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| 40. |
- Annuk, Margus, et al.
(författare)
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Erythropoietin impairs endothelial vasodilatory function in patients with renal anemia and in healthy subjects
- 2006
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Ingår i: Nephron. Clinical practice. - : S. Karger AG. - 1660-8151 .- 2235-3186 .- 1660-2110. ; 102:1, s. c30-c34
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: The mechanisms underlying the aggravation or development of hypertension frequently seen during treatment of renal anemia with epoetins are not fully elucidated. The aim of the present study was to investigate the effects of epoetin alfa on endothelial vasodilatory function in patients with renal anemia and in healthy subjects. Methods: Eighteen preuremic patients with anemia (GFR 23.4 ± 11 SD ml/min, Hb 101 ± 8 g/l) and 10 healthy subjects underwent evaluation of endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIDV) by means of forearm blood flow (FBF) measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (MCh, evaluating EDV) and sodium nitroprusside (SNP, evaluating EIDV). These investigations were performed before and 30 min after an intravenous injection of epoetin alfa (10,000 IU). Ten healthy subjects underwent the same procedure with the exception that saline were given instead of epoetin. The patients were treated with epoetin alfa subcutaneously for 12-19 weeks and revaluated when Hb exceeded 120 g/l. Results: EDV was attenuated after the epoetin injection in both renal patients and healthy subjects. This impairment persisted after anemia had been treated. EDIV and blood pressure remained constant. Saline had no effect on the variables measured. Conclusion: Our results indicate that epoetin alfa impairs endothelial function in renal patients and healthy subjects which may have an impact on vascular complications.
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| 41. |
- Annuk, Margus, et al.
(författare)
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Impaired endothelium-dependent vasodilatation in renal failure in humans
- 2001
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 16:2, s. 302-306
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main causes of death in patients with chronic renal failure (CRF) are cardiovascular complications. The aim of the present study was to compare endothelium-dependent vasodilatation (EDV) in patients with chronic renal failure with a control population controlling for hypertension, diabetes mellitus and hypercholesterolaemia. METHODS: Fifty-six patients with moderate CRF (mean creatinine clearance 29.4 ml/min/1.73 m(2)) underwent evaluation of EDV and endothelium-independent vasodilatation (EIDV) by means of forearm blood flow (FBF) measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (Mch, 2 and 4 microg/min evaluating EDV) and sodium nitroprusside (SNP, 5 and 10 microg/min evaluating EIDV). Fifty-six control subjects without renal impairment underwent the same investigation. RESULTS: Infusion of Mch increased FBF significantly less in patients with renal failure than in controls (198 vs 374%, P<0.001), whereas no significant difference was seen regarding the vasodilatation induced by SNP (278 vs 269%). The differences in EDV between the groups were still significant after controlling for hypertension, blood glucose, and serum cholesterol in multiple regression analysis (P<0.001). EDV was related to serum creatinine (r=-0.37, P<0.01), creatinine clearance (r=0.45, P<0.005) and to serum triglyceride levels (r=-0.29, P<0.005) in the CRF group. CONCLUSIONS: Patients with moderate CRF have an impaired EDV even after correction for traditional cardiovascular risk factors and this impairment is related to the degree of renal failure.
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| 42. |
- Annuk, Margus, et al.
