acute renal failure predictors in elderly patients with chronic kidney disease
Factores predictores de fracaso renal agudo en ancianos con enfermedad renal crónica
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Astrid" "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "NEFROLOGIA, HOSPITAL GENERAL DE SEGOVIA, SEGOVIA, SEGOVIA, Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Segovia, Segovia, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "GERIATRIA, HOSPITAL GENERAL DE SEGOVIA, SEGOVIA, SEGOVIA, Spain, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Servicio de Geriatría, Hospital General de Segovia, Segovia, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores predictores de fracaso renal agudo en ancianos con enfermedad renal crónica" ] ] "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" => "11631_16025_38375_en_t111631_copia.jpg" "Alto" => 772 "Ancho" => 2177 "Tamanyo" => 632306 ] ] "descripcion" => array:1 [ "en" => "Comparison of the sociodemographic characteristics, parameters of renal function, haematocrit, and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION AND OBJECTIVES</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Structural and functional changes associated with aging kidneys, together with the presence of certain comorbidities typical of the elderly, make this population particularly vulnerable to developing acute renal failure (ARF).<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">The aetiology of this condition generally involves multiple causes, such as volume depletion, processes that alter renal haemodynamics, exposure to nephrotoxic compounds, and even iatrogenic events.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">As regards prognosis, this syndrome is associated with increased morbidity and mortality rates.<span class="elsevierStyleSup">1,3</span> It has been shown that ARF is a risk factor for the development of chronic kidney disease (CKD) and the need for dialysis in the elderly.<span class="elsevierStyleSup">4</span> In a meta-analysis, Ishani et al. demonstrated that the risk of terminal nephropathy was 13 times greater in elderly individuals hospitalised with ARF than in those without ARF, suggesting that episodes of ARF could accelerate the progression of kidney disease.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The identification of risk factors for ARF in these patients may aid in establishing strategies for avoiding the appearance of this condition, thus reducing the morbidity and mortality produced by this syndrome.</p><p class="elsevierStylePara">The objectives of our study were to: a) evaluate which factors serve as predictors for the development of ARF in elderly individuals, and b) evaluate the impact that ARF has on the evolution of renal function.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHOD</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Of the 80 patients in the study of elderly patients with CKD at the Hospital General de Segovia (randomly recruited in external consultations in geriatrics and general nephrology between January and April 2006, during a period of clinical stability),<span class="elsevierStyleSup">6,7</span> we examined 56 patients who were still alive 36 months after recruitment and who had developed at least one episode of ARF during the period in which they were hospitalised.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Method</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Ours was a retrospective, observational study. We defined ARF as an increase in serum creatinine >0.5mg from the previous measurement. We registered the peak serum creatinine value measured during the ARF episode. We also examined the causes of ARF, as well as the need for renal replacement therapy. Glomerular filtration rate (GFR) was estimated using the abbreviated MDRD (Modification of Diet in Renal Disease) formula.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">We registered baseline comorbidity using the Charlson index, without including age as a factor.<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We performed all statistical analyses using SPSS statistical software, version 15.0. All data were expressed as percentages, means, and standard deviations. We compared means using Student’s t-tests if the data distribution was normal, and Mann-Whitney U-tests for non-parametric data. We compared proportions using Fisher’s chi-square test. With the objective of evaluating the impact of ARF on parameters of renal function over time, we used a linear model for repeated measures. In order to analyse the variables that serve as predictors for ARF, we performed a logistic regression analysis. The statistical significance level was set at 95% (<span class="elsevierStyleItalic">P</span><.05).