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  • 1.
    Andersson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wikberg, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lithner, Folke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Renal symtomatology in patients with acute intermitent porphyria2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, p. 319-325Article in journal (Refereed)
    Abstract [en]

    Objective: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?

    Design: A population-based study.

    Subjects: Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.

    Interventions: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.

    Results: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.

    Conclusion: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.

  • 2. Arsov, S.
    et al.
    Trajceska, L.
    van Oeveren, W.
    Smit, A. J.
    Dzekova, P.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sikole, A.
    Rakhorst, G.
    Graaff, R.
    The influence of body mass index on the accumulation of advanced glycation end products in hemodialysis patients2015In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, no 3, p. 309-313Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The level of skin autofluorescence (AF) at a given moment is an independent predictor of mortality in hemodialysis (HD) patients. Skin AF is a measure of the accumulation of advanced glycation end products (AGEs). The aim of the study was to estimate the influence of nutrition on the 1-year increase of skin AF (Delta AF) in HD patients.

    SUBJECTS/METHODS: A total of 156 HD patients were enrolled in this study. Skin AF, body mass index (BMI), superoxide dismutase, myeloperoxidase, C-reactive protein, inter-cellular adhesion molecule-1, von Willebrand factor and heart-type fatty acid-binding protein were measured four times at intervals of approximately half a year. Data from the monthly routine blood analysis were also used. Daily calorie, protein and AGE intakes were assessed from food recordings over a period of 1 week.

    RESULTS: A J-shaped relation was found between baseline BMI and Delta AF (P = 0.01). The lowest point of the J-shaped curve is found for BMI = 24.3 kg/m(2). In the univariate analysis of the contributors to the 1-year Delta AF, we found that beside BMI = 24.3 kg/m(2), AGE and calorie intakes, as well as myeloperoxidase and HD vintage, had a P < 0.10. The sole independent predictor of the 1-year Delta AF was BMI = 24.3 kg/m(2) (P = 0.01).

    CONCLUSIONS: It appears that calorie, protein and AGE intakes hardly influence the 1-year Delta AF in HD patients. BMI of HD patients of around 24 kg/m(2) resulted in a lower 1-year Delta AF.

  • 3. Arsov, S.
    et al.
    Trajceska, L.
    van Oeveren, W.
    Smit, A. J.
    Vidimliski, P. Dzekova
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sikole, A.
    Rakhorst, G.
    Graaff, R.
    The use of a skin age reader to evaluate risk of cvd and mortality in dialysis patients2011In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, no 8, p. 606-606Article in journal (Other academic)
  • 4. Arsov, S.
    et al.
    Vidimliski, P. Dzekova
    Trajceska, L.
    Graaff, R.
    van Oeveren, W.
    Smit, A. J.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Schalkwijk, C.
    Sikole, A.
    Rakhorst, G.
    Accumulation rate of ages in the skin biopsy tissue of dialysis patients2011In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, no 8, p. 650-650Article in journal (Other academic)
  • 5. Arsov, Stefan
    et al.
    Graaff, Reindert
    Morariu, Aurora M
    van Oeveren, Wim
    Smit, Andries J
    Busletic, Irena
    Trajcevska, Lada
    Selim, Gjulsen
    Dzekova, Pavlina
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sikole, Aleksandar
    Rakhorst, Gerhard
    Does hepatitis C increase the accumulation of advanced glycation end products in haemodialysis patients?2010In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 25, no 3, p. 885-891Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hepatitis C may cause increased levels of oxidative stress that contribute to accumulation of advanced glycation end products (AGEs), which increase the risk of cardiovascular disease (CVD). The aim of this study was to determine the influence of hepatitis C on AGE accumulation in haemodialysis patients. METHODS: AGE accumulation was measured by means of skin autofluorescence (AF) in 92 haemodialysis (HD) patients and 93 age-matched healthy controls. In the HD patients, CVD-related biochemical variables were also measured. The HD patients were tested for hepatitis C virus (HCV) antibodies and allocated to a HCV+ or HCV- group. RESULTS: Skin AF of the healthy subjects was lower than skin AF in the HD patients (3.13 +/- 0.95 vs 2.2 +/- 0.47; P < 0.001). We calculated the average increase of skin AF in the healthy subjects to be 0.017 arbitrary units per year, being 14 times lower than in HD patients with CVD only and 20 times lower than in HD patients suffering from combined CVD and diabetes mellitus (DM). Multivariate regression analysis showed that AGE accumulation in HD patients can be described by the independent effects of age, DM, CVD and HD vintage. Although inter-cellular adhesion molecule 1 and liver enzymes were elevated in HCV+ HD patients, levels of oxidative stress markers and skin AF were not significantly different between HCV+ and HCV- HD patients. CONCLUSIONS: AGE accumulation was higher in the HD patients than in the healthy controls. AGE accumulation did not differ in HCV+ and HCV- HD patients. This might be due to the fact that hepatitis C did not cause oxidative stress in our HD population. Independent markers of AGE accumulation were age, HD vintage, DM and CVD, but not hepatitis C.

