Analysis of psychological factors influencing peritoneal dialysis selection
Análisis de la influencia de los factores psicológicos en la elección de diálisis peritoneal
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C. Martínez Ocaña, D. Marquina Parra, C. Blasco Cabañas, C. Grau Pueyo, N. Mañé Buixó, M. García García" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Esther" "apellidos" => "Ponz Clemente" "email" => array:1 [ 0 => "eponz@tauli.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "J. C." "apellidos" => "Martínez Ocaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "D." "apellidos" => "Marquina Parra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "C." "apellidos" => "Blasco Cabañas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "C." "apellidos" => "Grau Pueyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "Iniciales" => "N." "apellidos" => "Mañé Buixó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 6 => array:3 [ "Iniciales" => "M." "apellidos" => "García García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Corporación Sanitaria Parc Taulí. Institut Universitari Parc Taulí (UAB), Sabadell, Barcelona, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la influencia de los factores psicológicos en la elección de diálisis peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10235108_a8_t1_demographic_characteristics_of_the_patients_who_agreed_to_participate.jpg" "Alto" => 856 "Ancho" => 1082 "Tamanyo" => 159855 ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of the patients who agreed to participate in the study (included) and patients who did not agree to participate (not included)" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The two dialysis techniques, haemodialysis (HD) and peritoneal dialysis (PD), have shown that, in general, they are equally effective as forms of renal replacement therapy (RRT),<span class="elsevierStyleSup">1,2 </span>although there are some differences in certain groups of patients, such as the elderly and diabetics.<span class="elsevierStyleSup">3 </span>Recent publications even indicate the possible advantages of starting RRT with PD rather than HD,<span class="elsevierStyleSup">4 </span>coining the concept of “integrated RRT”. Despite the two dialysis techniques being equally effective, the technical improvements of PD and the fact that it is more cost-effective than HD,<span class="elsevierStyleSup">5-7 </span>the extent to which PD is used varies widely and in Spain it does not even reach 3% of the total for RRT.<span class="elsevierStyleSup">8 </span>A recent prospective Canadian study reported that there were no medical contraindications for PD in 87% of patients and that 78% presented neither medical nor social contraindications for PD.<span class="elsevierStyleSup">9 </span>Therefore, essentially non-medical causes must underlie the diversity in the use of PD in different parts of the world.<span class="elsevierStyleSup">10 </span>The way health systems are organized and the funding of dialysis are factors which are decisive in the choice of this technique. Other reasons are the availability of HD machines, the distance patients have to travel to their HD centre and the training or opinion of nephrologists with respect to home dialysis techniques.<span class="elsevierStyleSup">11-14 </span>Proper planning when initiating RRT in patients with stage 5 chronic kidney disease (CKD-5) has been shown to correlate with lower morbidity and mortality and with greater choice of PD,<span class="elsevierStyleSup">15,16 </span>although an urgent and unscheduled start to dialysis may occur in up to half of cases.<span class="elsevierStyleSup">17,18 </span>The existence of structured educational programmes for patients with CRF-5 facilitates the choice of home dialysis techniques and, specifically, PD.<span class="elsevierStyleSup">17,19-21 </span>However, even in nephrology services the use of PD has not increased in circumstances which are optimal for its development, in other words, within a structure which favours PD and in which all patients are informed about the different dialysis techniques which exist, and in a situation in which there is a saturation of HD machines. Similar situations have already been seen in countries such as Canada, which are historically equipped with extensive PD programmes and which are now trying to promote institutional interventions that will enable at least 30% of patients to be treated with PD.<span class="elsevierStyleSup">22 </span>Since 1994 in our centre we have had a structured programme designed to provide information about dialysis techniques and renal transplants, which we have called the Decision Support Programme (DSP). It consists of the PD programme nursing personnel providing a detailed explanation of what CRF-5 and its treatment involve to patients and families.