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  • 1.
    Enberg, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Fridolin, Ivo
    Tallinn University of Technology, Estonia.
    Holmar, Jana
    Tallinn University of Technology, Estonia.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Utilization of UV absorbance for estimation of phosphate elimination during hemodiafiltration2012In: Nephron. Clinical practice, ISSN 1660-8151, E-ISSN 2235-3186, Vol. 121, no 1-2, p. c1-c9Article in journal (Refereed)
    Abstract [en]

    Background: Phosphate is an important factor in explaining the high progress of vascular calcification among dialysis patients. Today, phosphate concentration is measured in plasma on a regular basis. The aim of this study was to find out if it is possible to estimate total removed phosphate (TRp) in spent dialysate utilizing UV absorbance during hemodiafiltration. Methods: Eleven patients were monitored online with UV absorbance at 297 nm, three times during one week each (n = 33). Dialysate samples were taken at different times during treatment and from a collection tank to chemically determine phosphate concentrations. Two mathematical models (UVIND and UVGROUP) were tested to estimate TRp with supervision by UV absorbance and compared with TRp measured in the tank (reference). Results: High correlation between UV absorbance and phosphate concentration for each single patient and lower for the whole group together was found. TRp was (mean +/- SD) 30.7 +/- 7.3 mmol for the reference and 30.8 +/- 8.2 and 29.1 +/- 5.2 mmol for UVIND and UVGROUP, respectively (p > 0.05). Conclusion: This study demonstrates a novel possibility to estimate TRp based on linear relationship between online monitoring of UV absorbance and concentration of phosphate in spent dialysate.

  • 2.
    Eriksson, Annika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Lindelöf-Wastesson, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Ideer och verklighet inom njurmedicin2004In: Dialäsen : tidningen för personal inom njursjukvård, ISSN 1104-4616, Vol. 3, p. 46-46Article in journal (Other academic)
  • 3.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Färre smaklökar bidrar till dålig aptit vid uremi2008In: Dialäsen : tidningen för personal inom njursjukvård, ISSN 1104-4616, Vol. 1, p. 51-54Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Fernström, Anders
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Många mår väl av en längre dialys. Njurvårdens framtid2009Book (Other (popular science, discussion, etc.))
  • 5.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Ny upplaga av svensk lärobok i njurmedicin2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 39, p. 3019-3020Article in journal (Other academic)
  • 6.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Polycystisk sjukdom - en ärftlig sjukdom med hopp om behandling2013In: NjurFunk, ISSN 0347-1365, no 2, p. 12-15Article in journal (Other academic)
  • 7.
    Fernström, Anders
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Ätbeteende och smak vid predialys- och dialys.2009In: Incitament, Vol. 6, p. 381-384Article in journal (Refereed)
  • 8.
    Fernström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences.
    Axelsson, Ingemar
    Fritzson, Peter
    Linköping University, Department of Computer and Information Science.
    Sandholm, Anders
    Linköping University, Department of Computer and Information Science.
    Interactive WYSIWYG Book Software for Teaching Programming2006Conference paper (Refereed)
  • 9.
    Fernström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL. Linköping University, Department of Medical and Health Sciences, Nephrology.
    Giaever, Jan
    Karolinska University.
    Granroth, Barbara
    Sundsvall Hospital.
    Hylander, Britta
    Karolinska University.
    Jensen, Gert
    Sahlgrenska University.
    Christensson, Anders
    Malmo University Hospital.
    Wikstrom, Bjorn
    Akad University.
    Weiss, Lars
    Karlstad Hospital.
    Wrege, Ulf
    Gavle Cent Hospital.
    H Jacobson, Stefan
    Danderyd Hospital.
    Achievement of recommended treatment targets for bone and mineral metabolism in haemodialysis patients using paricalcitol: An observational study2011In: SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY, ISSN 0036-5599, Vol. 45, no 3, p. 196-205Article in journal (Refereed)
    Abstract [en]

    Objective. Secondary hyperparathyroidism (SHPT) is a common problem among patients with chronic kidney disease (CKD) on haemodialysis. This study was conducted to assess the use, effectiveness and safety of intravenous paricalcitol in haemodialysis patients with various degrees of SHPT. Material and methods. This observational, multicentre, prospective study was conducted in 14 Swedish dialysis centres from May 2007 to June 2008 and included 92 haemodialysis patients with a diagnosis of SHPT associated with CKD. The decision to initiate treatment with intravenous paricalcitol was made by the treating physician. No treatment algorithms were provided. Results. Mean patient age was 64 years. Of the 92 patients included, 74 had an intact parathyroid hormone (iPTH) level of andgt; 300 pg/ml at baseline. Median iPTH was 584 pg/ml in patients with a baseline PTH of andgt; 300 pg/ml. During follow-up there was a decrease in iPTH to 323 pg/ml at 6 months (--45%, p andlt; 0.0001). In parallel, there was a small increase in serum calcium, but serum phosphorus and the calcium xx phosphorus product remained unchanged. Conclusions. This study showed that intravenous paricalcitol substantially and safely decreased iPTH in haemodialysis patients with a baseline iPTH above the Kidney Disease Outcomes Quality Initiative recommended target range (150--300 pg/ml) and had minimal impact on serum minerals.