  • 6. Arsov, Stefan
    et al.
    Graaff, Reindert
    van Oeveren, Wim
    Stegmayr, Bernd
    Sikole, Aleksandar
    Rakhorst, Gerhard
    Smit, Andries J.
    Advanced glycation end-products and skin autofluorescence in end-stage renal disease: a review2014In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 52, no 1, SI, p. 11-20Article, review/survey (Refereed)
    Abstract [en]

    Chronic kidney disease (CKD), especially in its end stage, is marked by extremely high cardiovascular rates of morbidity and mortality; hemodialysis patients have a five-fold shorter life expectancy than healthy subjects of the same age. In CKD the metabolic products that accumulate in the body are so-called uremic toxins. These include advanced glycation end-products (AGE). AGE levels are markedly increased in CKD patients not only because of impaired excretion but also because of increased production. AGE formation has initially been described as a non-enzymatic reaction between proteins and glucose in the so-called Maillard reaction, but they are also more rapidly formed during oxidative stress and subsequent formation of reactive carbonyl compounds like (methyl) glyoxal. AGE accumulate in tissue where they cross-link with proteins, e. g., collagen, inducing tissue stiffening of blood vessels and skin. They may also interact with receptor of AGE (RAGE) and other receptors, which lead to activation of intracellular transduction mechanisms resulting in cytokine release and further tissue damage in CKD. The accumulation of AGE in the skin can be measured non-invasively using autofluorescence. The skin autofluorescence is a strong marker of cardiovascular mortality in CKD. The focus of this review is on the role of tissue and plasma AGE, and of skin autofluorescence as a proxy of tissue AGE accumulation, in the increase in cardiovascular disease in end stage renal disease (ESRD). This review will also present the possibility of reducing the AGE accumulation in ESRD patients using the following five methods: 1) use of low AGE peritoneal dialysis solutions; 2) use of advanced hemodialysis techniques; 3) use of AGE reducing drugs; 4) optimizing the nutrition of hemodialysis patients; and 5) renal transplantation.

  • 7. Arsov, Stefan
    et al.
    Trajceska, Lada
    van Oeveren, Wim
    Smit, Andries J
    Dzekova, Pavlina
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Sikole, Aleksandar
    Rakhorst, Gerhard
    Graaff, Reindert
    Increase in skin autofluorescence and release of heart-type fatty acid binding protein in plasma predicts mortality of hemodialysis patients2013In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 37, no 7, p. E114-E122Article in journal (Refereed)
    Abstract [en]

    Advanced glycation end-products (AGEs) are uremic toxins that accumulate progressively in hemodialysis (HD) patients. The aim of this study was to assess the 1-year increase in skin autofluorescence (DAF), a measure of AGEs accumulation and plasma markers, as predictors of mortality in HD patients. One hundred sixty-nine HD patients were enrolled in this study. Skin autofluorescence was measured twice, 1 year apart using an AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). Besides routine blood chemistry, additional plasma markers including superoxide dismutase, myeloperoxydase, intercellular adhesion molecule 1 (ICAM-1), C-reactive protein (hs-CRP), heart-type fatty acid binding protein (H-FABP), and von Willebrand factor were measured at baseline. The mortality of HD patients was followed for 36 months. Skin autofluorescence values of the HD patients at the two time points were significantly higher (P < 0.001) than those of healthy subjects of the same age. Mean 1-year DAF of HD patients was 0.16 +/- 0.06, which was around seven-to ninefold higher than 1-year DAF in healthy subjects. Multivariate Cox regression showed that age, hypertension, 1-year DAF, hs-CRP, ICAM-1, and H-FABP were independent predictors of overall mortality. Hypertension, 1-year DAF, hs-CRP, and H-FABP were also independent predictors of cardiovascular mortality. One-year DAF and plasma H-FABP, used separately and in combination, are strong predictors of overall and cardiovascular mortality in HD patients.

