| 1. |
- Brodin, Elisabeth, et al.
(författare)
-
Physical activity, muscle performance and quality of life in patients treated with chronic peritoneal dialysis.
- 2001
-
Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 35:1, s. 71-8
-
Tidskriftsartikel (refereegranskat)abstract
- Today's medical treatment of patients with end-stage renal failure has increased their opportunities for an active lifestyle. The aim of this study was to describe the muscle performance, level of physical activity, independence in activities of daily living and quality of life in patients treated with chronic peritoneal dialysis.The study investigated 33 patients (30-81 years old) treated with chronic peritoneal dialysis. The results were compared with an age-matched healthy reference group. Muscle mass was determined by measuring total body potassium, while maximal grip strength was measured with an electric force transducer. The ability to perform heel-lifts, walking speed and level of physical activity were also assessed, along with the extent to which patients were independent in activities of daily living (ADL) and satisfied with their health.Total body potassium was 97 +/- 11.6% of normal and correlated positively with the maximal grip strength (r = 0.658, p < 0.0002) and the maximal walking speed (r = 0.558, p < 0.0027). Maximal grip strength was 70% of the reference, the ability to perform heel-lifts was 49% of the reference, the walking speed was 85% the reference and the level of physical activity was 56% of expected. The patients were independent in ADL to a great extent and 52% of the patients were satisfied with their health.The peritoneal dialysis patients had a relatively good quality of life and were largely independent in ADL Further studies are needed to investigate whether it is possible to improve muscle performance and the level of physical activity with exercise and muscle training in these patients.
|
|
| 2. |
- Brodin, Elisabeth, et al.
(författare)
-
Rising from a chair: a simple screening test for physical function in predialysis patients.
- 2008
-
Ingår i: Scandinavian journal of urology and nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 42:3, s. 293-300
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Patients with chronic end-stage renal diseases have decreased physical fitness. This physical deconditioning is relative but the consequences in daily life are related to functional thresholds. The main purpose of this study was to gather information about physical performance, physical fitness and activity in predialysis patients. A second aim was to investigate the possibility of identifying patients at risk of physical deconditioning using clinical tests. MATERIAL AND METHODS: Fifty-five predialysis patients with a glomerular filtration rate (GFR) of
|
|
| 3. |
|
|
| 4. |
- Johansson, Mats, 1959, et al.
(författare)
-
Baroreflex effectiveness index and baroreflex sensitivity predict all-cause mortality and sudden death in hypertensive patients with chronic renal failure
- 2007
-
Ingår i: J Hypertens. - 0263-6352. ; 25:1, s. 163-8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Impaired arterial baroreflex sensitivity (BRS) has been associated with cardiac mortality and non-fatal cardiac arrests after a myocardial infarction. Patients with chronic renal failure (CRF) have a poor prognosis because of cardiovascular diseases, and sudden death is common. The aim of this study was to assess whether BRS or the baroreflex effectiveness index (BEI), a novel index reflecting the number of times the baroreflex is active in controlling the heart rate in response to blood pressure fluctuations, is associated with prognosis in CRF. METHODS: Hypertensive patients with CRF who were treated conservatively, by haemodialysis or peritoneal dialysis were studied. Electrocardiogram and beat-to-beat blood pressures were recorded continuously and BRS and BEI were calculated. Patients were then followed prospectively for 41 +/- 15 months (range 1-64). RESULTS: During follow-up 69 patients died. Cardiovascular diseases and uraemia accounted for the majority of deaths (60 and 20%, respectively), whereas sudden death occurred in 15 patients. In adjunct with established risk factors such as age, diabetes, congestive heart failure and diastolic blood pressure, reduced BEI was an independent predictor of all-cause mortality among CRF patients [relative risk (RR) 0.50, 95% confidence interval (CI) 0.33-0.71 for an increase of one standard deviation in BEI, P < 0.001]. Diabetes and reduced BRS were independent predictors of sudden death (RR 0.29, 95% CI 0.09-0.86 for an increase of one standard deviation in BRS, P=0.022). CONCLUSIONS: Both BEI and BRS convey prognostic information that may have clinical implications for patients with cardiovascular diseases in general.
|
|
| 5. |
- Johansson, Mats, 1959, et al.
(författare)
-
Elevated temporal QT variability index in patients with chronic renal failure
- 2004
-
Ingår i: Clin Sci (Lond). - 0143-5221. ; 107:6, s. 583-8
-
Tidskriftsartikel (refereegranskat)abstract
- Patients with CRF (chronic renal failure) are at increased risk of cardiovascular diseases, and 60% of cardiovascular mortality in CRF is attributed to sudden death. Various abnormalities in myocardial repolarization are associated with the risk of ventricular arrhythmia. The aim of this study was to evaluate an index of temporal myocardial repolarization lability, the temporal QTVI (QT variability index), in patients with CRF. ECGs were recorded in 153 patients with CRF on haemodialysis (n=67), continuous ambulatory peritoneal dialysis (n=43) or conservative treatment (n=43) during 30 min of rest. QTVI was calculated as the logarithm of the ratio between the variances of the normalized QT and RR intervals. Age-matched healthy subjects (n=39) were examined for comparison. QTVI was increased by 47% in CRF patients compared with healthy subjects (-0.82+/-0.56 compared with -1.54+/-0.27 respectively; P<0.01). QTVI did not differ among patients on dialysis or conservative treatment, whereas QTVI was elevated further in patients with diabetes compared with non-diabetic CRF patients (-0.56+/-0.54 compared with -0.94+/-0.52 respectively; P<0.01). In a multiple linear regression analysis, diabetes and a history of coronary artery disease were the only independent predictors of QTVI in the CRF population. The present study demonstrates that elevated QTVI in patients with CRF is associated with diabetes and coronary disease. The present findings are important given that repolarization instability may predispose to ventricular arrhythmia and sudden death, events that occur frequently in CRF patients.
|
|
| 6. |
- Johansson, Mats, 1959, et al.
