Metabolic syndrome is associated with cardiovascular events in haemodialysis
El síndrome metabólico se asocia con eventos cardiovasculares en hemodiálisis
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"apellidos" => "López-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Nephrology, Hospital Gregorio Marañón, Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Departamento de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El síndrome metabólico se asocia con eventos cardiovasculares en hemodiálisis" ] ] "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" => "12092_16025_54370_en_t1.12092.jpg" "Alto" => 1363 "Ancho" => 2155 "Tamanyo" => 649160 ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients on haemodialysis with and without metabolic syndrome" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Metabolic syndrome (MS) is defined by a set of factors in the same individual that increase the risk of suffering from cardiovascular disease or diabetes mellitus. It is characterised by resistance to insulin and compensatory hyperinsulinaemia associated with carbohydrate metabolism disorders, high blood pressure (HBP), lipid disorders and obesity.</p><p class="elsevierStylePara">MS is a risk factor for cardiovascular disease and mortality in the general population<span class="elsevierStyleSup">1,2</span> and in patients with chronic kidney disease.<span class="elsevierStyleSup">3</span> However, there are few data in the literature regarding its prevalence in haemodialysis (HD) patients and very few studies analyse its prognostic implications.</p><p class="elsevierStylePara">The conicity index (CI)<span class="elsevierStyleSup">4</span> has been used to assess the degree of abdominal adiposity. The index values range from 1 (cylinder) to 1.73 (double cone). The cut-off point from which the risk of cardiovascular disease increases in the general population is not well-established and it is even less so in HD patients.</p><p class="elsevierStylePara">The main objective of the study was to analyse the effect of MS on the occurrence of cardiovascular events after 3 years of follow-up in HD patients. The secondary objectives were to determine the influence of the fat tissue index (FTI) and the CI on the development of cardiovascular events in these patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">A prospective cohort study including 100 prevalent HD patients, of whom 60% were male, with a mean age of 60.6±16.5 years of age at the start of the study, which had been on renal replacement therapy for 8.9±9.6 years. 39% of patients had received a kidney transplant. 34% of patients were diabetic (DM) and 83% had high blood pressure. The follow-up time was 3 years, from January 2009 to January 2012.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cardiovascular events and mortality</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We prospectively recorded admissions due to cardiovascular events (ischaemic heart disease, arrhythmia, congestive heart failure, stroke or peripheral vascular disease) and mortality in patients classified in accordance with the presence or absence of MS.</p><p class="elsevierStylePara">We also collected demographic data, medical history, laboratory data and comorbidity data measured using the Charlson index. We measured resistance to insulin with the HOMA index.<span class="elsevierStyleSup">5</span> We used the CI<span class="elsevierStyleSup">4</span> to assess the degree of abdominal adiposity. We carried out a bioimpedance spectroscopy analysis (BCM<span class="elsevierStyleSup">®</span>, FMC) to determine body composition.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definition of metabolic syndrome</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">MS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII)<span class="elsevierStyleSup">6</span> and the International Diabetes Federation (IDF) criteria.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">In 2001, the third NCEP ATPIII report defined MS as the presence of 3 out of 5 clinical criteria: 1) waist circumference ≥102cm in males or 88cm in females, 2) triglycerides ≥150mg/dl, 3) HDL cholesterol <40mg/dl in males or 50mg/dl in females, 4) blood pressure ≥130/85mmHg and 5) glycaemia >110mg/dl. In 2005, the IDF proposed new criteria, similar to those of ATPIII, but with central obesity being considered as a necessary condition for the diagnosis of MS.