array:20 [
  "pii" => "X2013251408003901"
  "issn" => "20132514"
  "doi" => " "
  "estado" => "S300"
  "fechaPublicacion" => "2008-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2008;28:475-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4771
    "formatos" => array:3 [
      "EPUB" => 280
      "HTML" => 3812
      "PDF" => 679
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699508003904"
      "issn" => "02116995"
      "doi" => " "
      "estado" => "S300"
      "fechaPublicacion" => "2008-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2008;28:475-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8306
        "formatos" => array:3 [
          "EPUB" => 288
          "HTML" => 7631
          "PDF" => 387
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Papel fundamental del Sistema de Tratamiento del Agua (STA) en la calidad del agua para hemodiálisis."
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "475"
            "paginaFinal" => "478"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The essential role of water treatment system (WTS) in the quality of water for hemodialysis"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rafael Pérez García"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "Pérez García"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251408003901"
          "doi" => " "
          "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/X2013251408003901?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699508003904?idApp=UINPBA000064"
      "url" => "/02116995/0000002800000005/v0_201502091416/X0211699508003904/v0_201502091416/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251408003897"
    "issn" => "20132514"
    "doi" => " "
    "estado" => "S300"
    "fechaPublicacion" => "2008-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2008;28:479-82"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3726
      "formatos" => array:3 [
        "EPUB" => 277
        "HTML" => 2843
        "PDF" => 606
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "titulo" => "HIV and dialysis: unfounde optimism or real change"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "479"
          "paginaFinal" => "482"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "HIV y diálisis: optimismo infundado o cambios reales"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carmen Bernis Carro"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Bernis Carro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169950800389X"
        "doi" => " "
        "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/X021169950800389X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408003897?idApp=UINPBA000064"
    "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408003897/v0_201502091635/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "titulo" => "The essential role of water treatment system (WTS) in the quality of water for hemodialysis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "475"
        "paginaFinal" => "478"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Rafael Pérez García"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Rafael"
            "apellidos" => "Pérez García"
            "email" => array:1 [
              0 => "rperezga@salud.madrid.org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Jefe de Sección de Nefrología, Hospital Infanta Leonor Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Papel fundamental del Sistema de Tratamiento del Agua &#40;STA&#41; en la calidad del agua para hemodi&#225;lisis&#46;"
      ]
    ]
    "textoCompleto" => "INTRODUCTION <br></br><br></br>During hemodialysis &#40;HD&#41;&#44; dialysis fluid &#40;DF&#41; contaminants pass through the dialyzer to patient&#191;s blood&#46; Some of them accumulate&#44; and may sometimes causes acute and&#47;or chronic toxicity&#46; These contaminants&#44; which are classified as chemical and microbiological&#44; come from water treated for HD&#44; concentrates and other solid solutes&#44;&#160; and the hydraulic circuits of HD monitors&#46; Ideally&#44; DF would have to meet the quality criteria for fluids for intravenous infusion&#44; and if this requirement is not met is because of financial reasons&#46; It is obvious that contaminant toxicity should be prevented&#46; The question is&#58; What are the safe limits of contaminants in DF&#63; Where does contaminant overload or accumulation end and contaminant toxicity start&#63; Most current recommendations&#44; <br></br>such as the Guidelines for Quality Management of Dialysis Fluid of the Spanish Society of Nephrology&#44; 1 mention two quality levels&#46; A first level&#44; that we will call standard&#44; marks the maximum levels of contaminants in water and DF that can be admitted when performing HD&#46; The other level&#44; much more demanding&#44; corresponds to ultrapure water and DF and is the one currently recommended for any type of HD&#46; The main determinant factor for achieving high quality DF is availability of a modern water treatment system with dual osmosis&#44; on-line water production without a storage deposit&#44; automatic sterilization system of the water distribution ring and direct connection to monitors&#46; Modern continuous flow monitors should also be available&#46; The second determinant factor is a standardized&#44; rigorous control methodology&#46;2 In this same issue of Nefrolog&#237;a&#44; Sobrino P&#233;rez et al&#46;3 publish an article about the operation of a treatment or purification system for hemodialysis water and the control methods <br></br>used for 5 years&#46; It is a system that may be considered as &#191;modern&#191; and that provides very good results&#46; In this editorial&#44; I will try and make clear the basis for such statements&#46; <br></br><br></br>The chemical contamination to which HD patients are subjected has significantly decreased over the years&#46;4-8 While subacute aluminum intoxicationswith neurological and bone clinical signs previously occurred&#44; we now monitor how many patients have high Al levels in blood&#44;6 e&#46;g&#46; 2&#46;1&#37; of 1&#44;410 and 2&#46;5&#37; of 117&#44;000 samples in the United States&#44; and proportions have decreased every year&#46; This has been due to widespread use of reverse osmosis for water <br></br>treatment&#44; in an increasing number of cases using a dual stage&#46; While dialysis water is the main source of trace elements &#40;TEs&#41;&#44; these may come from contamination of solutes used for DF preparation&#44; and this aspect requires <br></br>control in the OL-HDF era&#46; In a study4 with a low Al level&#44; 15 &#956;g&#47;L&#44; in the water supplied&#44; the level in biosmotized <br></br>water was only 3&#46;3 &#956;g&#47;L&#44; but reached 5&#46;4 &#956;g&#47;L in DF and reinfusion fluid&#46; Significant increases in blood levels of <br></br>some metals such as aluminum&#44; lead&#44; mercury&#44; and cadmium may be seen with hemodialysis&#46;7&#44;8 Environmental <br></br>factors also have an influence&#44; of course&#46; 8 Other contamination sources&#44; such as pumps in centralized DF manufacturing systems&#44; should always be considered&#46; 5 New contaminants added to water&#44; such as&#160; perchloroethylene&#44; are regularly