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Of the 56 patients who completed the 36 month follow-up period, 12 (21.4%) developed at least one episode of ARF during hospitalisation. Table 1 summarises baseline comorbidity values, socio-demographic characteristics, renal function parameters, and haematocrit, and compares values between patients with and without ARF. Patients who developed ARF were significantly older, had worse baseline renal function, higher uric acid levels, and lower haematocrit. There were no significant differences in terms of comorbidity, history of ischaemic heart disease, heart failure, or use of diuretics during the baseline period when comparing between the two groups.</p><p class="elsevierStylePara">As regards the causes of ARF, four patients (33.3%) developed ARF in association with heart failure; 4 cases (33.3%) presented deterioration of renal function due to an infectious process/sepsis; 2 (16.7%) were caused by volume depletion associated with drug use (levofloxacin/opiates), and another 2 cases (16.7%) were caused by multiple factors. No patients required renal replacement therapy with dialysis. Three patients died during the episode of ARF (two of multiple origin and another related to sepsis).</p><p class="elsevierStylePara">Patients with ARF had a mean baseline serum creatinine value of 1.57±0.59mg/dl, and a maximum peak serum creatinine reached during the episode of ARF of 4.25±4.26mg/dl (<span class="elsevierStyleItalic">P</span>=.035).</p><p class="elsevierStylePara">We observed no significant differences in terms of level of control of blood pressure (BP) values after 36 months in our study patients (mean systolic BP: 130.02±16mm Hg without ARF vs. 136.16±12mm Hg with ARF; mean diastolic BP: 71.75±10mm Hg without ARF vs 67.83±7mm Hg with ARF).</p><p class="elsevierStylePara">Table 2 summarises the impact of the episode of ARF on renal function parameters during the follow-up period. Figure 1 displays how patients with ARF suffered a greater deterioration in MDRD-estimated glomerular filtration rate during the 36-month study period.</p><p class="elsevierStylePara">In the logistic regression analysis to evaluate which factors were the best predictors for the appearance of ARF in this study population (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric acid), age (relative risk [RR]: 1.20; 1.01-1.43; <span class="elsevierStyleItalic">P</span>=.039), uric acid (RR: 2.65; 1.11-6.30; <span class="elsevierStyleItalic">P</span>=.027), and haematocrit (RR: 0.64; 0.43-0.90; <span class="elsevierStyleItalic">P</span>=.031) were independently associated with the development of ARF.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Approximately one-fourth of all individuals in the study of elderly patients with CKD that were still alive 36 months after being recruited to the study had developed at least one episode of ARF during hospitalisation. In these cases, the primary aetiology was for the most part functional (in the context of heart failure, infectious processes, and in two cases, volume depletion associated with drug administration); in addition, these patients were treated without the need for dialysis. These results are comparable to those from previous studies.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara">The availability of biological markers for the early detection and treatment of ARF could aid in reducing the morbidity and mortality rates associated with this syndrome.<span class="elsevierStyleSup">10</span> In our study, the multivariate analysis revealed that baseline haematocrit and uric acid values were both predictive factors for ARF.</p><p class="elsevierStylePara">The association between preoperative haematocrit values or low haematocrit during the intra-operative procedure in patients undergoing cardiac surgery and ARF has already been described.<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">In recent years, a growing body of evidence has been compiled associating elevated uric acid levels in the blood with cardiovascular and renal pathologies.<span class="elsevierStyleSup">12</span> Studies have demonstrated an association between elevated blood uric acid levels and the incidence of CKD, as well as a reduced drop in renal function in patients with renal failure who are treated with alopurinol.<span class="elsevierStyleSup">13</span> In addition, our group has demonstrated that uric acid is an independent marker for risk of mortality in the global population of elderly individuals.