| 1. |
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| 2. |
- Forsberg, Ulf, et al.
(author)
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A high blood level in the air trap reduces microemboli during hemodialysis
- 2012
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In: Artificial Organs. - : Wiley. - 0160-564X .- 1525-1594. ; 36:6, s. 525-529
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Journal article (peer-reviewed)abstract
- Previous studies have demonstrated the presence of air microemboli in the dialysis circuit and in the venous circulation of the patients during hemodialysis. In vitro studies indicate that a high blood level in the venous air trap reduces the extent of microbubble formation. The purpose of this study was to examine whether air microbubbles can be detected in the patient's access and if so, whether the degree of microbubble formation can be altered by changing the blood level in the venous air trap. This was a randomized, double-blinded, interventional study of 20 chronic hemodialysis patients. The patients were assigned to hemodialysis with either an elevated or a low blood level in the air trap. The investigator and the patient were blinded to the settings. The numbers of microbubbles were measured at the site of the arteriovenous (AV) access for 2 min with the aid of an ultrasonic Doppler device. The blood level in the air trap was then altered to the opposite setting and a new measurement was carried out after an equilibration period of 30 min. Median (range) for the number of microbubbles measured with the high air trap level and the low air trap level in AV access was 2.5 (0-80) compared with 17.5 (0-77), respectively (P = 0.044). The degree of microbubble formation in hemodialysis patients with AV access was reduced significantly if the blood level in the air trap was kept high. The exposure of potentially harmful air microbubbles was thereby significantly reduced. This measure can be performed with no additional healthcare cost.
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| 3. |
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| 4. |
- Graaff, Reindert, et al.
(author)
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Skin and Plasma Autofluorescence During Hemodialysis : A Pilot Study
- 2014
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In: Artificial Organs. - : Wiley. - 0160-564X .- 1525-1594. ; 38:6, s. 515-518
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Journal article (peer-reviewed)abstract
- Skin autofluorescence (AF) is related to the accumulation of advanced glycation end products (AGEs) and is one of the strongest prognostic markers of mortality in hemodialysis (HD) patients. The aim of this pilot study was to investigate whether changes in skin AF appear after a single HD session and if they might be related to changes in plasma AF. Skin and plasma AF were measured before and after HD in 35 patients on maintenance HD therapy (nine women and 26 men, median age 68 years, range 33-83). Median dialysis time was 4h (range 3-5.5). Skin AF was measured noninvasively with an AGE Reader, and plasma AF was measured before and after HD at 460nm after excitation at 370nm. The HD patients had on average a 65% higher skin AF value than age-matched healthy persons (P<0.001). Plasma AF was reduced by 14% (P<0.001), whereas skin AF was not changed after a single HD treatment. No significant influence of the reduced plasma AF on skin AF levels was found. This suggests that the measurement of skin AF can be performed during the whole dialysis period and is not directly influenced by the changes in plasma AF during HD.
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| 5. |
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| 6. |
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| 7. |
- Jonsson, Per, et al.
(author)
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Venous chambers in clinical use for hemodialysis have limited capacity to eliminate microbubbles from entering the return bloodline : an in vitro study
- 2023
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In: Artificial Organs. - : John Wiley & Sons. - 0160-564X .- 1525-1594. ; 47:6, s. 961-970
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Journal article (peer-reviewed)abstract
- Background: During hemodialysis (HD), blood passes through an extracorporeal circuit (ECC). To prevent air administration to the patient, a venous chamber (chamber) is located before the blood return. Microbubbles (MBs) may pass through the chamber and end up as microemboli in organs such as the brain and heart. This in vitro study investigated the efficacy of various chambers in MB removal.Materials and Methods: The in vitro recirculated setting of an ECC included an FX10 dialyzer, a dextran-albumin solution to mimic blood viscosity and chambers with different flow characteristics in clinical use (Baxter: AK98 and Artis, Fresenius: 5008 and 6008) and preclinical test (Embody: Emboless®). A Gampt BCC200 device measured the presence and size of MBs (20–500 μm). Percentage change of MBs was calculated: ΔMB% = 100*(outlet–inlet)/inlet for each size of MB. Blood pump speed (Qb) was 200 (Qb200) or 300 (Qb300) ml/minute. Wilcoxon paired test determined differences.Results: With Qb200 median ΔMB% reduction was: Emboless −58%, AK98 −24%, Fresenius 5008 −23%, Artis −8%, and Fresenius 6008 ± 0%. With Qb300 ΔMB% was: Emboless −36%, AK98 ± 0%, Fresenius 5008 ± 0%, Artis +25%, and Fresenius 6008 + 21%. The Emboless was superior to all other chambers with Qb200 and Qb300 (p < 0.001). Further, the Emboless with Qb300 still eliminated more MBs than all other chambers with Qb200 (p ≤ 0.003).Conclusion: The results from the present study indicate that flow characteristics of the chamber and the Qb are important factors to limiting exposure of MB to the return bloodline. The Emboless chamber reduced MBs more effective than those chambers in clinical use investigated.