reported&#46;10 On this subject&#44; we may conclude that availability of a good water treatment with dual osmosis &#40;RO&#41; or deionizer &#40;DI&#41; plus an osmosis that maintains the recommended conductivities <br></br>&#40;1&#41; &#40;maximum conductivity should be 4&#46;3 &#956;S&#46;cm-1 at 20 &#186;C for purified water&#44; and 1&#46;1 &#956;S&#46;cm-1 for highly purified or ultrapure water&#41;&#44; combined with water aluminum controls &#40;atomic absorption spectrometry&#44; 0&#46;01 mg&#47;L &#40;10 &#956;g&#47;L&#41; at least every six months&#44; gives us a very high assurance that adequate levels exist of the other chemical contaminants &#40;table I&#41;&#46; Authorities responsible for water supply should inform dialysis units about any changes made or detected in water&#46; <br></br><br></br>Control of biological contamination is more difficult&#46;2&#44;12-14 The presence of biofilm in the pipes14 and the existence <br></br>of bacterial strains resistant to antibiotics16 are aspects requiring preventive action&#46; Once these have appeared&#44; they are very difficult to remove&#46; They are usually related to high bacterial contamination levels&#44; higher than 1&#44;000 <br></br>CFU&#47;mL&#44; and to contamination recurrence early after disinfection&#46;1 Prevention is therefore essential&#46; The two main factors for such prevention include water of a high chemical quality and regular effective disinfection&#46; They both are easily achieved with a modern water treatment system &#40;WTS&#41;&#46; The relationship of WTS quality and age and age of the hemodialysis unit to the degree of bacterial contamination is well known&#46;13&#44;14&#44;16&#44;17 A multicenter study conducted in 95&#37; of Quebec centers showed a lower degree of bacterial contamination in units with DI&#43;RO&#46;16 <br></br>Epidemiological studies conducted in all dialysis centers in Greece13 stressed the influence of water storage deposits&#44; as well as WTS seniority&#44; in poor water quality&#46; Highly purified or ultrapure water is currently recommended for any type of hemodialysis &#40;table I&#41;&#46; <br></br><br></br>What may be considered as a modern WTS&#63; The differential facts may be summarized as follows&#58;1 If water is stored&#44; it should be untreated&#44; as occurs in hospital tanks requiring rigorous maintenance&#46; Pretreatment with dual elements of adequate size for the flow rate&#44; from which duration and good treatment performance will depend&#46; Dual <br></br>reverse osmosis or on-line DI&#43;RO&#44; with no storage deposit for treated water&#46; A ring or loop water distribution <br></br>system made of pharmaceutical grade stainless steel&#44; or failing this of PEXa&#46; A programmable automatic sterilization system&#44; if possible by water steam&#44; and finally&#44; direct connection of the ring to the HD monitors&#46;1 We recently concluded a study18 reporting the degree of bacterial contamination and TE levels of treated water and DF in the HD unit of the HGUGM from January 1997 to March 2007 and examined the factors on which it had depended&#46; A modern WTS such as the one previously described was available in the latter period&#46; A total of 2&#44;822 bacteriological samples and 100 TE samples were tested&#46; It was concluded that contamination of water treated for dialysis depends to a great extent on the type of treatment system available&#46; This contamination has an influence <br></br>on monitor contamination&#44; with some monitors being more prone to get contaminated than others&#46; TE levels are <br></br>related to bacterial contamination&#46; <br></br><br></br>A good WTS is not enough&#44; however&#59; a good quality control is also required&#46; First&#44; a sufficiently sensitive system for <br></br>detecting bacterial contamination and pyrogenic substances should be available&#46; 2&#44;19-23 Marked differences exist in <br></br>sample culture procedures&#46;24 Several of these studies compared the TSA and R2A culture media&#44; incubation temperatures of 35 &#186;C and 23 &#186;C&#44; and short times&#44; 48 hours&#44; versus 5-7 days&#46; Based on these studies&#44; R2A&#44; 23 &#186;C&#44; and early and late readings should be used&#46; This procedure will allow for a high sensitivity&#46; R2A is not more expensive than TSA or standard agar&#46; Some guidelines recommend as culture medium TGEA &#40;tryptone glucose extract agar&#41; &#40;ISO-2007&#41;&#44; which would be partly&#44; like R2A&#44; a nutrient-poor culture medium&#46;2 There are also differences in the sampling procedure&#46;25 Samples should always be taken as close as possible to the water intake by the monitor and at the end of the distribution ring&#44; in the return&#46; Endotoxins must be measured using the LAL test&#46; For standard water&#44; a standard Gel-clot will suffice&#46; For ultrapure water&#44; a more sensitive method&#44; such as kinetic-chromogenic &#40;KC&#41; LAL&#44; will have to be used&#46; There is a need for a standardized method that allows for comparison of results&#46;26 The Spanish Society of Nephrology could lead a group for this purpose&#46; <br></br><br></br>Contamination should be prevented by regular disinfection&#46;2&#44;27-29 At least monthly disinfections are recommended&#46; With modern WTS&#44; one or two programmed weekly disinfections are enough&#46; Special care should be taken with rinsing of chemical disinfectants30 after a general disinfection&#46; UV lamps may be of value in certain WTS&#46;31 <br></br><br></br>In home HD&#44; one cannot renounce to having ultrapure water and regular disinfections&#46; 32-35 <br></br><br></br>CONCLUSIONS <br></br>There is increasing evidence of the clinical value of using a hemodialysis fluid with the lowest possible amount of contaminants&#46;36-45 Treated water is its essential component&#46; The main guarantee for quality of water for HD is availability of a modern WTS with an automatic disinfection system&#46; In order to control its function&#44; procedures with <br></br>adequate sensitivity for detecting quality levels of ultrapure water should be used&#46;1&#44;2 <br></br>"
    "pdfFichero" => "P-E-S-A351-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440627"
          "palabras" => array:1 [
            0 => "osmosis inversa"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440629"
          "palabras" => array:1 [
            0 => "hemodi&#225;lisis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440631"
          "palabras" => array:1 [
            0 => "cultivos del agua"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440633"
          "palabras" => array:1 [
            0 => "agua ultrapura"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440635"
          "palabras" => array:1 [
            0 => "aluminio"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440628"
          "palabras" => array:1 [
            0 => "water system quality"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440630"
          "palabras" => array:1 [
            0 => "hemodi&#225;lisis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440632"
          "palabras" => array:1 [
            0 => "cultivation technique"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440634"
