| 1. |
- Nilsson Sommar, Johan, et al.
(författare)
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End-stage renal disease and low level exposure to lead, cadmium and mercury; a population-based, prospective nested case-referent study in Sweden.
- 2013
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Ingår i: Environmental health : a global access science source. - : BioMed Central (BMC). - 1476-069X. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Background: Cadmium (Cd), lead (Pb), and mercury (Hg) cause toxicological renal effects, but the clinical relevance at low-level exposures in general populations is unclear. The objective of this study is to assess the risk of developing end-stage renal disease in relation to Cd, Pb, and Hg exposure. Methods: A total of 118 cases who later in life developed end-stage renal disease, and 378 matched (sex, age, area, and time of blood sampling) referents were identified among participants in two population-based prospective cohorts (130,000 individuals). Cd, Pb, and Hg concentrations were determined in prospectively collected samples. Results: Erythrocyte lead was associated with an increased risk of developing end-stage renal disease (mean in cases 76 μg/L; odds ratio (OR) 1.54 for an interquartile range increase, 95% confidence interval (CI) 1.18-2.00), while erythrocyte mercury was negatively associated (2.4 μg/L; OR 0.75 for an interquartile range increase, CI 0.56-0.99). For erythrocyte cadmium, the OR of developing end-stage renal disease was 1.15 for an interquartile range increase (CI 0.99-1.34; mean Ery-Cd among cases: 1.3 μg/L). The associations for erythrocyte lead and erythrocyte mercury, but not for erythrocyte cadmium, remained after adjusting for the other two metals, smoking, BMI, diabetes, and hypertension. Gender-specific analyses showed that men carried almost all of the erythrocyte lead and erythrocyte cadmium associated risks. Conclusions: Erythrocyte lead is associated with end-stage renal disease but further studies are needed to evaluate causality. Gender-specific analyses suggest potential differences in susceptibility or in exposure biomarker reliability.
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| 2. |
- Aiff, Harald, et al.
(författare)
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End-stage renal disease associated with prophylactic lithium treatment
- 2014
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Ingår i: European Neuropsychopharmacology. - : Elsevier BV. - 0924-977X .- 1873-7862. ; 24:4, s. 540-544
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of this study was to estimate the prevalence of lithium associated end-stage renal disease (ESRD) and to compare the relative risk of ESRD in lithium users versus non-lithium users. Second, the role of lithium in the pathogenesis of ESRD was evaluated. We used the Swedish Renal Registry to search for lithium-treated patients with ESRD among 2644 patients with chronic renal replacement therapy (RRT)-either dialysis or transplantation, within two defined geographical areas in Sweden with 2.8 million inhabitants. The prevalence date was December 31, 2010. We found 30 ESRD patients with a history of lithium treatment. ESRD with RRT was significantly more prevalent among lithium users than among non-lithium users (p<0.001). The prevalence of ESRD with RRT in the lithium user population was 15.0‰ (95% CI 9.7-20.3), and close to two percent of the RRT population were lithium users. The relative risk of ESRD with RRT in the lithium user population compared with the general population was 7.8 (95% CI 5.4-11.1). Out of those 30 patients, lithium use was classified, based on chart reviews, as being the sole (n=14) or main (n=10) cause of ESRD in 24 cases. Their mean age at the start of RRT was 66 years (46-82), their mean time on lithium 27 years (12-39), and 22 of them had been on lithium for 15 years or more. We conclude that lithium-associated ESRD is an uncommon but not rare complication of lithium treatment. © 2014.
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| 3. |
- Aiff, Harald, et al.
(författare)
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Reply to letter to the editor.
- 2014
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Ingår i: Journal of Psychopharmacology. - : SAGE Publications. - 1461-7285 .- 0269-8811. ; 28:12, s. 1190-1190
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Bendz, Hans, et al.
(författare)
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Renal failure occurs in chronic lithium treatment but is uncommon.