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| 8. |
- Mörtzell Henriksson, Monica, et al.
(author)
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Adverse events in apheresis : an update of the WAA registry data
- 2016
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In: Transfusion and apheresis science. - : Elsevier. - 1473-0502 .- 1878-1683. ; 54:1, s. 2-15
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Research review (peer-reviewed)abstract
- Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.
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| 9. |
- Ramsauer, Bernd, et al.
(author)
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Comparing changes in plasma and skin autofluorescence in low-flux versus high-flux hemodialysis
- 2015
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In: International Journal of Artificial Organs. - : SAGE Publications. - 0391-3988 .- 1724-6040. ; 38:9, s. 488-493
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Journal article (peer-reviewed)abstract
- Background: Tissue advanced glycation end products (AGE) are increased in hemodialysis (HD) patients, especially those with cardiovascular complications. Skin autofluorescence (skin-AF) can noninvasively estimate the accumulation of AGE in tissue. The aim was to clarify whether HD using a high-flux (HF) dialyzer favors plasma-or skin-AF removal compared to low-flux (LF) dialysis. Material and methods: 28 patients were treated with either an HF-HD or LF-HD but otherwise unchanged conditions in a cross-over design. A glucose containing dialysate was used. Skin-AF was measured noninvasively with an AGE reader before and after HD. Fluorescence (370 nm/465 nm) of plasma (p-AF) was determined as total and nonprotein-bound fractions. Correction for hemoconcentrations were made using the change in serum albumin. Paired and nonpaired statistical analyses were used. Results: Skin-AF was unchanged after LF- and HF-dialysis. Total, free, and protein-bound p-AF was reduced after a single LF-HD by 21%, 28%, and 17%, respectively (P<.001). After HF HD total and free p-AF was reduced by 5% and 15%, respectively (P<.001), while protein bound values were unchanged. The LF-HD resulted in a more pronounced reduction of p-AF than did HF HD (P<.001). Serum albumin correlated inversely with p-AF in HF-HD. Conclusions: In the dialysis settings used there was no significant change in skin AF after dialysis, with LF or with HF dialysis. Although only limited reduction in plasma fluorescence was observed, this was more pronounced when performing LF dialysis. These data are not in overwhelming support of the use of HF dialysis in the setting used in this study.
