Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case–control study paired by APACHE-II | Revista Española de Anestesiología y Reanimación (English Edition)

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"apellidos" => "Dierssen-Sotos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Cabueñes, Gijón, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Moisés Broggi, Sant Joan Despí, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Araba, Vitoria, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II" ] ] "textoCompleto" => "IntroductionTwo hypotheses linking fluid resuscitation of critically ill patients with the subsequent development of acute kidney injury and the need for renal replacement therapies (AKI-RRT) have been put forward in medical literature<a class="elsevierStyleCrossRefs" href="#bib0100">1–4</a>: on the one hand, hyperchloraemia triggered by the use of fluids with a high chlorine content, and on the other, over-administration of fluids (positive fluid balance or fluid overload). However, a possible connection between these variables cannot be ruled out, and either one could act as a confounder in the studies published to date.<a class="elsevierStyleCrossRef" href="#bib0120">5</a>The aim of this study is to analyse the association between fluid balance in the first 24h following admission and the development of AKI-RRT in patients subsequently transferred to the ICU. As a secondary objective, we studied the relationship between chlorine load in the same period and subsequent AKI-RRT.Patients and methodsStudy design and populationThis was a multicentre case–control hospital-based study carried out in 6 ICUs in Spain.Cases were patients aged over 18 years at the time of diagnosis, admitted to participating hospitals between 1 January 2013 and 31 December 2015, who developed AKI for which they were treated with RRT (haemodialysis and continuous venovenous haemodiafiltration) during their stay in the ICU. Patients were chosen on the basis of the parameters used in the Randomised Evaluation of Normal vs Augmented Level Replacement Therapy (RENAL) study, and met 1 of the following physiological criteria for ADI: diuresis <100mL/6h; serum potassium >6.5mmol/L; pH<7.2; serum urea >70mg/dL; serum creatinine >3.4mg/dL; and clinically significant organ oedema in the setting of AKI.<a class="elsevierStyleCrossRef" href="#bib0125">6</a> Patients undergoing RRT that did not meet RENAL criteria for AKI, patients with kidney transplant, and patients undergoing RRT due to end-stage chronic kidney failure were excluded.Controls were patients aged over 18 years, randomly selected (in terms of time) admitted during the same period to the same hospital as cases, who did not develop AKI-RRT during ICU stay, individually matched 1:1 with cases based on APACHE II score.Patients were classified according to creatinine kinetics in the first 24h, as proposed by Waikar and Bonventre.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> This classification system includes three stages of AKI, defined according to absolute changes in creatinine levels in the first 24h of admission (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Study patients were those with 0 creatinine kinetics in the first 24h of ICU admission.Study variablesDemographic variables (gender and age); history and comorbidities (hypertension, diabetes mellitus, heart disease, COPD, chronic renal failure); data related to the indication for ICU admission (presence of sepsis on admission [yes/no], need for vasopressors or inotropics [noradrenaline, adrenaline, dobutamine], hospital of origin and APACHE II); variables related to the use of RRT: RRT use (yes/no); laboratory data on admission to the ICU (urea [mg/dL], creatinine [mg/dL], chlorine [mmol/L], potassium [mmol/L], pH); laboratory data at 24h of ICU admission (urea [mg/dL], creatinine [mg/dL], chlorine [mmol/L], potassium [mmol/L], pH); exposure to nephrotoxic agents, as probable confounding variables, such as intravenous contrast, vancomycin, amikacin, colistin, amphotericin and NSAIDs (yes/no); use of furosemide (yes/no); data related to fluid replacement therapy in the first 24h of admission (type and volume [mL] of fluid administered in the first 24h of ICU admission, diuresis and fluid balance in the first 24h of ICU admission).Fluid balance in the first 24h was measured by subtracting fluid output from fluid input taken from the patient's hourly chart. Fluid output was classified as either measurable losses (diuresis, vomiting, ostomy, etc.), and unmeasured or insensitive losses. Insensitive losses were calculated as 30mL/kg per day lost through the respiratory tract, and 0.5mL/kg/h for temperatures between 37.5°C to 39°C and 1mL/kg/h for temperatures above 39°C.The chlorine load in the first 24h was calculated on the basis of the volume and type of fluids administered, taking into account the electrolyte composition of the different saline solutions (SS) used (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) measured in mmol/L.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Statistical analysisEstimating a prevalence of AKI-RRT of 38% among patients admitted to Spanish ICUs,<a class="elsevierStyleCrossRef" href="#bib0135">8</a> in order to detect an odds ratio (OR) of 1.1 as a measure of association between 1 unit (500cm3) of fluid administered and the need for RRT, with a power of 0.80 and a confidence level of 95%, a minimum sample size of 15 cases and 15 controls per ICU was needed.Data were analysed descriptively; continuous variables were expressed as mean±standard deviation, and categorical variables as numerical value and percentage.The comparative analysis was performed using Pearson's chi-square test (χ2) of categorical data, based on expected values. The Student's t test was used to compare quantitative variables with categorical variables.To evaluate the association between fluid balance and development of AKI-RRT, we performed an unconditional logistic regression adjusted for age, sex, APACHE II, personal history of chronic kidney failure and sepsis as a reason for ICU admission on data collected from patients who had not developed AKI within 24h of admission, following the Waikar and Bonventre creatinine kinetics classification.<a class="elsevierStyleCrossRef" href="#bib0130">7</a>OR and the corresponding 95% confidence interval (95% CI) was used as a measure of association. To determine whether an effect modification influenced the fluid balance-AKI-RRT association, we analysed the chlorine load administered to patients who had not developed IRA within 24h of ICU admission, following the Waikar Bonventre creatinine kinetics classification.<a class="elsevierStyleCrossRef" href="#bib0130">7</a> All p values were 2-tailed.Statistical analysis was performed using the statistical package Stata 12/SE (StataCorp, College Station, TX, USA).ResultsDescription of the study sampleVariables were collected from 430 patients: 215 cases and 215 controls.Taking into account the minimum sample size required, each of the 6 participating ICUs provided at least 20 cases and 20 controls. Fourteen patients were excluded from the analysis due to lack of data, and 106 were excluded for presenting creatinine kinetics >0.The average age of patients with stage 0 kidney failure determined by creatinine kinetics during the first 24h was 64.69±14.39 years; 61.94% were men, and average APACHE II at admission was 25.16±6.82. The principle study variables are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, and analytical differences observed between cases and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Analysis of fluid balance and its association with the development of acute kidney injury and the use of renal replacement therapies (AKI-RRT)The first and most significant finding in respect of the analysis of the 310 patients who did not develop kidney failure in the first 24h of admission was that patients who developed AKI-RRT presented a higher positive fluid balance (1951.14±2.552 vs. 3663.82±3164.79; p<0.01) during the first 24h of ICU stay.Secondly, logistic regression analysis adjusted for APACHE II, age and sex showed a significant correlation: the higher the fluid balance, the greater the risk of requiring RRT; the likelihood of developing AKI-RRT increases by 10% for every 500mL of positive fluid balance found during the first 24h of admission (OR: 1.09 [1.05–1.14]; p<0.01).Analysis of chlorine load and its association with the development of acute kidney injury and the use of renal replacement therapies (AKI-RRT)The analysis of the 310 patients who did not develop kidney failure within 24 hours of admission showed no difference in chlorine levels either at admission (controls: 104.06±6.06mmol/L; cases: 104.26±6.14mmol/L; p=0.73) or at 24h (controls: 106.21±5.67mmol/L; cases: 105.40±5.91; p=0.14).An analysis of the mean load administered in the first 24 hours of admission showed no differences between cases and controls (299.35±254.91 vs. 301.67±234.63; p=0.92).DiscussionOur study is the first to specifically explore the association between fluid balance and chlorine load in the first 24h of ICU stay in critically ill patients, and the subsequent need for RRT secondary to AKI.We limited the time frame of our study to the first 24h after ICU admission, as this is when most fluid resuscitation procedures are performed in critically ill patients. Due to considerable variations in the type and volume of fluids, this stage of resuscitation can reasonably be considered the most appropriate for studying the potentially harmful effects associated with fluid therapy.<a class="elsevierStyleCrossRefs" href="#bib0140">9,10</a>The main limitations of our study are derived from its case vs. control design, in which selection bias is difficult to control. In order to control selection bias, only data from patients who had not developed renal failure, based on creatinine kinetics, in the first 24h of resuscitation<a class="elsevierStyleCrossRef" href="#bib0150">11</a> were used in the statistical analysis, as it stands to reason that patients with kidney failure will receive more fluids, for the simple fact these are part of the resuscitation protocol in patients with kidney failure Given heterogeneous distribution of septic patients and patients with chronic kidney failure, both variables were included in the regression analysis.Waikar and Bonventre's kinetic classification was used to select patients who did not develop kidney failure in the first 24h instead of the RIFLE or AKIN system, since absolute changes in creatinine are able to detect a decrease in glomerular filtration rate before percentage changes.<a class="elsevierStyleCrossRef" href="#bib0130">7</a>Despite the foregoing limitations, we believe that, in respect of the primary study objective, our results suggest the existence of a significant association between positive fluid balance in the first 24h of ICU admission and development of AKI-RRT. However, we found no evidence of a significant association between chlorine load administered and AKI-RRT.Some studies have linked positive fluid balance to adverse outcomes in monitoring patients with AKI, irrespective of the severity of the disease and haemodynamic instability of the patient.