          "palabras" => array:1 [
            0 => "ultrapure"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440636"
          "palabras" => array:1 [
            0 => "aluminum"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "Durante la hemodi&#225;lisis &#40;HD&#41;&#44; los contaminantes del l&#237;quido de di&#225;lisis &#40;LD&#41; pasan a trav&#233;s de dializador a la sangre del paciente&#46; Algunos de ellos se acumulan y en ocasiones&#44; pueden producir toxicidad aguda y&#47;o cr&#243;nica&#46; Estos contaminantes&#44; que se clasifican como qu&#237;micos y microbiol&#243;gicos&#44; provienen del agua tratada para HD&#44; de los concentrados y otros solutos s&#243;lidos y de los circuitos hidr&#225;ulicos de los monitores de HD&#46;"
      ]
      "en" => array:1 [
        "resumen" => "During hemodialysis &#40;HD&#41;&#44; dialysis fluid &#40;DF&#41; contaminants pass through the dialyzer to patient&#191;s blood&#46; Some of them accumulate&#44; and may sometimes causes acute and&#47;or chronic toxicity&#46; These contaminants&#44; which are classified as chemical and microbiological&#44; come from water treated for HD&#44; concentrates and other solid solutes&#44; and the hydraulic circuits of HD monitors&#46;"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "BIBLIOGRAFIA"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "1/ Guía de Gestión de Calidad del Líquido de Diálisis. R. Pérez García y cols. Nefrología 2004; 24: 1-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15083969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2/ Nystrand R. Microbiology of water and fluids for hemodialysis. J Chin Med Assoc. 2008; 71(5): 223-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18490224" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3) Sobrino P; Barril G ; Del Rey C; Sánchez Tomero JA. Monitorización de la calidad del agua tratada ¿on line¿ y del líquido de diálisis. Nefrología 2008 (5) : poner paginas .. articulo de este numero <a href="http://www.ncbi.nlm.nih.gov/pubmed/11217655" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4/ Surian M, Bonforte G, Scanziani R, Dozio B, Baj A, Della Vedova L, Toffoletto F."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trace elements and micropollutant anions in the dialysis and reinfusion fluid prepared on-line for haemodiafiltration. Nephrol Dial Transplant. 1998; 13 Suppl 5:24-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9623527" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5/ Centers for Disease Control and Prevention (CDC). Elevated serum aluminum levels in hemodialysis patients associated with use of electric pumps--Wyoming, 2007."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "MMWR Morb Mortal Wkly Rep. 2008; 57(25): 689-91."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "6/ Jaffe JA, Liftman C, Glickman JD. Frequency of elevated serum aluminum levels in adult dialysis patients. Am J Kidney Dis. 2005; 46(2): 316-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16112051" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "7/ Skarupskiene I, Kuzminskis V, Abdrachmanovas O, Ryselis S, Smalinskiene A, Naginiene R. Water treatment systems of hemodialysis centers in Lithuania and trace metals in purified water in 2002. Medicina (Kaunas). 2003; 39 Suppl 1: 98-103."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8/ Lee SH, Huang JW, Hung KY, Leu LJ, Kan YT, Yang CS, Chung Wu D, Huang CL, Chen PY, Chen JS, Chen WY. Trace Metals' abnormalities in hemodialysis patients: relationship with medications. Artif Organs. 2000; 24(11): 841-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11119069" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9/ Berend K, van der Voet G, Boer WH. Acute aluminum encephalopathy in a dialysis center caused by a cement mortar water distribution pipe. Kidney Int. 2001; 59(2): 746-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11168958" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "10/ Spence LA, Aschengrau A, Gallagher LE, Webster TF, Heeren TC, Ozonoff DM. Evaluation of the Webler-Brown model for estimating tetrachloroethylene exposure from vinyl-lined asbestos-cement pipes. Environ Health. 2008; 7: 24-42."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "11/ Canaud B, Martin K, Morena M, Bosc JY, Leray-Moragues H, Mahowashi M, Stec F, Hansel S. Monitoring the microbial purity of the treated water and dialysate."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Saudi J Kidney Dis Transpl. 2001; 12(3): 325-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "12/ Schindler R, Beck W, Deppisch R, Aussieker M, Wilde A, Göhl H, Frei U. Short bacterial DNA fragments: detection in dialysate and induction of cytokines. J Am Soc Nephrol 2004; 15 (12): 3207-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15579524" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "13/ Arvanitidou M, Spaia S, Katsinas C, Pangidis P, Constantinidis T, Katsouyannopoulos V, Vayonas G. Microbiological quality of water and dialysate in all haemodialysis centres of Greece. Nephrol Dial Transplant. 1998; 13(4): 949-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9568856" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14/ Smeets E, Kooman J, van der Sande F, Stobberingh E, Frederik P, Claessens P, Grave W, Schot A, Leunissen K. Prevention of biofilm formation in dialysis water treatment systems.. Kidney Int. 2003; 63(4):1574-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631375" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "15/ Arvanitidou M, Vayonas G, Spanakis N, Tsakris A. Ocurrence and antimicrobial resistance of Gram-negative bacterial isolated in haemodialysis water and dialysate of renal units: results of a Greek multicentre study. J Appl Microbiol 2003; 95 (1): 180-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12807469" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "16/ Laurence RA, Lapierre ST . Quality of hemodialysis water: a 7-year multicenter study. Am J Kidney Dis. 1995; 25(5): 738-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7747728" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "17/ Pizzarelli F, Cerrai T, Biagini M, Malaguti M, Bargagna R. Dialysis water treatment systems and monitoring in Italy: results of a national survey. J Nephrol. 2004; 17(4): 565-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15372420" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "18/ Puerta Carretero M, Pérez García R, Vega A, Abad S, Rodríguez Benítez P, López Gómez JM, Jofre Ibañez R. Tratamiento del agua en una unidad de hemodiálisis: Nuestra experiencia en diez años. Nefrología 2007; 27, supl. 4: 87."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "19/ van der Linde K, Lim BT, Rondeel JM, Antonissen LP, de Jong GM. Improved bacteriological surveillance of haemodialysis fluids: a comparison between Tryptic soy agar and Reasoner's 2A media. Nephrol Dial Transplant. 