  • 10.
    Fernström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Herrlander Törnquist, Emma
    Nordenryd, Pernilla
    Melander, Stefan
    Frekvent självdialys "Back in the land of the living"2005In: Dialäsen : tidningen för personal inom njursjukvård, ISSN 1104-4616, Vol. 4, p. 31-33Article in journal (Other academic)
  • 11.
    Fernström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences.
    Hylander Rössner, Britta
    Njurmedicinska kliniken, Karolinska universitetssjukhuset, Solna .
    Polycystisk njursjukdom (ADPKD)2015Other (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.
  • 12.
    Fernström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Weiss, Lars
    Njurmedicinska kliniken, Centralsjukhuset, Karlstad.
    Hemodiafiltration - för och emot2013In: Vaskulär medicin, ISSN 2000-3188, Vol. 29, no 3, p. 142-144Article in journal (Other academic)
    Abstract [sv]

    ESHOL-studien är den första RCT som visat skillnad i mortalitet mellan två dialysmetoder. Studiens resultat styrks av de två post hoc-analyserna från CONTRAST-studien och den turkiska studien som båda visat ökad överlevnad i grupper med hög ultrafiltrerad volym. Resultatet torde innebära ökad användning av högvolyms OL-HDF-behandling vid de dialysenheter som har möjlighet att utföra detta.

  • 13.
    Fridolin, Ivo
    et al.
    Tallinn University, Estonia.
    Holmar, Jana
    Tallinn University, Estonia.
    Arund, Jürgen
    Tallinn University, Estonia.
    Tanner, Risto
    Tallinn University, Estonia.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Optical dialysis dose estimation for B2-microglubulin by fluorescencein the spent dialysate2011Conference paper (Refereed)
  • 14.
    Haarhaus, Mathias
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Larsson, Lasse
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Magnusson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of clinical chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Magnusson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology.
    Evaluation of bio-intact (1-84) parathyroid hormone, vitamin D status and bond mineral density in patients with predialysis chronic renal failure2004In: ASN Renal Week,2004, 2004Conference paper (Other academic)
  • 15.
    Haarhaus, Mathias
    et al.
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Nephrology.
    Fernström, Anders
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Magnusson, Martin
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Clinical significance of bone alkaline phosphatase isoforms, including the novel B1x isoform, in mild to moderate chronic kidney disease2009In: NEPHROLOGY DIALYSIS TRANSPLANTATION, ISSN 0931-0509, Vol. 24, no 11, p. 3382-3389Article in journal (Refereed)
    Abstract [en]

    Background. Mineral bone disorder (MBD) is a common complication of chronic kidney disease (CKD) even during the early stages. Bone alkaline phosphatase (BALP) is a marker of bone fort-nation and plays a pivotal role in the mineralization process. Three BALP isoforms (B/I, B1 and B2) have been identified in healthy individuals and a fourth isoform (B1x) has been discovered in serum from dialysis patients. We investigated these BALP isoforms, type I procollagen intact amino-terminal propeptide (PINP), carboxy-terminal telopeptide of type I collagen (CTX) and tartrate-resistant acid phosphatase isoform 5b (TRACP5b), as well as bone mineral density (BMD) in predialysis CKD patients. Methods. PINP, CTX, TRACP5b and BALP isoforms were analysed in serum from 46 patients within CKD stages 3-5. BMD was determined by dual-energy x-ray absorptiometry. Results. PINP, TRACP5b and the BALP isoforms, B/I, B1 and B2, were independent predictors of total hip BMD in all patients. Furthermore, B/I predicted osteopaenia in the hip and in the distal 1/3 of the radius in CKD stage 3. The B1x isoform was detected in nine patients (20%), who had lower GFR, higher phosphate and calcium x phosphate product. Conclusion. We found an association of BALP isoforms and other markers of bone turnover with total hip BMD, which predominantly comprises trabecular bone. The association of the new BALP isoform B1x with risk factors for vascular calcification leads us to hypothesize a possible role for B1x in this process. The significance of the BALP isoforms in CKD remains to be further explored in experimental and clinical settings in conjunction with bone histomorphometry.

  • 16.
    Haarhaus, Mathias
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology. Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology. Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, USA.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry. Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Albert B. Chandler Medical Center, USA.
    A multicenter prospective study of bone alkaline phosphatase isoforms and arterial calcification in chronic kidney disease patients on dialysis2014Manuscript (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.