<a class="elsevierStyleCrossRefs" href="#bib0150">11,12</a> In pathophysiological terms, increased abdominal pressure triggered by significant fluid overload could explain worsening renal function in patients.<a class="elsevierStyleCrossRef" href="#bib0160">13</a> Indeed, recent evidence<a class="elsevierStyleCrossRef" href="#bib0130">7</a> has confirmed that a positive water balance at 24h of ICU admission is an independent risk factor for acute kidney injury and increased disease severity.However, the theory that hyperchloraemia triggered by the infusion of chlorine-rich fluids, one of the cornerstones of fluid resuscitation, could play a part in the aetiology of kidney injury triggered by fluid balance has gained momentum.<a class="elsevierStyleCrossRef" href="#bib0145">10</a> The physiopathology of this hypothesis was explained by Lobo and Awad,<a class="elsevierStyleCrossRef" href="#bib0165">14</a> who showed that increased renal tubular chloride concentration can result in the entry of chloride into cells of the macula densa, causing depolarization of the basolateral membrane via chloride channels. This can lead to adenosine release from the macula densa, which through its effects on the A1 receptor causes afferent arteriolar vasoconstriction, and triggers increased afferent arteriolar resistance and reduced glomerular filtration rate, leading to reduced urine volume and sodium excretion. The findings of Chowdhury et al.,<a class="elsevierStyleCrossRef" href="#bib0170">15</a> who showed that administration of SS compared with a crystalloid solution containing 98mmol/L chlorine reduced renal blood flow velocity and perfusion in healthy subjects, seem to support this hypothesis.On this subject, after evaluating more than 700 patients Yunus et al.,<a class="elsevierStyleCrossRef" href="#bib0110">3</a> concluded that the application of a chloro-restrictive fluid protocol caused less AKI and less AKI-RRT compared with a chloro-liberal protocol.The results of the recent SPLIT<a class="elsevierStyleCrossRef" href="#bib0115">4</a> study, however, contradict these findings, insofar as 3.3% of patients treated with low chlorine content crystalloid developed AKI-RRT versus 3.4% in the SS group (absolute difference: −0.1% [95% CI: −1.6 to 1.4%]; RR: 0.96 [95% CI; 0.62–1.50]; p=0.91).Our results are consistent with those of the SPLIT study, as we found no correlation between chlorine load administered and development of AKI-RRT. However, one of the major limitations attributed to the SPLIT<a class="elsevierStyleCrossRef" href="#bib0175">16</a> study, namely, the low volume of SS administered in study patients, also holds true for our investigation. The SPLIT study compared patients receiving 1.105mL of SS in the first 24h with patients receiving 1152mL of another balanced crystalloid; in our study, controls received a mean of 1680.12±1450.42mL compared with a mean of 1633.58±1518.89mL in cases in the first 24h of ICU admission.One interpretation of these data could be that the administration of 1–2L SS would not increase the risk of AKI compared with other fluids. In other words, only large volumes of SS would trigger the proposed nephrotoxicity mechanism. Shaw et al.,<a class="elsevierStyleCrossRef" href="#bib0180">17</a> meanwhile, found a significant difference (p<0.001) in the development of AKI-RRT in favour of resuscitation with 1976±1560mL low chlorine content crystalloid compared with 1658±1288mL SS (p<0.001). Similarly, Yunus et al.<a class="elsevierStyleCrossRef" href="#bib0110">3</a> showed a difference in the need for RRT of 10% vs. 6.3% (p=0.05) in favour of chloro-restrictive therapies with an average SS infusion of 3200mL.In this regard, it is also important to note that hyper- or hypovolaemia prior to infusion of crystalloids is a decisive factor in post-resuscitation intraglomerular hemodynamics.<a class="elsevierStyleCrossRef" href="#bib0185">18</a> Glomerular vasoconstriction associated with low renal output of any kind is efferent, and is mediated by activation of the renin–angiotensin–aldosterone axis and catecholamines. The mechanism described by Wolf and Awad is tubuloglomerular feedback, which is observed when luminal flow in the loop of Henle is increased (in renal hypoperfusion, flow is reduced at the level of the macula densa). This luminal flow, detected by the cilia of the macula densa cells and triggering release of adenosine, provides the signal for activation of tubuloglomerular feedback, which ultimately determines afferent artery vasoconstriction. Although depolarization of the cell membrane via chloride channels, susceptible to furosemide, influences this signalling, feedback is not activated by the concentration of chlorine but by urine volume.Finally, we believe that the role of the chlorine-rich fluids used in the resuscitation of hypotense patients in triggering kidney failure has yet to be fully explained, particularly in view of the two-hit theory of multiple system organ failure. Applying this model, the hypotension itself would contribute to or indeed initiate the inflammatory response. Once activated, these cells can alter vascular tone and the response to a second insult, thus facilitating redistribution of renal blood flow. When a second insult, in the form of high chlorine load, stimulates these primed or suppressed cells, an inappropriate inflammatory response is triggered, causing further tissue damage, haemodynamic instability and renal dysfunction.<a class="elsevierStyleCrossRef" href="#bib0190">19</a>In summary, based on these findings, we believe that fluid overload in the first 24h of admission to an ICU in our patients must be considered an important contributor to ultimate deterioration of renal function and development of AKI-RRT.Ethical responsibilitiesProtection of people and animalsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Conflict of interestsDr. Alejandro Gonzalez Castro acknowledges that his collaboration with Baxter in an advisory capacity could represent a conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres833116" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec829026" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres833115" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec829027" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Description of the study sample" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Analysis of fluid balance and its association with the development of acute kidney injury and the use of renal replacement therapies (AKI-RRT)" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Analysis of chlorine load and its association with the development of acute kidney injury and the use of renal replacement therapies (AKI-RRT)" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-25" "fechaAceptado" => "2016-12-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec829026" "palabras" => array:6 [ 0 => "Resuscitation" 1 => "Fluids" 2 => "Chloraemia" 3 => "Fluid balance" 4 => "Acute kidney failure" 5 => "Renal replacement therapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec829027" "palabras" => array:6 [ 0 => "Reanimación" 1 => "Fluidos" 2 => "Cloremia" 3 => "Balance hídrico" 4 => "Insuficiencia renal" 5 => "Técnicas de reemplazo renal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients’ admission to ICU. Patients and methodsMulticentre case–control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid). ResultsWe analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500mL of positive water balance was evident (OR: 1.09 [95% CI: 1.05–1.14]; p<0.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; p=0.92). ConclusionsThe water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoAnalizar la asociación entre el balance hídrico durante las primeras 24h de ingreso en UCI y las variables relacionadas con los valores de cloro (carga de cloro, tipo de fluido administrado, hipercloremia), con el empleo de técnicas de reemplazo renal secundarias a insuficiencia renal aguda (IRA-TRR) durante el posterior ingreso en UCI de los enfermos. Pacientes y métodosEstudio multicéntrico de casos y controles, de base hospitalaria y ámbito nacional, llevado a cabo en 6 UCI. Los casos fueron pacientes mayores de 18 años que desarrollaron una IRA-TRR. Los controles fueron pacientes mayores de 18 años, ingresados en el mismo periodo y centro que los casos, que no desarrollaron IRA-TRR durante su ingreso en UCI. Se realizó emparejamiento por APACHE-II. Se llevó a cabo un análisis de regresión logística no condicional ajustada por edad, sexo, APACHE-II. Las variables de interés principales fueron: balance hídrico, carga de cloro administrada, e IRA-TRR. ResultadosSe han analizado las variables de 310 enfermos. Se evidenció un aumento del 10% en la posibilidad de desarrollar IRA-TRR por cada 500mL de balance hídrico positivo (OR: 1,09 [IC 95%:1,05–1,14]; p<0,001). El estudio de los valores medios de carga administrada no evidenció diferencias entre el grupo de casos y de controles (299,35±254,91 frente a 301,67±234,63; p=0,92). ConclusionesEl balance hídrico en las primeras 24h de ingreso en UCI se relaciona con el desarrollo de IRA-TRR, independientemente de la cloremia." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González-Castro A, Ortiz-Lasa M, Leizaola O, Salgado E, Irriguible T, Sánchez-Satorra M, et al. Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II. Rev Esp Anestesiol Reanim. 2017;64:243–249." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stage/criterion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Δ Creatinine at 24h \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.3mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1mg/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403300.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Kidney failure classification by creatinine kinetics." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Colloids</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Natural \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Synthetic</th><th class="td" title="table-head " align="left" valign="top" scope="col">Saline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Balanced</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Albumin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatins</th><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Ringer Sol. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Buffer</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Succinylated gelatin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Polygeline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lactate \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acetate \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ca2+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg2+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bicarbonate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acetate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gluconate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osmolarity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">250 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">284 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">301 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">308 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">309 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">280 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">294 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403302.