  • 8.
    Brändstrom, H.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Rydvall, A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Stegmayr, B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Söderberg-Svanström, J.
    Wikdahl, A. M.
    [A killer bacteria caused fasciitis with sepsis. Prompt handling saved the patient's life]1996In: Lakartidningen, Vol. 93, no 42, p. 3687-9Article in journal (Refereed)
    Abstract [sv]

    The article consists in a case report of a patient with rapidly progressive pain in the axillary region and deterioration in his clinical condition during the course of a skin infection, found to have pectoral muscle fascitis, and in whom progressive septic shock was accompanied by multiorgan failure. Blood culture yielded streptococci group A type 1 M1. In addition to conventional intensive care, he was treated with antibiotics, inotropic drugs, plasma exchange, and infusion of antithrombin and immunoglobulin. Surgical intervention such as fasciotomy was avoided initially and later proved unnecessary as the patient recovered well.

  • 9.
    Brännström, Thomas
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Forsberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Ch.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Micro embolies of air are deposited in the organs in hemodialysis patients: a case report2011In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, no 8, p. 636-636Article in journal (Other academic)
  • 10. Cohen, Gerald
    et al.
    Glorieux, Griet
    Thornalley, Paul
    Schepers, Eva
    Meert, Natalie
    Jankowski, Joachim
    Jankowski, Vera
    Argiles, Angel
    Anderstam, Björn
    Brunet, Philippe
    Cerini, Claire
    Dou, Laetitia
    Deppisch, Reinhold
    Marescau, Bart
    Massy, Ziad
    Perna, Alessandra
    Raupachova, Jana
    Rodriguez, Mariano
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Vanholder, Raymond
    Hörl, Walter H
    Review on uraemic toxins III: recommendations for handling uraemic retention solutes in vitro towards a standardized approach for research on uraemia.2007In: Nephrol Dial Transplant, ISSN 0931-0509, Vol. 27Article in journal (Refereed)
  • 11. Duranton, Flore
    et al.
    Palma, Alfonso
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wauthier, Michel
    Torres, Armando
    Argilés, Angel
    Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes2018In: Kidney and Blood Pressure Research, ISSN 1420-4096, E-ISSN 1423-0143, Vol. 43, no 5, p. 1529-1538Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Climate influences the regulation of blood pressure (BP). Our objective was to precisely estimate BP seasonality in hemodialysis (HD) patients from five European cities with marked climate differences. Methods: Stable prevalent HD patients from 5 European facilities (Santa Cruz de Tenerife (Spain), Seville (Spain), Montpellier (France), Ottignies (Belgium), Umea (Sweden)) present over the years 1995-1999 were included in this historical longitudinal observational study. Individual monthly averages of pre-dialysis BP level were computed from all facility BP measurements (>90 000 observations). The association between BP level and location, seasons and meteorological measurements was analyzed by mixed models. Results: 261 patients were included and followed-up for a median duration of 2 years (6903 monthly observations). Pre-dialysis SBP and DBP were minimal in summer (July) and maximal in winter (November and December), and mean changes were respectively 4.2 [3.0;5.4] and 2.0 [1.3;2.7] mmHg. Seasonality was confirmed in 4 locations (P-season <= 0.0010.001 for SBP and DBP), but not in Umea (both P-season >0.05). Seasonal changes in DBP were larger in southern locations (P-interaction =0.02). BP level was associated with climate parameters: in a positive manner with humidity or rainfall, and inversely with sunshine duration or temperature. The effects of temperature and rainfall on DBP varied with latitude (P-interaction <0.02) and were greater in southern locations. Conclusion: BP varies with seasons and climate in different European areas and seasonality can be more important in southern locations. These changes in BP deserve attention as they may be responsible for a significant increase in cardiovascular risk which may be preventable.