- 2010
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Ingår i: Kidney International. - : Elsevier BV. - 1523-1755 .- 0085-2538. ; 77, s. 219-224
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Tidskriftsartikel (refereegranskat)abstract
- We sought to establish the prevalence of lithium-induced end-stage renal disease in two regions of Sweden with 2.7 million inhabitants corresponding to about 30% of the Swedish population. Eighteen patients with lithium-induced end-stage renal disease were identified among the 3369 patients in the general lithium-treated population, representing a sixfold increase in prevalence compared with the general population for renal replacement therapy. All lithium-treated patients were older than 46 years at end-stage renal disease with a mean lithium treatment time of 23 years with ten patients having discontinued lithium treatment an average of 10 years before the start of renal replacement therapy. The prevalence of chronic kidney disease (defined as plasma creatinine over 150 mumol/l) in the general lithium-treated population was about 1.2% (excluding patients on renal replacement therapy). Compared with lithium-treated patients without renal failure, those with chronic kidney disease were older and most were men but, as groups, their mean serum lithium levels and psychiatric diagnoses did not differ. We found that end-stage renal disease is an uncommon but not rare consequence of long-term lithium treatment and is more prevalent than previously thought. Time on lithium was the only identified risk factor in this study, suggesting that regular monitoring of renal function in these patients is mandatory.Kidney International advance online publication, 25 November 2009; doi:10.1038/ki.2009.433.
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| 5. |
- Ciocanea-Teodorescu, Iuliana, et al.
(författare)
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Causal inference in survival analysis under deterministic missingness of confounders in register data
- 2023
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Ingår i: Statistics in Medicine. - : John Wiley & Sons. - 0277-6715 .- 1097-0258. ; 42:12, s. 1946-1964
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Tidskriftsartikel (refereegranskat)abstract
- Long-term register data offer unique opportunities to explore causal effects of treatments on time-to-event outcomes, in well-characterized populations with minimum loss of follow-up. However, the structure of the data may pose methodological challenges. Motivated by the Swedish Renal Registry and estimation of survival differences for renal replacement therapies, we focus on the particular case when an important confounder is not recorded in the early period of the register, so that the entry date to the register deterministically predicts confounder missingness. In addition, an evolving composition of the treatment arms populations, and suspected improved survival outcomes in later periods lead to informative administrative censoring, unless the entry date is appropriately accounted for. We investigate different consequences of these issues on causal effect estimation following multiple imputation of the missing covariate data. We analyse the performance of different combinations of imputation models and estimation methods for the population average survival. We further evaluate the sensitivity of our results to the nature of censoring and misspecification of fitted models. We find that an imputation model including the cumulative baseline hazard, event indicator, covariates and interactions between the cumulative baseline hazard and covariates, followed by regression standardization, leads to the best estimation results overall, in simulations. Standardization has two advantages over inverse probability of treatment weighting here: it can directly account for the informative censoring by including the entry date as a covariate in the outcome model, and allows for straightforward variance computation using readily available software.
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| 6. |
- Elinder, Carl-Gustaf, et al.
(författare)
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Variations in graft and patient survival after kidney transplantation in Sweden: caveats in interpretation of center effects when benchmarking.
- 2009
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Ingår i: Transplant international : official journal of the European Society for Organ Transplantation. - : Frontiers Media SA. - 1432-2277 .- 0934-0874. ; 22:11, s. 1051-7
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Tidskriftsartikel (refereegranskat)abstract
- Benchmarking and comparisons between transplantation centers are becoming more common. A crude comparison indicated a 50% difference in patient survival between centers in Sweden. A 'task group' was formed to refute or confirm and learn from this observation. Patient survival and graft survival of 5 933 patients transplanted at three different transplantation centers in Sweden (Stockholm, Göteborg, and Malmö) were followed up until February 2007. Patient survival and graft survival were compared between the centers with and without consideration being given to important covariates such as time period, type of donation (living or deceased donor), gender, and age. A refined cohort of 2,956 adult patients that had been transplanted for the first time between 1991 and 2007 was assessed in more detail using Cox regression analysis. The difference in patient and transplant outcome observed in the crude comparison diminished considerably after adjustment for differences in case mix and time period of transplantation, and was neither evident nor significant after 1999. Patient survival and graft survival have improved considerably during the time period since 1991. The adjusted hazards ratio for mortality was 0.39 (95% CI 0.29-0.53) for patients who were transplanted after 1999 when compared with those transplanted between 1991 and 1994. Crude comparisons between results from transplantation centers may be severely confounded not only by case mix but also by differences in the proportion of patients transplanted during different time periods. Patient outcome and graft outcome have improved considerably since 1991, and after 1999 center effects were no longer apparent in Sweden.
