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Uhlin, Fredrik
Alternative names
Publications (10 of 71) Show all publications
Uhlin, F., Fernström, A., Knapen, M. H. J., Vermeer, C. & Magnusson, P. (2019). Long-term follow-up of biomarkers of vascular calcification after switch from traditional hemodialysis to online hemodiafiltration. Scandinavian Journal of Clinical and Laboratory Investigation, 79(3), 174-181
Open this publication in new window or tab >>Long-term follow-up of biomarkers of vascular calcification after switch from traditional hemodialysis to online hemodiafiltration
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2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 3, p. 174-181Article in journal (Refereed) Published
Abstract [en]

Rapid progression of vascular calcification (VC) in hemodialysis (HD) patients is caused by several factors including inflammation and an imbalance between active inducers and inhibitors of VC. Growing evidence shows that online hemodiafiltration (ol-HDF), a combination of diffusive and convective solute transport, has positive effects on the uremic environment that affects patients on dialysis. However, we recently reported that serum 25-hydroxyvitamin D (25(OH)D) decreased after a switch from HD to ol-HDF. As a consequence of this finding, the present study was undertaken to investigate if inducers and inhibitors of VC (i.e. the inactive matrix Gla protein fractions dp-ucMGP and t-ucMGP, fetuin-A, Gla-rich protein (GRP), osteopontin (OPN), bone-specific alkaline phosphatase (BALP), and osteoprotegerin (OPG)) also are affected by ol-HDF. This non-comparative prospective study comprised 35 prevalent patients who were investigated 6, 12, and 24 months after their switch from HD to ol-HDF. Most patients had increased levels of the calcification inhibitors OPN and OPG; and of the inactive calcification inhibitor dp-ucMGP during the study period irrespective of the dialysis modality. BALP and t-ucMGP were mostly within the reference interval, but fetuin-A was mostly below the reference interval during the study period. OPN was significantly associated with BALP and parathyroid hormone, r = 0.62 and r = 0.65 (p amp;lt; .001), respectively. In conclusion, in contrast to decreased 25(OH)D levels, no differences were found for any of the measured biomarkers of VC following the switch from HD to ol-HDF. Further studies are needed to elucidate how these biomarkers can contribute to calcification risk assessment.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Alkaline phosphatase; chronic kidney disease; chronic renal insufficiency; renal dialysis; hemodiafiltration; osteopontin; pulse wave analysis; vascular calcification
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-157232 (URN)10.1080/00365513.2019.1576218 (DOI)000465174400004 ()30775941 (PubMedID)2-s2.0-85064567552 (Scopus ID)
Note

Funding Agencies|ALF Grants Region Ostergotland; Linkoping University Hospital Research Fund (Region Ostergotland); Linkoping University Hospital Research Fund (Linkoping University); Signhild Engkvists Stiftelse in Stockholm, Sweden

Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-18Bibliographically approved
Lindström, S. B., Uhlin, F., Bjarnegård, N., Gylling, M., Nilsson, K., Svensson, C., . . . Länne, T. (2018). Computer-Aided Evaluation of Blood Vessel Geometry From Acoustic Images. Journal of ultrasound in medicine, 37(4), 1025-1031
Open this publication in new window or tab >>Computer-Aided Evaluation of Blood Vessel Geometry From Acoustic Images
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2018 (English)In: Journal of ultrasound in medicine, ISSN 0278-4297, E-ISSN 1550-9613, Vol. 37, no 4, p. 1025-1031Article in journal (Refereed) Published
Abstract [en]