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We divided patients in accordance with presence of MS as defined by the NCEP ATPIII. We analysed the concordance between the two definitions using the kappa index. We determined MS risk factors (as defined by the ATPIII) with the logistic regression analysis. We performed a Kaplan-Meier analysis to study the influence of MS, FTI and CI on the occurrence of a cardiovascular event. We divided the patients into 2 groups in accordance with the presence or absence of MS and in accordance with the FTI and CI medians. We subsequently carried out a Cox regression analysis to determine risk factors associated with the occurrence of the first cardiovascular event.</p><p class="elsevierStylePara">Continuous variables were expressed as the mean ± standard deviation and the categorical variables were expressed as a percentage of the number of cases. The continuous variables of the two patient groups (with and without MS) were compared out using the Student’s <span class="elsevierStyleItalic">t</span>-test and the χ<span class="elsevierStyleSup">2</span> test was used for categorical variables. The data were presented as odds ratios (OR) with 95% confidence intervals (95% CI). The analysis was carried out using the SPSS 18.0 statistical software for Windows.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Cohort characteristics</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The baseline characteristics of the cohort studied, in accordance with the presence or absence of MS, are displayed in Table 1. The most common cause of renal failure in the cohort was glomerular disease (29%, n=29), followed by diabetic nephropathy (19%, n=19). The presence of a kidney transplant did not affect MS occurrence, the FTI or the CI. During the 3-year follow-up period, 2 patients were transferred to other hospitals, 8 patients received transplants and 35 died.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Presence and risk factors of metabolic syndrome</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The prevalence of MS as defined by the ATPIII was 32% (n=32), and by the IDF, 29% (n=29), without significant differences between both. The concordance between the two definitions was high, with a kappa index of 0.79 (95% CI 0.65-0.92).</p><p class="elsevierStylePara">In the univariate analysis, we found that MS patients were older and had higher comorbidity, measured by the Charlson index. MS patients had a higher CI and their body mass index (BMI) was significantly higher due to a higher FTI, without significant differences being observed in the lean tissue index. Acute-phase reactants, measured by C-reactive protein (CRP), were higher in the MS group and the prevalence of HBP and DM was also higher.</p><p class="elsevierStylePara">We performed a backward multivariate logistic regression analysis, in which we initially introduced the following variables: age, sex, time on HD, Kt/V measured by ionic dialysance, CRP and phosphorus. These variables were selected as they were significant in the univariate analysis or because they were clinically relevant. We found that the independent risk factors associated with MS as defined by ATPIII were old age, female sex, a lower Kt/V, hyperphosphataemia and increased CRP (Table 2). MS was not associated with time on renal replacement therapy.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Association between cardiovascular events and metabolic syndrome</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">During the 3-year follow-up period, 22 patients with MS as defined by the ATPIII (22/32 patients with MS, 68.8%) and 23 patients without MS (23/68 patients without MS, 33.8%) were admitted due to a cardiovascular event.</p><p class="elsevierStylePara">In the Kaplan-Meier analysis, the risk of a cardiovascular event was higher in MS patients (<span class="elsevierStyleItalic">log rank</span> 6.185, <span class="elsevierStyleItalic">p</span>=.013) (Figure 1).</p><p class="elsevierStylePara">In the non-adjusted Cox regression analysis for cardiovascular events during follow-up, MS patients had a higher risk of being admitted due to a cardiovascular event (OR 2.15, 95% CI 1.2-3.9, <span class="elsevierStyleItalic">p</span>=.015). On adjusting the Cox analysis for age and sex (Table 3), MS patients were still twice as likely to be admitted due to a cardiovascular event (OR 1.93, 95% CI 1.022-3.6, <span class="elsevierStyleItalic">p</span>=.043), which reinforces the non-adjusted analysis results.