| 1. |
- Legrand, Helen, et al.
(författare)
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Prevalence and determinants of differences in cystatin C and creatinine-based estimated glomerular filtration rate in community-dwelling older adults : A cross-sectional study
- 2017
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Ingår i: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Differences in cystatin C and creatinine-based estimated glomerular filtration rate (EGFR) can lead to clinical uncertainty. Existing EGFR equations perform poorly in a subset of individuals. This study aims to describe the prevalence of differences between cystatin C-based (EGFRcys) and creatinine-based (EGFRcreat) EGFR in older adults and to explore which subsets of individuals may be most affected by differing estimations. Methods: In this cross-sectional study, participants from a cohort of community-dwelling older adults were examined at a baseline visit in 2001-2004 as part of the larger "Good Aging in Skåne" study. Exposure variables were obtained from questionnaires, interviews, examinations, and medical records. Blood samples were taken during the baseline visit, cryopreserved, and analyzed at a later time for biomarkers. The CKD-EPI equations were used to estimate GFR. Initial descriptive analyses were performed on 2931 individuals. A total of 2532 participants were included in the final multiple linear regression. Results: Nearly two-Thirds of participants had EGFR differences exceeding 10%, with nearly 20 % of participants having EGFR differences exceeding 30%. Smoking, age, body mass index (BMI), C-reactive protein (CRP), glucocorticoid use, and mean EGFR were correlated with differences between EGFRcreat and EGFRcys. Conclusions: Differences between EGFRcreat and EGFRcys are common and often of large magnitude in this community-dwelling population of older adults. The finding of multiple non-GFR determinants correlated to differences in GFR estimations can help direct future research to improve EGFR equations for subgroups prone to conflicting GFR estimations or to guide choice of biomarker for GFR estimation in these subgroups.
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| 2. |
- Lundin, Karin E, et al.
(författare)
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Susceptibility to infections, without concomitant hyper-IgE, reported in 1976, is caused by hypomorphic mutation in the phosphoglucomutase 3 (PGM3) gene
- 2015
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Ingår i: Clinical Immunology. - : Elsevier. - 1521-6616 .- 1521-7035. ; 161:2, s. 366-372
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Tidskriftsartikel (refereegranskat)abstract
- Phosphoglucomutase 3 (PGM3) is an enzyme converting N-acetyl-glucosamine-6-phosphate to N-acetylglucosamine-l-phosphate, a precursor important for glycosylation. Mutations in the PGM3 gene have recently been identified as the cause of novel primary immunodeficiency with a hyper-IgE like syndrome. Here we report the occurrence of a homozygous mutation in the PGM3 gene in a family with immunodeficient children, described already in 1976. DNA from two of the immunodeficient siblings was sequenced and shown to encode the same homozygous missense mutation, causing a destabilized protein with reduced enzymatic capacity. Affected individuals were highly prone to infections, but lack the developmental defects in the nervous and skeletal systems, reported in other families. Moreover, normal IgE levels were found. Thus, belonging to the expanding group of congenital glycosylation defects, PGM3 deficiency is characterized by immunodeficiency, with or without increased IgE levels, and with variable forms of developmental defects affecting other organ systems.
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| 3. |
- PICULELL, MARIA, et al.
(författare)
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Partial nitrification in MBBRs for mainstream deammonification with thin biofilms and alternating feed supply
- 2016
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Ingår i: Water Science and Technology. - : IWA Publishing. - 0273-1223 .- 1996-9732. ; 73:6, s. 1253-1260
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Tidskriftsartikel (refereegranskat)abstract
- A new principle for mainstream nitrogen removal through nitritation followed by anammox was studied in a two-stage moving bed biofilm reactor (MBBR) configuration. The first stage was optimized for nitritation by using thin biofilms and a feed alternating between synthetic mainstream wastewater at 15°C and, for shorter periods, synthetic reject water at 30 °C. The exposure of the biofilm to reject water conditions aimed to improve the growth conditions for ammonia oxidizing bacteria, while inhibiting nitrite oxidizing bacteria. The biofilm thickness was maintained below 200 μm to ensure high exposure of the total biomass to the bulk reactor conditions. Nitritation was successfully achieved in the configuration, with a nitrite accumulation ratio above 75% during the majority of the study, and ammonia removal rates between 0.25 and 0.50 g NH4-N/L,d. The anoxic second stage, optimized for anammox, was fed with the effluent from the nitritation reactor, reaching nitrogen removal rates above 0.20 g TN/L,d.