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Electrolytic distribution of different study solutions, in mmol/L." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls, n=168 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases, n=142 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.14±15.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.15±12.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 (55.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 (69.72%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE-II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.66±6.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.66±7.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 (52.38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80 (56.34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (22.62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (30.28%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 (31.55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (31.69%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (16.07%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (15.49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (10.12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (22.54%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis at admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 (39.88%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101 (71.13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Nephrotoxic drugs</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amikacin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (3.57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (9.15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colistin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (5.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (7.75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NSAIDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (20.24%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (8.45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Furosemide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 (33.93%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 (35.21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amphotericin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (4.76%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (7.04%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Origin</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urgent admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (5.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (1.41%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Another hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (13.69%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (16.20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (24.40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (26.06%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (9.52%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (17.61%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 (47.02%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 (38.73%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403299.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and demographic variables of stage 0 study patients according to creatinine kinetics, grouped as cases and controls, during the first 24h of admission." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Analytical Var. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls, n=168 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases, n=142 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cr adm. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.84±1.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.44±2.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cr 24h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.56±1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.48±1.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea adm. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.09±58.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.63±89.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea 24h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.50±53.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.30±64.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ch adm.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.07±6.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.01±6.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ch 24 h<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106.47±5.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105.81±6.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K adm. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.14±0.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.56±1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K 24h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.94±0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.24±0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH adm. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.31±0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.27±0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH 24h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.37±0.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.32±0.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403301.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<10% loss of study patients in whom the variable was measured." ] ] ] "descripcion" => array:1 [ "en" => "Analytical variables at admission and at 24h in stage 0 kinetic creatinine patients in the first 24h." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid resuscitation: current perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. González-Castro" 1 => "Y. Peñasco Martin" 2 => "M. Ortiz-Lasa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2016" "volumen" => "146" "paginaInicial" => "128" "paginaFinal" => "132" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Beijing Acute Kidney Injury Trial (BAKIT) Workgroup" "etal" => false "autores" => array:5 [ 0 => "N. Wang" 1 => "L. Jiang" 2 => "B. Zhu" 3 => "Y. Wen" 4 => "X.M. Xi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-015-1085-4" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26494153" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.M. Yunos" 1 => "R. Bellomo" 2 => "C. Hegarty" 3 => "D. Story" 4 => "L. Ho" 5 => "M. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.13356" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "308" "paginaInicial" => "1566" "paginaFinal" => "1572" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23073953" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Young" 1 => "M. Bailey" 2 => "R. Beasley" 3 => "S. Henderson" 4 => "D. Mackle" 5 => "C. McArthur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2015.12334" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2015" "volumen" => "314" "paginaInicial" => "1701" "paginaFinal" => "1710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26444692" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyperchloremia as a confounding variable in fluid therapy studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. González-Castro" 1 => "J.C. Rodriguez-Borregan" 2 => "O. Azcune" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2016.02.002" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "366" "paginaFinal" => "367" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27044738" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The RENAL (Randomised Evaluation of Normal vs. Augmented Level of Replacement Therapy) study: statistical analysis plan" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "RENAL Study Investigators" "etal" => false "autores" => array:6 [ 0 => "S. Finfer" 1 => "A. Cass" 2 => "M. Gallagher" 3 => "J. Lee" 4 => "S. Su" 5 => "R. Bellomo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Resusc" "fecha" => "2009" "volumen" => "11" "paginaInicial" => "58" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19281446" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Creatinine kinetics and definition of acute kidney injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Waikar" 1 => "J. Bonventre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2008070669" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "672" "paginaFinal" => "679" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19244578" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio FRAMI. Epidemiology of acute kidney failure in Spanish ICU. Multicenter prospective study FRAMI" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de trabajo «Estado actual del fracaso renal agudo y de las técnicas de reemplazo renal en UCI»" "etal" => false "autores" => array:4 [ 0 => "M.E. Herrera-Gutiérrez" 1 => "G. Seller-Pérez" 2 => "J. Maynar-Moliner" 3 => "J.A. Sánchez-Izquierdo-Riera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intens" "fecha" => "2006" "volumen" => "30" "paginaInicial" => "260" "paginaFinal" => "267" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Four phases of intravenous fluid therapy: a conceptual model" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ADQI XII Investigators Group" "etal" => true "autores" => array:6 [ 0 => "E.A. Hoste" 1 => "K. Maitland" 2 => "C.S. Brudney" 3 => "R. Mehta" 4 => "J.L. Vincent" 5 => "D. Yates" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aeu300" "Revista" => array:7 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2014" "volumen" => "113" "paginaInicial" => "740" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25204700" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0025619613007374" "estado" => "S300" "issn" => "00256196" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid challenges in intensive care: the FENICE study: a global inception cohort study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "FENICE Investigators, ESICM Trial Group" "etal" => true "autores" => array:6 [ 0 => "M. Cecconi" 1 => "C. Hofer" 2 => "J.L. Teboul" 3 => "V. Pettila" 4 => "E. Wilkman" 5 => "Z. Molnar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-015-3850-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "1529" "paginaFinal" => "1537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162676" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid balance, diuretic use, and mortality in acute kidney injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.E. Grams" 1 => "M.M. Estrella" 2 => "J. Coresh" 3 => "R.G. Brower" 4 => "K.D. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2215/CJN.08781010" "Revista" => array:6 [ "tituloSerie" => "Clin J Am Soc Nephrol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "966" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21393482" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A positive fluid balance is associated with a worse outcome in patients with acute renal failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Payen" 1 => "A.C. DePont" 2 => "Y. Sakr" 3 => "C. Spies" 4 => "K. Reinhart" 5 => "J.L. 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Original article

Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case–control study paired by APACHE-II

Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II

A. González-Castroa,

Corresponding author

e409@humv.es
jandro120475@hotmail.com

Corresponding author.

, M. Ortiz-Lasaa, O. Leizaolab, E. Salgadob, T. Irriguiblec, M. Sánchez-Satorrac, C. Lomas-Fernándezd, P. Barral-Segadee, M. Cordero-Vallejof, E. Rodrigo-Calabiag, T. Dierssen-Sotosh

a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain

b Servicio de Medicina Intensiva, Hospital Universitario de Cabueñes, Gijón, Spain

c Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Spain

d Servicio de Medicina Intensiva, Hospital Moisés Broggi, Sant Joan Despí, Spain

e Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain

f Servicio de Medicina Intensiva, Hospital Universitario Araba, Vitoria, Spain

g Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Spain

h Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, Spain

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    "titulo" => "Fluid balance and chloride load in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission and its relation with renal replacement therapies through a multicentre&#44; retrospective&#44; case&#8211;control study paired by APACHE-II"
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        "titulo" => "Balance h&#237;drico y carga de cloro en las primeras 24<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCI y su relaci&#243;n con las terapias de reemplazo renal mediante un estudio multic&#233;ntrico&#44; retrospectivo&#44; de casos y controles emparejados por APACHE-II"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Two hypotheses linking fluid resuscitation of critically ill patients with the subsequent development of acute kidney injury and the need for renal replacement therapies &#40;AKI-RRT&#41; have been put forward in medical literature<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">1&#8211;4</span></a>&#58; on the one hand&#44; hyperchloraemia triggered by the use of fluids with a high chlorine content&#44; and on the other&#44; over-administration of fluids &#40;positive fluid balance or fluid overload&#41;&#46; However&#44; a possible connection between these variables cannot be ruled out&#44; and either one could act as a confounder in the studies published to date&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study is to analyse the association between fluid balance in the first 24<span class="elsevierStyleHsp" style=""></span>h following admission and the development of AKI-RRT in patients subsequently transferred to the ICU&#46; As a secondary objective&#44; we studied the relationship between chlorine load in the same period and subsequent AKI-RRT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and population</span><p id="par0015" class="elsevierStylePara elsevierViewall">This was a multicentre case&#8211;control hospital-based study carried out in 6 ICUs in Spain&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cases were patients aged over 18 years at the time of diagnosis&#44; admitted to participating hospitals between 1 January 2013 and 31 December 2015&#44; who developed AKI for which they were treated with RRT &#40;haemodialysis and continuous venovenous haemodiafiltration&#41; during their stay in the ICU&#46; Patients were chosen on the basis of the parameters used in the Randomised Evaluation of Normal vs Augmented Level Replacement Therapy &#40;RENAL&#41; study&#44; and met 1 of the following physiological criteria for ADI&#58; diuresis &#60;100<span class="elsevierStyleHsp" style=""></span>mL&#47;6<span class="elsevierStyleHsp" style=""></span>h&#59; serum potassium &#62;6&#46;5<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#46;2&#59; serum urea &#62;70<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; serum creatinine &#62;3&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; and clinically significant organ oedema in the setting of AKI&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a> Patients undergoing RRT that did not meet RENAL criteria for AKI&#44; patients with kidney transplant&#44; and patients undergoing RRT due to end-stage chronic kidney failure were excluded&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Controls were patients aged over 18 years&#44; randomly selected &#40;in terms of time&#41; admitted during the same period to the same hospital as cases&#44; who did not develop AKI-RRT during ICU stay&#44; individually matched 1&#58;1 with cases based on APACHE II score&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were classified according to creatinine kinetics in the first 24<span class="elsevierStyleHsp" style=""></span>h&#44; as proposed by Waikar and Bonventre&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> This classification system includes three stages of AKI&#44; defined according to absolute changes in creatinine levels in the first 24<span class="elsevierStyleHsp" style=""></span>h of admission &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Study patients were those with 0 creatinine kinetics in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study variables</span><p id="par0040" class="elsevierStylePara elsevierViewall">Demographic variables &#40;gender and age&#41;&#59; history and comorbidities &#40;hypertension&#44; diabetes mellitus&#44; heart disease&#44; COPD&#44; chronic renal failure&#41;&#59; data related to the indication for ICU admission &#40;presence of sepsis on admission &#91;yes&#47;no&#93;&#44; need for vasopressors or inotropics &#91;noradrenaline&#44; adrenaline&#44; dobutamine&#93;&#44; hospital of origin and APACHE II<span class="elsevierStyleSmallCaps">&#41;&#59;</span> variables related to the use of RRT&#58; RRT use &#40;yes&#47;no&#41;&#59; laboratory data on admission to the ICU &#40;urea &#91;mg&#47;dL&#93;&#44; creatinine &#91;mg&#47;dL&#93;&#44; chlorine &#91;mmol&#47;L&#93;&#44; potassium &#91;mmol&#47;L&#93;&#44; pH&#41;&#59; laboratory data at 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission &#40;urea &#91;mg&#47;dL&#93;&#44; creatinine &#91;mg&#47;dL&#93;&#44; chlorine &#91;mmol&#47;L&#93;&#44; potassium &#91;mmol&#47;L&#93;&#44; pH&#41;&#59; exposure to nephrotoxic agents&#44; as probable confounding variables&#44; such as intravenous contrast&#44; vancomycin&#44; amikacin&#44; colistin&#44; amphotericin and NSAIDs &#40;yes&#47;no&#41;&#59; use of furosemide &#40;yes&#47;no&#41;&#59; data related to fluid replacement therapy in the first 24<span class="elsevierStyleHsp" style=""></span>h of admission &#40;type and volume &#91;mL&#93; of fluid administered in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission&#44; diuresis and fluid balance in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fluid balance in the first 24<span class="elsevierStyleHsp" style=""></span>h was measured by subtracting fluid output from fluid input taken from the patient&#39;s hourly chart&#46; Fluid output was classified as either measurable losses &#40;diuresis&#44; vomiting&#44; ostomy&#44; etc&#46;&#41;&#44; and unmeasured or insensitive losses&#46; Insensitive losses were calculated as 30<span class="elsevierStyleHsp" style=""></span>mL&#47;kg per day lost through the respiratory tract&#44; and 0&#46;5<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;h for temperatures between 37&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C to 39<span class="elsevierStyleHsp" style=""></span>&#176;C and 1<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;h for temperatures above 39<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The chlorine load in the first 24<span class="elsevierStyleHsp" style=""></span>h was calculated on the basis of the volume and type of fluids administered&#44; taking into account the electrolyte composition of the different saline solutions &#40;SS&#41; used &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; measured in mmol&#47;L&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Estimating a prevalence of AKI-RRT of 38&#37; among patients admitted to Spanish ICUs&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a> in order to detect an odds ratio &#40;OR&#41; of 1&#46;1 as a measure of association between 1 unit &#40;500<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>&#41; of fluid administered and the need for RRT&#44; with a power of 0&#46;80 and a confidence level of 95&#37;&#44; a minimum sample size of 15 cases and 15 controls per ICU was needed&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Data were analysed descriptively&#59; continuous variables were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; and categorical variables as numerical value and percentage&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The comparative analysis was performed using Pearson&#39;s chi-square test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; of categorical data&#44; based on expected values&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span> test was used to compare quantitative variables with categorical variables&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To evaluate the association between fluid balance and development of AKI-RRT&#44; we performed an unconditional logistic regression adjusted for age&#44; sex&#44; APACHE II<span class="elsevierStyleSmallCaps">&#44;</span> personal history of chronic kidney failure and sepsis as a reason for ICU admission on data collected from patients who had not developed AKI within 24<span class="elsevierStyleHsp" style=""></span>h of admission&#44; following the Waikar and Bonventre creatinine kinetics classification&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">OR and the corresponding 95&#37; confidence interval &#40;95&#37; CI&#41; was used as a measure of association&#46; To determine whether an effect modification influenced the fluid balance-AKI-RRT association&#44; we analysed the chlorine load administered to patients who had not developed IRA within 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission&#44; following the Waikar Bonventre