" => "2014" "volumen" => "10" "paginaInicial" => "193" "paginaFinal" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24445744" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The daily burden of acute kidney injury: a survey of U.S. nephrologists on World Kidney Day" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Acute Kidney Injury Advisory Group of the American Society of Nephrology" "etal" => true "autores" => array:6 [ 0 => "J.L. Koyner" 1 => "J. Cerdá" 2 => "S.L. Goldstein" 3 => "B.L. Jaber" 4 => "K.D. Liu" 5 => "J.A. Shea" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2014.03.018" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2014" "volumen" => "64" "paginaInicial" => "394" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24815216" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury and chronic kidney disease: an integrated clinical syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.S. Chawla" 1 => "P.L. Kimmel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ki.2012.208" "Revista" => array:6 [ "tituloSerie" => "Kidney Int" "fecha" => "2012" "volumen" => "82" "paginaInicial" => "516" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22673882" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What is the real impact of acute kidney injury?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Bedford" 1 => "P.E. Stevens" 2 => "T.W. Wheeler" 3 => "C.K. Farmer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2369-15-95" "Revista" => array:5 [ "tituloSerie" => "BMC Nephrol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24952580" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Temporal changes in incidence of dialysis-requiring AKI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.K. Hsu" 1 => "C.E. McCulloch" 2 => "R.A. Dudley" 3 => "L.J. Lo" 4 => "C.Y. Hsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2012080800" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "37" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23222124" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terapia de reemplazo renal en la IRA. Recomendaciones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Grupo de trabajo de IRA-SAN" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "Ediciones Journal" "editorialLocalizacion" => "Buenos Aires" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of acute kidney injury in Latin America" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Lombardi" 1 => "L. Yu" 2 => "M. Younes-Ibrahim" 3 => "N. Schor" 4 => "E.A. Brudmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.semnephrol.2008.04.001" "Revista" => array:6 [ "tituloSerie" => "Semin Nephrol" "fecha" => "2008" "volumen" => "28" "paginaInicial" => "320" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18620955" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International Society of Nephrology's 0 by 25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.L. Mehta" 1 => "J. Cerdá" 2 => "E.A. Burdmann" 3 => "M. Tonelli" 4 => "G. Gracia-Garcia" 5 => "V. Jha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)60126-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2015" "volumen" => "385" "paginaInicial" => "2616" "paginaFinal" => "2643" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25777661" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0160" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "United States Census Bureau. Available from: <a href="http://www.census.gov/popclock/world">http://www.census.gov/popclock/world</a> [accessed 1.9.16]." ] ] ] 13 => array:3 [ "identificador" => "bib0165" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Banco Mundial. Available from: <a href="http://datos.bancomundial.org/indicador/NY.GNP.PCAP.CD">http://datos.bancomundial.org/indicador/NY.GNP.PCAP.CD</a> [accessed 28.10.16]." ] ] ] 14 => array:3 [ "identificador" => "bib0170" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Banco Mundial. Available from: <a href="http://datos.bancomundial.org/indicador/SH.XPD.PCAP">http://datos.bancomundial.org/indicador/SH.XPD.PCAP</a> [accessed 28.10.16]." ] ] ] 15 => array:3 [ "identificador" => "bib0175" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "United Nations Development Report. Available from: <a href="http://hdr.undp.org/es/content/el-%C3%ADndice-de-desarrollo-humano-idh">http://hdr.undp.org/es/content/el-%C3%ADndice-de-desarrollo-humano-idh</a> [accessed 28.10.16]." ] ] ] 16 => array:3 [ "identificador" => "bib0180" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury in low-resource settings: barriers to diagnosis, awareness, and treatment and strategies to overcome these barriers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Joseph Lunyera" 1 => "K. Kilonzo" 2 => "A. Lewington" 