1999; 14(10): 2433-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10528669" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "20/ Punakabutra N, Nunthapisud P, Pisitkun T, Tiranathanagul K, Tungsanga K, Eiam-Ong S. Comparison of different culture methods on bacterial recovery in hemodialysis fluids. J Med Assoc Thai. 2004; 87(11): 1361-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15825714" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "21/ Pass T., Wright R., Sharp B., Harding GB. Culture of dialysis fluids on nutrient-rich media for short periods at elevated temperature underestimate microbial contamination. Blood Purif 1996; 14: 136-145. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8785029" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "22/ Harding GB, Pass T, Wright R. Bacteriology of hemodialysis fluids: are current methodologies meaningful? Artif Organs. 1992; 16(5): 448-56."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "23/ Arduino MJ, Bland LA, Aguero SM, Favero MS. Effects of incubation time and temperature on microbiologic sampling procedures for hemodialysis fluids. J Clin Microbiol. 1991; 29(7): 1462. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1885742" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "24/ Ray J. Microbiological monitoring of dialysis water systems--which culture method? J Ren Care. 2007; 33(2): 66-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "25/ James R. Monitoring of dialysis water systems--is there a need for increased sampling? EDTNA ERCA J. 2006; 32(2): 74-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16898097" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "26/ Pizzarelli F, Cerrai T, Biagini M, Malaguti M, Bargagna R. Dialysis water treatment systems and monitoring in Italy: results of a national survey. J Nephrol. 2004; 17(4): 565-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15372420" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "27/ Pérez-García R, Rodríguez Benítez P. Why and how to monitor bacterial contamination of dialysate? Nephrol Dial Transplant. 2000; 15: 760-764"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "28/ Gorke A, Kittel J. Routine disinfection of the total dialysis fluid system. EDTNA ERCA J. 2002; 28(3): 130-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12371736" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "29/ Reimer R. Hemodialysis machine disinfection: a safe period of time between cycles.CANNT J. 2000; 10(2): 23-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15719600" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "30/ Davidovits M, Barak A, Cleper R, Krause I, Gamzo Z, Eisenstein B. Methaemoglobinaemia and haemolysis associated with hydrogen peroxide in a paediatric haemodialysis centre: a warning note. Nephrol Dial Transplant. 2003; 18(11): 2354-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14551365" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "31/ Stragier A. Is ultraviolet radiation on haemodialysis RO water beneficial? EDTNA ERCA J. 2005; 31(4): 194-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16551024" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "32/ Borges CR, Lascowski KM, Filho NR, Pelayo JS. Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil. J Appl Microbiol. 2007; 103(5): 1791-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17953589" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "33/ Savino A, Pasquarella C, Nnanga N. Water treatment in domiciliary hemodiálisis equipment: ultraviolet irradiation and Sartobind membrana. Ann Ig. 2006; 18 (1): 3-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16649498" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710001865"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "34/ Schlaeper C, Diaz-Buxo JA. The Fresenius Medical Care home hemodialysis system. Semin Dial. 2004; 17 (2): 159-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15043622" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "35/ Ouseph R, Ward RA. Ultrapure dialysate for home hemodialysis?. Adv Chronic Kidney Dis. 2007; 14 (3): 256-262. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17603979" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "36/ Jofre R, Rodríguez Benítez P, López-Gómez JM, Pérez-García R. Inflammatory Síndrome in Patients on Hemodiálisis. J Am Soc Nephrol. 2006; 17: S274-S-280."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "37/ Furuya R. y cols. Ultrapure dialysate reduces plasma levels of beta2-microglobulin and pentosidine in hemodialysis patients. Blood Purif. 2005; 23(4): 311-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15980621" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "38/ Hsu Y. y cols. Ultrapure dialysate improves iron utilization and erythropoietin response in chronic hemodialysis patients - a prospective cross-over study. J Nephrol. 2004; 17: 693-700. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15593037" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "39/ Lederer SR. y cols. Ultrapure dialysis fluid lowers the cardiovascular morbidity in patients on maintenance hemodialysis by reducing continuous microinflammation. Nephron. 2002; 91: 452-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12119476" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "40/ Gerdemann A, Zoltan Wagner, Andreas Solf, Udo Bahner, August Heidland, Jörg Vienken and Reinhard Schinzel."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Plasma levels of advanced glycation end products during haemodialysis, haemodiafiltration and haemofiltration: potential importance of dialysate quality. Nephrol Dial Transplant. 2002 Jun;17(6):1045-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12032195" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "41/ Arizono K. y cols. Use of ultrapure dialysate in reduction of chronic inflammation during hemodialysis. Blood Purif. 2004;22 Suppl 2: 26-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15655319" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "42/ Schiffl H. Y cols. Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients. Nephrol Dial Transplant. 2002 Oct;17(10):1814-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12270990" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "43/ Matsuhashi N y col. Endotoxin-free dialysate improves response to erythropoeitin in hemodialysis patients. Nephron 2002; 92: 601-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12372943" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "44/ Sato T y cols. Preparation of ultrapure dialysate in Japan--clinical usefulness and short-term future. Blood Purif. 2004; 22 Suppl 2:55-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15655325" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109705004894"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "45/ De Francisco ALM, Pérez García R. Ultrapure dialysate and its effect on patients outcome. Saudi J Kidney Dis Transplant. 2001; 12 (3): 406-412."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408003901/v0_201502091635/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002800000005/v0_201502091635/X2013251408003901/v0_201502091635/en/P-E-S-A351-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408003901?idApp=UINPBA000064"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

The essential role of water treatment system (WTS) in the quality of water for hemodialysis
Papel fundamental del Sistema de Tratamiento del Agua (STA) en la calidad del agua para hemodiálisis.
