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The Kidney in Diffe...
The Kidney in Different Stages of the Cardiovascular Continuum
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- Nerpin, Elisabet, 1962- (författare)
- Högskolan Dalarna,Uppsala universitet,Geriatrik,Högskolan Dalarna-Medicinsk vetenskap,Medicinsk vetenskap,Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik
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- Ärnlöv, Johan, Docent (preses)
- Högskolan Dalarna,Uppsala universitet,Geriatrik,Högskolan Dalarna Medicinsk vetenskap,Medicinsk vetenskap,Uppsala Universitet
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- Ingelsson, Erik, Professor (preses)
- Uppsala universitet,Molekylär epidemiologi,Uppsala Universitet
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- Riserus, Ulf, Associate professor (preses)
- Uppsala universitet,Klinisk nutrition och metabolism,Uppsala Universitet
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- Östergren, Jan, Professor (opponent)
- Karolinska Institutet,Karolinska institutionen
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(creator_code:org_t)
- ISBN 9789155487928
- Uppsala : Acta Universitatis Upsaliensis, 2013
- Engelska 72 s.
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Serie: Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 946
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Serie: Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206; 946 ; 946
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Abstract
Ämnesord
Stäng
- Patients with chronic kidney disease are at higher risk of developing cardiovascular disease. The complex, interaction between the kidney and the cardiovascular system is incompletely understood, particularly at the early stages of the cardiovascular continuum.The overall aim of this thesis was to clarify novel aspects of the interplay between the kidney and the cardiovascular system at different stages of the cardiovascular continuum; from risk factors such as insulin resistance, inflammation and oxidative stress, via sub-clinical cardiovascular damage such as endothelial dysfunction and left ventricular dysfunction, to overt cardiovascular death.This thesis is based on two community-based cohorts of elderly, Uppsala Longitudinal Study of Adult Men (ULSAM) and Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS).The first study, show that higher insulin sensitivity, measured with euglycemic-hyperinsulinemic clamp technique was associated to improve estimated glomerular filtration rate (eGFR) in participants with normal fasting plasma glucose, normal glucose tolerance and normal eGFR. In longitudinal analyses, higher insulin sensitivity at baseline was associated with lower risk of impaired renal function during follow-up. In the second study, eGFR was inversely associated with different inflammatory markers (C-reactive protein, interleukin-6, serum amyloid A) and positively associated with a marker of oxidative stress (urinary F2-isoprostanes). In line with this, the urinary albumin/creatinine ratio was positively associated with these inflammatory markers, and negatively associated with oxidative stress.In study three, higher eGFR was associated with better endothelial function as assessed by the invasive forearm model. Further, in study four, higher eGFR was significantly associated with higher left ventricular systolic function (ejection fraction). The 5th study of the thesis shows that higher urinary albumin excretion rate (UAER) and lower eGFR was independently associated with an increased risk for cardiovascular mortality. Analyses of global model fit, discrimination, calibration, and reclassification suggest that UAER and eGFR add relevant prognostic information beyond established cardiovascular risk factors in participants without prevalent cardiovascular disease.Conclusion: this thesis show that the interaction between the kidney and the cardiovascular system plays an important role in the development of cardiovascular disease and that this interplay begins at an early asymptomatic stage of the disease process.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Annan medicin och hälsovetenskap -- Gerontologi, medicinsk/hälsovetenskaplig inriktning (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Other Medical and Health Sciences -- Gerontology, specialising in Medical and Health Sciences (hsv//eng)
Nyckelord
- epidemiology
- chronic kidney disease
- cystatin C
- glomerular filtration rate
- albuminuria
- euglycemic hyperinsulinemic clamp
- insulin sensitivity
- inflammation
- oxidative stress
- endothelial dysfunction and left ventricular dysfunction
- Medicin
- Medicine
- Nedsatt njurfunktion, insulinresistens, oxidativ stress och utvecklingen av hjärt-kärlsjukdomar
Publikations- och innehållstyp
- vet (ämneskategori)
- dok (ämneskategori)
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