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| 10. |
- Ramsauer, Bernd, 1954-
(author)
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Glucose degradation products in patients on hemodialysis : interventional studies
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Hemodialysis (HD) is the most frequently used treatment for end-stage renal disease. Despite all efforts to improve the outcomes, the mortality of patients on HD is still high, and this especially is related to cardiovascular diseases (CVD). Glucose degradation products accumulate in plasma and tissue as a result of oxidative stress in these patients. Such accumulation is strongly related to the risk of developing CVD. Tissue deposits of advanced glycation end products (AGE) can be easily assessed by a skin autofluorescence (SAF) technique. SAF is one of the strongest prognostic markers of mortality in HD patients. The aim of this thesis is to examine whether intervention on HD treatment can reduce the load of AGE of these patients.The aim of the first study was to investigate whether changes in SAF appear after a single HD session and if they might be related to changes in plasma AF. Skin and plasma AF (PAF) were measured before and after HD in 35 patients on maintenance HD therapy. Median dialysis time was 4 h (range 3-5.5). SAF was measured noninvasively with an AGE Reader, and plasma AF was measured before and after HD. The HD patients had on average a 65% higher SAF value than age-matched healthy persons (P < 0.001). PAF was reduced by 14% (P < 0.001), whereas SAF was not changed after a single HD treatment. No significant influence of the reduced PAF on SAF levels was found. This suggests that the measurement of SAF can be performed during the whole dialysis period and is not directly influenced by the changes in plasma AF during HD.In study 2 different dialysis filters were compared to clarify whether using a high-flux (HF) dialyzer favors plasma or SAF removal compared to low-flux (LF) dialyzer. Twenty-eight patients were treated with either an HF-HD or LF-HD but otherwise unchanged conditions in a cross-over design. SAF was measured non-invasively with an AGE reader before and after HD. PAF was determined as total and non-protein-bound fractions. Corrections for hemoconcentrations by volume changes were made using the change in serum albumin. Paired and non-paired statistical analyses were used. The different treatments did not change SAF after LF- and HF-dialysis. Total, free, and protein-bound PAF were reduced after a single LF-HD by 21%, 28%, and 17%, respectively (P<.001). After HF-HD total and free PAF was reduced by 5% and 15%, respectively (P<.001), while protein-bound values were unchanged. The LF-HD resulted in a more pronounced reduction of PAF than did HF-HD (P<.001). Serum albumin correlated inversely with PAF in HF-HD. There was no significant change in SAF after dialysis, either with LF or with HF dialysis. Although only limited reductions in PAF were observed, these were more pronounced when performing LF dialysis. These data are not in overwhelming support of the use of HF dialysis in the setting used in this study.In the third study the effect on SAF was investigated using either glucose-containing or glucose-free dialysate. SAF and PAF were measured in patients on HD during standard treatment with a glucose-containing dialysate (n=24). After that, the patients were switched to a glucose-free dialysate for a 2 week period, and new measurements were performed on PAF and SAF.There was an increase of pre-dialysis SAF measured at the beginning of the study compared with the values one month later (as in study 4). By comparing pre- and post-dialysis values there was a significant decrease of SAF only when using glucose-free dialysate. Free PAF decreased independently whether glucose-containing or glucose-free dialysate was used. The important finding was that increase in SAF seemed possible to slow down using glucose-free dialysate.Study 4 was performed to investigate whether there are seasonal variations in SAF on a HD population. SAF was measured non-invasively with an AGE Reader in patients on HD at different seasonal periods during one year such as February-May (N=31), May–August (N=28), August–March (N=25). SAF was measured before HD. Paired statistical analyses were performed between each two periods. Unexpectedly there was at a median 6% increase in SAF during the winter (p=0.004) and a 11% decrease from 4.0 to 3.5 arbitrary units of the SAF during the summer (p<0.001). The study concluded that SAF shows seasonal variation. The cause of these changes could not be clarified. A beneficial effect may be due to extended exposure to sunlight during the summer and/or to different dietary intakes during the seasons.In conclusion, these interventional studies confirmed that PAF is lowered by dialysis. SAF was only decreased by HD when using glucose-free dialysate. SAF was not influenced by a single HD, with glucose-containing dialysate, independent of using HF or LF filters. These data favor glucose-free dialysate as a possible measure to slow down the progress of tissue AGE compared to glucose-containing dialysate. Longitudinal studies will help to clarify this issue further.
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| 11. |
- Ramsauer, Bernd, et al.
