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Fernström, Anders
Publications (10 of 54) Show all publications
Holmar, J., Uhlin, F., Fernström, A., Luman, M., Jankowski, J. & Fridolin, I. (2015). An Optical Method for Serum Calcium and Phosphorus Level Assessment during Hemodialysis. Toxins, 7(3), 719-727
Open this publication in new window or tab >>An Optical Method for Serum Calcium and Phosphorus Level Assessment during Hemodialysis
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2015 (English)In: Toxins, ISSN 2072-6651, Vol. 7, no 3, p. 719-727Article in journal (Refereed) Published
Abstract [en]

Survival among hemodialysis patients is disturbingly low, partly because vascular calcification (VC) and cardiovascular disease are highly prevalent. Elevated serum phosphorus (P) and calcium (Ca) levels play an essential role in the formation of VC events. The purpose of the current study was to reveal optical monitoring possibilities of serum P and Ca values during dialysis. Twenty-eight patients from Tallinn (Estonia) and Linköping (Sweden) were included in the study. The serum levels of Ca and P on the basis of optical information, i.e., absorbance and fluorescence of the spent dialysate (optical method) were assessed. Obtained levels were compared in means and SD. The mean serum level of Ca was 2.54 ± 0.21 and 2.53 ± 0.19 mmol/L; P levels varied between 1.08 ± 0.51 and 1.08 ± 0.48 mmol/L, measured in the laboratory and estimated by the optical method respectively. The levels achieved were not significantly different (p = 0.5). The Bland-Altman 95% limits of agreement between the two methods varied from -0.19 to 0.19 for Ca and from -0.37 to 0.37 in the case of P. In conclusion, optical monitoring of the spent dialysate for assessing the serum levels of Ca and P during dialysis seems to be feasible and could offer valuable and continuous information to medical staff.

Place, publisher, year, edition, pages
BASEL, SWITZERLAND: , 2015
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-115147 (URN)10.3390/toxins7030719 (DOI)000359339500006 ()25734785 (PubMedID)
Note

The research was funded partly by the County Council of Ostergotland, Sweden, Estonian Science Foundation Grant No. 8621, Estonian Ministry of Education and Research under institutional research financing IUT 19-2 and the European Union through the European Regional Development Fund.

Available from: 2015-03-10 Created: 2015-03-10 Last updated: 2016-03-23
Uhlin, F., Magnusson, P., Larsson, T. E. & Fernström, A. (2015). In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration.. Clinical Nephrology, 83(6), 315-21
Open this publication in new window or tab >>In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration.
2015 (English)In: Clinical Nephrology, ISSN 0301-0430, Vol. 83, no 6, p. 315-21Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Vitamin D deficiency and elevated serum fibroblast growth factor-23 (FGF23) levels are hallmark features and surrogate markers of adverse clinical outcomes in patients with chronic kidney disease (CKD). Convection of molecules over the dialysis membrane during online hemodiafiltration (ol-HDF) increases the removal of larger waste molecules compared with traditional high-flux hemodialysis (HD). The primary aim of this study was to explore the long-term impact of ol-HDF on serum 25(OH)D and FGF23.

METHOD: An observational, prospective, noncomparator study including 35 patients who were switched from HD to ol-HDF. Serum 25(OH)D and FGF23 were measured at baseline (i.e., time of switch to ol-HDF) and at 6, 12, and 24 months.

RESULTS: At follow-up time points, there was a significant reduction in serum 25(OH)D compared with baseline (p < 0.0001) whereas FGF23 was unaltered (p > 0.05). The decrease in 25(OH)D was more prominent in individuals with higher baseline 25(OH)D levels.

CONCLUSION: Ol-HDF may lower systemic 25(OH)D levels by convective mechanisms although the clinical significance remains unknown. Further controlled studies are warranted to replicate these findings in larger patient cohorts.

