Effects of suspending ACE inhibitors and ARBs in advanced chronic kidney disease
Efectos de la suspensión de IECA y ARAII en enfermedad crónica avanzada
Read
16375
Timeswas read the article
2623
Total PDF
13752
Total HTML
Share statistics
array:21 [ "pii" => "X2013251412001168" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Mar.11422" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:400-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8331 "formatos" => array:3 [ "EPUB" => 332 "HTML" => 7216 "PDF" => 783 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699512001160" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2012.Mar.11422" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2012;32:400-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 34226 "formatos" => array:3 [ "EPUB" => 333 "HTML" => 32619 "PDF" => 1274 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Efectos de la suspensión de IECA y ARAII en enfermedad crónica avanzada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "401" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effects of suspending ACE inhibitors and ARBs in advanced chronic kidney disease" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "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" => "11422_108_27787_es_11422_t1.jpg" "Alto" => 189 "Ancho" => 600 "Tamanyo" => 82559 ] ] "descripcion" => array:1 [ "es" => "Evolución del filtrado glomerular y de la proteinuria tras la retirada de IECA y ARAII" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Martha E. Díaz-Domínguez, Milagros Fernández-Lucas, Antonio Gomis-Couto, Gloria Ruiz-Roso, José L. Teruel, Carlos Quereda" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Martha E." "apellidos" => "Díaz-Domínguez" ] 1 => array:2 [ "nombre" => "Milagros" "apellidos" => "Fernández-Lucas" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gomis-Couto" ] 3 => array:2 [ "nombre" => "Gloria" "apellidos" => "Ruiz-Roso" ] 4 => array:2 [ "nombre" => "José L." "apellidos" => "Teruel" ] 5 => array:2 [ "nombre" => "Carlos" "apellidos" => "Quereda" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251412001168" "doi" => "10.3265/Nefrologia.pre2012.Mar.11422" "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/X2013251412001168?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512001160?idApp=UINPBA000064" "url" => "/02116995/0000003200000003/v0_201502091350/X0211699512001160/v0_201502091351/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X201325141200115X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Feb.11378" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:401-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4200 "formatos" => array:3 [ "EPUB" => 326 "HTML" => 3184 "PDF" => 690 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Microalbuminuria, another use for paricalcitol? Our experience in advanced chronic kidney disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "401" "paginaFinal" => "402" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Microalbuminuria, ¿otro uso del paricalcitol? Nuestra experiencia en enfermedad renal crónica avanzada" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Blanco-García, Juan J. Bravo-López, Mercedes Moreiras-Plaza, Walfred Nájera-de la Garza, Cynthia Cossio-Annibar, Laura Beato-Coo, Gloria Rodríguez-Goyanes" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Raquel" "apellidos" => "Blanco-García" ] 1 => array:2 [ "nombre" => "Juan J." "apellidos" => "Bravo-López" ] 2 => array:2 [ "nombre" => "Mercedes" "apellidos" => "Moreiras-Plaza" ] 3 => array:2 [ "nombre" => "Walfred" "apellidos" => "Nájera-de la Garza" ] 4 => array:2 [ "nombre" => "Cynthia" "apellidos" => "Cossio-Annibar" ] 5 => array:2 [ "nombre" => "Laura" "apellidos" => "Beato-Coo" ] 6 => array:2 [ "nombre" => "Gloria" "apellidos" => "Rodríguez-Goyanes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512001152" "doi" => "10.3265/Nefrologia.pre2012.Feb.11378" "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/X0211699512001152?