3 => "K. Yeates" 4 => "F.O. Finkelstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2015.12.018" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "834" "paginaFinal" => "840" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26830256" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0185" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esquemas innovadores de mejora del acceso al mercado de nuevas tecnologías: los acuerdos de riesgo compartido" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Espín" 1 => "J. Oliva" 2 => "J.M. Rodríguez-Barrios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2010.07.011" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "491" "paginaFinal" => "497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21074292" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0190" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimizing administrative datasets to examine acute kidney injury in the era of big data: workgroup statement from the 15th ADQI Consensus Conference" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "on behalf of the 15th ADQI Consensus Group" "etal" => true "autores" => array:6 [ 0 => "E.D. Siew" 1 => "R.K. Basu" 2 => "H. Wunsch" 3 => "A.D. Shaw" 4 => "S.L. Goldstein" 5 => "C. Ronco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40697-016-0098-5" "Revista" => array:6 [ "tituloSerie" => "Can J Kidney Health Dis" "fecha" => "2016" "volumen" => "3" "paginaInicial" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26925248" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0007091217311595" "estado" => "S300" "issn" => "00070912" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003700000005/v2_201710131456/S2013251417301591/v2_201710131456/en/main.assets" "Apartado" => array:4 [ "identificador" => "38706" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003700000005/v2_201710131456/S2013251417301591/v2_201710131456/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417301591?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 11 | 20 |
| 2024 October | 86 | 58 | 144 |
| 2024 September | 62 | 57 | 119 |
| 2024 August | 83 | 73 | 156 |
| 2024 July | 83 | 29 | 112 |
| 2024 June | 153 | 55 | 208 |
| 2024 May | 62 | 49 | 111 |
| 2024 April | 63 | 47 | 110 |
| 2024 March | 55 | 32 | 87 |
| 2024 February | 59 | 43 | 102 |
| 2024 January | 36 | 38 | 74 |
| 2023 December | 45 | 33 | 78 |
| 2023 November | 67 | 39 | 106 |
| 2023 October | 55 | 42 | 97 |
| 2023 September | 73 | 32 | 105 |
| 2023 August | 69 | 31 | 100 |
| 2023 July | 55 | 19 | 74 |
| 2023 June | 19 | 14 | 33 |
| 2023 May | 55 | 627 | 682 |
| 2023 April | 34 | 15 | 49 |
| 2023 March | 52 | 21 | 73 |
| 2023 February | 35 | 15 | 50 |
| 2023 January | 34 | 20 | 54 |
| 2022 December | 58 | 32 | 90 |
| 2022 November | 57 | 37 | 94 |
| 2022 October | 60 | 41 | 101 |
| 2022 September | 73 | 43 | 116 |
| 2022 August | 37 | 51 | 88 |
| 2022 July | 31 | 45 | 76 |
| 2022 June | 51 | 49 | 100 |
| 2022 May | 57 | 39 | 96 |
| 2022 April | 39 | 55 | 94 |
| 2022 March | 45 | 50 | 95 |
| 2022 February | 67 | 56 | 123 |
| 2022 January | 50 | 40 | 90 |
| 2021 December | 42 | 58 | 100 |
| 2021 November | 43 | 28 | 71 |
| 2021 October | 43 | 46 | 89 |
| 2021 September | 45 | 44 | 89 |
| 2021 August | 35 | 50 | 85 |
| 2021 July | 91 | 37 | 128 |
| 2021 June | 43 | 19 | 62 |
| 2021 May | 52 | 52 | 104 |
| 2021 April | 82 | 54 | 136 |
| 2021 March | 76 | 32 | 108 |
| 2021 February | 43 | 51 | 94 |
| 2021 January | 52 | 16 | 68 |
| 2020 December | 52 | 21 | 73 |
| 2020 November | 42 | 17 | 59 |
| 2020 October | 43 | 19 | 62 |
| 2020 September | 34 | 19 | 53 |
| 2020 August | 54 | 27 | 81 |
| 2020 July | 43 | 23 | 66 |
| 2020 June | 42 | 32 | 74 |
| 2020 May | 69 | 14 | 83 |
| 2020 April | 57 | 15 | 72 |
| 2020 March | 62 | 18 | 80 |
| 2020 February | 66 | 28 | 94 |
| 2020 January | 37 | 33 | 70 |
| 2019 December | 56 | 24 | 80 |
| 2019 November | 44 | 17 | 61 |
| 2019 October | 34 | 36 | 70 |
| 2019 September | 50 | 15 | 65 |
| 2019 August | 36 | 18 | 54 |
| 2019 July | 33 | 25 | 58 |
| 2019 June | 54 | 17 | 71 |
| 2019 May | 36 | 30 | 66 |
| 2019 April | 68 | 50 | 118 |
| 2019 March | 49 | 43 | 92 |
| 2019 February | 34 | 22 | 56 |
| 2019 January | 40 | 32 | 72 |
| 2018 December | 218 | 55 | 273 |
| 2018 November | 408 | 25 | 433 |
| 2018 October | 383 | 25 | 408 |
| 2018 September | 165 | 16 | 181 |
| 2018 August | 82 | 18 | 100 |
| 2018 July | 71 | 16 | 87 |
| 2018 June | 84 | 18 | 102 |
| 2018 May | 182 | 15 | 197 |
| 2018 April | 171 | 15 | 186 |
| 2018 March | 241 | 9 | 250 |
| 2018 February | 185 | 5 | 190 |
| 2018 January | 171 | 7 | 178 |
| 2017 December | 196 | 10 | 206 |
| 2017 November | 107 | 9 | 116 |
| 2017 October | 61 | 14 | 75 |
| 2017 September | 2 | 0 | 2 |
Show all