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| 7. |
- Fehrman-Ekholm, Ingela, 1947, et al.
(författare)
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Recovery of renal function after one-year of dialysis treatment: case report and registry data.
- 2010
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Ingår i: International journal of nephrology. - : Hindawi Limited. - 2090-2158. ; 2010
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Uncertainty has arisen as to whether renal function can be recovered from after long-term regular dialysis treatment. We therefore conducted an analysis and scrutinized one patient report. Material and Methods. Swedish registry of patients with kidney disease and one patient case. Results. 39 patients (0.2%) from the Swedish registry comprising 17590 patients who commenced RRT (renal replacement therapy) between 1991 and 2008 had recovered from renal function after more than 365 days of regular dialysis treatment. The most common diagnosis was renovascular disease with hypertension but a large group had uremia of unknown cause. HUS, cortical/tubular necrosis, and autoimmune diseases were also found. The mean treatment time before withdrawal was 2 years. Conclusions. A small number of patients recover after a long period of regular dialysis treatment. One could discuss whether it is difficult to identify patients who have recovered while undergoing regular dialysis treatment. Regular monitoring of renal function may be important.
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| 8. |
- Glenngard, Anna, et al.
(författare)
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Cost-effectiveness analysis of treatment with epoietin-alpha for patients with anaemia due to renal failure: The case of Sweden.
- 2007
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Ingår i: Scandinavian Journal of Urology and Nephrology. - 0036-5599. ; :Sep 28, s. 66-73
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Tidskriftsartikel (refereegranskat)abstract
- Abstract OBJECTIVE: Anaemia is a common complication of renal failure. It can be treated with erythropoietin (EPO) administration, red blood cell transfusion (RBCT), or a combination of both. EPO has been registered for the treatment of renal anaemia in Sweden since the beginning of the 1990s, and is the primary treatment regimen for anaemia related to renal failure. The objective of this study was to carry out a cost-effectiveness analysis from a provider perspective of a treatment strategy comprising EPO and complementary RBCT compared to the traditional treatment of RBCT alone for patients with anaemia associated with renal failure in Sweden. MATERIAL AND METHODS: Incremental costs and quality-adjusted life-years (QALYs) associated with EPO (epoietin-alpha) treatment compared to the traditional therapy of RBCT were estimated. The QALY gains were estimated using a modified version of a Markov model, which is used by the UK National Institute of Clinical Excellence in their evaluations of EPO treatment in the UK. Swedish treatment practice (i.e. EPO doses and iron supplementation), patient characteristics and unit costs were used throughout the study. RESULTS: The estimated cost per QALY gained from administration of EPO to renal patients falls within the range acceptable in Sweden for both haemodialysis and peritoneal dialysis patients. CONCLUSIONS: EPO administration to renal patients is much more costly in Sweden than in the UK, primarily due to the higher dosage of EPO and iron supplementation used in Sweden. However, Swedish patients reach higher haemoglobin levels, and thereby achieve higher QALY gains, compared to patients in the UK.
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| 9. |
- Golic, Mihaela, et al.
