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after 7 and 9 months on HHD&#46; The first was hypotension with loss of consciousness and recovery after being disconnected by the carer&#44; who called the emergency services and the patient was transferred to hospital without requiring admission&#46; The second episode was a new hypotensive episode with loss of consciousness and seizure&#44; with the carer again being present&#46; Hospitalisation was required to rule out the possibility that the patient had stopped taking antiepileptic medication&#46; In both cases&#44; the patient was ultrafiltrating a greater quantity than recommended by our unit&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The third episode occurred in a 43-year-old patient who had been on HHD for less than 6 months&#46; It was a clot in the circuit at the end of the HD session&#44; which reached the tunnelled catheter&#44; causing full obstruction thereof&#46; The patient was transferred to hospital where we removed the obstruction with urokinase and the patient was not admitted&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The fourth episode was a new hypotensive episode in a 72-year-old patient&#44; without loss of consciousness&#44; but a call to the emergency services was required without transfer to hospital&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the MAEs&#44; we retrospectively analysed 11&#44;463 haemodialysis sessions &#40;78&#46;9&#37; of the total HHD completed&#41;&#46; In the remaining cases it was impossible for us to recover the information&#46; We recorded 272 MAEs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; with a MAE rate of 23&#46;72&#47;1000 HD sessions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Forty-one hospitalisations occurred &#40;24&#46;4&#37; scheduled&#41;&#44; 0&#46;747 admissions&#47;patients&#47;year &#40;19&#46;5&#37; due to cardiovascular causes&#44; 26&#46;8&#37; due to infectious causes not related to vascular access&#44; and 12&#46;2&#37; due to infectious causes related to vascular access&#41;&#46; Six infection events related to the haemodialysis catheter&#44; 5 required hospital admission &#40;0&#46;12 infections&#47;patient&#47;year&#41; and none in the arteriovenous fistula&#46; Regarding vascular access dysfunctions recorded as such by the patient on HHD sheets&#44; 16 were due to catheter &#40;1&#46;59&#47;1000 HD&#44; 8 required hospital HD&#41;&#44; 13 were due to fistula &#40;8&#46;95&#47;1000 HD&#44; 10 required hospital HD&#41;&#44; relative risk 5&#46;6 &#40;2&#46;7&#8211;11&#46;6&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We did not record significant differences when we attempted to relate the MAE rates to patient age&#44; Charlson &#91;index&#93;&#44; number of training sessions&#44; and type of monitor used&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients required HD in a hospital unit&#44; without considering admission episodes&#44; for 454 days &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We present a SAE rate similar to those described in the few existing series in the medical literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a> although it depends what is considered as such&#44; while Wong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> describe it as a life-threatening event&#44; Tennankore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> consider it&#44; like we did&#44; as one requiring some kind of medical action&#46; As for MAEs&#44; data are also limited&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> again depending on what is considered a minor event&#44; but our report is similar to previous publications&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We consider that in each HHD unit there should be an ongoing record of AEs that occur&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> if possible in real time&#44; in order to establish the control and feedback methods for said events&#44; to generate strategies and action protocols in order to minimise them&#46; In our case&#44; we set lower ultrafiltration limits&#44; always at 10<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h&#46; The exploration of the possibilities offered by telemedicine can provide great assistance in this regard&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Furthermore&#44; in all HHD units there should also be a series of dialysis stations that ensure sessions are available at times when the patient cannot do it at home&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We conclude that&#44; despite being impossible to eradicate the possibility of AEs&#44; the rate thereof is more than acceptable&#44; making HHD a safe technique that can offer many benefits to patients&#46;</p></span>"
    "pdfFichero" => "main.pdf"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez Alba A&#44; Reque Santiv&#225;&#241;ez J&#44; Segarra Pedro A&#44; Torres Campos S&#44; S&#225;nchez Canel JJ&#44; Fenollosa Segarra M&#193;&#44; et al&#46; Baja tasa de eventos adversos en hemodi&#225;lisis domiciliaria&#46; Nefrolog&#237;a&#46; 2018&#59;38&#58;452&#8211;454&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage of minor adverse events&#46;</p>"
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        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">HD&#58; haemodialysis&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reason&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">No&#46; of frequency&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">Percentage of frequency&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">Days&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">Percentage of days&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">Average no&#46; of days&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">Range of days&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular access problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;30&nbsp;\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">Puncture training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;123&nbsp;\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">Monitor problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\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">Water problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;7&nbsp;\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">Monitor replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#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">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\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">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Outpatient HD needs at hospital unit&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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                      "titulo" => "US renal data system 2013 annual data report"
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                        0 => array:2 [
                          "etal" => true
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "fecha" => "2014"
                        "volumen" => "63"
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                        0 => array:2 [
                          "etal" => true
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                  ]
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                          "etal" => false
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                        0 => array:2 [
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                            0 => "B&#46; Wong"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;K&#46; Tennankore"
                            1 => "C&#46; d&#8217;Gama"
                            2 => "R&#46; Faratro"
                            3 => "S&#46; Fung"
                            4 => "E&#46; Wong"
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                          ]
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            6 => array:3 [
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                      "titulo" => "A comparison of center-based vs&#46; home-based daily hemodialysis for patients with end-stage renal disease"
                      "autores" => array:1 [
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Letter to the Editor
Low rate of adverse events in home hemodialysis
Baja tasa de eventos adversos en hemodiálisis domiciliaria
Alejandro Pérez Alba
Corresponding author
aperezalba@gmail.com

Corresponding author.