(författare)
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Oxidative stress and endothelial function in chronic renal failure
- 2001
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Ingår i: Journal of the American Society of Nephrology. - 1046-6673 .- 1533-3450. ; 12:12, s. 2747-2752
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This study aimed to investigate the relationship between oxidative stress and endothelium-dependent vasodilation in patients with chronic renal failure (CRF). Thirty-seven patients with CRF underwent evaluation of endothelium-dependent vasodilation and endothelium-independent vasodilation by means of forearm blood flow measurements with venous occlusion plethysmography during local intra-arterial infusions of methacholine (evaluating endothelium-dependent vasodilation) and sodium nitroprusside (evaluating endothelium-independent vasodilation). Lag phase of lipoprotein fraction to oxidation, total antioxidative activity, diene conjugates, thiobarbituric acid reactive substances, lipid hydroperoxide, reduced glutathione (GSH), oxidized GSH (GSSG), and the GSH redox ratio (GSSG/GSH) were all measured as markers of oxidative stress. Two groups of healthy subjects (61 and 37 subjects, respectively) were used as controls. In one group, oxidative stress markers were measured, whereas endothelium-dependent vasodilation and endothelium-independent vasodilation were assessed in the other group. Compared with controls, the patients with renal insufficiency had an impaired endothelium-dependent vasodilation, a shorter lag phase of lipoprotein fraction, and higher levels of diene conjugates, lipid hydroperoxide, and GSSG levels. The GSSG/GSH ratio was lower in patients with CRF. Endothelium-dependent vasodilation was positively correlated with total antioxidative activity (r = 0.41, P = 0.016), GSH (r = 0.44, P < 0.0098), and lag phase of LDL (r = 0.35, P = 0.036) and negatively correlated with GSSG (r = -0.40, P < 0.018), GSSG/GSH (r = -0.47, P = 0.0057), and diene conjugates (r = -0.53 P < 0.0015) in patients with CRF. These results show that an impaired endothelium vasodilation function and oxidative stress are related to each other in patients with CRF.
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| 43. |
- Arvidson, Johan, et al.
(författare)
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Toxic epidermal necrolysis and hemolytic uremic syndrome after allogeneic stem-cell transplantation
- 2007
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Ingår i: Pediatric Transplantation. - : Wiley. - 1397-3142 .- 1399-3046. ; 11:6, s. 689-693
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Tidskriftsartikel (refereegranskat)abstract
- TEN and HUS are challenging complications with excessive mortality after HSCT. We report the development of these two conditions in combination in a nine-yr-old boy after HSCT from an unrelated donor. TEN with skin detachment of more than 90% of body surface area developed after initial treatment for GvHD. Within a few days of admission to the burns unit, the patient developed severe hemolysis, hypertension, thrombocytopenia, and acute renal failure consistent with HUS, apparently caused by CSA. The management included intensive care in a burns unit, accelerated drug removal using plasmapheresis, and a dedicated multi-disciplinary team approach to balance immunosuppression and infections management in a situation with extensive skin detachment. The patient survived and recovered renal function but requires continued treatment for severe GvHD. Suspecting and identifying causative drugs together with meticulous supportive care in the burns unit is essential in the management of these patients and long-term survival is possible.
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| 44. |
- Beshara, Soheir, et al.
(författare)
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Anemia associated with advanced prostatic adenocarcinoma : Effects of recombinant human erythropoietin
- 1997
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Ingår i: The Prostate. - 0270-4137 .- 1097-0045. ; 31:3, s. 153-160
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND METHODS: Nine patients with hormone-refractory metastatic prostatic adenocarcinoma and anemia were treated with recombinant human erythropoietin (rHuEpo) at a median dose of 150 U/kg BW 3 times a week subcutaneously. Baseline hemoglobin (Hb) ranged from 70 to 116 g/L, and the study duration was 12 weeks (median patient participation period was 8 weeks). RESULTS: Four patients demonstrated a median Hb increase of 20 g/L and were considered responders. Three patients showed a median increase of 17 g/L but required blood transfusion once, and were therefore considered as partial responders. Baseline erythropoietic status showed a significant correlation between serum Epo and Hb. Inadequate Epo production, evaluated by the observed/predicted log Epo ratio, was found in two patients. Defective bone marrow activity, demonstrated by low transferrin receptor (TfR), and hypoferremia in spite of abundant iron stores were also shown. Hemorheological investigations showed elevated plasma viscosity. CONCLUSIONS: Our results indicate that suppression of erythropoiesis can be mainly explained by the depressed marrow activity. The altered hemorheology might contribute to the anemia. This anemia could possibly be corrected with rHuEpo.
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| 45. |
- Einarsson, Torbjörn, et al.