<span class="elsevierStyleSup">23 </span>The patient who is making a decision about RRT is going through a particularly stressful time; he has not only started to experience one or more symptoms of uraemia but, in addition, he has to make important decisions which will affect his life, those around him and his future. High levels of depression and anxiety hardly help him to do this. There is little information about the psychological state of patients when they choose RRT.<span class="elsevierStyleSup">24</span>We have designed this study with the aim of analyzing the influence of depression symptoms and personality traits on the choice of RRT technique. </p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHODS </span></p><p class="elsevierStylePara">This is a prospective observational study involving patients with no absolute contraindication for PD, who received information about RRT when they were referred to the DSP by their nephrologist from January 2004 to July 2006 and gave their informed consent, once patients who were clinically unstable or who had cognitive or sensorial deficits were excluded. The patients had to complete the Beck Depression Inventory (BDI)<span class="elsevierStyleSup">25 </span>and the Eysenck Personality questionnaire (EPQRS). <span class="elsevierStyleSup">26 </span>Demographic, clinical and social data was also collected when patients were informed about RRT. A note was made of the dialysis technique which was initially chosen and all the patients were monitored until the 31 October 2007, when their clinical situation, the length of time before RRT was started and the type of RRT which was finally applied were recorded. The BDI is a questionnaire which has been translated into Spanish and validated, and it is widely used to evaluate depression symptoms. It is a questionnaire consisting of 21 questions with four possible responses, the best score being 0 and the worst 63. The results are classified into the following categories: normal (0-10), borderline depression (11-14), mild depression (15-21) and moderate or severe depression (> 21). In dialysis patients with CRF-5 and a BDI score of >15 represent an excellent correlation with a diagnosis of depression, obtained by psychiatric assessment based on DSM-24.27 criteria. The short version of the Eysenck personality questionnaire (EPQ-RS)<span class="elsevierStyleSup">26 </span>is a test which is widely used in clinical practice to analyse personality traits. The questionnaire has been translated and adapted to the Spanish population. It consists of 48 questions which have two possible answers and it evaluates three dimensions of the personality: psychoticism, neuroticism and extraversion. In the general population the dimension of neuroticism shows good correlation with questionnaires which evaluate levels of depression and anxiety.<span class="elsevierStyleSup">28 </span>The following clinical variables were recorded: the underlying renal disease; comorbidity evaluated as the number of relevant pathologies; functional state measured by means of the Karnofsky activity scale adapted by Gutman for dialysis patients,<span class="elsevierStyleSup">29 </span>serum creatinine levels and glomerular filtration estimated by MDRD-4; haemoglobin and the use of agents which stimulate erythropoiesis; period of nephrological follow-up; existence of PD-related contraindications and physical deficiencies. The social data which was recorded included: educational level, family support and living arrangements. The data was analyzed using the SPSS for Windows 11.5 software program. The results are expressed either as the mean and standard deviation or proportionately. Nonparametric tests were used for the comparisons between groups: Fisher’s exact test in the case of categorical variables and the Mann-Whitney U test in the case of quantitative variables. The survival curves were calculated using the Kaplan-Meier method and the log-rank test was employed to compare the curves. A p value of < 0.05 was considered to be statistically significant. </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS </span></p><p class="elsevierStylePara">17 of the 101 patients who were referred to be informed about RRT were excluded owing to cognitive or sensorial defects and 11 owing to clinical instability. The remaining 73 patients were asked to give their informed consent in order to participate in the study and 44 patients (60%) agreed to take part. Significant differences were not observed with respect to clinical and demographic characteristics, nor with respect to the choice of PD, between the 44 patients who participated in the study and the 29 patients who did not wish to participate (table 1). Amongst the patients included in the study there were fewer patients who had undergone nephrological control for less than 3 months (9.1 compared to 28.6%; p = 0.05), fewer illiterate patients and patients with experience of higher education (11.7 compared to 42.3%; p = 0.03), and fewer patients with PD-related contraindications (63.6 compared to 29.6%; p = 0.01). 