, Javier Reque Santiváñez, Alba Segarra Pedro, Silvia Torres Campos, Juan José Sánchez Canel, M. Ángeles Fenollosa Segarra, Ramón Pons Prades
Hospital General de Castellón, Castellón de la Plana, Castellón, Spain
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          4 => array:2 [
            "nombre" => "Juan Jos&#233;"
            "apellidos" => "S&#225;nchez Canel"
          ]
          5 => array:2 [
            "nombre" => "M&#46; &#193;ngeles"
            "apellidos" => "Fenollosa Segarra"
          ]
          6 => array:2 [
            "nombre" => "Ram&#243;n"
            "apellidos" => "Pons Prades"
          ]
        ]
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          0 => array:2 [
            "entidad" => "Hospital General de Castell&#243;n&#44; Castell&#243;n de la Plana&#44; Castell&#243;n&#44; Spain"
            "identificador" => "aff0005"
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      "es" => array:1 [
        "titulo" => "Baja tasa de eventos adversos en hemodi&#225;lisis domiciliaria"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percentage of minor adverse events&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Currently due to the benefits reported with HHD&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> there is growing interest in home haemodialysis &#40;HHD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In Spain&#44; although the number of patients on HHD has increased in recent years&#44; the percentage remains low&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> one of the main problems being that there is little familiarity with the technique<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and the fear of adverse events &#40;AE&#41; is manifested&#46; For this reason&#44; we considered it appropriate to analyse the AEs observed in the HHD unit of our Hospital from the beginning of the programme in March 2008 until June 2017&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We consider a serious adverse event &#40;SAE&#41; the one that required some type of emergency action by medical professionals&#44; being automatically reported by the patient to the hospital&#44; usually over the phone&#46; Minor adverse events &#40;MAE&#41; were recorded by the patient in the haemodialysis form&#44; and we conducted a retrospective analysis of these&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since the HHD programme was started&#44; we have trained 35 patients&#44; 32 were able to move home and 3 did not pass the training &#40;2 patients lacked self confidence and one had associated comorbidity&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of the 32 patients on HHD&#58; average age 57&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;1 years&#59; Charlson index 4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&#59; 18 men&#44; 14 women&#44; 25&#37; with diabetes mellitus&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Haemodialysis &#40;HD&#41; time&#47;session was 149&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;1<span class="elsevierStyleHsp" style=""></span>min&#59; frequency 5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;5 sessions&#47;week&#59; weekly time 791&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>94&#46;8<span class="elsevierStyleHsp" style=""></span>min&#59; 14 NxStage systems and 18 conventional monitors&#59; 20&#44;034 days remaining at home &#40;17&#44;889 days&#47;catheter and 2145 days&#47;fistula&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In total&#44; 4 SAEs&#44; 0&#46;072 events&#47;patient&#47;year &#40;0&#46;275 SAEs&#47;1000 HD sessions&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two episodes occurred in the same 49-year-old patient&#44; after 7 and 9 months on HHD&#46; The first was hypotension with loss of consciousness and recovery after being disconnected by the carer&#44; who called the emergency services and the patient was transferred to hospital without requiring admission&#46; The second episode was a new hypotensive episode with loss of consciousness and seizure&#44; with the carer again being present&#46; Hospitalisation was required to rule out the possibility that the patient had stopped taking antiepileptic medication&#46; In both cases&#44; the patient was ultrafiltrating a greater quantity than recommended by our unit&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The third episode occurred in a 43-year-old patient who had been on HHD for less than 6 months&#46; It was a clot in the circuit at the end of the HD session&#44; which reached the tunnelled catheter&#44; causing full obstruction thereof&#46; The patient was transferred to hospital where we removed the obstruction with urokinase and the patient was not admitted&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The fourth episode was a new hypotensive episode in a 72-year-old patient&#44; without loss of consciousness&#44; but a call to the emergency services was required without transfer to hospital&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the MAEs&#44; we retrospectively analysed 11&#44;463 haemodialysis sessions &#40;78&#46;9&#37; of the total HHD completed&#41;&#46; In the remaining cases it was impossible for us to recover the information&#46; We recorded 272 MAEs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; with a MAE rate of 23&#46;72&#47;1000 HD sessions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Forty-one hospitalisations occurred &#40;24&#46;4&#37; scheduled&#41;&#44; 0&#46;747 admissions&#47;patients&#47;year &#40;19&#46;5&#37; due to cardiovascular causes&#44; 26&#46;8&#37; due to infectious causes not related to vascular access&#44; and 12&#46;2&#37; due to infectious causes related to vascular access&#41;&#46; Six infection events related to the haemodialysis catheter&#44; 5 required hospital admission &#40;0&#46;12 infections&#47;patient&#47;year&#41; and none in the arteriovenous fistula&#46; Regarding vascular access dysfunctions recorded as such by the