(author)
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Skin- and Plasmaautofluorescence in hemodialysis with glucose-free or glucose-containing dialysate
- 2017
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In: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 18
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Journal article (peer-reviewed)abstract
- Background: Haemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD). Skinautofluorescence (SAF) is a strong marker for CVD. SAF indirectly measures tissue advanced glycation end products(AGE) being cumulative metabolites of oxidative stress and cytokine-driven inflammatory reactions. The dialysatesoften contain glucose.Methods: Autofluorescence of skin and plasma (PAF) were measured in patients on HD during standard treatment(ST) with a glucose-containing dialysate (n = 24). After that the patients were switched to a glucose-free dialysate(GFD) for a 2-week period. New measurements were performed on PAF and SAF after 1 week (M1) and 2 weeks(M2) using GFD. Nonparametric paired statistical analyses were performed between each two periods.Results: SAF after HD increased non-significantly by 1.2% while when a GFD was used during HD at M1, a decreaseof SAF by 5.2% (p = 0.002) was found. One week later (M2) the reduction of 1.6% after the HD was not significant(p = 0.33). PAF was significantly reduced during all HD sessions. Free and protein-bound PAF decreased similarlywhether glucose containing or GFD was used. The HD resulted in a reduction of the total PAF of approximately15%, the free compound of 20% and the protein bound of 10%. The protein bound part of PAF correspondedto approximately 56% of the total reduction. The protein bound concentrations after each HD showed thelowest value after 2 weeks using glucose-free dialysate (p < 0.05). The change in SAF could not be related to achange in PAF.Conclusions: When changing to a GFD, SAF was reduced by HD indicating that such measure may hamperthe accumulation and progression of deposits of AGEs to protein in tissue, and thereby also the developmentof CVD. Glucose-free dialysate needs further attention. Protein binding seems firm but not irreversible.
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| 12. |
- Ramsauer, Bernd, 1954-, et al.
(author)
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Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Decreases During the Summer in Dialysis Patients
- 2019
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In: Artificial Organs. - : Wiley Periodicals, Inc.. - 0160-564X .- 1525-1594. ; 43:2, s. 173-180
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Journal article (peer-reviewed)abstract
- Tissue advanced glycation end products (AGEs) are a measure of cumulative metabolic and oxidative stress and cytokine-driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis (HD) patients. Skin autofluorescence (SAF) is related to the tissue accumulation of AGEs and rises with age. SAF is one of the strongest prognostic markers of mortality in these patients. The content of AGEs is high in barbecue food. Due to the location in northern Sweden, there is a short intense barbecue season between June and August. The aim of this study was to investigate if seasonal variations in SAF exist in HD patients, especially during the barbecue season. SAF was measured noninvasively with an AGE Reader in 34 HD-patients (15 of those with diabetes mellitus, DM). Each time the median of three measures were used. Skin-AF was measured before and after each one HD at the end of February and May in 31 patients (22 men/9 women); the end of May and August in 28 (20 m/8 w); the end of August and March in 25 (19 m/6 w). Paired statistical analyses were performed during all four periods (n = 23, 17 m/6 w); as was HbA1c of those with DM. There was at a median 5.6% increase in skin-AF during the winter period (February-May, P = 0.004) and a 10.6% decrease in the skin-AF during the summer (May-August, P < 0.001). HbA1c in the DM rose during the summer (P = 0.013). In conclusion, skin-AF decreased significantly during the summer. Future studies should look for favorable factors that prevent skin-AF and subsequently cardiovascular diseases.
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| 13. |
- Ramsauer, Bernd, et al.
(author)
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Skin Autofluorescence, a Measure of Cumulative Metabolic stress and Advanced Glycation End Products, shows seasonal variations in dialysis patients
-
Other publication (other academic/artistic)abstract
- AbstractTissue advanced glycation end products (AGE) are a measure of cumulative metabolic and oxidative stress and cytokine driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis patients. Skin autofluorescence (AF) is related to the tissue accumulation of AGE, and is one of the strongest prognostic markers on mortality in these patients. The content of AGE is high in barbecue food. Since the barbecue season in northern Sweden is between June and August a longitudinal study was performed to investigate whether there are seasonal variations in skin-AF on a hemodialysis (HD) in this population. Skin-AF was measured non-invasively with an AGE Reader (Diagnoptics Technologies BV, Groningen, The Netherlands) in patients on HD at different seasonal periods during one year such as February-May (N=29, 21 men/8 women), May – August (N=26, 19 m/7 w), August – March (N=24, 18 m/6 w). Skin-AF was measured before and after dialyses. Paired statistical analyses were performed between each two periods. A second analysis was performed including only the patients with measurements at all 4 points of time (n=23, 17m/6w).There was at a median 5.6% increase in skin-AF during the winter period (p=0.004) and a 10.6% decrease of the skin-AF during the summer (p<0.001). The study concluded that skin-AF shows seasonal variation. The cause of these changes could not be clarified. A beneficial effect may be due to extended exposure to sunlight during the summer and/or to different dietary intake during the seasons.