Rafael Pérez Garcíaa
a Jefe de Sección de Nefrología, Hospital Infanta Leonor Madrid, Madrid, España,
Read
10319
Times
was read the article
2635
Total PDF
7684
Total HTML
Share statistics
 array:20 [
  "pii" => "X2013251408003901"
  "issn" => "20132514"
  "doi" => " "
  "estado" => "S300"
  "fechaPublicacion" => "2008-10-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2008;28:475-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4771
    "formatos" => array:3 [
      "EPUB" => 280
      "HTML" => 3812
      "PDF" => 679
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699508003904"
      "issn" => "02116995"
      "doi" => " "
      "estado" => "S300"
      "fechaPublicacion" => "2008-10-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2008;28:475-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8306
        "formatos" => array:3 [
          "EPUB" => 288
          "HTML" => 7631
          "PDF" => 387
        ]
      ]
      "es" => array:9 [
        "idiomaDefecto" => true
        "titulo" => "Papel fundamental del Sistema de Tratamiento del Agua &#40;STA&#41; en la calidad del agua para hemodi&#225;lisis&#46;"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "475"
            "paginaFinal" => "478"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The essential role of water treatment system &#40;WTS&#41; in the quality of water for hemodialysis"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rafael P&#233;rez Garc&#237;a"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "P&#233;rez Garc&#237;a"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251408003901"
          "doi" => " "
          "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/X2013251408003901?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699508003904?idApp=UINPBA000064"
      "url" => "/02116995/0000002800000005/v0_201502091416/X0211699508003904/v0_201502091416/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251408003897"
    "issn" => "20132514"
    "doi" => " "
    "estado" => "S300"
    "fechaPublicacion" => "2008-10-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2008;28:479-82"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3726
      "formatos" => array:3 [
        "EPUB" => 277
        "HTML" => 2843
        "PDF" => 606
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "titulo" => "HIV and dialysis&#58; unfounde optimism or real change"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "479"
          "paginaFinal" => "482"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "HIV y di&#225;lisis&#58; optimismo infundado o cambios reales"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Carmen Bernis Carro"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Bernis Carro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X021169950800389X"
        "doi" => " "
        "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/X021169950800389X?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408003897?idApp=UINPBA000064"
    "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408003897/v0_201502091635/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "titulo" => "The essential role of water treatment system &#40;WTS&#41; in the quality of water for hemodialysis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "475"
        "paginaFinal" => "478"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Rafael P&#233;rez Garc&#237;a"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Rafael"
            "apellidos" => "P&#233;rez Garc&#237;a"
            "email" => array:1 [
              0 => "rperezga&#64;salud&#46;madrid&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Jefe de Sección de Nefrología, Hospital Infanta Leonor Madrid, Madrid, España, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Papel fundamental del Sistema de Tratamiento del Agua &#40;STA&#41; en la calidad del agua para hemodi&#225;lisis&#46;"
      ]
    ]
    "textoCompleto" => "INTRODUCTION <br></br><br></br>During hemodialysis &#40;HD&#41;&#44; dialysis fluid &#40;DF&#41; contaminants pass through the dialyzer to patient&#191;s blood&#46; Some of them accumulate&#44; and may sometimes causes acute and&#47;or chronic toxicity&#46; These contaminants&#44; which are classified as chemical and microbiological&#44; come from water treated for HD&#44; concentrates and other solid solutes&#44;&#160; and the hydraulic circuits of HD monitors&#46; Ideally&#44; DF would have to meet the quality criteria for fluids for intravenous infusion&#44; and if this requirement is not met is because of financial reasons&#46; It is obvious that contaminant toxicity should be prevented&#46; The question is&#58; What are the safe limits of contaminants in DF&#63; Where does contaminant overload or accumulation end and contaminant toxicity start&#63; Most current recommendations&#44; <br></br>such as the Guidelines for Quality Management of Dialysis Fluid of the Spanish Society of Nephrology&#44; 1 mention two quality levels&#46; A first level&#44; that we will call standard&#44; marks the maximum levels of contaminants in water and DF that can be admitted when performing HD&#46; The other level&#44; much more demanding&#44; corresponds to ultrapure water and DF and is the one currently recommended for any type of HD&#46; The main determinant factor for achieving high quality DF is availability of a modern water treatment system with dual osmosis&#44; on-line water production without a storage deposit&#44; automatic sterilization system of the water distribution ring and direct connection to monitors&#46; Modern continuous flow monitors should also be available&#46; The second determinant factor is a standardized&#44; rigorous control methodology&#46;2 In this same issue of Nefrolog&#237;a&#44; Sobrino P&#233;rez et al&#46;3 publish an article about the operation of a treatment or purification system for hemodialysis water and the control methods <br></br>used for 5 years&#46; It is a system that may be considered as &#191;modern&#191; and that provides very good results&#46; In this editorial&#44; I will try and make clear the basis for such statements&#46; <br></br><br></br>The chemical contamination to which HD patients are subjected has significantly decreased over the years&#46;4-8 While subacute aluminum intoxicationswith neurological and bone clinical signs previously occurred&#44; we now monitor how many patients have high Al levels in blood&#44;6 e&#46;g&#46; 2&#46;1&#37; of 1&#44;410 and 2&#46;5&#37; of 117&#44;000 samples in the United States&#44; and proportions have decreased every year&#46; This has been due to widespread use of reverse osmosis for water <br></br>treatment&#44; in an increasing number of cases using a dual stage&#46; While dialysis water is the main source of trace elements &#40;TEs&#41;&#44; these may come from contamination of solutes used for DF preparation&#44; and this aspect requires <br></br>control in the OL-HDF era&#46; In a study4 with a low Al level&#44; 15 &#956;g&#47;L&#44; in the water supplied&#44; the level in biosmotized <br></br>water was only 3&#46;3 &#956;g&#47;L&#44; but reached 5&#46;4 &#956;g&#47;L in DF and reinfusion fluid&#46; Significant increases in blood levels of <br></br>some metals such as aluminum&#44; lead&#44; mercury&#44; and cadmium may be seen with hemodialysis&#46;7&#44;8 Environmental <br></br>factors also have an influence&#44; of course&#46; 8 Other contamination sources&#44; such as pumps in centralized DF manufacturing systems&#44; should always be considered&#46; 5 New contaminants added to water&#44; such as&#160; perchloroethylene&#44; are regularly reported&#46;10 On this subject&#44; we may conclude that availability of a good water treatment with dual osmosis &#40;RO&#41; or deionizer &#40;DI&#41; plus an osmosis that maintains the recommended conductivities <br></br>&#40;1&#41; &#40;maximum conductivity should be 4&#46;3 &#956;S&#46;cm-1 at 20 &#186;C for purified water&#44; and 1&#46;1 &#956;S&#46;cm-1 for highly purified or ultrapure