  • 17.
    Hadimeri, Henrik
    et al.
    Kärnsjukhuset, Skövde, Sweden.
    Frisenette-Fich, Carsten
    Ryhov, Jönköping, Sweden.
    Deurell, Sven-Ingemar
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Svensson, Lars
    Höglandssjukhuset, Eksjö, Sweden.
    Carlsson-Bjering, Lena
    Höglandssjukhuset, Eksjö, Sweden.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Almroth, Gabriel
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Melander, Stefan
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Haarhaus, Mathias
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Andersson, Per-Olof
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Cassel, Agneta
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Mauritz, Nils-Johan
    Ryhov, Jönköping, Sweden.
    Ståhl-Nilsson, Agneta
    Ryhov, Jönköping, Sweden.
    Wilske, Jan
    Värnamo Sjukhus, Sweden .
    Nordström, Kataryna
    Värnamo Sjukhus, Sweden .
    Oruda, Pavel
    Värnamo Sjukhus, Sweden .
    Eriksson, Marie
    Umeå University, Sweden .
    Inghilesi Larsson, Annelie
    Umeå University, Sweden .
    Stegmayr, Bernd
    Umeå University, Sweden .
    A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure2013In: Renal failure, ISSN 0886-022X, E-ISSN 1525-6049, Vol. 35, no 6, p. 845-854Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome.

    METHODS:

    The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 µmol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement.

    RESULTS:

    At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium × phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1.

    CONCLUSIONS:

    However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.

  • 18.
    Holmar, J
    et al.
    Tallin University of Technology, Estonia .
    Fridolin, I
    Tallin University of Technology, Estonia .
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Luman, M
    North Estonian Medical Centre, Estonia .
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Can combined assessment of small molecule uremic markers improve prediction of dialysis patients survival?2014Conference paper (Other academic)
  • 19.
    Holmar, Jana
    et al.
    Tallinn University of Technology, Estonia.
    Fridolin, Ivo
    Tallinn University of Technology, Estonia.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology. Tallinn University of Technology, Estonia.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Luman, Merike
    Tallinn University of Technology, Estonia; North Estonian Medical Centre, Estonia.
    Estimation of dialysis patients survival through combined approach of small molecule uremic markers2014In: Proceedings of the Estonian Academy of Sciences, ISSN 1736-6046, E-ISSN 1736-7530, Vol. 63, no 3, p. 227-233Article in journal (Refereed)
    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.

  • 20.
    Holmar, Jana
    et al.
    Tallinn University of Technology, Estonia.
    Fridolin, Ivo
    Tallinn University of Technology, Estonia.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Luman, Merike
    Estonian Medical Centre, Tallinn, Estonia.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Serum uric acid level and long term survival in dialysis patients2013In: 50th ERA-EDTA Congress, Istanbul, 2013, 2013Conference paper (Other academic)
  • 21.
    Holmar, Jana
    et al.
    Tallin University of Technology, Tallin, Estonia .
    Uhlin, Fredrik
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences.
    Luman, Merike
    Tallin University of Technology, North Estonian Medical Centre, Tallin, Estonia.
    Jankowski, Joachim
    Aachen University , University Hospital Aachen, Germany .
    Fridolin, Ivo
    Tallin University of Technology, Tallin, Estonia.
    An Optical Method for Serum Calcium and Phosphorus Level Assessment during Hemodialysis2015In: Toxins, ISSN 2072-6651, Vol. 7, no 3, p. 719-727Article in journal (Refereed)
    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.

  • 22.
    Holmar, Jana
    et al.
    1Tallinn University of Technology, Department of Biomedical Engineering, Tallinn, Estonia.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences.
    Luman, Merike
    North Estonia, Medical Centre, Centre of Nephrology,Tallinn, Estonia.
    Jankowski, Joachim
    RWTH Aachen University, Institute for Molecular Cardiovascular.
    Fridolin, Ivo
    1Tallinn University of Technology, Department of Biomedical Engineering, Tallinn, Estonia.
    Optical assesment of calcification markers during hemodialysis2015Conference paper (Other academic)
  • 23. Indurain, A
    et al.
    Anderson, Chris D
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Dermatology and Venerology in Östergötland.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Uremic klåda2010In: Incitament, ISSN 1103-503XArticle in journal (Other (popular science, discussion, etc.))
  • 24.
    Indurain, Ainhoa
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Andersson, Chris
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Uremisk klåda och mikrodialys - ett forskningsprojekt.2010In: Incitament, ISSN 1103-503X, Vol. 19, p. 66-67Article in journal (Other academic)
  • 25.
    Indurain, Ainhoa
    et al.
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Anderson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Klåda hos dialyspatienter2007In: Dialäsen : tidningen för personal inom njursjukvård, ISSN 1104-4616, Vol. 3, p. 47-50Article in journal (Other academic)
    Abstract [sv]

    Uremisk klåda är ett stort problem hos patienter med avancerad njursvikt. En enkätstudie på dialyspatienter visade att omfattningen av problemet var större än förväntat. Att tillfredställande behandla uremisk klåda är svårt och många olika behandlingsalternativ finns. Den enda behandlingen som är riktigt effektiv är njurtransplantation.