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| 14. |
- Stegmayr, Bernd, et al.
(author)
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Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry
- 2017
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In: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 56:1, s. 71-74
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Journal article (peer-reviewed)abstract
- The WAA apheresis registry was established in 2003 and an increasing number of centers have since then included their experience and data of their procedures. The registry now contains data of more than 74,000 apheresis procedures in more than 10,000 patients. This report shows that the indications for apheresis procedures are changing towards more oncological diagnoses and stem cell collections from patients and donors and less therapeutic apheresis procedures. In centers that continue to register, the total extent of apheresis procedures and patients treated have expanded during the latest years.
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| 15. |
- Stegmayr, Bernd G, et al.
(author)
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Panorama of adverse events during cytapheresis
- 2013
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In: Transfusion and apheresis science. - : Pergamon Press. - 1473-0502 .- 1878-1683. ; 48:2, s. 155-156
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Journal article (other academic/artistic)
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| 16. |
- Stegmayr, Bernd, et al.
(author)
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Microbubbles of air may occur in the organs of hemodialysis patients
- 2012
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In: ASAIO journal (1992). - 1058-2916 .- 1538-943X. ; 58:2, s. 177-179
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Journal article (peer-reviewed)abstract
- During hemodialysis (HD), blood that passes the dialysis device gets loaded with microbubbles (MB) of air that are returned to the patient without inducing an alarm. The aim with this study was to clarify if these signals are due to microembolies of air, clots, or artifacts, by histopathology of autopsy material of HD patients. These first results are from a patient on chronic HD. Due to pulmonary edema he was ultrafiltered. Within 30 minutes after the start, he suffered from a cardiac arrest and died. Autopsy verified the clinical findings. Microscopic investigation verified microembolies of air that were surrounded by fibrin in the lungs, brain, and heart. The study verified that MBs can enter the blood during HD and are trapped in the lungs. In addition, MBs pass the pulmonary capillaries and enter the arterial part of the body and are dispersed throughout the body. This can contribute to organ damage and be part of the poor prognoses seen in HD patients. Data support the importance to reduce MBs in the dialysis circuit.
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| 17. |
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| 18. |
- Stegmayr, Christoffer, et al.
(author)
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Hemodialysis dialyzers contribute to contamination of air microemboli that bypass the alarm system in the air trap.
- 2008
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In: International Journal of Artificial Organs. - 0391-3988 .- 1724-6040. ; 31:4, s. 317-22
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Journal article (peer-reviewed)abstract
- BACKGROUND: Previous studies have shown that micrometer-sized air bubbles are introduced into the patient during hemodialysis. The aim of this study was to investigate, in vitro, the influence of dialysis filters on the generation of air bubbles. METHODS: Three different kind of dialyzers were tested: one high-flux FX80 dry filter (Fresenius Medical Care AG&Co. KGaA, Bad Homburg, Germany), one low-flux F8HPS dry filter (Fresenius Medical Care AG&Co. KGaA, Bad Homburg, Germany) and a wet-stored APS-18u filter (Asahi Kasei Medical, Tokyo, Japan). The F8HPS was tested with pump flow ranging between 100 to 400 ml/min. The three filters were compared using a constant pump flow of 300 ml/min. Measurements were performed using an ultrasound Doppler instrument. RESULTS: In 90% of the series, bubbles were measured after the outlet line of the air trap without triggering an alarm. There were significantly more bubbles downstream than upstream of the filters F8HPS and FX80, while there was a significant reduction using the APS-18u. There was no reduction in the number of bubbles after passage through the air trap versus before the air trap (after the dialyzer). Increased priming volume reduced the extent of bubbles in the system. CONCLUSIONS: Data indicate that the air trap does not prevent air microemboli from entering the venous outlet part of the dialysis tubing (entry to the patient). More extended priming of the dialysis circuit may reduce the extent of microemboli that originate from dialysis filters. A wet filter may be favorable instead of dry-steam sterilized filters.