water&#41;&#44; combined with water aluminum controls &#40;atomic absorption spectrometry&#44; 0&#46;01 mg&#47;L &#40;10 &#956;g&#47;L&#41; at least every six months&#44; gives us a very high assurance that adequate levels exist of the other chemical contaminants &#40;table I&#41;&#46; Authorities responsible for water supply should inform dialysis units about any changes made or detected in water&#46; <br></br><br></br>Control of biological contamination is more difficult&#46;2&#44;12-14 The presence of biofilm in the pipes14 and the existence <br></br>of bacterial strains resistant to antibiotics16 are aspects requiring preventive action&#46; Once these have appeared&#44; they are very difficult to remove&#46; They are usually related to high bacterial contamination levels&#44; higher than 1&#44;000 <br></br>CFU&#47;mL&#44; and to contamination recurrence early after disinfection&#46;1 Prevention is therefore essential&#46; The two main factors for such prevention include water of a high chemical quality and regular effective disinfection&#46; They both are easily achieved with a modern water treatment system &#40;WTS&#41;&#46; The relationship of WTS quality and age and age of the hemodialysis unit to the degree of bacterial contamination is well known&#46;13&#44;14&#44;16&#44;17 A multicenter study conducted in 95&#37; of Quebec centers showed a lower degree of bacterial contamination in units with DI&#43;RO&#46;16 <br></br>Epidemiological studies conducted in all dialysis centers in Greece13 stressed the influence of water storage deposits&#44; as well as WTS seniority&#44; in poor water quality&#46; Highly purified or ultrapure water is currently recommended for any type of hemodialysis &#40;table I&#41;&#46; <br></br><br></br>What may be considered as a modern WTS&#63; The differential facts may be summarized as follows&#58;1 If water is stored&#44; it should be untreated&#44; as occurs in hospital tanks requiring rigorous maintenance&#46; Pretreatment with dual elements of adequate size for the flow rate&#44; from which duration and good treatment performance will depend&#46; Dual <br></br>reverse osmosis or on-line DI&#43;RO&#44; with no storage deposit for treated water&#46; A ring or loop water distribution <br></br>system made of pharmaceutical grade stainless steel&#44; or failing this of PEXa&#46; A programmable automatic sterilization system&#44; if possible by water steam&#44; and finally&#44; direct connection of the ring to the HD monitors&#46;1 We recently concluded a study18 reporting the degree of bacterial contamination and TE levels of treated water and DF in the HD unit of the HGUGM from January 1997 to March 2007 and examined the factors on which it had depended&#46; A modern WTS such as the one previously described was available in the latter period&#46; A total of 2&#44;822 bacteriological samples and 100 TE samples were tested&#46; It was concluded that contamination of water treated for dialysis depends to a great extent on the type of treatment system available&#46; This contamination has an influence <br></br>on monitor contamination&#44; with some monitors being more prone to get contaminated than others&#46; TE levels are <br></br>related to bacterial contamination&#46; <br></br><br></br>A good WTS is not enough&#44; however&#59; a good quality control is also required&#46; First&#44; a sufficiently sensitive system for <br></br>detecting bacterial contamination and pyrogenic substances should be available&#46; 2&#44;19-23 Marked differences exist in <br></br>sample culture procedures&#46;24 Several of these studies compared the TSA and R2A culture media&#44; incubation temperatures of 35 &#186;C and 23 &#186;C&#44; and short times&#44; 48 hours&#44; versus 5-7 days&#46; Based on these studies&#44; R2A&#44; 23 &#186;C&#44; and early and late readings should be used&#46; This procedure will allow for a high sensitivity&#46; R2A is not more expensive than TSA or standard agar&#46; Some guidelines recommend as culture medium TGEA &#40;tryptone glucose extract agar&#41; &#40;ISO-2007&#41;&#44; which would be partly&#44; like R2A&#44; a nutrient-poor culture medium&#46;2 There are also differences in the sampling procedure&#46;25 Samples should always be taken as close as possible to the water intake by the monitor and at the end of the distribution ring&#44; in the return&#46; Endotoxins must be measured using the LAL test&#46; For standard water&#44; a standard Gel-clot will suffice&#46; For ultrapure water&#44; a more sensitive method&#44; such as kinetic-chromogenic &#40;KC&#41; LAL&#44; will have to be used&#46; There is a need for a standardized method that allows for comparison of results&#46;26 The Spanish Society of Nephrology could lead a group for this purpose&#46; <br></br><br></br>Contamination should be prevented by regular disinfection&#46;2&#44;27-29 At least monthly disinfections are recommended&#46; With modern WTS&#44; one or two programmed weekly disinfections are enough&#46; Special care should be taken with rinsing of chemical disinfectants30 after a general disinfection&#46; UV lamps may be of value in certain WTS&#46;31 <br></br><br></br>In home HD&#44; one cannot renounce to having ultrapure water and regular disinfections&#46; 32-35 <br></br><br></br>CONCLUSIONS <br></br>There is increasing evidence of the clinical value of using a hemodialysis fluid with the lowest possible amount of contaminants&#46;36-45 Treated water is its essential component&#46; The main guarantee for quality of water for HD is availability of a modern WTS with an automatic disinfection system&#46; In order to control its function&#44; procedures with <br></br>adequate sensitivity for detecting quality levels of ultrapure water should be used&#46;1&#44;2 <br></br>"
    "pdfFichero" => "P-E-S-A351-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440627"
          "palabras" => array:1 [
            0 => "osmosis inversa"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440629"
          "palabras" => array:1 [
            0 => "hemodi&#225;lisis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440631"
          "palabras" => array:1 [
            0 => "cultivos del agua"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440633"
          "palabras" => array:1 [
            0 => "agua ultrapura"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440635"
          "palabras" => array:1 [
            0 => "aluminio"
          ]
        ]
      ]
      "en" => array:5 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440628"
          "palabras" => array:1 [
            0 => "water system quality"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440630"
          "palabras" => array:1 [
            0 => "hemodi&#225;lisis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440632"
          "palabras" => array:1 [
            0 => "cultivation technique"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440634"
          "palabras" => array:1 [
            0 => "ultrapure"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440636"
          "palabras" => array:1 [
            0 => "aluminum"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "Durante la hemodi&#225;lisis &#40;HD&#41;&#44; los contaminantes del l&#237;quido de di&#225;lisis &#40;LD&#41; pasan a trav&#233;s de dializador a la sangre del paciente&#46; Algunos de ellos se acumulan y en ocasiones&#44; pueden producir toxicidad aguda y&#47;o cr&#243;nica&#46; Estos contaminantes&#44; que se clasifican como qu&#237;micos y microbiol&#243;gicos&#44; provienen del agua tratada para HD&#44; de los concentrados y otros solutos s&#243;lidos y de los circuitos hidr&#225;ulicos de los monitores de HD&#46;"
      ]
      "en" => array:1 [