<span class="elsevierStyleSup">14</span> Lapsia et al. demonstrated that preoperative uric acid levels are associated with increased incidence and risk of acute renal failure in patients following heart surgery.<span class="elsevierStyleSup">15</span> In our study, despite the limited number of elderly patients who developed ARF, the uric acid levels in baseline measurements taken from our patients upon recruitment into the study also turned out to be an independent risk factor for developing ARF. One possible explanation for the value of uric acid as a marker for ARF could be the fact that uric acid values increase during hypoxia (such as in chronic pulmonary obstructive disease, heart failure, etc.). As such, patients with greater levels of uric acid in the blood would tend to be also subjected to a greater degree of ischaemia, making them more susceptible for developing ARF.</p><p class="elsevierStylePara">In addition, studies have also shown that episodes of ARF accelerate the progression towards CKD.<span class="elsevierStyleSup">5</span> In our cohort of elderly patients with clinical stability upon recruitment into the study, we also demonstrated that these patients (who develop ARF) suffer a greater deterioration in renal function than those that do not, despite the fact that the episodes of ARF were functional in nature and related to other pathologies, in addition to the fact that no patients required dialysis treatment, making these the patients who would most benefit from monitoring in nephrological consultations.</p><p class="elsevierStylePara">To conclude, baseline uric acid and haematocrit values are independent risk factors for the development of ARF in elderly individuals. Despite the fact that these episodes of ARF are functional in nature and do not require dialysis treatment, they produce a deterioration in renal function over time.</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 declare that they have no potential conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/11631_16025_38375_en_t111631_copia.jpg" class="elsevierStyleCrossRefs"><img src="11631_16025_38375_en_t111631_copia.jpg" alt="Comparison of the sociodemographic characteristics, parameters of renal function, haematocrit, and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe"></img></a></p><p class="elsevierStylePara">Table 1. Comparison of the sociodemographic characteristics, parameters of renal function, haematocrit, and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe</p><p class="elsevierStylePara"><a href="grande/11631_16025_38376_en_t211631_copia.jpg" class="elsevierStyleCrossRefs"><img src="11631_16025_38376_en_t211631_copia.jpg" alt="Impact of acute renal failure on the evolution of renal parameters after 36 months"></img></a></p><p class="elsevierStylePara">Table 2. Impact of acute renal failure on the evolution of renal parameters after 36 months</p><p class="elsevierStylePara"><a href="grande/11631_16025_38377_en_f11611631.jpg" class="elsevierStyleCrossRefs"><img src="11631_16025_38377_en_f11611631.jpg" alt="Evolution of MDRD-estimated glomerular filtration rate following an episode of acute renal failure"></img></a></p><p class="elsevierStylePara">Figure 1. Evolution of MDRD-estimated glomerular filtration rate following an episode of acute renal failure</p>" "pdfFichero" => "P1-E544-S3761-A11631-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437167" "palabras" => array:1 [ 0 => "Hematocrito" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437169" "palabras" => array:1 [ 0 => "Fracaso renal agudo" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437171" "palabras" => array:1 [ 0 => "Ancianos" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437173" "palabras" => array:1 [ 0 => "Ácido úrico" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437175" "palabras" => array:1 [ 0 => "Enfermedad renal crónica" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437168" "palabras" => array:1 [ 0 => "Haematocrit" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437170" "palabras" => array:1 [ 0 => "Acute renal failure" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437172" "palabras" => array:1 [ 0 => "Elderly" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437174" "palabras" => array:1 [ 0 => "Uric acid" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437176" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción y objetivos</span><span class="elsevierStyleBold">:</span> El fracaso renal agudo (FRA) es un problema muy común