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Association between cardiovascular events and the fat tissue and conicity indexes</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In the Kaplan-Meier analysis, we observed that the risk of a cardiovascular event was significantly higher in patients with a FTI greater than or equal to 11.5kg/m<span class="elsevierStyleSup">2 </span>(<span class="elsevierStyleItalic">log rank</span> 10.22, <span class="elsevierStyleItalic">p</span><.001) (Figure 2) and a CI greater than 1.2 (<span class="elsevierStyleItalic">log rank</span> 6.393, <span class="elsevierStyleItalic">p</span><.011) (Figure 3).</p><p class="elsevierStylePara">During the 3-year follow-up period, 35 patients died (35%), 16 (50%) in the MS group and 19 (27.9%) in the group without MS (OR 2.58, 95% CI 1.1-6.2, <span class="elsevierStyleItalic">p</span>=.027). However, in the Kaplan-Meier analysis, we did not find significant differences in mortality between the two patient groups.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara">Our study shows that MS is very prevalent in the HD population; it affects one third of the population studied and is an independent risk factor for cardiovascular events in HD patients. This is a prospective study in which MS was defined by the ATPIII and the IDF and with a body composition analysis measured by bioimpedance spectroscopy. MS prevalence in patients on HD was 32%, similar to figures published in other series, which range between 30% and 70% (Table 4). It can be assumed that differences in MS prevalence may depend, amongst other factors, on the definition of MS that is used. However, the concordance found between the two definitions was high, and as such, it is necessary to find other explanations to justify the difference in prevalence in the different studies, which is probably linked to differences in age, sex, dialysis dose and prevalence of obesity in the different populations studied. These two definitions reflect the importance of abdominal fat in the genesis of MS, since they define obesity by a waist circumference greater than 102 in males and 88 in females, and not by BMI. The only difference between the two definitions is that that proposed by the IDF in 2005 considers central obesity as a necessary condition for MS to be diagnosed. However, in view of the high level of concordance, either of the two definitions is valid in HD patients.</p><p class="elsevierStylePara">Risk factors included in the definition of MS are very prevalent in HD patients, which explains its high prevalence. The purpose of measuring the parameters constituted by MS is to identify high-risk patients, in order to establish therapies to decrease the incidence of cardiovascular disease and mortality.</p><p class="elsevierStylePara">In this study, female sex, old age, a lower dialysis dose, hyperphosphataemia and inflammatory condition measured by an increase in CRP are risk factors for MS, and as such, cardiovascular events. However, MS is not associated with time on HD. CRP is significantly higher in the MS patient group, suggesting a worse inflammatory condition, which is one of the key components of MS. This association between inflammation and MS may explain the higher tendency for patients to develop atherosclerosis and cardiovascular disease.<span class="elsevierStyleSup">8 </span></p><p class="elsevierStylePara">The presence of MS as defined by the ATPIII, is an independent predictor of cardiovascular events in HD patients. However, in the 3 years of follow-up, we did not find significant differences in mortality between patients with and those without MS on HD. These results are similar to those published by Yang et al. and Wu et al.<span class="elsevierStyleSup">9,10</span> in a prospective study on a cohort of Asian patients on HD. These authors defined MS by modified ATPIII criteria and they found no differences in mortality between patients with and those without MS, but they did observe a higher admission rate due to all causes in the patient group with MS (relative risk 1.67). Stolic et al.<span class="elsevierStyleSup">11</span> studied 407 patients, 232 on HD and 175 on peritoneal dialysis (PD) with a 4-year follow-up and they found that MS did predict mortality in HD patients, but not in PD patients in the 4 years of follow-up. In our study, we did not find differences in mortality in the 3 years of follow-up. This may be due to the short follow-up period, since malnutrition is associated with short-term mortality, while overnutrition is associated with long-term mortality. However, the role of obesity in the progression of HD patients continues to be unclear. Some studies, such as that of Abbott et al.