(författare)
-
Reduced baroreflex effectiveness index in hypertensive patients with chronic renal failure
- 2005
-
Ingår i: Am J Hypertens. - : Oxford University Press (OUP). - 0895-7061. ; 18:7
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Impaired arterial baroreflex function has been associated with an increased risk of ventricular arrhythmia and sudden death. This has also been suggested for patients with chronic renal failure (CRF) who are at high risk for cardiovascular morbidity. The aim of this study was to investigate the arterial baroreflex function in CRF patients with emphasis on analyzing the time during which the arterial baroreflex is active, the baroreflex effectiveness index (BEI). METHODS: Beat-to-beat blood pressure (measured with Portapres) and electrocardiography were continuously registered during 30 min rest in 216 hypertensive CRF patients on hemodialysis (n=95), continuous ambulatory peritoneal dialysis (n=59), or conservative treatment (n=59). The spontaneous sequence method was used to calculate BRS and BEI. Age-matched healthy subjects (n=43) were examined for comparison. RESULTS: The BRS was reduced by 51% and the BEI by 49% in CRF patients compared with healthy subjects (P<.001 for both). In addition, CRF patients with diabetes showed further reductions compared with patients without diabetes (15% reduction of BRS and 44% of BEI, P<.01 for both). The treatment modality for renal failure had no effect on BRS or BEI. In a multivariate linear regression analysis, age, body mass index, and systolic blood pressure were independent predictors of BRS, whereas age and diabetes were independent predictors of BEI in patients with CRF. CONCLUSIONS: We conclude that BEI, which is markedly reduced in hypertensive patients with CRF, may convey information on arterial baroreflex function that is complementary to BRS.
|
|
| 7. |
- Lewerin, Catharina, 1961, et al.
(författare)
-
Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly
- 2007
-
Ingår i: J Intern Med. - 0954-6820. ; 261:1, s. 65-73
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population. DESIGN AND SETTING: Population-based study of 209 community-dwelling subjects, mean age 76 years. INTERVENTIONS: Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo. MAIN OUTCOME MEASURES: Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex. RESULTS: Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%). CONCLUSIONS: The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented.
|
|
| 8. |
- Ljungman, Susanne, 1942, et al.
(författare)
-
Retraining for prevention of peritonitis in peritoneal dialysis patients: A randomized controlled trial
- 2020
-
Ingår i: Peritoneal Dialysis International. - : SAGE Publications. - 0896-8608 .- 1718-4304. ; 40:2, s. 141-152
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Peritonitis is more common in peritoneal dialysis (PD) patients nonadherent to the PD exchange protocol procedures than in compliant patients. We therefore investigated whether regular testing of PD knowledge with focus on infection prophylaxis could increase the time to first peritonitis (primary outcome) and reduce the peritonitis rate in new PD patients. Methods: This physician-initiated, open-label, parallel group trial took place at 57 centers in Sweden, Denmark, Norway, Finland, Estonia, Latvia, the Netherlands, and the United Kingdom from 2010 to 2015. New peritonitis-free PD patients were randomized using computer-generated numbers 1 month after the start of PD either to a control group (n = 331) treated according to center routines or to a retraining group (n = 340), which underwent testing of PD knowledge and skills at 1, 3, 6, 12, 18, 24, 30, and 36 months after PD start, followed by retraining if the goals were not achieved. Results: In all, 74% of the controls and 80% of the retraining patients discontinued the study. The groups did not differ significantly regarding cumulative incidence of first peritonitis adjusted for competing risks (kidney transplantation, transfer to hemodialysis and death; hazard ratio 0.84; 95% confidence interval (CI) 0.65-1.09) nor regarding peritonitis rate per patient year (relative risk 0.93; 95% CI 0.75-1.16). Conclusions: In this randomized controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of new PD patients increased the time to first peritonitis or reduced the rate of peritonitis, as the study comprised patients with a low risk of peritonitis, was underpowered, open to type 1 statistical error, and contamination between groups.
|
|
| 9. |
- Wallerstedt, Susanna Maria, 1970, et al.
(författare)
-
[Iron deficiency is a common cause of bad response to epoetin treatment. It's important to follow iron status--not only the Hb value]
- 2005
-
Ingår i: Lakartidningen. - 0023-7205. ; 102:37
-
Tidskriftsartikel (refereegranskat)abstract
- Anaemia in patients with chronic kidney disease can be treated with epoetin. An adequate iron status is necessary for an optimal epoetin treatment effect. Guidelines from the Swedish Association of Nephrology recommend that haemoglobin (Hb) and iron status should be investigated every 3 - 6 months. Recommended target values are 110-130 g/l (Hb), >20% (transferrin saturation) and >100 microg/l (S-ferritin). A cross-sectional study was performed in 173 pre-dialysis patients (GFR <20 ml/minx1.73 m2 BSA), 35% of whom received epoetin. In epoetin-treated patients, laboratory investigations as recommended in the guidelines were present for 100% (Hb), 67% (transferrin saturation) and 62% (S-ferritin) of the patients. In these patients, target values were reached for 57% (Hb), 66% (transferrin saturation) and 58% (S-ferritin). Forty percent of the epoetin-treated patients had absolute iron deficiency, 60% of whom received iron therapy. In conclusion, adherence to guidelines concerning epoetin and iron therapy in patients with chronic kidney disease could probably be improved.
|
|