36% of the 44 patients who completed the questionnaires exhibited depression symptoms defined as a BDI >15 (mild, moderate or severe depression). Depression symptoms and the level of neuroticism showed no correlation with the choice of technique (table 2). Patients with symptoms of depression did not exhibit statistically significant clinical differences with respect to patients who had no symptoms, with the exception of a lower level of haemoglobin (data not shown). Initially, after being informed about the dialysis techniques, 59.1% of the patients chose HD and 40.9% PD. Following an average follow-up period of 2.25 ± 1.03 years, 31 of the 44 patients (70%) had started RRT 8 ± 8 months after the DSP (range 0-2.9 years). PD was the definitive dialysis technique for 32% of the patients. The patients who chose PD were significantly younger (p = 0.04) and tended to have fewer social problems (p = 0.06) (table 3). None of the patients who chose HD changed their mind, but 3 of the 13 patients (23%) who opted for PD finally received HD, generally due to acute complications. Our attention is drawn to the fact that half of the patients who had depressive symptoms (BDI >15) when they chose PD and a third of the patients with higher levels of neuroticism changed their initial decision and finally opted for HD. The 10 patients who were informed about RRT after having started HD in an urgent and unscheduled manner chose PD in the same proportion as the rest (50 compared to 38.2%; p = NS). The 2-year survival rate for patients with depression symptoms (BDI >15) tended to be worse (67%) in comparison with patients without depression symptoms (93%), although this finding was not statistically significant (figure 1). </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION </span></p><p class="elsevierStylePara">The percentage of patients with symptoms of depression at the time when they chose which RRT technique to use was high (36%), but similar to that reported by other authors.<span class="elsevierStyleSup">25,27 </span>One of the main characteristics of the patient with depression is their difficulty in resolving problems and starting RRT poses a major problem. Thus, we observed that, although the fact of having depression symptoms did not influence the choice of technique, it might have played a part in patients changing their mind when faced with crises or intercurrent complications. Initially, after being informed about RRT, 41% of the patients opted for PD, but finally only 32% actually received PD owing to changes in the choice of technique. It is of note that half of the patients with depression symptoms changed their initial choice about RRT to the detriment of the home dialysis technique. Our group of patients was not systematically assessed by mental health specialists, although some patients were being treated with antidepressants or ansiolytics prescribed by different doctors. It is a known fact that depression is related to mortality in the general population and also in CRF-5 dialysis patients.<span class="elsevierStyleSup">24 </span>Those of our patients with depression symptoms showed higher mortality, although this was not statistically significant, probably because of the small size of the sample. As far as the personality questionnaire is concerned, no correlation was detected between different personality tendencies and the choice of technique. We found it interesting to evaluate the association between the choice of technique and the trait of neuroticism, which showed an excellent correlation with depression symptoms and anxiety,<span class="elsevierStyleSup">28 </span>and might offer us information about how people cope with everyday problems. In a previous study which evaluated psychosocial aspects that might influence the choice of technique, albeit retrospectively, we found that a poorer ability to cope with problems was related to a less frequent choice of PD.<span class="elsevierStyleSup">30 </span>In accordance with these findings, patients with avoidant attitudes have been seen to benefit most from psychological and educational intervention programmes.<span class="elsevierStyleSup">31 </span>The application of techniques that potentiate active learning, which aim to improve the perception of the patient about the advantages of home dialysis techniques, increases the choice of PD.