<span class="elsevierStyleSup">12</span>, which was a retrospective cohort study and measured obesity by BMI, found that after 5 years of follow-up, a BMI >30kg/m<span class="elsevierStyleSup">2 </span>was associated with better survival in HD patients (HR 0.89, 95% CI 0.81-0.99, <span class="elsevierStyleItalic">p</span>=.042), although not in PD patients. However, BMI does not distinguish between lean tissue and fat tissue, and as such, the correct interpretation of these results is not clear.</p><p class="elsevierStylePara">Wu et al.<span class="elsevierStyleSup">9</span> analysed the implications of MS in HD in a study that included 91 patients who were followed up for 3 years. They found that patients with MS, as defined by the IDF, had a higher risk of suffering a cardiovascular event and furthermore, they observed that abdominal obesity was the individual MS component that best predicted the risk of suffering a cardiovascular event (<span class="elsevierStyleItalic">hazard ratio</span><span class="elsevierStyleItalic"> </span>[HR] 6.25). In our study, we also found that a CI higher than 1.2 increased the risk of cardiovascular events. Cordeiro et al.<span class="elsevierStyleSup">13</span>,<span class="elsevierStyleSup"> </span>in a study on HD patients, found that a high CI increased mortality (HR 2.8). Waist circumference, necessary for calculating CI, is a cheap, easy to measure parameter that is associated with morbidity and mortality in HD and one which is hardly being used in HD hospital units.</p><p class="elsevierStylePara">Our study has some limitations, since it is a single centre study and the sample size was relatively small. It also has strong points, since it determined the prevalence of MS as defined by the ATPIII and by the IDF, which implies that, as well as BMI, the abdominal circumference of all patients was measured and the conicity index was calculated. Likewise, we measured body composition with bioimpedance spectroscopy. All admissions due to a cardiovascular event and mortality were recorded prospectively in the 3 years of follow-up. Furthermore, this is one of the few studies published to date that analyses the prognostic implications of MS in HD patients.</p><p class="elsevierStylePara">In conclusion, MS is a very prevalent disease in HD patients and is a risk factor for cardiovascular events. Its predisposing factors are: old age, female sex, hyperphosphataemia, a lower dialysis dose and inflammation. An increase in the conicity index and the fat tissue index are risk factors associated with the occurrence of a cardiovascular event. Abdominal circumference should be widely used as a parameter in HD units. MS doubles the risk of cardiovascular events in HD patients, but no association was observed with higher mortality in the 3-year follow-up period. Studies with a larger number of patients and with a longer follow-up period are necessary to analyse the effect of MS on mortality in HD patients.</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 conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/12092_16025_54370_en_t1.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54370_en_t1.12092.jpg" alt="Characteristics of patients on haemodialysis with and without metabolic syndrome"></img></a></p><p class="elsevierStylePara">Table 1. Characteristics of patients on haemodialysis with and without metabolic syndrome</p><p class="elsevierStylePara"><a href="grande/12092_16025_54371_en_t2.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54371_en_t2.12092.jpg" alt="Predictors of metabolic syndrome (ATPIII): multivariate logistic regression analysis"></img></a></p><p class="elsevierStylePara">Table 2. Predictors of metabolic syndrome (ATPIII): multivariate logistic regression analysis</p><p class="elsevierStylePara"><a href="grande/12092_16025_54372_en_t3.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54372_en_t3.12092.jpg" alt="Risk factors associated with the occurrence of the first cardiovascular event: Cox regression analysis"></img></a></p><p class="elsevierStylePara">Table 3. Risk factors associated with the occurrence of the first cardiovascular event: Cox regression analysis</p><p class="elsevierStylePara"><a href="grande/12092_16025_54373_en_t4.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54373_en_t4.12092.jpg" alt="Studies of metabolic syndrome prevalence in haemodialysis patients "></img></a></p><p class="elsevierStylePara">Table 4. Studies of metabolic syndrome prevalence in haemodialysis patients </p><p class="elsevierStylePara"><a href="grande/12092_16025_54374_en_f1.