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| 19. |
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| 20. |
- Ulf, Forsberg, et al.
(author)
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A high blood level in the venous chamber and a wet-stored dialyzer help to reduce exposure for microemboli during hemodialysis
- 2013
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In: Hemodialysis International. - : Wiley. - 1492-7535 .- 1542-4758. ; 17:4, s. 612-617
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Journal article (peer-reviewed)abstract
- During hemodialysis (HD), microemboli develop in the blood circuit of the apparatus. These microemboli can pass through the venous chamber and enter into the patient's circulation. The aim of this study was to investigate whether it is possible to reduce the risk for exposure of microemboli by altering of the treatment mode. Twenty patients on chronic HD were randomized to a prospective cross-over study of three modes of HD: (a) a dry-stored dialyzer (F8HPS, Fresenius, steam sterilized) with a low blood level in the venous chamber (DL), (b) the same dialyzer as above, but with a high level in the venous chamber (DH), and (c) a wet-stored dialyzer (Rexeed, Asahi Kasei Medical, gamma sterilized) with a high blood level (WH). Microemboli measurements were obtained in a continuous fashion during 180 minutes of HD for all settings. A greater number of microemboli were detected during dialysis with the setting DL vs. WH (odds ratio [OR] 4.07, 95% confidence interval [CI] 4.03-4.11, P<0.0001) and DH vs. WH (OR 1.18, 95% CI 1.17-1.19, P<0.0001) and less for DH vs. DL (OR 0.290, 95% CI 0.288-0.2930.288-0.293, P<0.0001). These data indicate that emboli exposure was least when using WH, greater with DH, and most with DL. This study shows that using a high blood level in the venous chamber and wet-stored dialyzers may reduce the number of microemboli.CallSend SMSAdd to SkypeYou'll need Skype CreditFree via Skype
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| 21. |
- Andersson, Christer, 1945-, et al.
(author)
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Renal symtomatology in patients with acute intermitent porphyria
- 2000
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In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 248, s. 319-325
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Journal article (peer-reviewed)abstract
- Objective: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?Design: A population-based study.Subjects: Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.Interventions: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.Results: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.Conclusion: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.
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| 22. |
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| 23. |
- Arsov, Stefan, et al.
(author)
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Advanced glycation end-products and skin autofluorescence in end-stage renal disease : a review
- 2014
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In: Clinical Chemistry and Laboratory Medicine. - : Walter de Gruyter. - 1434-6621 .- 1437-4331. ; 52:1, SI, s. 11-20
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Research review (peer-reviewed)abstract
- Chronic kidney disease (CKD), especially in its end stage, is marked by extremely high cardiovascular rates of morbidity and mortality; hemodialysis patients have a five-fold shorter life expectancy than healthy subjects of the same age. In CKD the metabolic products that accumulate in the body are so-called uremic toxins. These include advanced glycation end-products (AGE). AGE levels are markedly increased in CKD patients not only because of impaired excretion but also because of increased production. AGE formation has initially been described as a non-enzymatic reaction between proteins and glucose in the so-called Maillard reaction, but they are also more rapidly formed during oxidative stress and subsequent formation of reactive carbonyl compounds like (methyl) glyoxal. AGE accumulate in tissue where they cross-link with proteins, e. g., collagen, inducing tissue stiffening of blood vessels and skin. They may also interact with receptor of AGE (RAGE) and other receptors, which lead to activation of intracellular transduction mechanisms resulting in cytokine release and further tissue damage in CKD. The accumulation of AGE in the skin can be measured non-invasively using autofluorescence. The skin autofluorescence is a strong marker of cardiovascular mortality in CKD. The focus of this review is on the role of tissue and plasma AGE, and of skin autofluorescence as a proxy of tissue AGE accumulation, in the increase in cardiovascular disease in end stage renal disease (ESRD). This review will also present the possibility of reducing the AGE accumulation in ESRD patients using the following five methods: 1) use of low AGE peritoneal dialysis solutions; 2) use of advanced hemodialysis techniques; 3) use of AGE reducing drugs; 4) optimizing the nutrition of hemodialysis patients; and 5) renal transplantation.