creatinine kinetics classification&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> All <span class="elsevierStyleItalic">p</span> values were 2-tailed&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the statistical package Stata 12&#47;SE &#40;StataCorp&#44; College Station&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Description of the study sample</span><p id="par0085" class="elsevierStylePara elsevierViewall">Variables were collected from 430 patients&#58; 215 cases and 215 controls&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Taking into account the minimum sample size required&#44; each of the 6 participating ICUs provided at least 20 cases and 20 controls&#46; Fourteen patients were excluded from the analysis due to lack of data&#44; and 106 were excluded for presenting creatinine kinetics &#62;0&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The average age of patients with stage 0 kidney failure determined by creatinine kinetics during the first 24<span class="elsevierStyleHsp" style=""></span>h was 64&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;39 years&#59; 61&#46;94&#37; were men&#44; and average APACHE II at admission was 25&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;82&#46; The principle study variables are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; and analytical differences observed between cases and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Analysis of fluid balance and its association with the development of acute kidney injury and the use of renal replacement therapies &#40;AKI-RRT&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">The first and most significant finding in respect of the analysis of the 310 patients who did not develop kidney failure in the first 24<span class="elsevierStyleHsp" style=""></span>h of admission was that patients who developed AKI-RRT presented a higher positive fluid balance &#40;1951&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;552 vs&#46; 3663&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3164&#46;79&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; during the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU stay&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Secondly&#44; logistic regression analysis adjusted for APACHE II<span class="elsevierStyleSmallCaps">&#44;</span> age and sex showed a significant correlation&#58; the higher the fluid balance&#44; the greater the risk of requiring RRT&#59; the likelihood of developing AKI-RRT increases by 10&#37; for every 500<span class="elsevierStyleHsp" style=""></span>mL of positive fluid balance found during the first 24<span class="elsevierStyleHsp" style=""></span>h of admission &#40;OR&#58; 1&#46;09 &#91;1&#46;05&#8211;1&#46;14&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Analysis of chlorine load and its association with the development of acute kidney injury and the use of renal replacement therapies &#40;AKI-RRT&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">The analysis of the 310 patients who did not develop kidney failure within 24 hours of admission showed no difference in chlorine levels either at admission &#40;controls&#58; 104&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;06<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; cases&#58; 104&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;14<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&#41; or at 24<span class="elsevierStyleHsp" style=""></span>h &#40;controls&#58; 106&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;67<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#59; cases&#58; 105&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;91&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;14&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">An analysis of the mean load administered in the first 24 hours of admission showed no differences between cases and controls &#40;299&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>254&#46;91 vs&#46; 301&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>234&#46;63&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;92&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our study is the first to specifically explore the association between fluid balance and chlorine load in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU stay in critically ill patients&#44; and the subsequent need for RRT secondary to AKI&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We limited the time frame of our study to the first 24<span class="elsevierStyleHsp" style=""></span>h after ICU admission&#44; as this is when most fluid resuscitation procedures are performed in critically ill patients&#46; Due to considerable variations in the type and volume of fluids&#44; this stage of resuscitation can reasonably be considered the most appropriate for studying the potentially harmful effects associated with fluid therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The main limitations of our study are derived from its case vs&#46; control design&#44; in which selection bias is difficult to control&#46; In order to control selection bias&#44; only data from patients who had not developed renal failure&#44; based on creatinine kinetics&#44; in the first 24<span class="elsevierStyleHsp" style=""></span>h of resuscitation<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a> were used in the statistical analysis&#44; as it stands to reason that patients with kidney failure will receive more fluids&#44; for the simple fact these are part of the resuscitation protocol in patients with kidney failure Given heterogeneous distribution of septic patients and patients with chronic kidney failure&#44; both variables were included in the regression analysis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Waikar and Bonventre&#39;s kinetic classification was used to select patients who did not develop kidney failure in the first 24<span class="elsevierStyleHsp" style=""></span>h instead of the RIFLE or AKIN system&#44; since absolute changes in creatinine are able to detect a decrease in glomerular filtration rate before percentage changes&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Despite the foregoing limitations&#44; we believe that&#44; in respect of the primary study objective&#44; our results suggest the existence of a significant association between positive fluid balance in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission and development of AKI-RRT&#46; However&#44; we found no evidence of a significant association between chlorine load administered and AKI-RRT&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Some studies have linked positive fluid balance to adverse outcomes in monitoring patients with AKI&#44; irrespective of the severity of the disease and haemodynamic instability of the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11&#44;12</span></a> In pathophysiological terms&#44; increased abdominal pressure triggered by significant fluid overload could explain worsening renal function in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> Indeed&#44; recent evidence<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> has confirmed that a positive water balance at 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission is an independent risk factor for acute kidney injury and increased disease severity&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">However&#44; the theory that hyperchloraemia triggered by the infusion of chlorine-rich fluids&#44; one of the cornerstones of fluid resuscitation&#44; could play a part in the aetiology of kidney injury triggered by fluid balance has gained momentum&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a> The physiopathology of this hypothesis was explained by Lobo and Awad&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> who showed that increased renal tubular chloride concentration can result in the entry of chloride into cells of the macula densa&#44; causing depolarization of the basolateral membrane via chloride channels&#46; This can lead to adenosine release from the macula densa&#44; which through its effects on the A1 receptor causes afferent arteriolar vasoconstriction&#44; and triggers increased afferent arteriolar resistance and reduced glomerular filtration rate&#44; leading to reduced urine volume and sodium excretion&#46; The findings of Chowdhury et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> who showed that administration of SS compared with a crystalloid solution containing 98<span class="elsevierStyleHsp" style=""></span>mmol&#47;L chlorine reduced renal blood flow velocity and perfusion in healthy subjects&#44; seem to support this hypothesis&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">On this subject&#44; after evaluating more than 700 patients Yunus et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> concluded that the application of a chloro-restrictive fluid protocol caused less AKI and less AKI-RRT compared with a chloro-liberal protocol&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The results of the recent SPLIT<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">4</span></a> study&#44; however&#44; contradict these findings&#44; insofar as 3&#46;3&#37; of patients treated with low chlorine content crystalloid developed AKI-RRT versus 3&#46;4&#37; in the SS group &#40;absolute difference&#58; &#8722;0&#46;1&#37; &#91;95&#37; CI&#58; &#8722;1&#46;6 to 1&#46;4&#37;&#93;&#59; RR&#58; 0&#46;96 &#91;95&#37; CI&#59; 0&#46;62&#8211;1&#46;50&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;91&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our results are consistent with those of the SPLIT study&#44; as we found no correlation between chlorine load administered and development of AKI-RRT&#46; However&#44; one of the major limitations attributed to the SPLIT<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a> study&#44; namely&#44; the low volume of SS administered in study patients&#44; also holds true for our investigation&#46; The SPLIT study compared patients receiving 