Place, publisher, year, edition, pages
DUSTRI-VERLAG DR KARL FEISTLE, 2015
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-119669 (URN)10.5414/CN108468 (DOI)000364530600001 ()25943141 (PubMedID)
Note

Funding agencies:  Linkoping University Hospital Research Fund (County Council of Ostergotland); Linkoping University Hospital Research Fund (Linkoping University); Signhild Engkvists Stiftelse in Stockholm

Available from: 2015-06-24 Created: 2015-06-24 Last updated: 2017-12-04
Holmar, J., Uhlin, F., Fernström, A., Luman, M., Jankowski, J. & Fridolin, I. (2015). Optical assesment of calcification markers during hemodialysis. In: : . Paper presented at The 52th Congress of the ERA-EDTA, London, May 28-31, 2015 (pp. iii556-iii569). , 3
Open this publication in new window or tab >>Optical assesment of calcification markers during hemodialysis
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2015 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-124390 (URN)10.1093/ndt/gfv197.03 (DOI)
Conference
The 52th Congress of the ERA-EDTA, London, May 28-31, 2015
Available from: 2016-01-28 Created: 2016-01-28 Last updated: 2016-02-05
Uhlin, F., Holmar, J., Yngman-Uhlin, P., Fernström, A. & Fridolin, I. (2015). Optical Estimation of Beta 2 Microglobulin during Hemodiafiltration - Does It Work?. Blood Purification, 40(2), 113-119
Open this publication in new window or tab >>Optical Estimation of Beta 2 Microglobulin during Hemodiafiltration - Does It Work?
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2015 (English)In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 40, no 2, p. 113-119Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Currently, urea reduction seems to be the most widely used dialysis dose parameter. The aim of this study was to investigate the possibility to monitor beta 2-microglobulin (β2-M) elimination by utilizing the ultraviolet (UV) absorbance of spent dialysate.

METHODS: Blood and spent dialysate were collected during two week's sessions in 8 patients, one week in hemodialysis (HD) and one in hemodiafiltration (HDF). Correlation analysis between UV-wavelengths and concentrations of solutes in spent dialysate was performed. The reduction ratio (RR) of concentrations in blood, dialysate and UV-absorbance were compared.

RESULTS: Differences between HD and HDF were discovered in wavelength correlation maxima for the solutes. Relative error in RR (%) was larger (p < 0.05) for β2-M than for the other solutes. The most reasonable explanation is that β2-M does not absorb UV-radiation; instead, the absorbance of surrogate substances is measured.

CONCLUSION: A high correlation between UV-absorbance and β2-M can be achieved for HDF but not for HD. Still, UV-absorbance could perhaps be used in solely HDF mode for estimation of β2-M removal. © 2015 S. Karger AG, Basel.

Place, publisher, year, edition, pages
S. Karger, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121293 (URN)10.1159/000381797 (DOI)000361154700003 ()26159848 (PubMedID)
Note

Funding text: Estonian Science Foundation [8621]; Estonian Ministry of Education and Research [IUT 19-2]; European Union through the European Regional Development Fund

Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2017-12-04Bibliographically approved
Fernström, A. & Hylander Rössner, B. (2015). Polycystisk njursjukdom (ADPKD). Internetmedicin i Göteborg AB, Article ID 5892.
Open this publication in new window or tab >>Polycystisk njursjukdom (ADPKD)
2015 (Swedish)Other (Other academic)
Abstract [sv]
  • Polycystisk njursjukdom (ADPKD) innebär att man i njurarna bildar ett fåtal till hundratals cystor i njurarna som slår ut den normala njurfunktionen och ökar buktrycket.
  • Orsakas av mutationer på PKD-1 och PKD-2-generna.
  • Ärvs autosomalt dominant.
  • Vanliga symtom är:- Tryckkänsla/smärta i buken- Njursten- Nedsatt urinkoncentrationsförmåga- Hypertoni- UVI- Hematuri- Uremiska symtom
  • Kan ge manifestationer extrarenalt- Levercystor- Pankreascystor- Intracerebrala aneurysm- Klaffvitium- Divertikulos- Bukväggsbråck
  • Diagnos sätts antingen på förekomst av cystor och ärftlighet för ADPKD eller enbart på förekomst av cystor (dock krävs då fler cystor).
  • Botande behandling annan än transplantation saknas.
  • Symtomlindrande behandling syftar till att minska mortalitet och morbiditet på grund av sjunkande njurfunktion.
  • Transplantation är indicerat om patienten är uremisk.
  • Nya behandlingar är under utveckling.
Place, publisher, year, pages
Internetmedicin i Göteborg AB, 2015
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-124578 (URN)
Note

Internetmedicin i Göteborg AB är företaget som står bakom webbplatsen internetmedicin.se.

