| 1. |
- Fernström, Anders, et al.
(författare)
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Achievement of recommended treatment targets for bone and mineral metabolism in haemodialysis patients using paricalcitol : An observational study
- 2011
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 45:3, s. 196-205
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Secondary hyperparathyroidism (SHPT) is a common problem among patients with chronic kidney disease (CKD) on haemodialysis. This study was conducted to assess the use, effectiveness and safety of intravenous paricalcitol in haemodialysis patients with various degrees of SHPT. Material and methods. This observational, multicentre, prospective study was conducted in 14 Swedish dialysis centres from May 2007 to June 2008 and included 92 haemodialysis patients with a diagnosis of SHPT associated with CKD. The decision to initiate treatment with intravenous paricalcitol was made by the treating physician. No treatment algorithms were provided. Results. Mean patient age was 64 years. Of the 92 patients included, 74 had an intact parathyroid hormone (iPTH) level of > 300 pg/ml at baseline. Median iPTH was 584 pg/ml in patients with a baseline PTH of > 300 pg/ml. During follow-up there was a decrease in iPTH to 323 pg/ml at 6 months (--45%, p < 0.0001). In parallel, there was a small increase in serum calcium, but serum phosphorus and the calcium xx phosphorus product remained unchanged. Conclusions. This study showed that intravenous paricalcitol substantially and safely decreased iPTH in haemodialysis patients with a baseline iPTH above the Kidney Disease Outcomes Quality Initiative recommended target range (150--300 pg/ml) and had minimal impact on serum minerals.
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| 2. |
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| 3. |
- Peters, Björn, et al.
(författare)
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Dynamics of urine proteomics biomarker and disease progression in patients with IgA nephropathy
- 2023
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press. - 0931-0509 .- 1460-2385. ; 38:12, s. 2826-2834
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immunoglobulin A nephropathy (IgAN) frequently leads to kidney failure. The urinary proteomics-based classifier IgAN237 may predict disease progression at the time of kidney biopsy. We studied whether IgAN237 also predicts progression later in the course of IgAN.Methods: Urine from patients with biopsy-proven IgAN was analyzed using capillary electrophoresis-mass spectrometry at baseline (IgAN237-1, n = 103) and at follow-up (IgAN237-2, n = 89). Patients were categorized as "non-progressors" (IgAN237 ≤0.38) and "progressors" (IgAN237 >0.38). Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio slopes were calculated.Results: Median age at biopsy was 44 years, interval between biopsy and IgAN237-1 was 65 months and interval between IgAN237-1 and IgAN237-2 was 258 days (interquartile range 71-531). IgAN237-1 and IgAN237-2 values did not differ significantly and were correlated (rho = 0.44, P < .001). Twenty-eight percent and 26% of patients were progressors based on IgAN237-1 and IgAN237-2, respectively. IgAN237 inversely correlated with chronic eGFR slopes (rho = -0.278, P = .02 for score-1; rho = -0.409, P = .002 for score-2) and with ±180 days eGFR slopes (rho = -0.31, P = .009 and rho = -0.439, P = .001, respectively). The ±180 days eGFR slopes were worse for progressors than for non-progressors (median -5.98 versus -1.22 mL/min/1.73 m2 per year for IgAN237-1, P < .001; -3.02 vs 1.08 mL/min/1.73 m2 per year for IgAN237-2, P = .0047). In multiple regression analysis baseline progressor/non-progressor according to IgAN237 was an independent predictor of eGFR180days-slope (P = .001).Conclusion: The urinary IgAN237 classifier represents a risk stratification tool in IgAN also later in the course of the dynamic disease. It may guide patient management in an individualized manner.
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| 4. |
- Barratt, Jonathan, et al.
(författare)
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Phase 2 Trial of Cemdisiran in Adult Patients with IgA Nephropathy: A Randomized Controlled Trial
- 2024
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Ingår i: American Society of Nephrology. Clinical Journal. - : AMER SOC NEPHROLOGY. - 1555-9041 .- 1555-905X. ; 19:4, s. 452-462
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Tidskriftsartikel (refereegranskat)abstract
- Background IgA nephropathy is the most common primary GN. Clinical features of IgA nephropathy include proteinuria, which is the strongest known surrogate of progression to kidney failure. Complement pathway activation is a critical driver of inflammation and tissue injury in IgA nephropathy. Cemdisiran is an investigational RNA interference therapeutic that suppresses hepatic production of complement component 5 (C5), thereby potentially reducing proteinuria in IgA nephropathy. We evaluated the efficacy and safety of cemdisiran in adult patients with IgA nephropathy at high risk of kidney disease progression. Methods In this phase 2, 36-week, double-blind study, adult patients with IgA nephropathy and urine protein >= 1 g/24 hours were randomized (2:1) to subcutaneous cemdisiran 600 mg or placebo every 4 weeks in combination with the standard of care. The primary end point was percentage change from baseline at week 32 in urine protein-to-creatinine ratio (UPCR) measured by 24-hour urine collection. Additional end points included change from baseline in UPCR measured by spot urine, serum C5 level, and safety assessments. Results Thirty-one patients were randomized (cemdisiran, N=22; placebo, N=9). Cemdisiran-treated patients had a placebo-adjusted geometric mean change in 24-hour UPCR of -37.4% (cemdisiran-adjusted geometric mean ratio to baseline [SEM], 0.69 [0.10]) at week 32. Spot UPCR was consistent with 24-hour UPCR placebo-adjusted change of -45.8% (cemdisiran-adjusted geometric mean ratio to baseline [SEM], 0.73 [0.11]). Mean (SD) change in serum C5 level from baseline at week 32 was -98.7% (1.2) with cemdisiran and 25.2% (57.7) with placebo. Over 36 weeks, most adverse events were mild or moderate and transient; the most common adverse event after cemdisiran treatment was injection-site reaction (41%). Conclusions These findings indicate that treatment with cemdisiran resulted in a reduction of proteinuria at week 32 and was well tolerated.