  • 12. Engert, Andreas
    et al.
    Balduini, Carlo
    Brand, Anneke
    Coiffier, Bertrand
    Cordonnier, Catherine
    Doehner, Hartmut
    de Wit, Thom Duyvene
    Eichinger, Sabine
    Fibbe, Willem
    Green, Tony
    de Haas, Fleur
    Iolascon, Achille
    Jaffredo, Thierry
    Rodeghiero, Francesco
    Salles, Gilles
    Schuringa, Jan Jacob
    Andre, Marc
    Andre-Schmutz, Isabelle
    Bacigalupo, Andrea
    Bochud, Pierre-Yves
    den Boer, Monique
    Bonini, Chiara
    Camaschella, Clara
    Cant, Andrew
    Cappellini, Maria Domenica
    Cazzola, Mario
    Lo Celso, Cristina
    Dimopoulos, Meletios
    Douay, Luc
    Dzierzak, Elaine
    Einsele, Hermann
    Ferreri, Andres
    De Franceschi, Lucia
    Gaulard, Philippe
    Gottgens, Berthold
    Greinacher, Andreas
    Gresele, Paolo
    Gribben, John
    de Haan, Gerald
    Hansen, John-Bjarne
    Hochhaus, Andreas
    Kadir, Rezan
    Kaveri, Srini
    Kouskoff, Valerie
    Kuehne, Thomas
    Kyrle, Paul
    Ljungman, Per
    Maschmeyer, Georg
    Mendez-Ferrer, Simon
    Milsom, Michael
    Mummery, Christine
    Ossenkoppele, Gert
    Pecci, Alessandro
    Peyvandi, Flora
    Philipsen, Sjaak
    Reitsma, Pieter
    Maria Ribera, Jose
    Risitano, Antonio
    Rivella, Stefano
    Ruf, Wolfram
    Schroeder, Timm
    Scully, Marie
    Socie, Gerard
    Staal, Frank
    Stanworth, Simon
    Stauder, Reinhard
    Stilgenbauer, Stephan
    Tamary, Hannah
    Theilgaard-Monch, Kim
    Thein, Swee Lay
    Tilly, Herve
    Trneny, Marek
    Vainchenker, William
    Vannucchi, Alessandro Maria
    Viscoli, Claudio
    Vrielink, Hans
    Zaaijer, Hans
    Zanella, Alberto
    Zolla, Lello
    Zwaginga, Jaap Jan
    Martinez, Patricia Aguilar
    van den Akker, Emile
    Allard, Shubha
    Anagnou, Nicholas
    Andolfo, Immacolata
    Andrau, Jean-Christophe
    Angelucci, Emanuele
    Anstee, David
    Aurer, Igor
    Avet-Loiseau, Herve
    Aydinok, Yesim
    Bakchoul, Tamam
    Balduini, Alessandra
    Barcellini, Wilma
    Baruch, Dominique
    Baruchel, Andre
    Bayry, Jagadeesh
    Bento, Celeste
    van den Berg, Anke
    Bernardi, Rosa
    Bianchi, Paola
    Bigas, Anna
    Biondi, Andrea
    Bohonek, Milos
    Bonnet, Dominique
    Borchmann, Peter
    Borregaard, Niels
    Braekkan, Sigrid
    van den Brink, Marcel
    Brodin, Ellen
    Bullinger, Lars
    Buske, Christian
    Butzeck, Barbara
    Cammenga, Jorg
    Campo, Elias
    Carbone, Antonino
    Cervantes, Francisco
    Cesaro, Simone
    Charbord, Pierre
    Claas, Frans
    Cohen, Hannah
    Conard, Jacqueline
    Coppo, Paul
    Vives Corrons, Joan-Lluis
    da Costa, Lydie
    Davi, Frederic
    Delwel, Ruud
    Dianzani, Irma
    Domanovic, Dragoslav
    Donnelly, Peter
    Drnovsek, Tadeja Dovc
    Dreyling, Martin
    Du, Ming-Qing
    Dufour, Carlo
    Durand, Charles
    Efremov, Dimitar
    Eleftheriou, Androulla
    Elion, Jacques
    Emonts, Marieke
    Engelhardt, Monika
    Ezine, Sophie
    Falkenburg, Fred
    Favier, Remi
    Federico, Massimo
    Fenaux, Pierre
    Fitzgibbon, Jude
    Flygare, Johan