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54374_en_f1.12092.jpg" alt="Influence of the metabolic syndrome in the occurrence of cardiovascular events: Kaplan-Meier analysis"></img></a></p><p class="elsevierStylePara">Figure 1. Influence of the metabolic syndrome in the occurrence of cardiovascular events: Kaplan-Meier analysis</p><p class="elsevierStylePara"><a href="grande/12092_16025_54375_en_f2.12092.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54375_en_f2.12092.jpg" alt="Influence of the fat tissue index in the occurrence of cardiovascular events: Kaplan-Meier analysis"></img></a></p><p class="elsevierStylePara">Figure 2. Influence of the fat tissue index in the occurrence of cardiovascular events: Kaplan-Meier analysis</p><p class="elsevierStylePara"><a href="grande/12092_16025_54376_en_f3.12092_copy1.jpg" class="elsevierStyleCrossRefs"><img src="12092_16025_54376_en_f3.12092_copy1.jpg" alt="Influence of the conicity index in the occurrence of cardiovascular events: Kaplan-Meier analysis"></img></a></p><p class="elsevierStylePara">Figure 3. Influence of the conicity index in the occurrence of cardiovascular events: Kaplan-Meier analysis</p>" "pdfFichero" => "P1-E565-S4482-A12092-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439149" "palabras" => array:1 [ 0 => "Índice de tejido graso" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439151" "palabras" => array:1 [ 0 => "Índice de conicidad" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439153" "palabras" => array:1 [ 0 => "Bioimpedancia" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439155" "palabras" => array:1 [ 0 => "Eventos cardiovasculares" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439157" "palabras" => array:1 [ 0 => "Síndrome metabólico" ] ] ] "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439150" "palabras" => array:1 [ 0 => "Fat tissue index" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439152" "palabras" => array:1 [ 0 => "Conicity index" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439154" "palabras" => array:1 [ 0 => "Bioimpedance" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439156" "palabras" => array:1 [ 0 => "Cardiovascular events" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439158" "palabras" => array:1 [ 0 => "Metabolic syndrome" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Antecedentes:</span> El síndrome metabólico (SM) es un factor de riesgo cardiovascular y de mortalidad en la población general y en pacientes con enfermedad renal crónica. Sin embargo, apenas se ha estudiado en pacientes en hemodiálisis (HD). <span class="elsevierStyleBold">Objetivos:</span> El objetivo del estudio es analizar el efecto del SM sobre la aparición de eventos cardiovasculares en HD. El objetivo secundario es determinar la influencia del índice de tejido graso y del índice de conicidad en los eventos cardiovasculares. <span class="elsevierStyleBold">Métodos:</span> Estudio prospectivo en el que se incluyeron 100 pacientes en HD. El tiempo de seguimiento es de 3 años. Se recogieron eventos cardiovasculares y mortalidad.<span class="elsevierStyleBold"> </span>Se definió SM según los criterios de ATPIII e IDF. <span class="elsevierStyleBold">Resultados: </span>La prevalencia del SM definido por ATPIII es 32 % y por IDF 29 %. La concordancia entre las dos definiciones es elevada (índice kappa 0,79, intervalo de confianza 95 % 0,65-0,92). El riesgo de desarrollar un evento cardiovascular es mayor en pacientes con SM (<span class="elsevierStyleItalic">log rank</span> 6,185, p = 0,013), con índice de tejido graso mayor 11,5 kg/m<span class="elsevierStyleSup">2</span> (<span class="elsevierStyleItalic">log rank</span> 10,220, p = 0,001) y con índice de conicidad mayor 1,2 (<span class="elsevierStyleItalic">log rank</span> 6,393, p = 0,011). En el análisis de Cox, ajustado a la edad y sexo, los pacientes con SM tienen el doble de riesgo de ingresar por un evento cardiovascular (<span class="elsevierStyleItalic">odds ratio</span> 1,93, 1,022-3,6, p = 0,043). La mortalidad fue 35 % en los 3 años de seguimiento sin diferencias entre los grupos con y sin SM. <span class="elsevierStyleBold">Conclusiones: </span>El SM es una patología muy prevalente en pacientes en HD y su presencia duplica el riesgo de hospitalización por eventos cardiovasculares a corto plazo.