patient on HHD sheets&#44; 16 were due to catheter &#40;1&#46;59&#47;1000 HD&#44; 8 required hospital HD&#41;&#44; 13 were due to fistula &#40;8&#46;95&#47;1000 HD&#44; 10 required hospital HD&#41;&#44; relative risk 5&#46;6 &#40;2&#46;7&#8211;11&#46;6&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We did not record significant differences when we attempted to relate the MAE rates to patient age&#44; Charlson &#91;index&#93;&#44; number of training sessions&#44; and type of monitor used&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients required HD in a hospital unit&#44; without considering admission episodes&#44; for 454 days &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We present a SAE rate similar to those described in the few existing series in the medical literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a> although it depends what is considered as such&#44; while Wong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> describe it as a life-threatening event&#44; Tennankore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> consider it&#44; like we did&#44; as one requiring some kind of medical action&#46; As for MAEs&#44; data are also limited&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> again depending on what is considered a minor event&#44; but our report is similar to previous publications&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We consider that in each HHD unit there should be an ongoing record of AEs that occur&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> if possible in real time&#44; in order to establish the control and feedback methods for said events&#44; to generate strategies and action protocols in order to minimise them&#46; In our case&#44; we set lower ultrafiltration limits&#44; always at 10<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h&#46; The exploration of the possibilities offered by telemedicine can provide great assistance in this regard&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Furthermore&#44; in all HHD units there should also be a series of dialysis stations that ensure sessions are available at times when the patient cannot do it at home&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">We conclude that&#44; despite being impossible to eradicate the possibility of AEs&#44; the rate thereof is more than acceptable&#44; making HHD a safe technique that can offer many benefits to patients&#46;</p></span>"
    "pdfFichero" => "main.pdf"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; P&#233;rez Alba A&#44; Reque Santiv&#225;&#241;ez J&#44; Segarra Pedro A&#44; Torres Campos S&#44; S&#225;nchez Canel JJ&#44; Fenollosa Segarra M&#193;&#44; et al&#46; Baja tasa de eventos adversos en hemodi&#225;lisis domiciliaria&#46; Nefrolog&#237;a&#46; 2018&#59;38&#58;452&#8211;454&#46;</p>"
      ]
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reason&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">No&#46; of frequency&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">Percentage of frequency&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">Days&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">Percentage of days&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">Average no&#46; of days&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">Range of days&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular access problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;30&nbsp;\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">Puncture training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#8211;123&nbsp;\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">Monitor problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\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">Water problem&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;7&nbsp;\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">Monitor replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#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">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\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">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">181&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#8211;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Outpatient HD needs at hospital unit&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "US renal data system 2013 annual data report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Collins"
                            1 => "R&#46;N&#46; Foley"
                            2 => "B&#46; Chavers"
                            3 => "D&#46; Gilbertson"
                            4 => "C&#46; Herzog"
                            5 => "A&#46; Ishani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.ajkd.2013.11.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2014"
                        "volumen" => "63"
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                        "paginaInicial" => "A7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24360288"
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            1 => array:3 [
              "identificador" => "bib0060"
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1001593"
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                            "web" => "Medline"
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            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Intensive hemodialysis associates with improved survival compared with conventional hemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "G&#46;E&#46; Nesrallah"
                            1 => "R&#46;M&#46; Lindsay"
                            2 => "M&#46;S&#46; Cuerden"
                            3 => "A&#46;X&#46; Garg"
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                            5 => "P&#46;C&#46; Austin"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2011070676"
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