        "resumen" => "During hemodialysis &#40;HD&#41;&#44; dialysis fluid &#40;DF&#41; contaminants pass through the dialyzer to patient&#191;s blood&#46; Some of them accumulate&#44; and may sometimes causes acute and&#47;or chronic toxicity&#46; These contaminants&#44; which are classified as chemical and microbiological&#44; come from water treated for HD&#44; concentrates and other solid solutes&#44; and the hydraulic circuits of HD monitors&#46;"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "BIBLIOGRAFIA"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "1/ Guía de Gestión de Calidad del Líquido de Diálisis. R. Pérez García y cols. Nefrología 2004; 24: 1-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15083969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "2/ Nystrand R. Microbiology of water and fluids for hemodialysis. J Chin Med Assoc. 2008; 71(5): 223-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18490224" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "3) Sobrino P; Barril G ; Del Rey C; Sánchez Tomero JA. Monitorización de la calidad del agua tratada ¿on line¿ y del líquido de diálisis. Nefrología 2008 (5) : poner paginas .. articulo de este numero <a href="http://www.ncbi.nlm.nih.gov/pubmed/11217655" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "4/ Surian M, Bonforte G, Scanziani R, Dozio B, Baj A, Della Vedova L, Toffoletto F."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trace elements and micropollutant anions in the dialysis and reinfusion fluid prepared on-line for haemodiafiltration. Nephrol Dial Transplant. 1998; 13 Suppl 5:24-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9623527" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "5/ Centers for Disease Control and Prevention (CDC). Elevated serum aluminum levels in hemodialysis patients associated with use of electric pumps--Wyoming, 2007."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "MMWR Morb Mortal Wkly Rep. 2008; 57(25): 689-91."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "6/ Jaffe JA, Liftman C, Glickman JD. Frequency of elevated serum aluminum levels in adult dialysis patients. Am J Kidney Dis. 2005; 46(2): 316-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16112051" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "7/ Skarupskiene I, Kuzminskis V, Abdrachmanovas O, Ryselis S, Smalinskiene A, Naginiene R. Water treatment systems of hemodialysis centers in Lithuania and trace metals in purified water in 2002. Medicina (Kaunas). 2003; 39 Suppl 1: 98-103."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "8/ Lee SH, Huang JW, Hung KY, Leu LJ, Kan YT, Yang CS, Chung Wu D, Huang CL, Chen PY, Chen JS, Chen WY. Trace Metals' abnormalities in hemodialysis patients: relationship with medications. Artif Organs. 2000; 24(11): 841-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11119069" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "9/ Berend K, van der Voet G, Boer WH. Acute aluminum encephalopathy in a dialysis center caused by a cement mortar water distribution pipe. Kidney Int. 2001; 59(2): 746-53. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11168958" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "10/ Spence LA, Aschengrau A, Gallagher LE, Webster TF, Heeren TC, Ozonoff DM. Evaluation of the Webler-Brown model for estimating tetrachloroethylene exposure from vinyl-lined asbestos-cement pipes. Environ Health. 2008; 7: 24-42."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "11/ Canaud B, Martin K, Morena M, Bosc JY, Leray-Moragues H, Mahowashi M, Stec F, Hansel S. Monitoring the microbial purity of the treated water and dialysate."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Saudi J Kidney Dis Transpl. 2001; 12(3): 325-6."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "12/ Schindler R, Beck W, Deppisch R, Aussieker M, Wilde A, Göhl H, Frei U. Short bacterial DNA fragments: detection in dialysate and induction of cytokines. J Am Soc Nephrol 2004; 15 (12): 3207-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15579524" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "13/ Arvanitidou M, Spaia S, Katsinas C, Pangidis P, Constantinidis T, Katsouyannopoulos V, Vayonas G. Microbiological quality of water and dialysate in all haemodialysis centres of Greece. Nephrol Dial Transplant. 1998; 13(4): 949-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9568856" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "14/ Smeets E, Kooman J, van der Sande F, Stobberingh E, Frederik P, Claessens P, Grave W, Schot A, Leunissen K. Prevention of biofilm formation in dialysis water treatment systems.. Kidney Int. 2003; 63(4):1574-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631375" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "15/ Arvanitidou M, Vayonas G, Spanakis N, Tsakris A. Ocurrence and antimicrobial resistance of Gram-negative bacterial isolated in haemodialysis water and dialysate of renal units: results of a Greek multicentre study. J Appl Microbiol 2003; 95 (1): 180-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12807469" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "16/ Laurence RA, Lapierre ST . Quality of hemodialysis water: a 7-year multicenter study. Am J Kidney Dis. 1995; 25(5): 738-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7747728" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "17/ Pizzarelli F, Cerrai T, Biagini M, Malaguti M, Bargagna R. Dialysis water treatment systems and monitoring in Italy: results of a national survey. J Nephrol. 2004; 17(4): 565-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15372420" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "18/ Puerta Carretero M, Pérez García R, Vega A, Abad S, Rodríguez Benítez P, López Gómez JM, Jofre Ibañez R. Tratamiento del agua en una unidad de hemodiálisis: Nuestra experiencia en diez años. Nefrología 2007; 27, supl. 4: 87."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "19/ van der Linde K, Lim BT, Rondeel JM, Antonissen LP, de Jong GM. Improved bacteriological surveillance of haemodialysis fluids: a comparison between Tryptic soy agar and Reasoner's 2A media. Nephrol Dial Transplant. 1999; 14(10): 2433-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10528669" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "20/ Punakabutra N, Nunthapisud P, Pisitkun T, Tiranathanagul K, Tungsanga K, Eiam-Ong S. Comparison of different culture methods on bacterial recovery in hemodialysis fluids. J Med Assoc Thai. 2004; 87(11): 1361-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15825714" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "21/ Pass T., Wright R., Sharp B., Harding GB. Culture of dialysis fluids on nutrient-rich media for short periods at elevated temperature underestimate microbial contamination. Blood Purif 1996; 14: 136-145. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8785029" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "22/ Harding GB, Pass T, Wright R. Bacteriology of hemodialysis fluids: are current methodologies meaningful? Artif Organs. 1992; 16(5): 448-56."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "23/ Arduino MJ, Bland LA, Aguero SM, Favero MS. Effects of incubation time and temperature on microbiologic sampling procedures for hemodialysis fluids. J Clin Microbiol. 1991; 29(7): 1462. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1885742" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "24/ Ray J. Microbiological monitoring of dialysis water systems--which culture method? J Ren Care. 2007; 33(2): 66-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "25/ James R. Monitoring of dialysis water systems--is there a need for increased sampling? EDTNA ERCA J. 2006; 32(2): 74-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16898097" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "26/ Pizzarelli F, Cerrai T, Biagini M, Malaguti M, Bargagna R. Dialysis water treatment systems and monitoring in Italy: results of a national survey. J Nephrol. 2004; 17(4): 565-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15372420" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "27/ Pérez-García R, Rodríguez Benítez P. Why and how to monitor bacterial contamination of dialysate? Nephrol Dial Transplant. 