  • 26.
    Jerotskaja, Jana
    et al.
    n/a.
    Uhlin, Fredrik
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Internal Medicine .
    Fridolin, Ivo
    n/a.
    Fernström, Anders
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Luman, Merike
    n/a.
    Multicenter optical monitoring of removed uremic toxin and cardiovascular risk marker uric acid during dialysis2009In: World Congress of Nephrology, 2009Conference paper (Other (popular science, discussion, etc.))
  • 27.
    Jerotskaja, Jana
    et al.
    Tallinn University Technology.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Östergötlands Läns Landsting, Heart and Medicine Center.
    Fridolin, Ivo
    Tallinn University Technology.
    Lauri, Kai
    Tallinn University Technology.
    Luman, Merike
    North Estonia Medical Centre.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Optical Online Monitoring of Uric Acid Removal during Dialysis2010In: BLOOD PURIFICATION, ISSN 0253-5068, Vol. 29, no 1, p. 69-74Article in journal (Refereed)
    Abstract [en]

    This study estimates the total removal of uric acid (TRUA) by online UV absorbance measurements in the spent dialysate in two different dialysis centers in Estonia and Sweden. Sixteen dialysis patients were included. All dialysate was collected that gave the reference for TRUA. Two regression models were investigated: one for each patient (UV1) and one for the entire material (UV2). TRUA from the three methods was in the same order but showed a statistically significant difference when the UV2 model was built on data from both centers together. TRUA, (n = 56) was (mean +/- SD, mu mol): 5,854 +/- 1,377 for reference, 6,117 +/- 1,795 for UV1 and 5,762 +/- 1,591 for UV2. Six patients were monitored 1 year after the first study session, using the same models as the previous year, still having a nonsignificant difference. The results show the possibility of estimating TRUA by using UV absorbance. The method appeared to be reliable also in long-term patient monitoring.

  • 28.
    Jia, Ting
    et al.
    Karolinska Institute, Sweden .
    Rashid Qureshi, Abdul
    Karolinska Institute, Sweden .
    Brandenburg, Vincent
    Aachen University Hospital, Germany .
    Ketteler, Markus
    Klinikum Coburg, Germany .
    Barany, Peter
    Karolinska Institute, Sweden .
    Heimburger, Olof
    Karolinska Institute, Sweden .
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Lindholm, Bengt
    Karolinska Institute, Sweden .
    Stenvinkel, Peter
    Karolinska Institute, Sweden .
    Larsson, Tobias E.
    Karolinska Institute, Sweden .
    Determinants of Fibroblast Growth Factor-23 and Parathyroid Hormone Variability in Dialysis Patients2013In: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 37, no 5, p. 462-471Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Treatment strategies for abnormal mineral metabolism in chronic kidney disease are largely based on achieving target ranges of biomarkers that vary considerably over time, yet determinants of their variability are poorly defined. Methods: Observational study including 162 patients of three dialysis cohorts (peritoneal dialysis, n = 78; hemodialysis, n = 49; hemodiafiltration, n = 35). Clinical and biochemical determinants of parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) variability were analyzed in the peritoneal dialysis cohort. All cohorts were used for comparison of PTH and FGF23 intra-subject variability (intra-class correlation), and their intra-subject variability in different modes of dialysis was explored. Results: High PTH variability was independently associated with lower 25-hydroxyvitamin D concentration and factors of lipid and glucose metabolism, whereas high FGF23 variability was mainly associated with lower baseline serum phosphorous. These results were consistent in multivariate and sensitivity analyses. The intra-subject variability of FGF23 was lower than for PTH irrespective of dialysis mode. Conclusions: Baseline vitamin D status and serum phosphorous are independent determinants of the longitudinal variation in PTH and FGF23, respectively. The clinical utility of FGF23 measurement remains unknown, yet it appears favorable based on its greater temporal stability than PTH in dialysis patients.

  • 29.
    Kloster Smerud, Hilde
    et al.
    Uppsala University.
    Barany, Peter
    Karolinska Institutet.
    Lindström, Karin
    Karolinska Institutet.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL. Linköping University, Department of Medical and Health Sciences, Nephrology.
    Sandell, Anna
    Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Påhlsson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Fellström, Bengt
    Uppsala University.
    New treatment for IgA nephropathy:  enteric budesonide targeted to the ileocecal region ameliorates proteinuria2011In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 26, no 10, p. 3237-3241Article in journal (Refereed)
    Abstract [en]

    Background. Systemic corticosteroid treatment has been shown to exert some protection against renal deterioration in IgA nephropathy (IgAN) but is not commonly recommended for long-term use due to the well-known systemic side effects. In this study, we investigated the efficacy and safety of a new enteric formulation of the locally acting glucocorticoid budesonide (Nefecon (R)), designed to release the active compound in the ileocecal region. The primary objective was to evaluate the efficacy of targeted release budesonide on albuminuria. less thanbrgreater than less thanbrgreater thanMethods. Budesonide 8 mg/day was given to 16 patients with IgAN for 6 months, followed by a 3-month follow-up period. The efficacy was measured as change in 24-h urine albumin excretion, serum creatinine and estimated glomerular filtration rate (eGFR). less thanbrgreater than less thanbrgreater thanResults. The median relative reduction in urinary albumin excretion was 23% during the treatment period (interquartile range: -0.36 to -0.04, P = 0.04) with pretreatment values ranging from 0.3 to 6 g/24 h (median: 1.5 g/24 h). The median reduction in urine albumin peaked at 40% (interquartile range: -0.58 to -0.15) 2 months after treatment discontinuation. Serum creatinine was reduced by 6% (interquartile range: -0.12 to -0.02; P = 0.003), and eGFR [Modification of Diet in Renal Disease (MDRD)] increased similar to 8% (interquartile range: 0.02-0.16, P = 0.003) during treatment. No major corticosteroid-related side effects were observed. less thanbrgreater than less thanbrgreater thanConclusions. In the present pilot study, enteric budesonide targeted to the ileocecal region had a significant effect on urine albumin excretion, accompanied by a minor reduction of serum creatinine and a modest increase of eGFR calculated by the MDRD equation, while eGFR calculated from Cockcroft-Gault equation and cystatin C was not changed. Enteric budesonide may represent a new treatment of IgAN warranting further investigation.