A method for computer-aided assessment of blood vessel geometries based on shape-fitting algorithms from metric vision was evaluated. Acoustic images of cross sections of the radial artery and cephalic vein were acquired, and medical practitioners used a computer application to measure the wall thickness and nominal diameter of these blood vessels with a caliper method and the shape-fitting method. The methods performed equally well for wall thickness measurements. The shape-fitting method was preferable for measuring the diameter, since it reduced systematic errors by up to 63% in the case of the cephalic vein because of its eccentricity.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
blood vessel wall, computer-aided assessment, informatics/image processing, lumen diameter, peripheral vascular, shape fitting
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-144016 (URN)10.1002/jum.14439 (DOI)000428445900024 ()29027696 (PubMedID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2018-05-17Bibliographically approved
Arund, J., Luman, M., Uhlin, F., Tanner, R. & Fridolin, I. (2016). Is Fluorescence Valid to Monitor Removal of Protein Bound Uremic Solutes in Dialysis?. PLoS ONE, 11(5), Article ID e0156541.
Open this publication in new window or tab >>Is Fluorescence Valid to Monitor Removal of Protein Bound Uremic Solutes in Dialysis?
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0156541Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the contribution and removal dynamics of the main fluorophores during dialysis by analyzing the spent dialysate samples to prove the hypothesis whether the fluorescence of spent dialysate can be utilized for monitoring removal of any of the protein bound uremic solute. A high performance liquid chromatography system was used to separate and quantify fluorophoric solutes in the spent dialysate sampled at the start and the end of 99 dialysis sessions, including 57 hemodialysis and 42 hemodiafiltration treatments. Fluorescence was acquired at excitation 280 nm and emission 360 nm. The main fluorophores found in samples were identified as indole derivatives: tryptophan, indoxyl glucuronide, indoxyl sulfate, 5-hydroxy-indoleacetic acid, indoleacetyl glutamine, and indoleacetic acid. The highest contribution (35 +/- 11%) was found to arise from indoxyl sulfate. Strong correlation between contribution values at the start and end of dialysis (R-2 = 0.90) indicated to the stable contribution during the course of the dialysis. The reduction ratio of indoxyl sulfate was very close to the decrease of the total fluorescence signal of the spent dialysate (49 +/- 14% vs 51 +/- 13% respectively, P = 0.30, N = 99) and there was strong correlation between these reduction ratio values (R-2 = 0.86). On-line fluorescence measurements were carried out to illustrate the technological possibility for real-time dialysis fluorescence monitoring reflecting the removal of the main fluorophores from blood into spent dialysate. In summary, since a predominant part of the fluorescence signal at excitation 280 nm and emission 360 nm in the spent dialysate originates from protein bound derivatives of indoles, metabolites of tryptophan and indole, the fluorescence signal at this wavelength region has high potential to be utilized for monitoring the removal of slowly dialyzed uremic toxin indoxyl sulfate.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2016
National Category
Analytical Chemistry
Identifiers
urn:nbn:se:liu:diva-129672 (URN)10.1371/journal.pone.0156541 (DOI)000376882500155 ()27228162 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden; Estonian Science Foundation [8621]; Estonian targeted financed project [SF0140027s07]; Estonian Ministry of Education and Research [IUT 19-2]; European Union through the European Regional Development Fund

Available from: 2016-06-27 Created: 2016-06-23 Last updated: 2017-11-28
Yngman Uhlin, P., Fogelberg, A. & Uhlin, F. (2016). Life in standby: hemodialysis patients' experiences of waiting for kidney transplantation.. Journal of Clinical Nursing, 25(1-2), 92-98
Open this publication in new window or tab >>Life in standby: hemodialysis patients' experiences of waiting for kidney transplantation.
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, p. 92-98Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVES: Our aim was to explore the experiences of hemodialysis patients who are waiting for a kidney transplant.

BACKGROUND: Currently, more than 100,000 persons are waiting for kidney transplantation in the United States. In Sweden, the number is exceeding 600. The waiting period for a deceased donor can be one to three years or even longer in Sweden. This can be challenging, since the patients' situation, with chronic treatment and illness, is burdensome and requires advanced self-care.

DESIGN: This study included a purposeful sample of eight patients (33-53 years old) who had been undergoing hemodialysis treatment for at least six months and were waiting for kidney transplantation.

METHODS: The patients were interviewed, and descriptive content analysis was performed.