    Foa, Robin
    Forrester, Lesley
    Galacteros, Frederic
    Garagiola, Isabella
    Gardiner, Chris
    Garraud, Olivier
    van Geet, Christel
    Geiger, Hartmut
    Geissler, Jan
    Germing, Ulrich
    Ghevaert, Cedric
    Girelli, Domenico
    Godeau, Bertrand
    Goekbuget, Nicola
    Goldschmidt, Hartmut
    Goodeve, Anne
    Graf, Thomas
    Graziadei, Giovanna
    Griesshammer, Martin
    Gruel, Yves
    Guilhot, Francois
    von Gunten, Stephan
    Gyssens, Inge
    Halter, Jorg
    Harrison, Claire
    Harteveld, Cornelis
    Hellstrom-Lindberg, Eva
    Hermine, Olivier
    Higgs, Douglas
    Hillmen, Peter
    Hirsch, Hans
    Hoskin, Peter
    Huls, Gerwin
    Inati, Adlette
    Johnson, Peter
    Kattamis, Antonis
    Kiefel, Volker
    Kleanthous, Marina
    Klump, Hannes
    Krause, Daniela
    Hovinga, Johanna Kremer
    Lacaud, Georges
    Lacroix-Desmazes, Sebastien
    Landman-Parker, Judith
    LeGouill, Steven
    Lenz, Georg
    von Lilienfeld-Toal, Marie
    von Lindern, Marieke
    Lopez-Guillermo, Armando
    Lopriore, Enrico
    Lozano, Miguel
    MacIntyre, Elizabeth
    Makris, Michael
    Mannhalter, Christine
    Martens, Joost
    Mathas, Stephan
    Matzdorff, Axel
    Medvinsky, Alexander
    Menendez, Pablo
    Migliaccio, Anna Rita
    Miharada, Kenichi
    Mikulska, Malgorzata
    Minard, Veronique
    Montalban, Carlos
    de Montalembert, Mariane
    Montserrat, Emili
    Morange, Pierre-Emmanuel
    Mountford, Joanne
    Muckenthaler, Martina
    Mueller-Tidow, Carsten
    Mumford, Andrew
    Nadel, Bertrand
    Navarro, Jose-Tomas
    el Nemer, Wassim
    Noizat-Pirenne, France
    O'Mahony, Brian
    Oldenburg, Johannes
    Olsson, Martin
    Oostendorp, Robert
    Palumbo, Antonio
    Passamonti, Francesco
    Patient, Roger
    de Latour, Regis Peffault
    Pflumio, Francoise
    Pierelli, Luca
    Piga, Antonio
    Pollard, Debra
    Raaijmakers, Marc
    Radford, John
    Rambach, Ralf
    Rao, A. Koneti
    Raslova, Hana
    Rebulla, Paolo
    Rees, David
    Ribrag, Vincent
    Rijneveld, Anita
    Rinalducci, Sara
    Robak, Tadeusz
    Roberts, Irene
    Rodrigues, Charlene
    Rosendaal, Frits
    Rosenwald, Andreas
    Rule, Simon
    Russo, Roberta
    Saglio, Guiseppe
    Sanchez, Mayka
    Scharf, Ruediger E.
    Schlenke, Peter
    Semple, John
    Sierra, Jorge
    So-Osman, Cynthia
    Manuel Soria, Jose
    Stamatopoulos, Kostas
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stunnenberg, Henk
    Swinkels, Dorine
    Taborda Barata, Joao Pedro
    Taghon, Tom
    Taher, Ali
    Terpos, Evangelos
    Thachil, Jecko
    Tissot, Jean Daniel
    Touw, Ivo
    Toye, Ash
    Trappe, Ralf
    Traverse-Glehen, Alexandra
    Unal, Sule
    Vaulont, Sophie
    Viprakasit, Vip
    Vitolo, Umberto
    van Wijk, Richard
    Wojtowicz, Agnieszka
    Zeerleder, Sacha
    Zieger, Barbara
    The European Hematology Association Roadmap for European Hematology Research: a consensus document2016In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 101, no 2, p. 115-208Article in journal (Refereed)
    Abstract [en]