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Background:</span> Metabolic syndrome (MS) is a cardiovascular risk factor and is associated with mortality in the general population and in patients with chronic kidney disease. However, few studies have been carried out in patients on haemodialysis (HD). <span class="elsevierStyleBold">Objectives:</span> The objective of the study is to analyse the effect of MS on the occurrence of cardiovascular events in HD. The secondary objective is to determine the influence of the fat tissue index and conicity index on cardiovascular events. <span class="elsevierStyleBold">Methods:</span> A prospective study including 100 patients on HD. The follow-up period was 3 years. Cardiovascular events and mortality were recorded.<span class="elsevierStyleBold"> </span>MS was defined in accordance with ATPIII and IDF criteria. <span class="elsevierStyleBold">Results:</span> MS prevalence as defined by the ATPIII was 32%, and by the IDF, 29%. The concordance between the two definitions was high (kappa index 0.79, 95% confidence interval 0.65 to 0.92). The risk of cardiovascular events was higher in patients with MS (Log Rank 6.185, p = 0.013), with a fat tissue index greater than 11.5 kg/m<span class="elsevierStyleSup">2</span> (log rank 10.220, <span class="elsevierStyleItalic">p</span>=.001) and a conicity index greater than 1.2 (log rank 6.393, <span class="elsevierStyleItalic">p</span>=.011). In the Cox analysis, adjusted for age and sex, patients with MS had twice the risk of being admitted due to a cardiovascular event (odds ratio 1.93, 1.022 to 3.6, <span class="elsevierStyleItalic">p</span>=.043). Mortality was 35% in the 3 year follow-up period with no differences between the groups with and without MS. <span class="elsevierStyleBold">Conclusions:</span> MS is a very prevalent disease in HD patients and its presence doubles the risk of hospitalisation due to cardiovascular events in the short term.</p>" ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54370_en_t1.12092.jpg" "Alto" => 1363 "Ancho" => 2155 "Tamanyo" => 649160 ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients on haemodialysis with and without metabolic syndrome" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54371_en_t2.12092.jpg" "Alto" => 473 "Ancho" => 1051 "Tamanyo" => 124531 ] ] "descripcion" => array:1 [ "en" => "Predictors of metabolic syndrome (ATPIII): multivariate logistic regression analysis" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54372_en_t3.12092.jpg" "Alto" => 336 "Ancho" => 1061 "Tamanyo" => 96371 ] ] "descripcion" => array:1 [ "en" => "Risk factors associated with the occurrence of the first cardiovascular event: Cox regression analysis" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54373_en_t4.12092.jpg" "Alto" => 1852 "Ancho" => 1064 "Tamanyo" => 390902 ] ] "descripcion" => array:1 [ "en" => "Studies of metabolic syndrome prevalence in haemodialysis patients" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54374_en_f1.12092.jpg" "Alto" => 1047 "Ancho" => 1007 "Tamanyo" => 124050 ] ] "descripcion" => array:1 [ "en" => "Influence of the metabolic syndrome in the occurrence of cardiovascular events: Kaplan-Meier analysis" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54375_en_f2.12092.jpg" "Alto" => 1113 "Ancho" => 1018 "Tamanyo" => 143023 ] ] "descripcion" => array:1 [ "en" => "Influence of the fat tissue index in the occurrence of cardiovascular events: Kaplan-Meier analysis" ] ] 6 => array:8 [ "identificador" => "fig7" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "12092_16025_54376_en_f3.12092_copy1.jpg" "Alto" => 1137 "Ancho" => 1008 "Tamanyo" => 144257 ] ] "descripcion" => array:1 [ "en" => "Influence of the conicity index in the occurrence of cardiovascular events: Kaplan-Meier analysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24(4):683-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11315831" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middel age men. JAMA 2002;288(21):2709-16. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12460094" 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" => "Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD. Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2011;6:2364-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21852664" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Valdez R, Seidell JC, Ahn YI, Weiss KM. A new index of abdominal adiposity as an indicator of risk for cardiovascular disease. A cross-population study. Int J Obes Relat Metab Disord 1993;17(2):77-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8384168" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resisteance and beta-cell function fron fasting plasma glucose and insulin concentration in man. Diabetología 1985;28(7):412-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3899825" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Executive Summary of the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11368702" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Alberti K, Zimmet P, Shaw J. The metabolic syndrome a new world wide definition. Lancet 2005; 366(9491):1059-62. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16182882" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haffner SM. The Metabolic Syndrome: inflamation, diabetes mellitus and cardiovascular disease. Am J Cardiol 2006;97(2A):3A-11A. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16442931" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wu CC, Liou HH, Su PF, Chang MY, Wang HH, Chen MJ, et al. Abdominal obesity is the most significant metabolic syndrome component predictive of cardiovascular events in chronic hemodialysis patients. Nephrol Dial Transplant 2011;26:3689-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21357211" 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" => "Yang SY, Chiang ChK, Hsu SP, Peng YS, Pai MF, Ho TI, et al. Metabolic syndrome predicts hospitalization in hemodialysis patients: a prospective Asian Cohort Study. Blood Purif 2007;25:252-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17429199" 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" => "Stolic RV, Trajkovic GZ, Jovanovic A, Peric V, Stolic D, Sovtic S, et al. Asociation of metabolic changes with mortality of patients treated by peritoneal dislysis or hemodialysis. Renal Failure 2010;32:778-83. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20662689" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Abbott KC, Glanton CW, Trespalacios FC, Oliver DK, Ortiz MI, Agodoa LY, et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney int 2004;65(2):597-605. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14717930" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cordeiro AC, Qureshi AR, Stenvinkel P, Heimbürger O, Axelsson J, Bárány P, et al. Abdominal fat deposition is associated with increased inflammation, protein-energy wasting and worse outcome in patients undergoing haemodialysis. Nephrol Dial Transplant 2010;25:562-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19762603" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tsangalis G, Papaconstantinou S, Kosmadakis G, Valis D, Zerefos N. Prevalence of the metabolic syndrome in hemodialysis. Int J Artif Organs 2007;30(2):118-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17377906" 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" => "Young DO, Lund RJ, Haynatzki G, Dunlay RW. Prevalence of the metabolic syndrome in an incident dialysis population. Hemodial Int 2007;11:86-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17257361" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lee CC, Lee RP, Subeq YM, Wang CH, Fang TC, Hsu BG. Fasting serum total ghrelin level inversely correlates with metabolic syndrome in hemodialysis patients. Arch Med Res 2008;39(8):785-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18996292" 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" => "Ucar E, Huzmeli C, Guven O, Savas N, Gullu M, Asilyoruk S, et al. Frequency of metabolic syndrome among heemodialysis patients according to NCEP-ATP III and IDF definitions. Renal Failure 2009;31:221-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19288328" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Afsar B, Elsurer R, Sezer S, Ozdemir NF. Does metabolic syndrome have an impact on the quality of life and mood of hemodialysis patients? J Ren Nutr 2009;19(5):365-71. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19464928" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Stolic RV, Trajkovic GZ, Peric VM, Stolic DZ, Sovtic SR, Aleksandar JN, et al. Impact of metabolic syndrome and malnutrition on mortality in chronic hemodialysis patients. J Ren Nutr 2010;20(1):38-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19464925" 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" => "Tsai JP, Tsai CC, Liu HM, Lee CJ, Liou HH, Hsu BG. Hyperleptinaemia positively correlated with metabolic syndrome in hemodialysis. Eur J Intern Med 2011;22(6):e105-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22075293" 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" => "Al Saran