  • 30.
    Kloster Smerud, Hilde
    et al.
    n/a.
    Bàràny, Peter
    n/a.
    Lindström, Karin
    n/a.
    Fernström, Anders
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Fellström, Bengt
    n/a.
    Enteric budesonide ameliorates albuminuria and glomerular filtration rate in IgA nephropathy patients2009In: World Congress of Nephrology, 2009Conference paper (Other (popular science, discussion, etc.))
  • 31.
    Kloster Smerud, Hilde
    et al.
    n/a.
    Bárány, Peter
    n/a.
    Lindström, Karin
    n/a.
    Fernström, Anders
    Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences.
    Fellström, Bengt
    n/a.
    Enteric budesonide ameliorates albuminuria and glomerular filtration rate in IgA nephropathy patients2009In: World Congress of Nephrology, Satellite Symposium on IgA Nephropathy, 2009Conference paper (Other (popular science, discussion, etc.))
  • 32.
    Osman, Abdimajid
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Uhlin, Fredrik
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Frånlund, Ebba
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Fernström, Anders
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Exon resequencing of the gene encoding UCMA/GRP reveals a common carboxy-terminal 138Thr > Ser Polymorphism2013In: Clinical Laboratory, ISSN 1433-6510, Vol. 59, no 11-12, p. 1397-1401Article in journal (Refereed)
    Abstract [en]

    Background: The upper zone of growth plate and cartilage matrix-associated protein (UCMA), also called Gla-rich protein (GRP), is a novel protein found at sites af-fected by pathological calcifications.Methods: We performed a full exon resequencing on DNA samples from 17 chronic kid-ney disease (CKD) patients (stage 5) and compared the results with 121 healthy con-trols in a Swedish population.Results: A novel non-synonymous single nucleotide polymorphism (SNP) causing a car-boxy-terminal amino acid exchange was found. This SNP involves an alteration of the last ACC codon for threonine in exon 5 (adjacent to the stop codon) to an AGC ser-ine codon (138Thr > Ser). Six controls and two CKD patients were heterozygous for the 138Thr > Ser polymorphism. Both patients had histories of vascular calcifica-tion; however, it is uncertain whether this SNP has any significance for the func-tional domains of the UCMA protein. In addition, a heterozygous transversion muta-tion was found in a patient at SNP rs4750328 (A/G) in intron 2, involving an ex-change of the ancestral A allele to a T base.Conclusions: The 138Thr > Ser polymorphism seems to be the only non-synonymous SNP found in the UCMA gene in a Swedish population.

  • 33. Strömstedt, Lina
    et al.
    Berglund, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Kärlaccessen - en utmaning för njurmedicinare2005In: Dialäsen : tidningen för personal inom njursjukvård, ISSN 1104-4616, Vol. 3, p. 31-33Article in journal (Other academic)
  • 34.
    Tuyet Vuong, Mai
    et al.
    Karolinska Institutet.
    Gunnarsson, Iva
    Karolinska Institutet.
    Lundberg, Sigrid
    Karolinska University Hospital.
    Svenungsson, Elisabet
    Karolinska Institutet.
    Wramner, Lars
    Sahlgrens University Hospital.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Syvanen, Ann-Christine
    Uppsala University.
    Thi Do, Lieu
    Hanoi Med University.
    Jacobson, Stefan H.
    Karolinska Institutet.
    Padyukov, Leonid
    Karolinska Institutet.
    Genetic Risk Factors in Lupus Nephritis and IgA Nephropathy - No Support of an Overlap2010In: PLOS ONE, ISSN 1932-6203, Vol. 5, no 5Article in journal (Refereed)
    Abstract [en]