    The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at (sic)23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap. The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders. The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients.

  • 13.
    Forsberg, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Air contamination during medical treatment results in deposits of microemboli in the lungs: an autopsy study2019In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 42, no 9, p. 477-481Article in journal (Refereed)
    Abstract [en]

    Introduction: Microbubbles of air may enter into patients during conventional hemodialysis, infusions of fluids, or by injections. The aim of this study was to investigate whether the air that enters the patient during hemodialysis can be detected in the lungs after death, and if so, whether this may be related to tissue damage. Methods: The material consisted of lung tissue from five chronic hemodialysis patients who died either during (two) or after hemodialysis (range 10 min from start until 3333 min after the last hemodialysis session); as reference group tissue was taken from seven patients who died due to amyotrophic lateral sclerosis. The lung tissue was investigated by microscopy after autopsy using a fluorescein-marked polyclonal antibody against fibrinogen as a marker for clots preformed before death. Results: All five hemodialysis patients had microbubbles of air in the lung tissue, whereas two of seven amyotrophic lateral sclerosis patients had such findings (Fisher's test p = 0.0278, relative risk = 3.5, confidence interval: 1.08-11.3). There were more microbubbles of air/10 randomly investigated microscopic fields of tissue in the hemodialysis patients than the amyotrophic lateral sclerosis patients (Student's test, p < 0.05). All hemodialysis patients had a medium graded extent of pulmonary fibrosis that was not found in any of the ALS patients. The microbubbles of air were surrounded by fibrin as a sign of development of clots around the air bubbles while the patients were still alive. Conclusion: Exposure to microbubbles of air during various treatments such as hemodialysis may result in microemboli. Future studies should clarify whether microbubbles of air contribute to tissue scarring. We suggest preventive measures against the exposure to microbubbles of air during especially repeated exposures such as hemodialysis.

  • 14.
    Forsberg, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A high blood level in the air trap reduces microemboli during hemodialysis2012In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 36, no 6, p. 525-529Article in journal (Refereed)
    Abstract [en]

    Previous studies have demonstrated the presence of air microemboli in the dialysis circuit and in the venous circulation of the patients during hemodialysis. In vitro studies indicate that a high blood level in the venous air trap reduces the extent of microbubble formation. The purpose of this study was to examine whether air microbubbles can be detected in the patient's access and if so, whether the degree of microbubble formation can be altered by changing the blood level in the venous air trap. This was a randomized, double-blinded, interventional study of 20 chronic hemodialysis patients. The patients were assigned to hemodialysis with either an elevated or a low blood level in the air trap. The investigator and the patient were blinded to the settings. The numbers of microbubbles were measured at the site of the arteriovenous (AV) access for 2 min with the aid of an ultrasonic Doppler device. The blood level in the air trap was then altered to the opposite setting and a new measurement was carried out after an equilibration period of 30 min. Median (range) for the number of microbubbles measured with the high air trap level and the low air trap level in AV access was 2.5 (0-80) compared with 17.5 (0-77), respectively (P = 0.044). The degree of microbubble formation in hemodialysis patients with AV access was reduced significantly if the blood level in the air trap was kept high. The exposure of potentially harmful air microbubbles was thereby significantly reduced. This measure can be performed with no additional healthcare cost.

  • 15.
    Forsberg, Ulf
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Medicin-geriatriska kliniken, Skellefteå lasarett.
    Jonsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Microemboli, developed during haemodialysis, pass the lung barrier and may cause ischaemic lesions in organs such as the brain2010In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 25, no 8, p. 2691-2695Article in journal (Refereed)
    Abstract [en]

    The infused and returning fluid from HD devices contains air microbubbles that enter the patient without triggering any alarms. These small emboli pass the lung and may cause ischaemic lesions in organs supported by the arterial circuit, such as the brain.

  • 16.
    Fransson, Filip
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kyrk, Tobias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Skagerlind, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rinsing the extra corporeal circuit with a heparin and albumin solution reduces the need for systemic anticoagulant in hemodialysis2013In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 36, no 10, p. 725-729Article in journal (Refereed)
    Abstract [en]

    Background: Systemic anticoagulation during hemodialysis (HD) increases the risk for bleeding complications pre- or post-operatively. Based on the concept of blood-membrane interaction, we developed a heparin-albumin solution to rinse the dialysis circuit before start. The aim of this study was to investigate if this method was a valuable tool for our patients at risk for bleeding complications.

    Material and methods: This retrospective, comparative, quality assessment study included 248 HD in 68 patients; Group 1: 178 treatments were performed at patients for risk of bleeding using heparin-albumin-priming and Group 2: 70 acute HD were performed on patients without increased risk of bleeding using a bolus of heparin at start and a continuous infusion of heparin. In Group 1 additional heparin was given upon suspicion of progressive clotting. One L saline contained albumin (1 g/I) and heparin (5000 U/I) used for priming. Excess priming solution was removed by filling the circuit with blood at start of treatment.

    Results: In Group 1, a mean total dose of 2000 U of heparin was given during the HD (18% performed HD without any heparin) and Group 2 used a mean total dose of 5500 U (p<0.001). There was no increased incidence of clotting in Group 1 versus Group 2 compared to standard HD. No bleeding complications were reported during any of the HA-priming treatments.