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| 4. |
- Piculell, Maria, et al.
(författare)
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The inhibitory effects of reject water on nitrifying populations grown at different biofilm thickness
- 2016
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Ingår i: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 104:1 Nov, s. 292-302
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Tidskriftsartikel (refereegranskat)abstract
- Suppression of nitrite oxidizing bacteria (NOB) is of vital importance to achieve successful, energy efficient, mainstream anammox processes for wastewater treatment. In this study, biofilm carriers from a fully nitrifying MBBR system, fed with mainstream wastewater, were temporarily exposed to reject water from sludge dewatering, to evaluate this as a possible strategy to inhibit NOB and achieve nitrite production under realistic conditions. Two different carrier types were compared, in which biofilm thickness was maintained at approximately 400 and 50 mm, respectively, and reject treatment was tested at different exposure time and loading rates. Reject exposure almost always resulted in an increased nitrite production in the thinner biofilm, and overall, nitrifiers growing in the thin biofilm were more sensitive than those grown in the thicker biofilm. The effect from reject exposure remained in the systems for four days after returning to mainstream operation, with nitrite production gradually increasing for three days. Increased concentrations of free ammonia correlated with reject exposure and may be the cause of inhibition, although other factors cannot be excluded.
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| 5. |
- Werner, Karin, et al.
(författare)
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Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin
- 2017
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Ingår i: Nephron. - : S. Karger AG. - 1660-8151 .- 2235-3186. ; 137, s. 29-37
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Tidskriftsartikel (refereegranskat)abstract
- Background: The glomerular filtration rate (GFR) is the most important measure of kidney function and chronic kidney disease (CKD). This study aims to validate commonly used equations for estimated GFR (eGFR) based on creatinine (cr), cystatin C (cys), β-trace protein (BTP), and β2-microglobulin (B2M) in older adults. Method: We conducted a validation study with 126 participants aged between 72 and 98 with a mean measured GFR (mGFR) by iohexol clearance of 54 mL/min/1.73 m2. The eGFR equations (CKD-Epidemiology collaboration [CKD-EPI], Berlin Initiative Study [BIS], Full Age Spectrum [FAS], Modification of Diet in Renal Disease [MDRD]cr, Caucasian-Asian-Pediatric-Adult [CAPA]cys, Lund-Malmö Revised [LM-REV]cr, and MEAN-LM-CAPAcr-cys), were assessed in terms of bias (median difference: eGFR-mGFR), precision (interquartile range of the differences), and accuracy (P30: percentage of estimates ±30% of mGFR). The equations were compared to a benchmark equation: CKD-EPIcr-cys. Results: All cystatin C-based equations underestimated the GFR compared to mGFR, whereas bias was mixed for the equations based only on creatinine. Accuracy was the highest for CKD-EPIcr-cys (98%) and lowest for MDRD (82%). Below mGFR 45 mL/min/1.73 m2 only equations incorporating cystatin C reached P30 accuracy >90%. CKD-EPIcr-cys was not significantly more accurate than the other cystatin C-based equations. In contrast, CKD-EPIcr-cys was significantly more accurate than all creatinine-based equations except LM-REVcr. Conclusion: This study confirms that it is reasonable to use equations incorporating cystatin C and creatinine in older patients across a wide spectrum of GFR. However, the results call into question the use of creatinine alone below mGFR 45 mL/min/1.73 m2. B2M and BTP do not demonstrate additional value in eGFR determination in older adults.
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| 6. |
- Werner, Karin, et al.
(författare)
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Cystatin C and creatinine-based eGFR levels and their correlation to long-term morbidity and mortality in older adults
- 2019
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Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 31:10, s. 1461-1469
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Tidskriftsartikel (refereegranskat)abstract
- Background: The prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality. Aims: This study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults. Methods: The 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60–89 mL/min/1.73 m2 as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m2 per year or more). Results: The mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34–1.88), 1.22 (1.05–1.41), 1 (reference), and 0.90 (0.67–1.21) for eGFR < 45, 45–59, 60–89 and ≥ 90 mL/min/1.73 m2, respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81–1.87), 1.21 (0.87–1.69), 1 (reference), and 0.53 (0.28–1.00) for the same eGFR levels. Conclusions: This study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today’s threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.
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