(författare)
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Lifetime risk of severe kidney disease in lithium-treated patients: a retrospective study
- 2023
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Ingår i: International Journal of Bipolar Disorders. - 2194-7511. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lithium is an essential psychopharmaceutical, yet side effects and concerns about severe renal function impairment limit its usage. Aims: Our objectives were to quantify the occurrence of chronic kidney disease stage 4 or higher (CKD4 +) within a lithium-treated population, using age- and time-specific cumulative incidence and age-specific lifetime risk as measures of disease occurrence. Additionally, we aimed to investigate the association between the duration of lithium treatment and the risk of CKD4 +. Methods: We identified patients from the Sahlgrenska University Hospital’s laboratory database. We conducted a retrospective cohort study employing cumulative incidence functions that account for competing deaths to estimate cumulative and lifetime risk of CKD4 +. A subdistribution hazards model was employed to explore baseline covariates. For measuring the association between the duration of lithium treatment and CKD4 + occurrence, we used a matched 1:4 case–control study design and logistic regression. Results: Considering a 90-year lifetime horizon, the lifetime risk of CKD4 + for patients initiating lithium treatment between ages 55 and 74 ranged from 13.9% to 18.6%. In contrast, the oldest patient group, those starting lithium at 75 years or older, had a lower lifetime risk of 5.4%. The 10-year cumulative risk for patients starting lithium between ages 18 and 54 was minimal, ranging from 0% to 0.7%. Pre-treatment creatinine level was a predictive factor, with a hazard ratio of 4.6 (95% CI 2.75–7.68) for values within the upper third of the reference range compared to the lower third. Moreover, twenty or more years of lithium exposure showed a strong association with an increased risk of CKD4 + compared to 1–5 years of lithium use, with an odds ratio of 6.14 (95% CI 2.65–14.26). Conclusions: The risk of CKD4 + among lithium-treated patients exhibited significant age-related differences. Patients under 55 years old had negligible 10-year risk, while the lifetime risk for those aged 75 and older was limited. Duration of lithium treatment, especially exceeding 20 years, emerged as a significant risk factor. For individual risk assessment and prediction, consideration of age, pre-treatment creatinine levels, and the chosen time horizon for prediction is essential.
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| 10. |
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| 11. |
- Olarte Parra, Camila, et al.
(författare)
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Trial emulation and survival analysis for disease incidence registers : A case study on the causal effect of pre-emptive kidney transplantation
- 2022
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Ingår i: Statistics in Medicine. - : John Wiley & Sons. - 0277-6715 .- 1097-0258. ; 41:21, s. 4176-4199
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Tidskriftsartikel (refereegranskat)abstract
- When drawing causal inference from observed data, failure time outcomes present additional challenges of censoring often combined with other missing data patterns. In this article, we follow incident cases of end-stage renal disease to examine the effect on all-cause mortality of starting treatment with transplant, so-called pre-emptive kidney transplantation, vs starting with dialysis possibly followed by delayed transplantation. The question is relatively simple: which start-off treatment is expected to bring the best survival for a target population? To address it, we emulate a target trial drawing on the long term Swedish Renal Registry, where a growing common set of baseline covariates was measured nationwide. Several lessons are learned which pertain to long term disease registers more generally. With characteristics of cases and versions of treatment evolving over time, informative censoring is already introduced in unadjusted Kaplan-Meier curves. This leads to misrepresented survival chances in observed treatment groups. The resulting biased treatment association may be aggravated upon implementing IPW for treatment. Aware of additional challenges, we further recall how similar studies to date have selected patients into treatment groups based on events occurring post treatment initiation. Our study reveals the dramatic impact of resulting immortal time bias combined with other typical features of long-term incident disease registers, including missing covariates during the early phases of the register. We discuss feasible ways of accommodating these features when targeting relevant estimands, and demonstrate how more than one causal question can be answered relying on the no unmeasured baseline confounders assumption.
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| 12. |
- Szummer, Karolina, et al.
(författare)
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Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome : data from the SWEDEHEART register
- 2010
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 268:1, s. 40-49
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Tidskriftsartikel (refereegranskat)abstract
- Abstract. Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, Wallentin L, Jernberg T, for SWEDEHEART. (Karolinska Institute, Karolinska University Hospital, Stockholm; Karolinska Institute, Danderyd Hospital, Danderyd; Ryhov County Hospital, Jönköping; University Hospital, Uppsala and University Hospital, Linköping; Sweden) Relation between renal function, presentation, use of therapies and in-hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med 2009; doi: 10.1111/j.1365-2796.2009.02204.x. Objective. To examine clinical characteristics, presenting symptoms, use of therapy and in-hospital complications in relation to renal function in patients with myocardial infarction (MI). Design. Observational study. Setting. Nationwide coronary care unit registry between 2003-2006 in Sweden. Subjects. Consecutive MI patients with available creatinine (n = 57 477). Results. Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co-morbidities and more often used cardio-protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST-elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non-ST-elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal-to-moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in-hospital mortality from 2.5% to 24.2% across the renal function groups. Conclusion. Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short-term prognosis remains poor.
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| 13. |
- Toppe, Cecilia, et al.