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200115X?idApp=UINPBA000064" "url" => "/20132514/0000003200000003/v0_201502091613/X201325141200115X/v0_201502091614/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251412001176" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2012.Feb.11385" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2012;32:399" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4216 "formatos" => array:3 [ "EPUB" => 305 "HTML" => 3300 "PDF" => 611 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Diabetic foot and renal failure. Theoretical and practical considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "399" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pie diabético e insuficiencia renal. De la teoría a la práctica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fátima Batista-García, Michele Hernández, Santiago Suria, Noemí Esparza, M. Dolores Checa" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Fátima" "apellidos" => "Batista-García" ] 1 => array:2 [ "nombre" => "Michele" "apellidos" => "Hernández" ] 2 => array:2 [ "nombre" => "Santiago" "apellidos" => "Suria" ] 3 => array:2 [ "nombre" => "Noemí" "apellidos" => "Esparza" ] 4 => array:2 [ "nombre" => "M. Dolores" "apellidos" => "Checa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699512001179" "doi" => "10.3265/Nefrologia.pre2012.Feb.11385" "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/X0211699512001179?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001176?idApp=UINPBA000064" "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001176/v0_201502091614/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Effects of suspending ACE inhibitors and ARBs in advanced chronic kidney disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "400" "paginaFinal" => "401" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Martha E. Díaz-Domínguez, Milagros Fernández-Lucas, Antonio Gomis-Couto, Gloria Ruiz-Roso, José L. Teruel, Carlos Quereda" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Martha E." "apellidos" => "Díaz-Domínguez" "email" => array:1 [ 0 => "marthdiaz@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Milagros" "apellidos" => "Fernández-Lucas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Antonio" "apellidos" => "Gomis-Couto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Gloria" "apellidos" => "Ruiz-Roso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "José L." "apellidos" => "Teruel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Carlos" "apellidos" => "Quereda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos de la suspensión de IECA y ARAII en enfermedad crónica avanzada" ] ] "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" => "11422_16025_30821_en_t1_411422.jpg" "Alto" => 489 "Ancho" => 1446 "Tamanyo" => 201916 ] ] "descripcion" => array:1 [ "en" => "Evolution of glomerular filtration rate and proteinuria following suspension of ACE inhibitors and ARBs" ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Renin-angiotensin system inhibition is a commonly used therapeutic measure for slowing the progression of kidney disease in diabetic nephropathy and nephropathies with proteinuria. It has also been established that activation of this system is necessary for maintaining glomerular filtration when renal perfusion is severely impaired, as occurs in ischaemic nephropathy and cases of hypotension and dehydration. In these situations, the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can deteriorate renal function.</p><p class="elsevierStylePara">In a recent and very shocking study carried out in patients with advanced chronic renal failure, Ahmed et al showed that halting renin-angiotensin system inhibitor treatment was associated with a relevant and persistent improvement in renal function, with an increase in glomerular filtration rate >25% in 61.5% of cases.