1&#46;105<span class="elsevierStyleHsp" style=""></span>mL of SS in the first 24<span class="elsevierStyleHsp" style=""></span>h with patients receiving 1152<span class="elsevierStyleHsp" style=""></span>mL of another balanced crystalloid&#59; in our study&#44; controls received a mean of 1680&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1450&#46;42<span class="elsevierStyleHsp" style=""></span>mL compared with a mean of 1633&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1518&#46;89<span class="elsevierStyleHsp" style=""></span>mL in cases in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">One interpretation of these data could be that the administration of 1&#8211;2<span class="elsevierStyleHsp" style=""></span>L SS would not increase the risk of AKI compared with other fluids&#46; In other words&#44; only large volumes of SS would trigger the proposed nephrotoxicity mechanism&#46; Shaw et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a> meanwhile&#44; found a significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in the development of AKI-RRT in favour of resuscitation with 1976<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1560<span class="elsevierStyleHsp" style=""></span>mL low chlorine content crystalloid compared with 1658<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1288<span class="elsevierStyleHsp" style=""></span>mL SS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Similarly&#44; Yunus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">3</span></a> showed a difference in the need for RRT of 10&#37; vs&#46; 6&#46;3&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in favour of chloro-restrictive therapies with an average SS infusion of 3200<span class="elsevierStyleHsp" style=""></span>mL&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In this regard&#44; it is also important to note that hyper- or hypovolaemia prior to infusion of crystalloids is a decisive factor in post-resuscitation intraglomerular hemodynamics&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> Glomerular vasoconstriction associated with low renal output of any kind is efferent&#44; and is mediated by activation of the renin&#8211;angiotensin&#8211;aldosterone axis and catecholamines&#46; The mechanism described by Wolf and Awad is tubuloglomerular feedback&#44; which is observed when luminal flow in the loop of Henle is increased &#40;in renal hypoperfusion&#44; flow is reduced at the level of the macula densa&#41;&#46; This luminal flow&#44; detected by the cilia of the macula densa cells and triggering release of adenosine&#44; provides the signal for activation of tubuloglomerular feedback&#44; which ultimately determines afferent artery vasoconstriction&#46; Although depolarization of the cell membrane via chloride channels&#44; susceptible to furosemide&#44; influences this signalling&#44; feedback is not activated by the concentration of chlorine but by urine volume&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; we believe that the role of the chlorine-rich fluids used in the resuscitation of hypotense patients in triggering kidney failure has yet to be fully explained&#44; particularly in view of the two-hit theory of multiple system organ failure&#46; Applying this model&#44; the hypotension itself would contribute to or indeed initiate the inflammatory response&#46; Once activated&#44; these cells can alter vascular tone and the response to a second insult&#44; thus facilitating redistribution of renal blood flow&#46; When a second insult&#44; in the form of high chlorine load&#44; stimulates these primed or suppressed cells&#44; an inappropriate inflammatory response is triggered&#44; causing further tissue damage&#44; haemodynamic instability and renal dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In summary&#44; based on these findings&#44; we believe that fluid overload in the first 24<span class="elsevierStyleHsp" style=""></span>h of admission to an ICU in our patients must be considered an important contributor to ultimate deterioration of renal function and development of AKI-RRT&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical responsibilities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of people and animals</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">Dr&#46; Alejandro Gonzalez Castro acknowledges that his collaboration with Baxter in an advisory capacity could represent a conflict of interest&#46;</p></span></span>"
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              "titulo" => "Analysis of fluid balance and its association with the development of acute kidney injury and the use of renal replacement therapies &#40;AKI-RRT&#41;"
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              "titulo" => "Analysis of chlorine load and its association with the development of acute kidney injury and the use of renal replacement therapies &#40;AKI-RRT&#41;"
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              "titulo" => "Protection of people and animals"
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              "identificador" => "sec0065"
              "titulo" => "Confidentiality of data"
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              "titulo" => "Right to privacy and informed consent"
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            0 => "Resuscitation"
            1 => "Fluids"
            2 => "Chloraemia"
            3 => "Fluid balance"
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            5 => "Renal replacement therapy"
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            0 => "Reanimaci&#243;n"
            1 => "Fluidos"
            2 => "Cloremia"
            3 => "Balance h&#237;drico"
            4 => "Insuficiencia renal"
            5 => "T&#233;cnicas de reemplazo renal"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse the association between water balance during the first 24<span class="elsevierStyleHsp" style=""></span>h of admission to ICU and the variables related to chloride levels &#40;chloride loading&#44; type of fluid administered&#44; hyperchloraemia&#41;&#44; with the development of acute kidney injury renal replacement therapy &#40;AKI-RRT&#41; during patients&#8217; admission to ICU&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multicentre case&#8211;control study&#46; Hospital-based&#44; national&#44; carried out in 6 ICUs&#46; Cases were patients older than 18 years who developed an AKI-RRT&#46; Controls were patients older than 18 years admitted to the same institutions during the study period&#44; who did not develop AKI-RRT during ICU admission&#46; Pairing was done by APACHE-II&#46; An analysis of unconditional logistic regression adjusted for age&#44; sex&#44; APACHE-II and water balance &#40;in evaluating the type of fluid&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analysed the variables of 430 patients&#58; 215 cases and 215 controls&#46; An increase of 10&#37; of the possibility of developing AKI-RRT per 500<span class="elsevierStyleHsp" style=""></span>mL of positive water balance was evident &#40;OR&#58; 1&#46;09 &#91;95&#37; CI&#58; 1&#46;05&#8211;1&#46;14&#93;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The study of mean values of chloride load administered did not show differences between the group of cases and controls &#40;299&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>254&#46;91 vs&#46; 301&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>234&#46;63&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;92&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The water balance in the first 24<span class="elsevierStyleHsp" style=""></span>h of ICU admission relates to the development of IRA-TRR&#44; regardless of chloraemia&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
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          2 => array:2 [
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la asociaci&#243;n entre el balance h&#237;drico durante las primeras 24<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCI y las variables relacionadas con los valores de cloro &#40;carga de cloro&#44; tipo de fluido administrado&#44; hipercloremia&#41;&#44; con el empleo de t&#233;cnicas de reemplazo renal secundarias a insuficiencia renal aguda &#40;IRA-TRR&#41; durante el posterior ingreso en UCI de los enfermos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico de casos y controles&#44; de base hospitalaria y &#225;mbito nacional&#44; llevado a cabo en 6 UCI&#46; Los casos fueron pacientes mayores de 18 a&#241;os que desarrollaron una IRA-TRR&#46; Los controles fueron pacientes mayores de 18 a&#241;os&#44; ingresados en el mismo periodo y centro que los casos&#44; que no desarrollaron IRA-TRR durante su ingreso en UCI&#46; Se realiz&#243; emparejamiento por APACHE-II&#46; Se llev&#243; a cabo un an&#225;lisis de regresi&#243;n log&#237;stica no condicional ajustada por edad&#44; sexo&#44; APACHE-II&#46; Las variables de inter&#233;s principales fueron&#58; balance h&#237;drico&#44; carga de cloro administrada&#44; e IRA-TRR&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se han analizado las variables de 310 enfermos&#46; Se evidenci&#243; un aumento del 10&#37; en la posibilidad de desarrollar IRA-TRR por cada 500<span class="elsevierStyleHsp" style=""></span>mL de balance h&#237;drico positivo &#40;OR&#58; 1&#44;09 &#91;IC 95&#37;&#58;1&#44;05&#8211;1&#44;14&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El estudio de los valores medios de carga administrada no evidenci&#243; diferencias entre el grupo de casos y de controles &#40;299&#44;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>254&#44;91 frente a 301&#44;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>234&#44;63&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;92&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El balance h&#237;drico en las primeras 24<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCI se relaciona con el desarrollo de IRA-TRR&#44; independientemente de la