en los ancianos y conlleva una elevada morbimortalidad. En este estudio se analizan los factores predictores de FRA en una cohorte de ancianos y su impacto en la evolución de la función renal. <span class="elsevierStyleBold">Pacientes y métodos</span><span class="elsevierStyleBold">:</span> Sobre un grupo de 80 ancianos reclutados entre enero-abril de 2006, se estudian de forma retrospectiva, en 56 pacientes que continúan con vida a los 36 meses, los episodios de FRA, sus causas y la necesidad de diálisis. <span class="elsevierStyleBold">Resultados:</span><span class="elsevierStyleBold"> </span>12 pacientes (21,4 %) presentaron FRA: 4 (33,3 %) con relación a insuficiencia cardiaca, 4 (33,3 %) por infección/sepsis, 2 (16,7 %) por depleción de volumen y otros 2 multifactorial (16,7 %). Ningún paciente precisó terapia con diálisis. Los pacientes con FRA eran más añosos (p = 0,017), tenían basalmente peor función renal (p = 0,031), mayores niveles de ácido úrico (p = 0,002) y menores de hematocrito (p = 0,003). Los pacientes con FRA tenían una creatinina sérica basal de 1,57 ± 0,59 mg/dl y el pico máximo de creatinina durante el FRA fue de 4,25 ± 4,26 mg/dl (p = 0,035). La función renal a los 36 meses en pacientes con FRA había disminuido (p = 0,024). En el análisis de regresión logística (variables independientes: edad, género, índice de Charlson, creatinina sérica, urea, ácido úrico, MDRD basales), la edad (riesgo relativo [RR]: 1,20; 1,01-1,43; p = 0,039), el ácido úrico (RR: 2,65; 1,11-6,30; p = 0,027) y el hematocrito (RR: 0,64; 0,43-0,96; p = 0,031) se asociaban independientemente con el desarrollo posterior de un FRA. <span class="elsevierStyleBold">Conclusión</span><span class="elsevierStyleBold">:</span> el nivel basal de ácido úrico y de hematocrito son factores de riesgo independiente para el desarrollo de FRA en ancianos, que, aun siendo de carácter funcional y sin necesidad de diálisis, producen un deterioro de la función renal en el tiempo.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction:</span> Acute renal failure (ARF) is a very common problem in the elderly and is associated with high morbidity and mortality rates. This study analysed ARF predictors in a cohort of elderly subjects and their impact on the evolution of renal function. <span class="elsevierStyleBold">Patients and method:</span> A group of 80 elderly individuals were recruited between January and April 2006, and 56 of these who were still alive after 36 months were retrospectively studied, examining episodes of ARF, their causes, and the need for dialysis. <span class="elsevierStyleBold">Results:</span> Twelve patients (21.4%) developed ARF: 4 (33.3%) related to heart failure, 4 (33.3%) due to infection/sepsis, 2 (16.7%) due to volume depletion, and another 2 were multifactorial (16.7%). No patients required dialysis therapy. Patients with ARF were older (<span class="elsevierStyleItalic">P</span>=.017), had worse renal function at baseline (<span class="elsevierStyleItalic">P</span>=.031), higher levels of uric acid (<span class="elsevierStyleItalic">P</span>=.002), and lower haematocrit (<span class="elsevierStyleItalic">P</span>=.003). Patients with ARF had a mean baseline serum creatinine of 1.57±0.59mg/dl and peak creatinine levels during episodes of ARF averaged 4.25±4.26mg/dl (<span class="elsevierStyleItalic">P</span>=.035). Mean renal function at 36 months in patients with ARF had decreased (<span class="elsevierStyleItalic">P</span>=.024). In a logistic regression analysis (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric acid), age (RR: 1.20, 1.01-1.43, <span class="elsevierStyleItalic">P</span>=.039), uric acid (RR: 2.65, 1.11-6.30, <span class="elsevierStyleItalic">P</span>=.027), and haematocrit (RR: 0.64, 0.43-0.96, <span class="elsevierStyleItalic">P</span>=.031) were independently associated with the development of ARF. <span class="elsevierStyleBold">Conclusions: </span>Baseline levels of uric acid and haematocrit are independent risk factors for the development of ARF in the elderly. Although these episodes may be functional in nature and not require dialysis, this can still cause a deterioration of renal function over time.