<span class="elsevierStyleSup">1</span> These results led us to question the adequacy of using these drugs in advanced chronic kidney disease, and we decided to confirm these findings in our own patients.</p><p class="elsevierStylePara">Between January and June 2011, ACE inhibitors and ARBs were suspended in patients with stage 5 chronic kidney disease that were undergoing predialysis programmes at the Hospital Ramón y Cajal Hospital in Madrid. The study included a total of 14 patients (5 women and 9 men) with a mean age of 68±12 years (range: 42-88 years). The aetiologies of the different cases were diabetic nephropathy (5 cases), nephroangiosclerosis (3 cases) polycystic kidney disease (2 cases), and other (4 cases). Eleven patients were receiving ARBs, one received ACE inhibitors, and the other two received both ARBs and ACE inhibitors. These drugs were replaced with calcium channel blockers or beta blockers. When the renin-angiotensin system inhibitor was suspended, all patients were clinically stable, with no signs or symptoms of heart failure, with blood pressure values under control and fractional sodium excretion ranging between 2% and 5.6%.</p><p class="elsevierStylePara">Table 1 summarises the progression of glomerular filtration rate (MDRD-4), proteinuria (proteinuria:creatinine ratio) and serum potassium concentration since the renin-angiotensin system inhibitors were suspended (baseline values) to three months later.</p><p class="elsevierStylePara">We only observed an increase in glomerular filtration rate >25% in one patient, and this increase was temporary. Overall, the removal of ACE inhibitor and ARB treatment was associated with an almost statistically significant increase in proteinuria. However, in 5 patients, the increase in proteinuria:creatinine ratio in urine samples was greater than 1mg/mg. There were no changes in serum potassium concentrations. We did not found an increase in blood pressure in any patient following the suspension of renin-angiotensin system inhibitors; however, two patients requested reinstatement of treatment, attesting to a better clinical tolerance. No patients suffered cardiovascular events during the follow-up period.</p><p class="elsevierStylePara">Our results in patients with stage 5 chronic kidney disease differ from those published by Ahmed et al. Although these drugs may worsen renal function in cases of compromised renal perfusion, the removal of renin-angiotensin system inhibitors failed to provide any relevant benefits in clinically stable patients without signs of dehydration. Even in these advanced phases of renal failure, ACE inhibitors and ARBs have an antiproteinuric effect. We believe that larger studies are needed in order to clarify whether suspending treatment with ACE inhibitors or ARBs in advanced chronic kidney disease impacts glomerular filtration rate, and if so, which patients would benefit from this protocol.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article.</p><p class="elsevierStylePara"><a href="grande/11422_16025_30821_en_t1_411422.jpg" class="elsevierStyleCrossRefs"><img src="11422_16025_30821_en_t1_411422.jpg" alt="Evolution of glomerular filtration rate and proteinuria following suspension of ACE inhibitors and ARBs"></img></a></p><p class="elsevierStylePara">Table 1. Evolution of glomerular filtration rate and proteinuria following suspension of ACE inhibitors and ARBs</p>" "pdfFichero" => "P1-E536-S3516-A11422-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11422_16025_30821_en_t1_411422.jpg" "Alto" => 489 "Ancho" => 1446 "Tamanyo" => 201916 ] ] "descripcion" => array:1 [ "en" => "Evolution of glomerular filtration rate and proteinuria following suspension of ACE inhibitors and ARBs" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ahmed AK, Kamarth NS, El Kossi M, El Nahas AM. The impact of stopping inhibitors of the rennin-angiotensin system in patients with advance chronic kidney disease. Nephrol Dial Transplant 2010;25:3977-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19820248" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001168/v0_201502091614/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X2013251412001168/v0_201502091614/en/P1-E536-S3516-A11422-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001168?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 10 | 29 |