(författare)
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Civilsamhällets mobilisering av resurser och lärande i kriser
- 2024
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Ingår i: Svensk kyrkotidning. - Uppsala : Svensk kyrkotidning AB. - 0346-2153. ; :3, s. 78-82
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Short text presenting a study of Swedish civil society organizations and their work during three different extraordinary situations (or crises): the European Refugee "crisis" of 2015/16, the COVID pandemic and the refugee situation emerging as a consequence of Russias war against Ukraine. In the study we focus on the organizational learning as well as the mobilization of resources.
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| 46. |
- Fadul, Jamal E., et al.
(författare)
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Effects of LDL apheresis on blood rheology in two patients with homozygous familial hypercholesterolaemia
- 1997
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Ingår i: Blood Purification. - 0253-5068 .- 1421-9735. ; 15:3, s. 182-187
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Tidskriftsartikel (refereegranskat)abstract
- Changes in haemorheological and lipid variables were investigated in 2 patients with homozygous familial hypercholesterolaemia (FH) treated with low-density lipoprotein (LDL) apheresis using dextran sulphate adsorbent. The immediate effect of LDL apheresis was a fall in plasma fibrinogen by 50%, total and LDL cholesterol by 60%, plasma viscosity by 12% and whole blood viscosity by 17%. Before the 12th treatment session, plasma fibrinogen concentration remained reduced by 22%, whole blood viscosity by 17% and the plasma viscosity by 11% compared with the initial values. Total and LDL cholesterol in plasma also remained reduced by about 50%. We conclude that LDL apheresis, using dextran sulphate adsorbent, improves blood rheology. The decrease in plasma fibrinogen concentrations, plasma viscosity and LDL cholesterol might be factors contributing to the improved haemorheological properties.
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| 47. |
- Fadul, Jamal E. M., et al.
(författare)
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Effects of extracorporeal hemapheresis therapy on blood rheology
- 1997
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Ingår i: Journal of clinical apheresis. - 0733-2459 .- 1098-1101. ; 12:4, s. 183-186
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Tidskriftsartikel (refereegranskat)abstract
- The blood flow property is one of the factors determining blood perfusion and oxygen supply. The viscosity of the blood is primarily related to the hematocrit, but also to the amount of fibrinogen and other macromolecules present in the blood. Patients with ischemic heart disease have shown a rapid and safe improvement in their hemorheological state when treated with heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP). In this study we used two extracorporeal hemapheresis methods, plasmapheresis (PP) and immunoadsorption (IA), in 15 patients (eight patients treated with PP and seven patients with IA) with various diseases. Hemorheological variables and plasma fibrinogen were measured before and after the first and before the third treatment performed at 3 consecutive days. The aim of our study was to investigate the immediate effects of these two treatment modalities on the flow properties of blood. Immediately after the first PP and IA session statistically significant declines in plasma fibrinogen concentration, plasma viscosity, whole blood viscosity, and erythrocyte aggregation tendency were found. These changes persisted before the third treatment session. The erythrocyte fluidity and hematocrit remained unchanged. We conclude that extracorporeal hemapheresis therapy, with plasmapheresis or immunoadsorption, affects the blood rheology by decreasing the plasma viscosity and erythrocyte aggregation tendency. The decrease in plasma fibrinogen is probably the main factor underlying that, but other factors such as a decrease in immunoglobulins may also be of importance.
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| 48. |
- Falk, David, et al.
(författare)
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Civilsamhällets förmåga till lärande, samverkan samt mobilisering av resurser i samband med kriser
- 2024
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Ingår i: Forskning som förändrar civilsamhället – krisberedskap, krishantering och samverkan. - Stockholm, Sweden : Myndigheten för ungdoms- och civilsamhällesfrågor (MUCF). ; , s. 35-43
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Vid såväl mindre som mer omfattande samhällsstörningar (i dagligt tal ”kriser”) bidrar ideella organisationer, trossamfund, folkrörelser och andra delar av civilsamhället ofta med insatser i de olika faserna av en kris där den offentliga sektorns resurser, kompetenser, tempo eller sätt att arbeta inte räcker till. Det gör man till exempel genom att mobilisera och koordinera volontärer, ordna med sovplatser, boende och tak över huvudet för utsatta grupper, bidra med transporter, hjälpa till med matinköp, ge röst åt och stöd för de mest sårbara och utsatta i vårt samhälle. Dessa insatser sker inte sällan i samverkan med andra idéburna organisationer och med offentliga aktörer som kommuner, sjukhus, skolor eller statliga myndigheter samt med näringslivets företag.