RESULTS: Four categories emerged: (1) 'The waiting process,' what thoughts and expectations occur and what to do and how to be prepared for the transplant. (2) 'Awareness that time is running out,' patients felt tied up by treatment and by needing to be available for transplantation, and they had concerns about health. (3) 'Need for communication,' patients described needing support from others and continuous information from the staff. (4) 'Having relief and hope for the future,' patients described how to preserve the hope of being able to participate fully in life once again.

CONCLUSIONS: This study reveals the need for extra attention paid to patients waiting for kidney transplantation. Patients' experiences during the waiting period indicate that pretransplant patients have an increased need to be prepared for the transition and for life post-transplantation.

RELEVANCE TO CLINICAL PRACTICE: Dialysis patients on waiting lists must be prepared for the upcoming life change. This includes preserving hope during the waiting period and being mentally prepared for transplantation and a dialysis-free life. A pretransplant education program to prevent medical and psychosocial issues is highly recommended.

Keywords
content analysis; end-stage renal disease; hemodialysis; kidney transplantation; nursing care
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-124011 (URN)10.1111/jocn.12994 (DOI)000368278200008 ()26443674 (PubMedID)
Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2018-03-27
Almroth, G., Lönn, J., Uhlin, F., Brudin, L., Andersson, B. A. & Hahn-Zoric, M. (2016). Sclerostin, TNF-alpha and Interleukin-18 Correlate and are Together with Klotho Related to Other Growth Factors and Cytokines in Haemodialysis Patients. Scandinavian Journal of Immunology, 83(1), 58-63
Open this publication in new window or tab >>Sclerostin, TNF-alpha and Interleukin-18 Correlate and are Together with Klotho Related to Other Growth Factors and Cytokines in Haemodialysis Patients
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2016 (English)In: Scandinavian Journal of Immunology, ISSN 0300-9475, E-ISSN 1365-3083, Vol. 83, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Patients with chronic renal failure are known to have renal osteodystrophy (bone disease) and increased calcification of vessels. A new marker of bone disease, sclerostin, the two pro-inflammatory cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-18 (IL-18), and the fibroblast growth factor-23 (FGF-23) receptor-associated marker Klotho were tested in 84 haemodialysis (HD) patients and in healthy controls. The patients had significantly higher levels of the three former markers than of the controls while Klotho was significantly higher in the controls. Low level, but significant, correlations were observed in the patient group when the levels of these four markers were compared to each other and to those of 5 cytokines and growth factors tested earlier; high-sensitive CRP (hsCRP), interleukin-6 (IL-6), hepatocyte growth factor (HGF), fibroblast growth factor-23 (FGF-23) and soluble urokinase plasminogen activator (suPAR). Ln sclerostin correlated positively to Ln hsTNF-alpha, Ln HGF and Ln suPAR. Ln hsTNF-alpha correlated positively to Ln sclerostin, Ln hsCRP, Ln IL-6, Ln FGF-23, Ln suPAR and Ln IL-18. Ln IL-18 correlated positively to Ln suPAR and Ln TNF-alpha. Ln Klotho correlated negatively to Ln hsCRP but did not correlate to Ln FGF-23. The markers studied here may be involved in the calcification of vessels seen in HD patients due to a combination of inflammation and bone disease. The mechanisms are still not fully known but may be of importance for future therapeutic possibilities in this group of patients.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-124013 (URN)10.1111/sji.12392 (DOI)000366927600009 ()26448366 (PubMedID)
Note

Funding agencies: County Council of ostergotland; Research Council of South Eastern Sweden (FORSS)

Available from: 2016-01-18 Created: 2016-01-18 Last updated: 2017-04-24
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. (2015). Fler patienter fick D-vitaminbrist efter övergång till HDF.. Dialäsen, 4, 19-20
Open this publication in new window or tab >>Fler patienter fick D-vitaminbrist efter övergång till HDF.
2015 (Swedish)In: Dialäsen, ISSN 1104-4616, Vol. 4, p. 19-20Article in journal (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-124388 (URN)
Available from: 2016-01-28 Created: 2016-01-28 Last updated: 2016-04-25
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
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