    Background: IgA nephropathy (IgAN) and nephritis in Systemic Lupus Erythematosus (SLE) are two common forms of glomerulonephritis in which genetic findings are of importance for disease development. We have recently reported an association of IgAN with variants of TGFB1. In several autoimmune diseases, particularly in SLE, IRF5, STAT4 genes and TRAF1-C5 locus have been shown to be important candidate genes. The aim of this study was to compare genetic variants from the TGFB1, IRF5, STAT4 genes and TRAF1-C5 locus with susceptibility to IgAN and lupus nephritis in two Swedish cohorts. Patients and Methods: We genotyped 13 single nucleotide polymorphisms (SNPs) in four genetic loci in 1252 DNA samples from patients with biopsy proven IgAN or with SLE (with and without nephritis) and healthy age-and sex-matched controls from the same population in Sweden. Results: Genotype and allelic frequencies for SNPs from selected genes did not differ significantly between lupus nephritis patients and SLE patients without nephritis. In addition, haplotype analysis for seven selected SNPs did not reveal a difference for the SLE patient groups with and without nephritis. Moreover, none of these SPNs showed a significant difference between IgAN patients and healthy controls. IRF5 and STAT4 variants remained significantly different between SLE cases and healthy controls. In addition, the data did not show an association of TRAF1-C5 polymorphism with susceptibility to SLE in this Swedish population. Conclusion: Our data do not support an overlap in genetic susceptibility between patients with IgAN or SLE and reveal no specific importance of SLE associated SNPs for the presence of lupus nephritis.

  • 35.
    Tuyet Vuong, Mai
    et al.
    Karolinska University Hospital, Sweden .
    Lundberg, Sigrid
    Karolinska University Hospital, Sweden .
    Gunnarsson, Iva
    Karolinska University Hospital, Sweden .
    Wramner, Lars
    Sahlgrens University Hospital, Sweden .
    Lundstrom, Emeli
    Karolinska University Hospital, Sweden .
    Fernström, Anders
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Alfredsson, Lars
    Karolinska Institute, Sweden .
    Jacobson, Stefan H.
    Karolinska Institute, Sweden .
    Padyukov, Leonid
    Karolinska University Hospital, Sweden .
    Genetic evidence for involvement of adaptive immunity in the development of IgA nephropathy: MHC class II alleles are protective in a Caucasian population2013In: Human Immunology, ISSN 0198-8859, E-ISSN 1879-1166, Vol. 74, no 8, p. 957-960Article in journal (Refereed)
    Abstract [en]

    There is evidence suggesting that IgA nephropathy (IgAN) is an immunological disease. The role of FILA class II DR beta 1 (DRB1) has previously not been well studied. The aim of our study was to investigate the association of HLA-DRB1 variants with IgAN in a Swedish Caucasian cohort. Our study consisted of 213 patients with biopsy proven IgAN, all of self-reported Caucasian ancestry. As a control cohort, 1569 healthy subjects from the same population in Sweden were included. HLA-DRB1 low-resolution genotyping was performed and odds ratios were calculated to assess the risk. less thanbrgreater than less thanbrgreater thanIn an allelic model the HLA-DRB1*03 and *10, demonstrated association for IgAN after correction for multiple comparison, with subsequent OR = 0.54 (95% CI 0.37-0.78) and 3.44 (95% Cl 1.67-7.07). When the influence of risk allelic groups was adjusted for protective allelic groups and vice versa, only a protective effect of HLA-DRB1*03 remained significant. less thanbrgreater than less thanbrgreater thanIn conclusion, the variants of HLA-DRB1 were associated with IgAN of which the HLA-DRB1*03 revealed a strong protective effect for IgAN. Our data replicates finding from other Caucasian populations and suggest that involvement of adaptive immunity may be of importance in the development of the disease.

  • 36.
    Tuyet Vuong, Mai
    et al.
    Karolinska Institute.
    Lundberg, Sigrid
    Karolinska University Hospital.
    Gunnarsson, Iva
    Karolinska Institute.
    Wramner, Lars
    Sahlgrens University Hospital.
    Seddighzadeh, Maria
    Karolinska Institute.
    Hahn-Zoric, Mirjana
    Sahlgrenska University Hospital.
    Fernström, Anders
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Hanson, Lars A
    Sahlgrenska University Hospital.
    Thi Do, Lieu
    Hanoi Medical University.
    Jacobson, Stefan H
    Karolinska Institute.
    Padyukov, Leonid
    Karolinska Institute.
    Genetic variation in the transforming growth factor-beta 1 gene is associated with susceptibility to IgA nephropathy2009In: NEPHROLOGY DIALYSIS TRANSPLANTATION, ISSN 0931-0509, Vol. 24, no 10, p. 3061-3067Article in journal (Refereed)
    Abstract [en]

    Background. There is growing evidence of genetic risk for susceptibility to IgA nephropathy. Among several candidate genes related to immunological regulation in renal tissue, TGFB1 is known to be a contributor to proliferation and the development of fibrosis. Methods. We analysed several SNPs in a region of this gene using 212 DNA samples from biopsy-proven IgA nephropathy patients, 146 men and 66 women and 477 healthy age-matched controls (321 men and 156 women) from the same population in Sweden. Results. Frequencies of four out of five selected SNPs (rs6957, rs2241715, rs1800471, rs1982073 and rs1800469) were found to significantly differ between male patients and male controls in a co-dominant model (corrected P andlt;= 0.05) and of two SNPs (rs1982073 and rs1800469) in the allelic model (P andlt;= 0.05 in 100 000 permutation test). Haplotype analysis for five selected SNPs revealed a significant association of TGGCG with protective effect (P = 0.0012, empirical P = 0.006, 100 000 permutations) and of CT-GTA with susceptibility effect (P = 0.0018, empirical P = 0.008, 100 000 permutations). In our study, no association with TGFB1 variations was found when comparing female patients and female controls. No association was found for TGFB1 markers with disease progression for selected individuals from the patients group. In addition, meta-analysis performed for SNP rs1982073 for combined patients and controls from our study together with published data from two independent studies showed a significant association. Conclusions. Our experimental data together with the meta-analysis suggest TGFB1 as an important candidate gene for further biological studies of IgA nephropathy and as a possible target for therapy. Our data also indicate a possibility of a gender effect in the genetic background of IgA nephropathy.