cloremia&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Gonz&#225;lez-Castro A&#44; Ortiz-Lasa M&#44; Leizaola O&#44; Salgado E&#44; Irriguible T&#44; S&#225;nchez-Satorra M&#44; et al&#46; Balance h&#237;drico y carga de cloro en las primeras 24<span class="elsevierStyleHsp" style=""></span>h de ingreso en UCI y su relaci&#243;n con las terapias de reemplazo renal mediante un estudio multic&#233;ntrico&#44; retrospectivo&#44; de casos y controles emparejados por APACHE-II&#46; Rev Esp Anestesiol Reanim&#46; 2017&#59;64&#58;243&#8211;249&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stage&#47;criterion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#916; Creatinine at 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Colloids</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Natural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Synthetic</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Saline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Balanced</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatins</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Ringer Sol&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Buffer</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Succinylated gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Polygeline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lactate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acetate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Na<span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cl<span class="elsevierStyleSup">&#8211;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ca<span class="elsevierStyleSup">2&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mg<span class="elsevierStyleSup">2&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bicarbonate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acetate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gluconate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osmolarity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">308&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">294&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Men</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;55&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99 &#40;69&#46;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">APACHE</span>-II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HTN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;52&#46;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80 &#40;56&#46;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;22&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;30&#46;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;31&#46;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;31&#46;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;16&#46;07&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;15&#46;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;10&#46;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;22&#46;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sepsis at admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;39&#46;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101 &#40;71&#46;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Nephrotoxic drugs</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Amikacin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;3&#46;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;9&#46;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Colistin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;5&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;7&#46;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NSAIDs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;20&#46;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;8&#46;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Furosemide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;33&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;35&#46;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Amphotericin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;4&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;7&#46;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urgent admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;5&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#46;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Another hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;13&#46;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;16&#46;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hospital ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;24&#46;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;26&#46;06&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;9&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;17&#46;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79 &#40;47&#46;02&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;38&#46;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Analytical Var&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cases&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cr adm&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cr 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea adm&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>58&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;63<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>89&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>64&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ch adm&#46;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;94&nbsp;\t\t\t\t\t\t\n
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              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid resuscitation&#58; current perspective"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "A&#46; Gonz&#225;lez-Castro"
                            1 => "Y&#46; Pe&#241;asco Martin"
                            2 => "M&#46; Ortiz-Lasa"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
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                        "volumen" => "146"
                        "paginaInicial" => "128"
                        "paginaFinal" => "132"
                      ]
                    ]
                  ]
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              ]
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              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid balance and mortality in critically ill patients with acute kidney injury&#58; a multicenter prospective epidemiological study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Beijing Acute Kidney Injury Trial &#40;BAKIT&#41; Workgroup"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Wang"
                            1 => "L&#46; Jiang"
                            2 => "B&#46; Zhu"
                            3 => "Y&#46; Wen"
                            4 => "X&#46;M&#46; Xi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13054-015-1085-4"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26494153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Yunos"
                            1 => "R&#46; Bellomo"
                            2 => "C&#46; Hegarty"
                            3 => "D&#46; Story"
                            4 => "L&#46; Ho"
                            5 => "M&#46; Bailey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.13356"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "308"
                        "paginaInicial" => "1566"
                        "paginaFinal" => "1572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23073953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit&#58; the SPLIT randomized clinical trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Bailey"
                            2 => "R&#46; Beasley"
                            3 => "S&#46; Henderson"
                            4 => "D&#46; Mackle"
                            5 => "C&#46; McArthur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2015.12334"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2015"
                        "volumen" => "314"
                        "paginaInicial" => "1701"
                        "paginaFinal" => "1710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26444692"
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                          ]
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                ]
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            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hyperchloremia as a confounding variable in fluid therapy studies"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "A&#46; Gonz&#225;lez-Castro"
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                            2 => "O&#46; Azcune"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.redar.2016.02.002"
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                        "tituloSerie" => "Rev Esp Anestesiol Reanim"
                        "fecha" => "2016"
                        "volumen" => "63"
                        "paginaInicial" => "366"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27044738"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The RENAL &#40;Randomised Evaluation of Normal vs&#46; Augmented Level of Replacement Therapy&#41; study&#58; statistical analysis plan"
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                        0 => array:3 [
                          "colaboracion" => "RENAL Study Investigators"
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Finfer"
                            1 => "A&#46; Cass"
                            2 => "M&#46; Gallagher"
                            3 => "J&#46; Lee"
                            4 => "S&#46; Su"
                            5 => "R&#46; Bellomo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Resusc"
                        "fecha" => "2009"
                        "volumen" => "11"