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11631_16025_38375_en_t111631_copia.jpg" "Alto" => 772 "Ancho" => 2177 "Tamanyo" => 632306 ] ] "descripcion" => array:1 [ "en" => "Comparison of the sociodemographic characteristics, parameters of renal function, haematocrit, and comorbidity during the baseline period between elderly patients with and without at least one episode of acute renal failure during a 36-month monitoring pe" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11631_16025_38376_en_t211631_copia.jpg" "Alto" => 871 "Ancho" => 2161 "Tamanyo" => 422424 ] ] "descripcion" => array:1 [ "en" => "Impact of acute renal failure on the evolution of renal parameters after 36 months" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11631_16025_38377_en_f11611631.jpg" "Alto" => 1269 "Ancho" => 1059 "Tamanyo" => 227648 ] ] "descripcion" => array:1 [ "en" => "Evolution of MDRD-estimated glomerular filtration rate following an episode of acute renal failure" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000006/v0_201502091602/X201325141200223X/v0_201502091603/en/main.assets" "Apartado" => array:4 [ "identificador" => "35444" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000006/v0_201502091602/X201325141200223X/v0_201502091603/en/P1-E544-S3761-A11631-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141200223X?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 36 | 60 | 96 |
| 2024 September | 38 | 57 | 95 |
| 2024 August | 45 | 78 | 123 |
| 2024 July | 39 | 50 | 89 |
| 2024 June | 72 | 51 | 123 |
| 2024 May | 56 | 48 | 104 |
| 2024 April | 46 | 45 | 91 |
| 2024 March | 72 | 41 | 113 |
| 2024 February | 51 | 44 | 95 |
| 2024 January | 42 | 31 | 73 |
| 2023 December | 48 | 41 | 89 |
| 2023 November | 44 | 40 | 84 |
| 2023 October | 27 | 45 | 72 |
| 2023 September | 30 | 39 | 69 |
| 2023 August | 33 | 21 | 54 |
| 2023 July | 37 | 31 | 68 |
| 2023 June | 34 | 31 | 65 |
| 2023 May | 36 | 39 | 75 |
| 2023 April | 15 | 22 | 37 |
| 2023 March | 47 | 27 | 74 |
| 2023 February | 27 | 49 | 76 |
| 2023 January | 44 | 33 | 77 |
| 2022 December | 51 | 31 | 82 |
| 2022 November | 46 | 41 | 87 |
| 2022 October | 64 | 49 | 113 |
| 2022 September | 67 | 34 | 101 |
| 2022 August | 41 | 56 | 97 |
| 2022 July | 46 | 174 | 220 |
| 2022 June | 45 | 30 | 75 |
| 2022 May | 38 | 32 | 70 |
| 2022 April | 41 | 48 | 89 |
| 2022 March | 49 | 60 | 109 |
| 2022 February | 51 | 54 | 105 |
| 2022 January | 34 | 30 | 64 |
| 2021 December | 41 | 39 | 80 |
| 2021 November | 44 | 47 | 91 |
| 2021 October | 53 | 50 | 103 |
| 2021 September | 34 | 42 | 76 |
| 2021 August | 44 | 47 | 91 |
| 2021 July | 41 | 38 | 79 |
| 2021 June | 46 | 35 | 81 |
| 2021 May | 62 | 38 | 100 |
| 2021 April | 116 | 38 | 154 |
| 2021 March | 73 | 33 | 106 |
| 2021 February | 62 | 24 | 86 |
| 2021 January | 45 | 16 | 61 |
| 2020 December | 54 | 21 | 75 |
| 2020 November | 28 | 5 | 33 |
| 2020 October | 27 | 16 | 43 |
| 2020 September | 33 | 11 | 44 |
| 2020 August | 46 | 19 | 65 |
| 2020 July | 46 | 19 | 65 |
| 2020 June | 40 | 31 | 71 |
| 2020 May | 37 | 22 | 59 |
| 2020 April | 38 | 14 | 52 |
| 2020 March | 45 | 14 | 59 |
| 2020 February | 62 | 24 | 86 |
| 2020 January | 56 | 22 | 78 |
| 2019 December | 52 | 26 | 78 |
| 2019 November | 35 | 16 | 51 |
| 2019 October | 20 | 11 | 31 |
| 2019 September | 30 | 17 | 47 |
| 2019 August | 18 | 20 | 38 |
| 2019 July | 53 | 24 | 77 |
| 2019 June | 49 | 12 | 61 |
| 2019 May | 78 | 19 | 97 |
| 2019 April | 141 | 20 | 161 |
| 2019 March | 66 | 26 | 92 |
| 2019 February | 49 | 20 | 69 |
| 2019 January | 48 | 18 | 66 |
| 2018 December | 131 | 31 | 162 |
| 2018 November | 137 | 16 | 153 |
| 2018 October | 180 | 19 | 199 |
| 2018 September | 170 | 18 | 188 |
| 2018 August | 91 | 20 | 111 |
| 2018 July | 56 | 17 | 73 |
| 2018 June | 66 | 15 | 81 |
| 2018 May | 63 | 11 | 74 |
| 2018 April | 86 | 8 | 94 |
| 2018 March | 63 | 10 | 73 |
| 2018 February | 81 | 10 | 91 |
| 2018 January | 61 | 8 | 69 |
| 2017 December | 58 | 11 | 69 |
| 2017 November | 73 | 6 | 79 |
| 2017 October | 43 | 11 | 54 |
| 2017 September | 57 | 12 | 69 |
| 2017 August | 75 | 12 | 87 |
| 2017 July | 86 | 16 | 102 |
| 2017 June | 80 | 13 | 93 |
| 2017 May | 95 | 14 | 109 |
| 2017 April | 91 | 14 | 105 |
| 2017 March | 78 | 18 | 96 |
| 2017 February | 153 | 17 | 170 |
| 2017 January | 43 | 15 | 58 |
| 2016 December | 115 | 15 | 130 |
| 2016 November | 133 | 7 | 140 |
| 2016 October | 145 | 12 | 157 |
| 2016 September | 187 | 8 | 195 |
| 2016 August | 243 | 14 | 257 |
| 2016 July | 213 | 11 | 224 |
| 2016 June | 160 | 0 | 160 |
| 2016 May | 191 | 0 | 191 |
| 2016 April | 176 | 0 | 176 |
| 2016 March | 117 | 0 | 117 |
| 2016 February | 148 | 0 | 148 |
| 2016 January | 164 | 0 | 164 |
| 2015 December | 155 | 0 | 155 |
| 2015 November | 119 | 0 | 119 |
| 2015 October | 139 | 0 | 139 |
| 2015 September | 87 | 0 | 87 |
| 2015 August | 79 | 0 | 79 |
| 2015 July | 96 | 0 | 96 |
| 2015 June | 42 | 0 | 42 |
| 2015 May | 62 | 0 | 62 |
| 2015 April | 12 | 0 | 12 |
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