  • 37.
    Tuyet Vuong, Mai
    et al.
    n/a.
    Lundberg, Sigrid
    n/a.
    Gunnarsson, Iva
    n/a.
    Wramner, Lars
    n/a.
    Seddighzadeh, Maria
    n/a.
    Hahn-Zoric, Mirjana
    n/a.
    Fernström, Anders
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
    Hanson, Lars
    n/a.
    Do Lieu, Thi
    n/a.
    Jacobson, Stefan
    n/a.
    Association of the transforming growth factor-b1 gene with IgA nephropathy in Swedish population2009In: World Congress of Nephrology, Satellite Symposium on IgA Nephropathy, 2009Conference paper (Refereed)
  • 38.
    Tuyet Vuong, Mai
    et al.
    n/a.
    Lundberg, Sigrid
    n/a.
    Gunnarsson, Iva
    n/a.
    Wramner, Lars
    n/a.
    Seddighzadeh, Maria
    n/a.
    Hahn-Zoric, Mirjana
    n/a.
    Fernström, Anders
    Linköping University, Department of Medicine and Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences.
    Hanson, Lars
    n/a.
    Do Lieu, Thi
    n/a.
    Jacobson, Stefan
    n/a.
    Genetic polymorphism in FCAR may regulate levels of Fc alpha receptor (CD89) in plasma but do not influence the susceptibility for IgA nephropathy2009In: World Congress of Nephrology, Satellite Symposium on IgA Nephropathy, 2009Conference paper (Refereed)
  • 39.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Från traditionell hemodialys (HD) till hemodiafiltration (HDF)2010In: Incitament, ISSN 1103-503X, no 2, p. 135-139Article in journal (Other (popular science, discussion, etc.))
  • 40.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Tallinn Univ Technol, Estonia.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology.
    Knapen, Marjo H. J.
    Maastricht Univ, Netherlands.
    Vermeer, Cees
    Maastricht Univ, Netherlands.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Long-term follow-up of biomarkers of vascular calcification after switch from traditional hemodialysis to online hemodiafiltration2019In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 3, p. 174-181Article in journal (Refereed)
    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.

  • 41.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Holmar, Jana
    Tallinn University of Technology, Estonia .
    Yngman-Uhlin, Pia
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Fridolin, Ivo
    Tallinn University of Technology, Estonia .
    DIALYSDOSEN UPPSKATTAD MED NY MARKÖR - BETA 2-MIKROGLOBULIN (β2M)2012Conference paper (Other academic)
  • 42.
    Uhlin, Fredrik
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Holmar, Jana
    Technomedicum, Tallinn University of Technology, Tallinn, Estonia.
    Yngman-Uhlin, Pia
    Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Fernström, Anders
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Fridolin, Ivo
    Technomedicum, Tallinn University of Technology, Tallinn, Estonia.
    Optical Estimation of Beta 2 Microglobulin during Hemodiafiltration - Does It Work?2015In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 40, no 2, p. 113-119Article in journal (Refereed)
    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.

  • 43.
    Uhlin, Fredrik
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Tallin University of Technology, Tallin, Estonia.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Larsson, Tobias E
    Karolinska Instituet, Karolinska University Hospital, Stockholm.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences.
    In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration.2015In: Clinical Nephrology, ISSN 0301-0430, Vol. 83, no 6, p. 315-21Article in journal (Refereed)
    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.

  • 44.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Magnusson, Per
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Larsson, Tobias
    Njurmedicinska kliniken, Karolinska Universitetssjukhuset, Stockholm.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Minskade nivåer av 25-hydroxyvitamin D i serum efter byte till online hemodiafiltration2014Conference paper (Other academic)
  • 45.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology.
    Odar-Cederlöf, Ingegerd
    Karolinska University Hospital, Huddinge, Stockholm .
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences.
    Vasoactive Peptide Levels after Change of Dialysis Mode.2015In: Nephron Extra, ISSN 1664-5529, Vol. 5, no 3, p. 68-78Article in journal (Refereed)
    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.