Available from: 2016-02-04 Created: 2016-02-04 Last updated: 2017-03-21Bibliographically approved
Uhlin, F., Odar-Cederlöf, I., Theodorsson, E. & Fernström, A. (2015). Vasoactive Peptide Levels after Change of Dialysis Mode.. Nephron Extra, 5(3), 68-78
Open this publication in new window or tab >>Vasoactive Peptide Levels after Change of Dialysis Mode.
2015 (English)In: Nephron Extra, ISSN 1664-5529, Vol. 5, no 3, p. 68-78Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIMS: Plasma concentrations of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) are increased in end-stage renal disease. Improvement in hemodynamic stability has been reported when switching from hemodialysis (HD) to on-line hemodiafiltration (ol-HDF). The aim of this study was to investigate plasma concentrations of NT-proBNP, BNP and neuropeptide Y (NPY) during a 1-year follow-up, after a change from high-flux HD to postdilution ol-HDF. Additional variables were also studied, e.g. pulse wave velocity and ordinary clinical parameters.

METHOD: We conducted a prospective, single-center study including 35 patients who were switched from HD to HDF. Plasma concentrations of NT-proBNP, BNP and NPY before and after dialysis were measured at baseline (i.e. HD) and at 1, 2, 4, 6 and 12 months on HDF.

RESULTS: All three peptide levels decreased significantly during HD and HDF when comparing concentrations before and after dialysis. Mean absolute value (before/after) and relative decrease (%) before versus after dialysis was 13.697/9.497 ng/l (31%) for NT-proBNP, 62/40 ng/ml (35%) for BNP and 664/364 pg/l (45%) for NPY. No significant differences were observed when comparing predialysis values over time. However, postdialysis NT-proBNP concentration showed a significant decrease of 48% over time after the switch to HDF.

CONCLUSION: The postdialysis plasma levels of NT-proBNP, BNP and NPY decreased significantly during both dialysis modes when compared to before dialysis. The postdialysis lowering of NT-proBNP increased further over time after the switch to ol-HDF; the predialysis levels were unchanged, suggesting no effect on its production in the ventricles of the heart.

Keywords
Convective therapies; Hemodiafiltration; N-terminal fragment of pro-brain natriuretic peptide; Neuropeptide Y; Vasoactive peptides
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:liu:diva-124043 (URN)10.1159/000440816 (DOI)26648973 (PubMedID)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2018-01-10
Haarhaus, M., Fernström, A. & Magnusson, P. (2014). A multicenter prospective study of bone alkaline phosphatase isoforms and arterial calcification in chronic kidney disease patients on dialysis.
Open this publication in new window or tab >>A multicenter prospective study of bone alkaline phosphatase isoforms and arterial calcification in chronic kidney disease patients on dialysis
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Chronic kidney disease – mineral and bone disorder (CKD-MBD) is associated with high morbidity and mortality due to frequent cardiovascular (CV) complications. Accelerated arterial stiffening and calcification are associated with serum alkaline phosphatase (ALP) in advanced CKD. We have previously described three bone ALP (BALP) isoforms in healthy individuals and detected a novel isoform, B1x, exclusively in serum from some CKD patients, in bone and in calcifying vascular smooth muscle cells. We investigated the association of these BALP isoforms, abdominal aortic calcification (AAC) score and carotid – femoral pulse wave velocity (PWV), with outcome in a 2-year prospective multicenter study of 68 prevalent dialysis patients participating in the Calcification Outcome in Renal Disease (CORD) study. Twenty-one patients experienced a combined event of all-cause mortality or a first nonfatal CV event during follow-up. PWV (hazard ratio 1.067, P = 0.03) was independently associated with the combined event. B1x was detected in 53 patients and was associated with baseline PWV (Kendall's tau 0.23, P = 0.007) and with variation of PWV over time (estimate 14.14, P = 0.03). Patients with B1x had lower levels of PTH and total ALP, indicating a possible association with low bone turnover. We found no association of BALP isoforms with AAC score. Cox regression revealed B1x as a positive predictor of event free survival (hazard ratio 0.98, P = 0.01). In conclusion, B1x is associated with vascular stiffness in CKD 5D. This finding is contrasted by the ability of B1x to predict longer event free survival in the current study.