(författare)
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Decreasing cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden : A 38-year prospective nationwide study
- 2019
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 42:1, s. 27-31
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Diabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden. RESEARCH DESIGN AND METHODS In this study, patients with duration of type 1 diabetes >14 years and age at onset of diabetes 0–34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Sweden, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD. RESULTS We found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabetes onset in 1991–2001 compared with onset in 1977–1984 and 1985–1990, independent of diabetes duration. CONCLUSIONS The risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time.
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| 14. |
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| 15. |
- Toppe, Cecilia, et al.
(författare)
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Low cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden : a population based study
- 2015
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Ingår i: Diabetologia. - : Springer. - 0012-186X .- 1432-0428. ; 58:Suppl. 1 Abstr. 402, s. S201-S202
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: A previous study from our group showed a low cumulative incidence of end-stage renal disease (ESRD) in a Swedish cohort of type 1 diabetes (T1D) patients with median duration of 20 years. We speculated that a good diabetes health care system might have postponed the peak incidence of ESRD and that young age at onset of T1D can postpone the development of diabetic nephropathy (DN) and ESRD. Moreover, diabetes onset during puberty may promote the development of diabetic complications. Our previous study also indicated differences by sex in ESRD development and a possible interaction with age at onset. Female patients who developed T1D after puberty had similar risk of ESRD as those with onset before 10 years of age. Male patients had the same high risk with onset during puberty and after puberty, those with onset before 10 years had the lowest risk. The aims of the present study are to assess the cumulative incidence of ESRD due to DN in a large prospective population-based cohort of T1D patients at maximum 36 years of diabetes duration and to study the effects of sex and age at onset of T1D.Materials andmethods: Since 1977 all incident cases of T1D in the ages 0-14 years are recorded in the Swedish Childhood Diabetes Register (SCDR). The Swedish Renal Registry (SRR) started in 1991 and collects data on all patients with active uraemia treatment, ESRD. We decided to include patients with diabetes duration ≥14 years. In total 9381 patients from the SCDR were included. We have recently received permission to include data from the Swedish National Diabetes Register, a national quality register, and are awaiting data to include patients with age at onset 15-34 years.Results: For the childhood onset cases the median diabetes duration was 23.8 years, maximum 36.7 years, and 154 patients had developed ESRD due to diabetes. The cumulative incidence was 4.5%. There was no statistical difference between male and female patients with age at diabetes onset before 15 years of age, males 5.0%, females 3.8%.We confirm that onset of diabetes before 10 years of age postpones the development of ESRD when compared to onset during 10-14 years, HR 2.3 (95% CI= 1.7-3.3). Further analyses will be available for presentation in September.Conclusion: The cumulative risk of ESRD due to diabetic nephropathy in Swedish T1D patients at maximum36 years of diabetes duration is still exceptionally low. There is no difference in the development of ESRD between male and female patients with onset of diabetes before 15 years of age.
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| 16. |
- Toppe, Cecilia, et al.
(författare)
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Renal replacement therapy due to type 1 diabetes; time trends during 1995-2010 : a Swedish population based register study
- 2014
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Ingår i: Journal of diabetes and its complications. - : Elsevier BV. - 1056-8727 .- 1873-460X. ; 28:2, s. 152-155
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Tidskriftsartikel (refereegranskat)abstract
- Background: End stage renal disease (ESRD), is the most severe complication of diabetes mellitus. This population-based study analysed time trends for start of renal replacement therapy (RRT) due to type 1 diabetes compared to type 2 diabetes and other diagnoses. Material and Methods: We used data on patients who were registered 1995-2010 in the Swedish Renal Registry, a nationwide register covering 95 % of all patients with uraemia. The patients were analysed according to their original kidney disease. The incidence was analysed by calendar year, age at start of RRT and gender. Results: Of 17389 patients who were registered, 1833 had type 1 diabetes; 65% were men. The mean age at onset of RRT for patients with type 1 diabetes was 52.8 years which increased by more than 3 years over the studied period. The number of patients in need of RRT due to type 1 diabetes decreased, while RRT due to type 2 diabetes increased during the period studied. Conclusions: The overall incidence of RRT in Sweden is rather constant over the years but the need for RRT in type 1 diabetes patients decreased and patients with type 1 diabetes tend to become older at onset of RRT.
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