  • 46.
    Uhlin, Fredrik
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology.
    Pettersson, Jonas
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering.
    Fernström, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nephrology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Lindberg, Lars-Göran
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Physiological Measurements.
    A new parameter for dialysis efficiency2007In: World Congress of Nephrology, wcn2007,2007, 2007Conference paper (Refereed)
  • 47.
    Uhlin, Fredrik
    et al.
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Pettersson, Jonas
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Fernström, Anders
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Complementary parameter for dialysis monitoring based on UV absorbance2009In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 4, p. 492-497Article in journal (Refereed)
    Abstract [en]

    An optical on-line monitoring system aimed at the estimation of dialysis dose has been tested clinically. The natural logarithmic slope is used to calculate Kt/V(urea) from ultraviolet (UV)-absorbance measurements. Errors in the calculation of Kt/V(urea) may appear due to changes in blood and dialysate flow or due to disturbances when the slope is used to estimate dialysis dose. This study introduces a new parameter for dialysis monitoring that may be used as a complementary parameter, the area under UV-absorbance curve (AUCa), to reflect a total solute removal during dialysis. The aim was to investigate the relationship between this new dialysis on-line monitoring parameter, AUCa, and the total removal of a few solutes. Fifteen patients were monitored during hemodialysis using UV absorbance at the wavelength of 297 nm. All spent dialysate passed through a flow cuvette in a spectrophotometer and then further to a collection tank where solute concentrations in the entire spent dialysate were determined. The AUCa at 297 nm was compared with the total amount of removed solute in the tank (reference method). The result shows strong correlations between AUCa and the total removal of urea, urate, creatinine, and phosphate during a given treatment and less strong correlation in all 15 patients together. A first indication of a new, possible, complementary parameter in hemodialysis treatment is presented, the AUCa, prospected to estimate solute removal.

  • 48.
    Uhlin, Fredrik
    et al.
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences.
    Yngman-Uhlin, Pia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Jerotskaja, Jana
    n/a.
    Fridolin, Ivo
    n/a.
    Fernström, Anders
    Östergötlands Läns Landsting, Centre for Medicine, Department of Nephrology UHL. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences.
    On-line Monitoring of Middle Molecule Removal during HemoDiaFiltration - does it work?2009In: ASN (F-P01520), 2009Conference paper (Refereed)
  • 49.
    Vuong, Mai
    et al.
    Karolinska Institute.
    Gunnarsson, Iva
    Karolinska Institute.
    Lundberg, Sigrid
    Karolinska Institute.
    Wramner, Lars
    Sahlgrens University Hospital.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Syvanen, Ann-Christine
    Uppsala University.
    Do, Lieu
    Hanoi Medical University.
    Jacobson, Stefan
    Karolinska Institute.
    Padyukov, Leonid
    Karolinska Institute.
    Genetic Study of IgA Nephropathy and Lupus Nephritis: No Overlap in Genetic Risk Factors in CLINICAL IMMUNOLOGY, vol 135, issue , pp S114-S1142010In: CLINICAL IMMUNOLOGY, Elsevier Science B.V., Amsterdam , 2010, Vol. 135, p. S114-S114Conference paper (Refereed)
    Abstract [en]

    n/a

  • 50.
    Vuong, Mai T
    et al.
    Karolinska Institute.
    Hahn-Zoric, Mirjana
    Sahlgrens University Hospital.
    Lundberg, Sigrid
    Karolinska University Hospital.
    Gunnarsson, Iva
    Karolinska Institute.
    van Kooten, Cees
    Leiden University.
    Wramner, Lars
    Sahlgrens University Hospital.
    Seddighzadeh, Maria
    Karolinska Institute.
    Fernström, Anders
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Nephrology UHL.
    Hanson, Lars A
    Sahlgrens University Hospital.
    Thi Do, Lieu
    Hanoi Med University.
    Jacobson, Stefan H
    Karolinska Institute.
    Padyukov, Leonid
    Karolinska Institute.
    Association of soluble CD89 levels with disease progression but not susceptibility in IgA nephropathy2010In: KIDNEY INTERNATIONAL, ISSN 0085-2538, Vol. 78, no 12, p. 1281-1287Article in journal (Refereed)
    Abstract [en]

    The Fc-alpha receptor (Fc alpha R/CD89) is involved in IgA complex formation and may affect the development of IgA nephropathy (IgAN). In this study, we tested the genetic variations of the CD89 gene in relation to disease susceptibility in IgAN and the expression of soluble CD89 (sCD89) in sera of patients with IgAN and in controls. There was a significant difference between the levels of sCD89-IgA complexes, measured by sandwich enzyme-linked immunosorbent assay (ELISA), in 177 patients with IgAN with and without disease progression at the time of first diagnosis. No such difference was found in 42 patients with other renal diseases. The patients with IgAN without disease progression had stable but high levels of sCD89 over 5-15 years of follow-up in contrast to stable but low levels of sCD89 in the disease progression group. Moreover, levels of sCD89 complexes were correlated with one of the five CD89 genetic variants in 212 patients with IgAN and 477 healthy Caucasians; the single-nucleotide polymorphism (SNP) rs11084377 was significantly associated with a lower expression of sCD89. However, no association between CD89 gene polymorphisms and susceptibility to IgAN was detected. Thus, we found an association between the levels of sCD89-IgA complexes in serum and the severity of IgAN, and a possible genetic component in regulating the production or expression of sCD89.

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