Keywords
Chronic kidney disease – mineral and bone disorder, dialysis, bone alkaline phosphatase, mortality, cardiovascular disease
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111869 (URN)
Available from: 2014-11-06 Created: 2014-11-06 Last updated: 2015-03-31Bibliographically approved
Holmar, J., Fridolin, I., Uhlin, F., Luman, M. & Fernström, A. (2014). Can combined assessment of small molecule uremic markers improve prediction of dialysis patients survival?. In: : . Paper presented at European Renal Association - European Dialysis and Transplant Association for the ERA-EDTA Congress 2014. The ERA-EDTA Congress, from 31 May to 3 June 2014 at Amsterdam.
Open this publication in new window or tab >>Can combined assessment of small molecule uremic markers improve prediction of dialysis patients survival?
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2014 (English)Conference paper, Oral presentation only (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113248 (URN)
Conference
European Renal Association - European Dialysis and Transplant Association for the ERA-EDTA Congress 2014. The ERA-EDTA Congress, from 31 May to 3 June 2014 at Amsterdam
Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2015-01-13
Holmar, J., Fridolin, I., Uhlin, F., Fernström, A. & Luman, M. (2014). Estimation of dialysis patients survival through combined approach of small molecule uremic markers. Proceedings of the Estonian Academy of Sciences, 63(3), 227-233
Open this publication in new window or tab >>Estimation of dialysis patients survival through combined approach of small molecule uremic markers
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2014 (English)In: Proceedings of the Estonian Academy of Sciences, ISSN 1736-6046, E-ISSN 1736-7530, Vol. 63, no 3, p. 227-233Article in journal (Refereed) Published
Abstract [en]

Survival rate of dialysis patients is still alarmingly low and various factors may have in it an important role. The purpose of this study was to observe the relationship between the survival of dialysis patients and the serum level of urea, creatinine, and uric acid (UA). Serum urea and creatinine concentrations may express patients nutritional status and muscle mass, and high UA value may refer to higher risk for cardiovascular events. The idea of combining the concentrations and removal of urea and UA into a single model for predicting the patients outcome is introduced. The study included 33 hemodialysis patients from Link ping, Sweden and 10 from Tallinn, Estonia. Kaplan-Meier analysis was used for survival analysis. Logistic and Cox regression analysis was applied to create models for predicting patients three-year survival. It was observed that higher serum UA is significantly related to poor survival in dialysis patients (p = 0.026). A reverse effect was observed in case of urea (p = 0.095). The level of creatinine was not related to survival (p = 0.905). The best logistic regression model for predicting patients outcome included both UA and urea based parameters (Chi Square 21.0, p = 0.0001). Survival of dialysis patients seems to be determined by a set of causal factors and combined models may have a predictive relevance. A possibility for automatic online monitoring of small molecule uremic markers is proposed. Since the number of participating patients was small, larger studies including more patients and testing the models in independent validation cohort is the future goal.

Place, publisher, year, edition, pages
Estonian Academy Publishers, 2014
Keywords
dialysis; survival; prediction models; urea; uric acid; creatinine
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111305 (URN)10.3176/proc.2014.3.04 (DOI)000341620600006 ()
Note

Funding Agencies|County Council of Ostergotland, Sweden; Estonian Science Foundation [8621]; Estonian Ministry of Education and Research [IUT 19-2]; European Union through the European Regional Development Fund

Available from: 2014-10-14 Created: 2014-10-14 Last updated: 2017-12-05
Uhlin, F., Magnusson, P., Larsson, T. & Fernström, A. (2014). Minskade nivåer av 25-hydroxyvitamin D i serum efter byte till online hemodiafiltration. In: : . Paper presented at Njurmedicinskt vårmöte i Trollhättan 3-5 maj 2014.
Open this publication in new window or tab >>Minskade nivåer av 25-hydroxyvitamin D i serum efter byte till online hemodiafiltration
2014 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113240 (URN)
Conference
Njurmedicinskt vårmöte i Trollhättan 3-5 maj 2014
Available from: 2015-01-13 Created: 2015-01-13 Last updated: 2015-01-13
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