K, Elsayed S, Sabry A, Hamada M. Obesity and metabolic syndrome in hemodialysis patients: single center experience. Saudi J Kidney Dis Transpl 2011;22(6):1193-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22089780" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Maoujoud O, Ahid S, Asseraji M, Bahadi A, Aatif T, Zajari Y, et al. Prevalence of metabolic syndrome in chronic haemodialysis patients in Morocco. East Mediterr Health J 2011;17(1):56-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21735803" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003400000001/v0_201502091619/X2013251414053638/v0_201502091620/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/20132514/0000003400000001/v0_201502091619/X2013251414053638/v0_201502091620/en/P1-E565-S4482-A12092-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251414053638?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 9 | 20 |
| 2024 October | 51 | 50 | 101 |
| 2024 September | 52 | 43 | 95 |
| 2024 August | 64 | 75 | 139 |
| 2024 July | 62 | 40 | 102 |
| 2024 June | 65 | 42 | 107 |
| 2024 May | 57 | 28 | 85 |
| 2024 April | 64 | 49 | 113 |
| 2024 March | 56 | 30 | 86 |
| 2024 February | 48 | 32 | 80 |
| 2024 January | 21 | 21 | 42 |
| 2023 December | 38 | 30 | 68 |
| 2023 November | 44 | 27 | 71 |
| 2023 October | 35 | 25 | 60 |
| 2023 September | 27 | 30 | 57 |
| 2023 August | 31 | 21 | 52 |
| 2023 July | 31 | 32 | 63 |
| 2023 June | 42 | 20 | 62 |
| 2023 May | 51 | 38 | 89 |
| 2023 April | 29 | 21 | 50 |
| 2023 March | 44 | 20 | 64 |
| 2023 February | 31 | 20 | 51 |
| 2023 January | 34 | 26 | 60 |
| 2022 December | 84 | 33 | 117 |
| 2022 November | 63 | 28 | 91 |
| 2022 October | 59 | 43 | 102 |
| 2022 September | 37 | 22 | 59 |
| 2022 August | 35 | 45 | 80 |
| 2022 July | 39 | 42 | 81 |
| 2022 June | 41 | 34 | 75 |
| 2022 May | 32 | 32 | 64 |
| 2022 April | 43 | 49 | 92 |
| 2022 March | 34 | 56 | 90 |
| 2022 February | 36 | 53 | 89 |
| 2022 January | 44 | 29 | 73 |
| 2021 December | 41 | 43 | 84 |
| 2021 November | 35 | 35 | 70 |
| 2021 October | 69 | 36 | 105 |
| 2021 September | 25 | 37 | 62 |
| 2021 August | 61 | 45 | 106 |
| 2021 July | 48 | 41 | 89 |
| 2021 June | 46 | 33 | 79 |
| 2021 May | 48 | 41 | 89 |
| 2021 April | 122 | 66 | 188 |
| 2021 March | 53 | 32 | 85 |
| 2021 February | 57 | 17 | 74 |
| 2021 January | 38 | 17 | 55 |
| 2020 December | 41 | 15 | 56 |
| 2020 November | 36 | 20 | 56 |
| 2020 October | 45 | 16 | 61 |
| 2020 September | 38 | 11 | 49 |
| 2020 August | 43 | 17 | 60 |
| 2020 July | 50 | 14 | 64 |
| 2020 June | 50 | 31 | 81 |
| 2020 May | 65 | 12 | 77 |
| 2020 April | 49 | 18 | 67 |
| 2020 March | 35 | 16 | 51 |
| 2020 February | 53 | 20 | 73 |
| 2020 January | 48 | 14 | 62 |
| 2019 December | 51 | 28 | 79 |
| 2019 November | 55 | 24 | 79 |
| 2019 October | 47 | 22 | 69 |
| 2019 September | 51 | 18 | 69 |
| 2019 August | 43 | 25 | 68 |
| 2019 July | 59 | 34 | 93 |
| 2019 June | 61 | 24 | 85 |
| 2019 May | 69 | 19 | 88 |
| 2019 April | 82 | 44 | 126 |
| 2019 March | 59 | 33 | 92 |
| 2019 February | 38 | 23 | 61 |
| 2019 January | 38 | 26 | 64 |
| 2018 December | 90 | 52 | 142 |
| 2018 November | 91 | 16 | 107 |
| 2018 October | 82 | 17 | 99 |
| 2018 September | 85 | 21 | 106 |
| 2018 August | 54 | 25 | 79 |
| 2018 July | 48 | 11 | 59 |
| 2018 June | 57 | 13 | 70 |
| 2018 May | 50 | 24 | 74 |
| 2018 April | 59 | 12 | 71 |
| 2018 March | 90 | 18 | 108 |
| 2018 February | 49 | 15 | 64 |
| 2018 January | 50 | 11 | 61 |
| 2017 December | 65 | 11 | 76 |
| 2017 November | 60 | 21 | 81 |
| 2017 October | 30 | 14 | 44 |
| 2017 September | 50 | 13 | 63 |
| 2017 August | 45 | 15 | 60 |
| 2017 July | 50 | 19 | 69 |
| 2017 June | 48 | 17 | 65 |
| 2017 May | 53 | 13 | 66 |
| 2017 April | 56 | 17 | 73 |
| 2017 March | 29 | 20 | 49 |
| 2017 February | 48 | 17 | 65 |
| 2017 January | 33 | 10 | 43 |
| 2016 December | 71 | 9 | 80 |
| 2016 November | 97 | 12 | 109 |
| 2016 October | 127 | 16 | 143 |
| 2016 September | 174 | 6 | 180 |
| 2016 August | 188 | 7 | 195 |
| 2016 July | 189 | 12 | 201 |
| 2016 June | 134 | 0 | 134 |
| 2016 May | 169 | 0 | 169 |
| 2016 April | 146 | 0 | 146 |
| 2016 March | 125 | 0 | 125 |
| 2016 February | 154 | 0 | 154 |
| 2016 January | 145 | 0 | 145 |
| 2015 December | 139 | 0 | 139 |
| 2015 November | 111 | 0 | 111 |
| 2015 October | 128 | 0 | 128 |
| 2015 September | 110 | 0 | 110 |
| 2015 August | 81 | 0 | 81 |
| 2015 July | 107 | 0 | 107 |
| 2015 June | 59 | 0 | 59 |
| 2015 May | 80 | 0 | 80 |
| 2015 April | 16 | 0 | 16 |
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