<span class="elsevierStyleSup">32 </span>Although in this study depression and personality traits were not shown to influence the choice of dialysis technique, we believe that they are factors which should be taken very much into account in the multidisciplinary assessment of the CRF-5 patient. It remains to be seen what type of psychological and pharmacological strategies could be most effective in this group of patients. As has been widely described in the literature, being young, having a higher educational level and better family support are factors that favour the use of home dialysis techniques.<span class="elsevierStyleSup">33,34 </span>It is interesting to see that the choice of PD does not decrease in patients who first received information about RRT after having started HD on an urgent basis. At our centre patients who start HD in an unscheduled way are also informed about the different RRT options, which might explain these results. As two of the principal limitations of the study, we might highlight: firstly, only 44 patients completed the psychological questionnaires, so the lack of correlation of depression symptoms and personality traits with the choice of technique may be due to the small size of the sample. Secondly, 40% of the patients who met the inclusion criteria for the study chose not to participate, although we think that the population which responded to the psychological questionnaires had similar characteristics to the general population and was capable of deciding which RRT technique they wished to receive. In conclusion, in our experience symptoms of depression and personality traits do not influence the initial choice of dialysis technique, although they may be factors which are implicated in subsequent changes in decisions, which tend to reduce the use of PD. When faced with the choice of which RRT technique, 36% of patients exhibit depression symptoms. Patients with depression tend to show higher mortality.  </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgements </span></p><p class="elsevierStylePara">The authors would like to thank Esther Pousa Tomás and Dr. Rosa Duñó Ambrós, the former a psychologist and the latter a psychiatrist for the Mental Health Service of the Corporació Sanitària del Parc Taulí, for their technical advice on how to use the psychological questionnaires.  </p><p class="elsevierStylePara"><a href="grande/10235108_a8_t1_demographic_characteristics_of_the_patients_who_agreed_to_participate.jpg" class="elsevierStyleCrossRefs"><img src="10235108_a8_t1_demographic_characteristics_of_the_patients_who_agreed_to_participate.jpg" alt="Demographic characteristics of the patients who agreed to participate in the study (included) and patients who did not agree to participate (not included)"></img></a></p><p class="elsevierStylePara">Table 1. Demographic characteristics of the patients who agreed to participate in the study (included) and patients who did not agree to participate (not included)</p><p class="elsevierStylePara"><a href="grande/10235108_a8_t2_beck_depression_inventory_and_eysenck_personality_questionnaire.jpg" class="elsevierStyleCrossRefs"><img src="10235108_a8_t2_beck_depression_inventory_and_eysenck_personality_questionnaire.jpg" alt="Beck Depression Inventory and Eysenck Personality Questionnaire (EPQ-RS) Scores depending on the choice of dialysis technique"></img></a></p><p class="elsevierStylePara">Table 2. Beck Depression Inventory and Eysenck Personality Questionnaire (EPQ-RS) Scores depending on the choice of dialysis technique</p><p class="elsevierStylePara"><a href="grande/10235108_a8_t3_demographic_characteristics_of_patients_who_completed_the_beck_depression.jpg" class="elsevierStyleCrossRefs"><img src="10235108_a8_t3_demographic_characteristics_of_patients_who_completed_the_beck_depression.jpg" alt="Demographic characteristics of patients who completed the Beck Depression Inventory and the Eysenck Personality Questionnaire - Differences depending on the choice of dialysis technique"></img></a></p><p class="elsevierStylePara">Table 3. Demographic characteristics of patients who completed the Beck Depression Inventory and the Eysenck Personality Questionnaire - Differences depending on the choice of dialysis technique</p><p class="elsevierStylePara"><a href="grande/10235108_a8_f1_survival_of_patients_comparing_patients_with_and_without_depressive.jpg" class="elsevierStyleCrossRefs"><img src="10235108_a8_f1_survival_of_patients_comparing_patients_with_and_without_depressive.jpg" alt="Survival of patients comparing patients with and without depressive symptoms according to their score on the beck depression inventory when they chose their dialysis technique."></img></a></p><p class="elsevierStylePara">Figure 1. Survival of patients comparing patients with and without depressive symptoms according to their score on the beck depression inventory when they chose their dialysis technique.