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| 24. |
- Arsov, Stefan, et al.
(author)
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Does hepatitis C increase the accumulation of advanced glycation end products in haemodialysis patients?
- 2010
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In: Nephrology, Dialysis and Transplantation. - : Oxford Journals. - 0931-0509 .- 1460-2385. ; 25:3, s. 885-891
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Journal article (peer-reviewed)abstract
- BACKGROUND: Hepatitis C may cause increased levels of oxidative stress that contribute to accumulation of advanced glycation end products (AGEs), which increase the risk of cardiovascular disease (CVD). The aim of this study was to determine the influence of hepatitis C on AGE accumulation in haemodialysis patients. METHODS: AGE accumulation was measured by means of skin autofluorescence (AF) in 92 haemodialysis (HD) patients and 93 age-matched healthy controls. In the HD patients, CVD-related biochemical variables were also measured. The HD patients were tested for hepatitis C virus (HCV) antibodies and allocated to a HCV+ or HCV- group. RESULTS: Skin AF of the healthy subjects was lower than skin AF in the HD patients (3.13 +/- 0.95 vs 2.2 +/- 0.47; P < 0.001). We calculated the average increase of skin AF in the healthy subjects to be 0.017 arbitrary units per year, being 14 times lower than in HD patients with CVD only and 20 times lower than in HD patients suffering from combined CVD and diabetes mellitus (DM). Multivariate regression analysis showed that AGE accumulation in HD patients can be described by the independent effects of age, DM, CVD and HD vintage. Although inter-cellular adhesion molecule 1 and liver enzymes were elevated in HCV+ HD patients, levels of oxidative stress markers and skin AF were not significantly different between HCV+ and HCV- HD patients. CONCLUSIONS: AGE accumulation was higher in the HD patients than in the healthy controls. AGE accumulation did not differ in HCV+ and HCV- HD patients. This might be due to the fact that hepatitis C did not cause oxidative stress in our HD population. Independent markers of AGE accumulation were age, HD vintage, DM and CVD, but not hepatitis C.
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| 25. |
- Arsov, Stefan, et al.
(author)
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Increase in skin autofluorescence and release of heart-type fatty acid binding protein in plasma predicts mortality of hemodialysis patients
- 2013
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In: Artificial Organs. - : Wiley. - 0160-564X .- 1525-1594. ; 37:7, s. E114-E122
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Journal article (peer-reviewed)abstract
- Advanced glycation end-products (AGEs) are uremic toxins that accumulate progressively in hemodialysis (HD) patients. The aim of this study was to assess the 1-year increase in skin autofluorescence (DAF), a measure of AGEs accumulation and plasma markers, as predictors of mortality in HD patients. One hundred sixty-nine HD patients were enrolled in this study. Skin autofluorescence was measured twice, 1 year apart using an AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). Besides routine blood chemistry, additional plasma markers including superoxide dismutase, myeloperoxydase, intercellular adhesion molecule 1 (ICAM-1), C-reactive protein (hs-CRP), heart-type fatty acid binding protein (H-FABP), and von Willebrand factor were measured at baseline. The mortality of HD patients was followed for 36 months. Skin autofluorescence values of the HD patients at the two time points were significantly higher (P < 0.001) than those of healthy subjects of the same age. Mean 1-year DAF of HD patients was 0.16 +/- 0.06, which was around seven-to ninefold higher than 1-year DAF in healthy subjects. Multivariate Cox regression showed that age, hypertension, 1-year DAF, hs-CRP, ICAM-1, and H-FABP were independent predictors of overall mortality. Hypertension, 1-year DAF, hs-CRP, and H-FABP were also independent predictors of cardiovascular mortality. One-year DAF and plasma H-FABP, used separately and in combination, are strong predictors of overall and cardiovascular mortality in HD patients.
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