                        "paginaInicial" => "58"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19281446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Creatinine kinetics and definition of acute kidney injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Waikar"
                            1 => "J&#46; Bonventre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2008070669"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol"
                        "fecha" => "2009"
                        "volumen" => "20"
                        "paginaInicial" => "672"
                        "paginaFinal" => "679"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19244578"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0135"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Estudio FRAMI&#46; Epidemiology of acute kidney failure in Spanish ICU&#46; Multicenter prospective study FRAMI"
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                        0 => array:3 [
                          "colaboracion" => "Grupo de trabajo &#171;Estado actual del fracaso renal agudo y de las t&#233;cnicas de reemplazo renal en UCI&#187;"
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                          "autores" => array:4 [
                            0 => "M&#46;E&#46; Herrera-Guti&#233;rrez"
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                            3 => "J&#46;A&#46; S&#225;nchez-Izquierdo-Riera"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intens"
                        "fecha" => "2006"
                        "volumen" => "30"
                        "paginaInicial" => "260"
                        "paginaFinal" => "267"
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0140"
              "etiqueta" => "9"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Four phases of intravenous fluid therapy&#58; a conceptual model"
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                        0 => array:3 [
                          "colaboracion" => "ADQI XII Investigators Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;A&#46; Hoste"
                            1 => "K&#46; Maitland"
                            2 => "C&#46;S&#46; Brudney"
                            3 => "R&#46; Mehta"
                            4 => "J&#46;L&#46; Vincent"
                            5 => "D&#46; Yates"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aeu300"
                      "Revista" => array:7 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2014"
                        "volumen" => "113"
                        "paginaInicial" => "740"
                        "paginaFinal" => "747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25204700"
                            "web" => "Medline"
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              "identificador" => "bib0145"
              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fluid challenges in intensive care&#58; the FENICE study&#58; a global inception cohort study"
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                        0 => array:3 [
                          "colaboracion" => "FENICE Investigators&#44; ESICM Trial Group"
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                            3 => "V&#46; Pettila"
                            4 => "E&#46; Wilkman"
                            5 => "Z&#46; Molnar"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00134-015-3850-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1529"
                        "paginaFinal" => "1537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26162676"
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              "identificador" => "bib0150"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Fluid balance&#44; diuretic use&#44; and mortality in acute kidney injury"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;E&#46; Grams"
                            1 => "M&#46;M&#46; Estrella"
                            2 => "J&#46; Coresh"
                            3 => "R&#46;G&#46; Brower"
                            4 => "K&#46;D&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.08781010"
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                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "966"
                        "paginaFinal" => "973"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21393482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0155"
              "etiqueta" => "12"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A positive fluid balance is associated with a worse outcome in patients with acute renal failure"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Payen"
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                            2 => "Y&#46; Sakr"
                            3 => "C&#46; Spies"
                            4 => "K&#46; Reinhart"
                            5 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc6916"
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                        "tituloSerie" => "Crit Care"
                        "fecha" => "2008"
                        "volumen" => "12"
                        "paginaInicial" => "R74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18533029"
                            "web" => "Medline"
                          ]
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              "etiqueta" => "13"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Mohmand"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2010121222"
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                        "volumen" => "22"
                        "paginaInicial" => "615"
                        "paginaFinal" => "621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21310818"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent &#8216;pre-renal&#8217; acute kidney injury&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;N&#46; Lobo"
                            1 => "S&#46; Awad"
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                      "doi" => "10.1038/ki.2014.105"
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                        "tituloSerie" => "Kidney Int"
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                        "paginaInicial" => "1096"
                        "paginaFinal" => "1105"
                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "A randomized&#44; controlled&#44; double-blind crossover study on the effects of 2-L infusions of 0&#46;9&#37; saline and plasma-lyte&#40;R&#41; 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "S&#46;T&#46; Francis"
                            3 => "D&#46;N&#46; Lobo"
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                        "tituloSerie" => "Ann Surg"
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                        "volumen" => "256"
                        "paginaInicial" => "18"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22580944"
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                      "titulo" => "Assessing toxicity of intravenous crystalloids in critically ill patients"
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                            0 => "J&#46;A&#46; Kellum"
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                        "tituloSerie" => "JAMA"
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                        "volumen" => "314"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26444442"
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                      "titulo" => "Major complications&#44; mortality&#44; and resource utilization after open abdominal surgery&#58; 0&#46;9&#37; saline compared to plasma-lyte"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "S&#46;L&#46; Goldstein"
                            3 => "L&#46;A&#46; Scherer"
                            4 => "M&#46; Duan"
                            5 => "C&#46;R&#46; Schermer"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e31825074f5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2012"
                        "volumen" => "255"
                        "paginaInicial" => "821"
                        "paginaFinal" => "829"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22470070"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
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                      "titulo" => "Lactated ringer&#39;s is superior to normal saline in a model of massive hemorrhage and resuscitation"
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                          "etal" => false
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                            3 => "W&#46;H&#46; Loomis"
                            4 => "D&#46;B&#46; Hoyt"
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                        ]
                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
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                        "paginaInicial" => "894"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9820700"
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                    0 => array:2 [
                      "titulo" => "Microvascular changes explain the two-hit theory of multiple organ failure"
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                            0 => "N&#46; Garrison"
                            1 => "D&#46;A&#46; Spain"
                            2 => "M&#46;A&#46; Wilson"
                            3 => "P&#46;A&#46; Keelen"
                            4 => "P&#46;D&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1998"
                        "volumen" => "227"
                        "paginaInicial" => "851"
                        "paginaFinal" => "860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9637548"
                            "web" => "Medline"
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                      ]
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                ]
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