</p>" "pdfFichero" => "P1-E47-S1877-A10235-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437383" "palabras" => array:1 [ 0 => "Elección de la técnica de diálisis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437385" "palabras" => array:1 [ 0 => "Factores psicológicos" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437387" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] ] "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437384" "palabras" => array:1 [ 0 => "Dialysis modality selection" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437386" "palabras" => array:1 [ 0 => "Psychological factors" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437388" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background</span>: Peritoneal dialysis (PD) is not frequently used in our setting. <span class="elsevierStyleBold">Objective</span>: To analyze the psychological factors involved in the choice of renal replacement therapy (RRT). <span class="elsevierStyleBold">Material and methods</span>: Prospective observational study of stable patients without cognitive or sensory deficits, who were informed about RRT from January 2004 to July 2006, and agreed to participate. The Beck Depression Inventory and the Eysenck personality questionnaire were administered. Clinical and sociodemographic data, and RRT choice were recorded. End of follow-up: 2007/10/31. <span class="elsevierStyleBold">Results</span>: We studied 44 patients: age, 65.4 ± 13.1 years, 48% male, 34% diabetic. When choosing RRT, 36% of patients had depressive symptoms. Neither depressive symptoms nor personality traits were related to the choice of the dialysis type. Patients who chose PD (41%) were younger. After a mean follow-up of 8 ± 8 months, 70% of patients started RRT (68% hemodialysis [HD], 32% PD). None<br />of the patients who chose HD changed their mind, but 3 of the 13 patients (23%) who chose PD finally commenced HD, usually in the context of disease exacerbations. Half of the patients with depressive symptoms when choosing PD, and a third of the patients with higher levels of neuroticism changed their decision and finally opted for HD. <span class="elsevierStyleBold">Conclusions</span>: When choosing RRT, the prevalence of depressive symptoms is high. Neither depression nor personality traits influenced the initial choice of RRT, but these factors may be involved in subsequent changes of the initial choice.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Antecedentes: La diálisis peritoneal (DP) se utiliza poco en nuestro medio. Objetivo: Analizar los factores psicológicos implicados en la elección del tratamiento sustitutivo renal (TSR). Material y métodos: Estudio observacional prospectivo de los enfermos estables y sin déficit cognitivo o sensorial que recibieron información del TSR entre enero de 2004 y julio de 2006 y que aceptaron participar. Se les entregaron para su cumplimentación el inventario de depresión de Beck y el cuestionario de personalidad de Eysenck, y se recogieron datos sociodemográficos, clínicos y el TSR elegido. El final del seguimiento fue el 31 de octubre de 2007. Resultados: Se estudiaron 44 pacientes: edad, 65,4 ± 13,1 años; 48% hombres; 34% diabéticos. Un 36% tenían síntomas depresivos. Ni éstos ni los rasgos de personalidad se relacionaron con la elección de la técnica. Eligieron DP (41%) los enfermos más jóvenes. Un 70% de los enfermos iniciaron TSR (68% hemodiálisis [HD], 32% DP) a los 8 ± 8 meses. Ninguno de los pacientes que eligieron HD cambió de opinión, pero tres de los 13 pacientes (23%) que habían elegido DP realizaron finalmente HD, en general en el contexto de agudizaciones. La mitad de los pacientes con síntomas depresivos y un tercio de los pacientes con mayores niveles de neuroticismo cambiaron su decisión inicial y optaron finalmente por la HD. Conclusiones: La prevalencia de síntomas depresivos en el momento de elegir TSR es elevada. Ni los síntomas depresivos ni los rasgos de personalidad influyeron en el TSR inicialmente elegido, aunque pueden ser factores implicados en los cambios de decisión posteriores.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10235108_a8_t1_demographic_characteristics_of_the_patients_who_agreed_to_participate.jpg" "Alto" => 856 "Ancho" => 1082 "Tamanyo" => 159855 ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of the patients who agreed to participate in the study (included) and patients who did not agree to participate (not included)" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10235108_a8_t2_beck_depression_inventory_and_eysenck_personality_questionnaire.jpg" "Alto" => 380 "Ancho" => 1082 "Tamanyo" => 57997 ] ] "descripcion" => array:1 [ "en" => "Beck Depression Inventory and Eysenck Personality Questionnaire (EPQ-RS) Scores depending on the choice of dialysis technique" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10235108_a8_t3_demographic_characteristics_of_patients_who_completed_the_beck_depression.jpg" "Alto" => 856 "Ancho" => 1082 "Tamanyo" => 135349 ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of patients who completed the Beck Depression Inventory and the Eysenck Personality Questionnaire - Differences depending on the choice of dialysis technique" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10235108_a8_f1_survival_of_patients_comparing_patients_with_and_without_depressive.jpg" "Alto" => 583 "Ancho" => 1082 "Tamanyo" => 67180 ] ] "descripcion" => array:1 [ "en" => "Survival of patients comparing patients with and without depressive symptoms according to their score on the beck depression inventory when they chose their dialysis technique." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, Krediet RT; NECOSAD Study Group. Hemodialysis and peritoneal dialysis: Comparison of adjusted mortality rates according to the duration of dialysis: Analysis of the Netherlands Cooperative Study on The Adequacy of Dialysis 2. J Am Soc Nephrol 2003;14:2851-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14569095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013001825" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vonesh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int Suppl 2006;103:S3-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17080109" 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" => "Mujais S, Story K. Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts. Kidney Int Suppl 2006;103:S21-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17080107" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0140673612621679" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Biesen W, Vanholder RC, Veys N, Dhondt A, Lameire NH. An evaluation of an integrative care approach for end-stage renal disease patients. J Am Soc Nephrol 2000;11:16-125." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rodríguez Carmona A, Pérez Fontán M, Valdés F, Cañado F. Estudio comparativo de costes de las diferentes modalidades de diálisis. Nefrologia 1997;16:539-48." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ponz E, Sató J, García García M, Mañé N, Ramírez Vaca J, García Morales M, et al. Análisis de la gestión económica de un programa de diálisis peritoneal. Comparación con el programa de hemodiálisis. Nefrologia 1997;17:152-61." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013006403" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Baboolal K, McEwan P, Sondhi S, Spiewanowski P, Wechowski J, Wilson K. The cost of renal dialysis in a UK setting-a multicentre study. Nephrol Dial Transplant 2008;23:1982-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18174268" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013000820" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García López FJ, Robles R, Gentil MA, Lorenzo V, Clèries M, García Blasco MJ, et al. Comparación de la incidencia, prevalencia, modalidades de tratamiento y mortalidad en pacientes con tratamiento sustitutivo en cinco comunidades autónomas españolas en el periodo 1991-1996. Nefrologia 1999;19:443-59." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mendelssohn DC, Mujais SK, Soroka SD, Brouillette J, Takano T, Barre PE, et al. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant 2009;24:555-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18755848" 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" => "Nissenson AR, Prichard SS, Cheng IK, Gokal R, Kubot M, Maiorca R, et al. Non-medical factors that impact on ESRD modality selection. Kidney Int Suppl 1993;40:S120-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8445833" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jung B, Blake PG, Mheta RK, Mendelsshon DC. Attitudes of Canadian nephrologists toward dialysis modality selection. Perit Dial Inter 1999;19:263-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mendelssohn DC, Mullaney SR, Jung B, Blake PG, Mehta RL. What do American nephrologists thin about dialysis modality selection? Am J Kidney Dis 2001;37:22-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jassal SV, Krishna G, Mallick NP, Mendelssohn DC. Attitudes of British isles nephrologists towards dialysis modality selection: a questionnaire study. Nephrol Dial Transplant 2002;17:474-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11865095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0140673612621679" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jager KJ, Korevaar JC, Dekker FW, Krediet RT, Boeschoten EW; NECOSAD Study Group. The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. Am J Kidney Dis 2004;43:891-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15112180" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kazmi WH, Obrador GT. Khan SS, Pereira BJ, Kause AT. Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis. Nephrol Dial Transplant 2004;19:1808-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15199194" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013001825" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Curtis BR, Ravani P, Malberti F, Kennett F, Taylor PA, Djurdiev O, et al. The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care in patient outcomes. Nephrol Dial Transplant 2005;20:147-54. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15585514" 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" => "Marrón B, Ortiz A, De Sequera P, Martín-Reyes G, De Arriba G, Lamas JM, et al, Spanish Group for CKD. Impact of end-stage renal disease care in planned dialysis start and type of renal replacement therapy-a Spanish multicentre experience. Nephrol Dial Transplant 2006; 21(Suppl 2):ii51-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16825262" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013006403" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Buck J, Baker R, Cannaby A-M, Nicholson S, Peters J, Warwick G.Why do patients known to renal services still undergo urgent dialysis initiation. A cross-sectional survey. Nephrol Dial Transplant 2007;22:3240-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17616535" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013001825" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Marrón B, Martínez Ocaña JC, Salgueira M, Barril G, Lamas JM, Martín M, et al, Spanish Group for CKD. Analysis of patient flow into dialysis: role of education in choice of dialysis modality. Perit Dial Int 2005;25(Suppl 3):S56-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16048258" 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" => "Mehrotra R, Marsh D, Vonesh E, Peters V, Nissenson A. Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney Int 2005;68:378-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15954930" 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" => "Manns BJ, Taur K, VanderStraeten C, Jones H, Mills C, Visser M, et al. The impact of education on chronic kidney disease patients¿ plans to initiate dialysis with self-care dialysis: A randomized trial. Kidney Int 2005;68:1777-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16164654" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1525861013006403" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Oreopoulos DG. Coleman S, Doyle E. Reversing the decreasing peritoneal dialysis (PD) trend in Ontario: a government initiative to increase PD use in Ontario to 30 % by 2010. Perit Dial Int 2007;27:489-95." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García M, Rodríguez A, Ponz E, Almirall J, Ramírez J. Opciones ante la insuficiencia renal crónica en un hospital comunitario. Aspectos éticos, decisiones y participación de los pacientes. Nefrologia 1995;15:349-55." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cukor D, Cohen SD, Peterson RA, Kimmel PL. Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. J Am Soc Nephrol 2007;18:3042-55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18003775" 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" => "Wiebe JS, Penley JA. A psychometric comparison of the Beck Depression Inventory-II in English and Spanish. Psychol Assess 2005;17:481-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16393015" 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" => "Sato T. The Eysenck Personality Questionnaire Brief Version: factor structure and reliability. J Psychol 2005;139:545-52. 27. Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis patients. Kidney Int 2000;57:2093-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis patients. Kidney Int 2000;57:2093-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10792629" 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" => "Jylhä P, Isometsä E. The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population. Depress Anxiety 2006;23:281-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16688731" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gutman RA, Stead WW, Robinson RR. Physical activity and employement status of patients on maintenance dialysis. N Engl J Med 1981;304:309-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7442770" 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" => "Marquina D, Blasco C, Mañé N, Ponz E, Martínez Ocaña JC, Yuste E, et al. Influencia de los rasgos de personalidad en la elección de la técnica de diálisis. Rev Esp Enferm Nefrol 2005; 8:13-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Devins GM, Mendelssohn DG, Barré PE, Taub K, Binik YM. Predialysis psychoeducational intervention extends survival in CKD: a 20-year follow-up. Am J Kidney Dis 2005;46:1088-98. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16310575" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "McLaughlin K, Jones H, VanderStraeten C, Mills C, Visser M, Tabú K, et al. Why do patients choose self-care dialysis? Nephrol Dial Transplant 2008;23:3972-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18577531" 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" => "Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger A, Finkelstein FO. Patients¿ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 2002;22:184-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11990402" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Little J, Irwin A, Marshall T, Rayner H, Smith S. Predicting a patient¿s choice of dialysis modality: experience in a United Kingdom renal department. Am J Kidney Dis 2001;37:981-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11325680" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036159/v0_201502091606/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000002/v0_201502091606/X2013251410036159/v0_201502091606/en/P1-E47-S1877-A10235-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036159?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 4 | 18 |
| 2024 October | 58 | 41 | 99 |
| 2024 September | 66 | 33 | 99 |
| 2024 August | 71 | 65 | 136 |
| 2024 July | 55 | 24 | 79 |
| 2024 June | 71 | 29 | 100 |
| 2024 May | 67 | 24 | 91 |
| 2024 April | 46 | 33 | 79 |
| 2024 March | 47 | 23 | 70 |
| 2024 February | 42 | 35 | 77 |
| 2024 January | 48 | 24 | 72 |
| 2023 December | 34 | 32 | 66 |
| 2023 November | 45 | 37 | 82 |
| 2023 October | 53 | 35 | 88 |
| 2023 September | 75 | 27 | 102 |
| 2023 August | 68 | 22 | 90 |
| 2023 July | 53 | 32 | 85 |
| 2023 June | 52 | 22 | 74 |
| 2023 May | 60 | 47 | 107 |
| 2023 April | 72 | 28 | 100 |
| 2023 March | 74 | 18 | 92 |
| 2023 February | 74 | 16 | 90 |
| 2023 January | 62 | 23 | 85 |
| 2022 December | 42 | 32 | 74 |
| 2022 November | 42 | 29 | 71 |
| 2022 October | 91 | 46 | 137 |
| 2022 September | 94 | 37 | 131 |
| 2022 August | 59 | 42 | 101 |
| 2022 July | 40 | 41 | 81 |
| 2022 June | 43 | 38 | 81 |
| 2022 May | 30 | 23 | 53 |
| 2022 April | 46 | 56 | 102 |
| 2022 March | 62 | 45 | 107 |
| 2022 February | 53 | 40 | 93 |
| 2022 January | 44 | 25 | 69 |
| 2021 December | 43 | 44 | 87 |
| 2021 November | 39 | 31 | 70 |
| 2021 October | 66 | 44 | 110 |
| 2021 September | 41 | 34 | 75 |
| 2021 August | 44 | 32 | 76 |
| 2021 July | 43 | 38 | 81 |
| 2021 June | 43 | 24 | 67 |
| 2021 May | 46 | 32 | 78 |
| 2021 April | 116 | 63 | 179 |
| 2021 March | 66 | 28 | 94 |
| 2021 February | 90 | 20 | 110 |
| 2021 January | 53 | 26 | 79 |
| 2020 December | 64 | 16 | 80 |
| 2020 November | 55 | 17 | 72 |
| 2020 October | 38 | 13 | 51 |
| 2020 September | 45 | 5 | 50 |
| 2020 August | 64 | 13 | 77 |
| 2020 July | 68 | 8 | 76 |
| 2020 June | 62 | 11 | 73 |
| 2020 May | 84 | 17 | 101 |
| 2020 April | 53 | 17 | 70 |
| 2020 March | 70 | 16 | 86 |
| 2020 February | 112 | 21 | 133 |
| 2020 January | 99 | 23 | 122 |
| 2019 December | 99 | 25 | 124 |
| 2019 November | 89 | 18 | 107 |
| 2019 October | 107 | 14 | 121 |
| 2019 September | 158 | 24 | 182 |
| 2019 August | 117 | 19 | 136 |
| 2019 July | 109 | 21 | 130 |
| 2019 June | 120 | 37 | 157 |
| 2019 May | 112 | 24 | 136 |
| 2019 April | 201 | 33 | 234 |
| 2019 March | 137 | 39 | 176 |
| 2019 February | 73 | 27 | 100 |
| 2019 January | 73 | 17 | 90 |
| 2018 December | 139 | 43 | 182 |
| 2018 November | 166 | 13 | 179 |
| 2018 October | 132 | 8 | 140 |
| 2018 September | 155 | 20 | 175 |
| 2018 August | 103 | 15 | 118 |
| 2018 July | 85 | 14 | 99 |
| 2018 June | 95 | 15 | 110 |
| 2018 May | 71 | 8 | 79 |
| 2018 April | 133 | 17 | 150 |
| 2018 March | 108 | 14 | 122 |
| 2018 February | 90 | 9 | 99 |
| 2018 January | 76 | 13 | 89 |
| 2017 December | 91 | 10 | 101 |
| 2017 November | 78 | 16 | 94 |
| 2017 October | 70 | 12 | 82 |
| 2017 September | 79 | 10 | 89 |
| 2017 August | 67 | 15 | 82 |
| 2017 July | 62 | 10 | 72 |
| 2017 June | 58 | 9 | 67 |
| 2017 May | 57 | 6 | 63 |
| 2017 April | 69 | 11 | 80 |
| 2017 March | 65 | 6 | 71 |
| 2017 February | 199 | 4 | 203 |
| 2017 January | 37 | 8 | 45 |
| 2016 December | 92 | 6 | 98 |
| 2016 November | 130 | 4 | 134 |
| 2016 October | 218 | 4 | 222 |
| 2016 September | 426 | 3 | 429 |
| 2016 August | 274 | 10 | 284 |
| 2016 July | 210 | 5 | 215 |
| 2016 June | 168 | 0 | 168 |
| 2016 May | 176 | 0 | 176 |
| 2016 April | 138 | 0 | 138 |
| 2016 March | 119 | 0 | 119 |
| 2016 February | 126 | 0 | 126 |
| 2016 January | 170 | 0 | 170 |
| 2015 December | 128 | 0 | 128 |
| 2015 November | 102 | 0 | 102 |
| 2015 October | 125 | 0 | 125 |
| 2015 September | 99 | 0 | 99 |
| 2015 August | 98 | 0 | 98 |
| 2015 July | 85 | 0 | 85 |
| 2015 June | 44 | 0 | 44 |
| 2015 May | 60 | 0 | 60 |
| 2015 April | 5 | 0 | 5 |
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