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| 5. |
- Enberg, Per, et al.
(författare)
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Utilization of UV absorbance for estimation of phosphate elimination during hemodiafiltration
- 2012
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Ingår i: Nephron. Clinical practice. - : S. Karger. - 1660-8151 .- 2235-3186 .- 1660-2110. ; 121:1-2, s. c1-c9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Phosphate is an important factor in explaining the high progress of vascular calcification among dialysis patients. Today, phosphate concentration is measured in plasma on a regular basis. The aim of this study was to find out if it is possible to estimate total removed phosphate (TRp) in spent dialysate utilizing UV absorbance during hemodiafiltration. Methods: Eleven patients were monitored online with UV absorbance at 297 nm, three times during one week each (n = 33). Dialysate samples were taken at different times during treatment and from a collection tank to chemically determine phosphate concentrations. Two mathematical models (UVIND and UVGROUP) were tested to estimate TRp with supervision by UV absorbance and compared with TRp measured in the tank (reference). Results: High correlation between UV absorbance and phosphate concentration for each single patient and lower for the whole group together was found. TRp was (mean +/- SD) 30.7 +/- 7.3 mmol for the reference and 30.8 +/- 8.2 and 29.1 +/- 5.2 mmol for UVIND and UVGROUP, respectively (p > 0.05). Conclusion: This study demonstrates a novel possibility to estimate TRp based on linear relationship between online monitoring of UV absorbance and concentration of phosphate in spent dialysate.
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| 6. |
- Eriksson, Anders, 1975, et al.
(författare)
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An accurate model for genetic hitchhiking
- 2008
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Ingår i: Genetics. - : Oxford University Press (OUP). - 0016-6731 .- 1943-2631. ; 178:1, s. 439-451
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Tidskriftsartikel (refereegranskat)abstract
- We suggest a simple deterministic approximation for the growth of the favored-allele frequency during a selective sweep. Using this approximation we introduce an accurate model for genetic hitchhiking. Only when Ns < 10 (N is the population size and s denotes the selection coefficient) are discrepancies between our approximation and direct numerical simulations of a Moran model notable. Our model describes the gene genealogies of a contiguous segment of neutral loci close to the selected one, and it does not assume that the selective sweep happens instantaneously. This enables us to compute SNP distributions on the neutral segment without bias.
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| 7. |
- Eriksson, Annika, 1962-, et al.
(författare)
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Ideer och verklighet inom njurmedicin
- 2004
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Ingår i: Dialäsen : tidningen för personal inom njursjukvård. - 1104-4616. ; 3, s. 46-46
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Fernström, Anders
(författare)
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Bra lärobok – kan bli bättre
- 2016
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 113:763
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Recension (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Fernström, Anders
(författare)
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Factors affecting body weight development and eating behaviour in patients on continuous ambulatory peritoneal dialysis treatment
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) have different metabolic effects in dialysis patients, since absorption of intraperitoneal glucose implies an additional energy source in CAPD patients. In spite of this, protein-energy malnutrition is known to occur frequently, both in patients on hemodialysis and in patients on CAPD, and an association with increased morbidity and mortality is well established. It is therefore of great importance to identify factors which have the potential of negatively influencing the nutritional state. In this thesis, it is demonstrated that taste acuity of primary tastes in end-stage renal disease (ESRD) patients is hampered in the form of increased recognition thresholds. The taste thresholds were significantly higher for salt and bitter in preuremic patients, compared to control subjects. In CAPD patients, taste recognition of bitter was impaired and in HD patients, recognition of salty taste was impaired. Patients with ESRD have significantly fewer fungiform taste buds, which might be an important factor contributing to the impaired taste acuity. In addition to the study of the number of taste buds, the presence of peripheral nervous tissue in taste buds with the aid of specific markers (primary antibodies) was also analysed. With these antibodies, no major immunohistochemical differences were disclosed between uremic patients and healthy controls. In a study of energy intake in CAPD patients (five days food recording), it is also established that dietary energy intake from carbohydrates, protein and fat is lower in patients treated with CAPD than in those treated with hemodialysis, although the energy percentage composition of the dietary macronutrients is unaffected. Transperitoneal energy intake compensates for this lower dietary energy intake, and makes total energy intake almost the same in CAPD and HD patients, but with a change in the composition of the diet of CAPD patients towards a significantly higher carbohydrate percentage in energy intake. The level of total energy intake observed places both patient groups in the risk zone for developing malnutrition. CAPD patients have a slower gastric emptying rate, as measured with scintigraphy. This impairment of gastric emptying rate correlates with disturbances in the normal myoelectric rhythm of the stomach (tachygastria), as measured with electrogastrography. A body composition analysis of CAPD patients, as studied with computed tomography of the abdomen and of the right thigh, as well as with dual energy x-ray absorptiometry, reveals an increase in the intraabdominal fat area after commencement of peritoneal dialysis. Thus CAPD induces a distribution of body fat that resembles the pattern observed in the metabolic syndrome. In conclusion, several factors which have the potential of negatively influencing the nutritional state in CAPD patients have been identified. Moreover, a metabolic consequence in the form of an increase in intraabdominal fat is demonstrated in patients treated with CAPD, which may accelerate the development of risk factors for cardiovascular disease.
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