2000; 15: 760-764"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "28/ Gorke A, Kittel J. Routine disinfection of the total dialysis fluid system. EDTNA ERCA J. 2002; 28(3): 130-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12371736" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "29/ Reimer R. Hemodialysis machine disinfection: a safe period of time between cycles.CANNT J. 2000; 10(2): 23-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15719600" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "30/ Davidovits M, Barak A, Cleper R, Krause I, Gamzo Z, Eisenstein B. Methaemoglobinaemia and haemolysis associated with hydrogen peroxide in a paediatric haemodialysis centre: a warning note. Nephrol Dial Transplant. 2003; 18(11): 2354-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14551365" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "31/ Stragier A. Is ultraviolet radiation on haemodialysis RO water beneficial? EDTNA ERCA J. 2005; 31(4): 194-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16551024" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "32/ Borges CR, Lascowski KM, Filho NR, Pelayo JS. Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil. J Appl Microbiol. 2007; 103(5): 1791-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17953589" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "33/ Savino A, Pasquarella C, Nnanga N. Water treatment in domiciliary hemodiálisis equipment: ultraviolet irradiation and Sartobind membrana. Ann Ig. 2006; 18 (1): 3-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16649498" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710001865"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "34/ Schlaeper C, Diaz-Buxo JA. The Fresenius Medical Care home hemodialysis system. Semin Dial. 2004; 17 (2): 159-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15043622" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "35/ Ouseph R, Ward RA. Ultrapure dialysate for home hemodialysis?. Adv Chronic Kidney Dis. 2007; 14 (3): 256-262. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17603979" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "36/ Jofre R, Rodríguez Benítez P, López-Gómez JM, Pérez-García R. Inflammatory Síndrome in Patients on Hemodiálisis. J Am Soc Nephrol. 2006; 17: S274-S-280."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "37/ Furuya R. y cols. Ultrapure dialysate reduces plasma levels of beta2-microglobulin and pentosidine in hemodialysis patients. Blood Purif. 2005; 23(4): 311-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15980621" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "38/ Hsu Y. y cols. Ultrapure dialysate improves iron utilization and erythropoietin response in chronic hemodialysis patients - a prospective cross-over study. J Nephrol. 2004; 17: 693-700. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15593037" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "39/ Lederer SR. y cols. Ultrapure dialysis fluid lowers the cardiovascular morbidity in patients on maintenance hemodialysis by reducing continuous microinflammation. Nephron. 2002; 91: 452-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12119476" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "40/ Gerdemann A, Zoltan Wagner, Andreas Solf, Udo Bahner, August Heidland, Jörg Vienken and Reinhard Schinzel."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Plasma levels of advanced glycation end products during haemodialysis, haemodiafiltration and haemofiltration: potential importance of dialysate quality. Nephrol Dial Transplant. 2002 Jun;17(6):1045-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12032195" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "41/ Arizono K. y cols. Use of ultrapure dialysate in reduction of chronic inflammation during hemodialysis. Blood Purif. 2004;22 Suppl 2: 26-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15655319" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "42/ Schiffl H. Y cols. Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients. Nephrol Dial Transplant. 2002 Oct;17(10):1814-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12270990" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "43/ Matsuhashi N y col. Endotoxin-free dialysate improves response to erythropoeitin in hemodialysis patients. Nephron 2002; 92: 601-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12372943" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "44/ Sato T y cols. Preparation of ultrapure dialysate in Japan--clinical usefulness and short-term future. Blood Purif. 2004; 22 Suppl 2:55-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15655325" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109705004894"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "45/ De Francisco ALM, Pérez García R. Ultrapure dialysate and its effect on patients outcome. Saudi J Kidney Dis Transplant. 2001; 12 (3): 406-412."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000002800000005/v0_201502091635/X2013251408003901/v0_201502091635/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35428"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial Comments"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002800000005/v0_201502091635/X2013251408003901/v0_201502091635/en/P-E-S-A351-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408003901?idApp=UINPBA000064"
]
Article information
ISSN: 20132514
Original language: English
DOI:
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 6 13
2024 October 68 46 114
2024 September 89 50 139
2024 August 136 63 199
2024 July 94 33 127
2024 June 98 54 152
2024 May 100 47 147
2024 April 84 76 160
2024 March 38 31 69
2024 February 35 42 77
2024 January 38 38 76
2023 December 30 35 65
2023 November 72 37 109
2023 October 68 48 116
2023 September 71 31 102
2023 August 41 33 74
2023 July 48 37 85
2023 June 67 17 84
2023 May 81 30 111
2023 April 50 20 70
2023 March 73 22 95
2023 February 80 19 99
2023 January 44 48 92
2022 December 58 40 98
2022 November 60 54 114
2022 October 58 33 91
2022 September 54 28 82
2022 August 61 39 100
2022 July 45 45 90
2022 June 50 28 78
2022 May 68 62 130
2022 April 46 39 85
2022 March 77 63 140
2022 February 61 42 103
2022 January 85 35 120
2021 December 75 45 120
2021 November 53 35 88
2021 October 71 44 115
2021 September 66 44 110
2021 August 53 40 93
2021 July 72 33 105
2021 June 55 31 86
2021 May 56 31 87
2021 April 173 59 232
2021 March 89 26 115
2021 February 91 21 112
2021 January 102 25 127
2020 December 83 12 95
2020 November 68 13 81
2020 October 59 17 76
2020 September 57 16 73
2020 August 58 6 64
2020 July 39 7 46
2020 June 58 14 72
2020 May 73 18 91
2020 April 68 20 88
2020 March 75 15 90
2020 February 85 26 111
2020 January 85 26 111
2019 December 70 43 113
2019 November 82 20 102
2019 October 72 21 93
2019 September 72 38 110
2019 August 67 20 87
2019 July 66 27 93
2019 June 52 14 66
2019 May 65 21 86
2019 April 114 30 144
2019 March 62 20 82
2019 February 42 15 57
2019 January 45 26 71
2018 December 74 42 116
2018 November 70 19 89
2018 October 52 13 65
2018 September 62 15 77
2018 August 53 24 77
2018 July 65 9 74
2018 June 44 15 59
2018 May 53 14 67
2018 April 44 2 46
2018 March 51 10 61
2018 February 45 5 50
2018 January 45 7 52
2017 December 44 11 55
2017 November 40 14 54
2017 October 41 6 47
2017 September 43 11 54
2017 August 50 5 55
2017 July 33 9 42
2017 June 29 8 37
2017 May 47 11 58
2017 April 35 13 48
2017 March 24 7 31
2017 February 30 16 46
2017 January 15 12 27
2016 December 57 8 65
2016 November 76 10 86
2016 October 93 5 98
2016 September 136 8 144
2016 August 198 6 204
2016 July 148 10 158
2016 June 109 0 109
2016 May 127 0 127
2016 April 90 0 90
2016 March 85 0 85
2016 February 82 0 82
2016 January 84 0 84
2015 December 99 0 99
2015 November 84 0 84
2015 October 72 0 72
2015 September 57 0 57
2015 August 64 0 64
2015 July 46 0 46
2015 June 33 0 33
2015 May 42 0 42
2015 April 5 0 5
Show all

Follow this link to access the full text of the article

Idiomas
Nefrología (English Edition)