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| 49. |
- Furuland, Hans, et al.
(författare)
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A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients
- 2003
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 18:2, s. 353-361
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Partial correction of renal anaemia with erythropoietin improves quality of life (QoL). We aimed to examine if normalization of haemoglobin with epoetin alfa in pre-dialysis and dialysis patients further improves QoL and is safe. METHODS: 416 Scandinavian patients with renal anaemia [pre-dialysis, haemodialysis (HD) and peritoneal dialysis patients] were randomized to reach a normal haemoglobin of 135-160 g/l (n=216) or a subnormal haemoglobin of 90-120 g/l (n=200) with or without epoetin alfa. Study duration was 48-76 weeks. QoL was measured using Kidney Disease Questionnaires in 253 Swedish dialysis patients. Safety was examined in all patients. RESULTS: QoL improved, measured as a decrease in physical symptoms (P=0.02), fatigue (P=0.05), depression (P=0.01) and frustration (P=0.05) in the Swedish dialysis patients when haemoglobin was normalized. In pre-dialysis patients, diastolic blood pressure was higher in the normal compared with the subnormal haemoglobin group after 48 weeks. However, the progression rate of chronic renal failure was comparable. In the normal haemoglobin group (N-Hb), 51% had at least one serious adverse event compared with 49% in the subnormal haemoglobin group (S-Hb) (P=0.32). The incidence of thrombovascular events and vascular access thrombosis in HD patients did not differ. The mortality rate was 13.4% in the N-Hb group and 13.5% in the S-Hb group (P=0.98). Mortality decreased with increasing mean haemoglobin in both groups. CONCLUSIONS: Normalization of haemoglobin improved QoL in the subgroup of dialysis patients, appears to be safe and can be considered in many patients with end-stage renal disease.
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| 50. |
- Furuland, Hans, 1956-
(författare)
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Effects of Hemoglobin Normalization with Epoetin in Chronic Kidney Disease
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anemia is common in patients with chronic kidney disease (CDK), contributes to reduced Quality of Life (QoL) and is associated with cardiovascular disease, morbidity and mortality. Epoetin raises hemoglobin (Hb) and increases QoL and physical exercise capacity. Because of concerns about safety and economics, current anemia treatment with epoetin aims to achieve subnormal Hb (110-120 g/l). Normalization of Hb may be of additional benefit regarding QoL and cardiovascular effects. The present study examines the effects of Hb normalization with epoetin on safety variables, QoL, graft function after kidney transplantation, dialysis adequacy, hemorheology, hemodynamics and cardiac autonomic function in CKD patients. In a randomized, multicenter study comprising 416 pre-dialysis and dialysis patients no difference was observed between patients treated to a normal or a subnormal Hb level on mortality, thrombovascular events, serious adverse events, vascular access thrombosis and residual renal function. QoL was enhanced in a subgroup of hemodialysis patients. Pretransplant epoetin treatment directed toward normal Hb levels did not result in worse graft function during 6 postoperative months. Dialysis adequacy was reduced in a subgroup of hemodialysis patients after normalization of Hb. The blood flow properties of pre-dialysis patients were altered. The hemorheological investigation demonstrated that Hb normalization caused a parallel increase in hematocrit and blood viscosity without other hemorheological changes. While the total peripheral resistance index increased, the cardiac index (CI) decreased. In a separate study cardiac autonomic function, measured by heart rate variability, was decreased in pre-dialysis patients. It was improved, but not fully normalized, by Hb normalization. On the basis of this study, Hb normalization with epoetin appears to be safe and increases QoL in hemodialysis patients though may result in lower dialysis adequacy and increased blood pressure. A reduction in CI and improved cardiac autonomic function indicate a positive effect on cardiovascular function.
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