| 2024 October | 155 | 34 | 189 |
| 2024 September | 211 | 35 | 246 |
| 2024 August | 169 | 51 | 220 |
| 2024 July | 171 | 47 | 218 |
| 2024 June | 128 | 44 | 172 |
| 2024 May | 89 | 45 | 134 |
| 2024 April | 85 | 28 | 113 |
| 2024 March | 64 | 26 | 90 |
| 2024 February | 61 | 37 | 98 |
| 2024 January | 82 | 29 | 111 |
| 2023 December | 61 | 27 | 88 |
| 2023 November | 78 | 46 | 124 |
| 2023 October | 92 | 27 | 119 |
| 2023 September | 103 | 33 | 136 |
| 2023 August | 100 | 15 | 115 |
| 2023 July | 78 | 30 | 108 |
| 2023 June | 84 | 31 | 115 |
| 2023 May | 95 | 30 | 125 |
| 2023 April | 61 | 17 | 78 |
| 2023 March | 80 | 29 | 109 |
| 2023 February | 54 | 19 | 73 |
| 2023 January | 60 | 26 | 86 |
| 2022 December | 60 | 33 | 93 |
| 2022 November | 75 | 29 | 104 |
| 2022 October | 76 | 33 | 109 |
| 2022 September | 72 | 32 | 104 |
| 2022 August | 87 | 39 | 126 |
| 2022 July | 70 | 43 | 113 |
| 2022 June | 74 | 38 | 112 |
| 2022 May | 75 | 26 | 101 |
| 2022 April | 121 | 51 | 172 |
| 2022 March | 129 | 51 | 180 |
| 2022 February | 99 | 42 | 141 |
| 2022 January | 99 | 41 | 140 |
| 2021 December | 99 | 41 | 140 |
| 2021 November | 116 | 29 | 145 |
| 2021 October | 136 | 47 | 183 |
| 2021 September | 131 | 42 | 173 |
| 2021 August | 143 | 49 | 192 |
| 2021 July | 166 | 38 | 204 |
| 2021 June | 185 | 20 | 205 |
| 2021 May | 157 | 43 | 200 |
| 2021 April | 515 | 64 | 579 |
| 2021 March | 299 | 46 | 345 |
| 2021 February | 225 | 38 | 263 |
| 2021 January | 150 | 28 | 178 |
| 2020 December | 123 | 24 | 147 |
| 2020 November | 95 | 21 | 116 |
| 2020 October | 62 | 12 | 74 |
| 2020 September | 53 | 11 | 64 |
| 2020 August | 62 | 17 | 79 |
| 2020 July | 70 | 13 | 83 |
| 2020 June | 117 | 14 | 131 |
| 2020 May | 101 | 16 | 117 |
| 2020 April | 112 | 28 | 140 |
| 2020 March | 165 | 18 | 183 |
| 2020 February | 129 | 21 | 150 |
| 2020 January | 169 | 26 | 195 |
| 2019 December | 196 | 33 | 229 |
| 2019 November | 243 | 23 | 266 |
| 2019 October | 227 | 18 | 245 |
| 2019 September | 197 | 25 | 222 |
| 2019 August | 231 | 29 | 260 |
| 2019 July | 286 | 47 | 333 |
| 2019 June | 213 | 31 | 244 |
| 2019 May | 216 | 38 | 254 |
| 2019 April | 263 | 56 | 319 |
| 2019 March | 204 | 54 | 258 |
| 2019 February | 96 | 30 | 126 |
| 2019 January | 134 | 42 | 176 |
| 2018 December | 148 | 39 | 187 |
| 2018 November | 139 | 14 | 153 |
| 2018 October | 132 | 12 | 144 |
| 2018 September | 108 | 13 | 121 |
| 2018 August | 93 | 19 | 112 |
| 2018 July | 77 | 11 | 88 |
| 2018 June | 88 | 15 | 103 |
| 2018 May | 71 | 10 | 81 |
| 2018 April | 100 | 6 | 106 |
| 2018 March | 91 | 8 | 99 |
| 2018 February | 76 | 9 | 85 |
| 2018 January | 91 | 10 | 101 |
| 2017 December | 83 | 14 | 97 |
| 2017 November | 83 | 9 | 92 |
| 2017 October | 69 | 9 | 78 |
| 2017 September | 85 | 9 | 94 |
| 2017 August | 65 | 14 | 79 |
| 2017 July | 55 | 16 | 71 |
| 2017 June | 83 | 8 | 91 |
| 2017 May | 107 | 11 | 118 |
| 2017 April | 290 | 9 | 299 |
| 2017 March | 56 | 1 | 57 |
| 2017 February | 49 | 9 | 58 |
| 2017 January | 27 | 5 | 32 |
| 2016 December | 52 | 2 | 54 |
| 2016 November | 81 | 9 | 90 |
| 2016 October | 87 | 4 | 91 |
| 2016 September | 116 | 5 | 121 |
| 2016 August | 202 | 3 | 205 |
| 2016 July | 211 | 14 | 225 |
| 2016 June | 121 | 0 | 121 |
| 2016 May | 145 | 0 | 145 |
| 2016 April | 114 | 0 | 114 |
| 2016 March | 91 | 0 | 91 |
| 2016 February | 111 | 0 | 111 |
| 2016 January | 133 | 0 | 133 |
| 2015 December | 133 | 0 | 133 |
| 2015 November | 117 | 0 | 117 |
| 2015 October | 118 | 0 | 118 |
| 2015 September | 76 | 0 | 76 |
| 2015 August | 81 | 0 | 81 |
| 2015 July | 79 | 0 | 79 |
| 2015 June | 54 | 0 | 54 |
| 2015 May | 51 | 0 | 51 |
| 2015 April | 10 | 0 | 10 |
Show all