    Conclusions: Heparin-albumin priming resulted in a reduced total dose of heparin. There was no increased clotting and no incidence of bleeding was reported in either group.

  • 17. Graaff, R.
    et al.
    Arsov, S.
    Trajceska, L.
    Dzekova, P.
    Engels, G. E.
    Koetsier, M.
    van Oeveren, W.
    Lundberg, L.
    Assa, S.
    Franssen, C. F. M.
    Smit, A. J.
    Rakhorst, G.
    Sikole, A.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ages in hemodialysis: tissue- and plasma- autofluorescence2011In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, no 8, p. 606-606Article in journal (Other academic)
  • 18. Graaff, Reindert
    et al.
    Arsov, Stefan
    Ramsauer, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Koetsier, Marten
    Sundvall, Nils
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Engels, Gerwin E.
    Sikole, Aleksandar
    Lundberg, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rakhorst, Gerhard
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Skin and Plasma Autofluorescence During Hemodialysis: A Pilot Study2014In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 38, no 6, p. 515-518Article in journal (Refereed)
    Abstract [en]

    Skin autofluorescence (AF) is related to the accumulation of advanced glycation end products (AGEs) and is one of the strongest prognostic markers of mortality in hemodialysis (HD) patients. The aim of this pilot study was to investigate whether changes in skin AF appear after a single HD session and if they might be related to changes in plasma AF. Skin and plasma AF were measured before and after HD in 35 patients on maintenance HD therapy (nine women and 26 men, median age 68 years, range 33-83). Median dialysis time was 4h (range 3-5.5). Skin AF was measured noninvasively with an AGE Reader, and plasma AF was measured before and after HD at 460nm after excitation at 370nm. The HD patients had on average a 65% higher skin AF value than age-matched healthy persons (P<0.001). Plasma AF was reduced by 14% (P<0.001), whereas skin AF was not changed after a single HD treatment. No significant influence of the reduced plasma AF on skin AF levels was found. This suggests that the measurement of skin AF can be performed during the whole dialysis period and is not directly influenced by the changes in plasma AF during HD.

  • 19. Hadimeri, Henrik
    et al.
    Frisenette-Fich, Carsten
    Deurell, Sven-Ingemar
    Svensson, Lars
    Carlsson-Bjering, Lena
    Fernstrom, Anders
    Almroth, Gabriel
    Melander, Stefan
    Haarhaus, Mattias
    Andersson, Per-Olof
    Cassel, Agneta
    Mauritz, Nils-Johan
    Stahl-Nilsson, Agneta
    Wilske, Jan
    Nordstrom, Kataryna
    Oruda, Pavel
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Larsson, Annelie Inghilesi
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    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 mu mol/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 x 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.

  • 20. Hadimeri, Ursula
    et al.
    Smedby, Örjan
    Fransson, Sven-Göran
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Hadimeri, Henrik
    Fistula diameter correlates with echocardiographic characteristics in stable hemodialysis patients2015In: NEPHROLOGY @ POINT OF CARE, ISSN 2059-3007, Vol. 1, no 1, p. E44-E48Article in journal (Refereed)
    Abstract [en]

    Aims and background: Left ventricular hypertrophy (LVH) is a common finding in hemodialysis patients. The aim of the present study was to investigate if the diameter of the distal radiocephalic fistula could influence left ventricular variables in stable hemodialysis patients.

    Methods: Nineteen patients were investigated. Measurements of the diameter of the arteriovenous (AV) fistula were performed in 4 different locations. The patients were investigated using M-mode recordings and measurements in the 2D image. Doppler ultrasound was also performed. Transonic measurements were performed after ultrasound investigation.

    Results: Fistula mean and maximal diameter correlated with left ventricular characteristics. Fistula flow correlated neither with the left ventricular characteristics nor with fistula diameters.

    Conclusions: The maximal diameter of the distal AV fistula seems to be a sensitive marker of LVH in stable hemodialysis patients.

  • 21. Hadimeri, Ursula
    et al.
    Warme, Anna
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A single treatment, using Far Infrared light improves blood flow conditions in arteriovenous fistula2017In: Clinical hemorheology and microcirculation, ISSN 1386-0291, E-ISSN 1875-8622, Vol. 66, no 3, p. 211-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A native arteriovenous fistula (AVF) is recommended for angio access in patients on chronic hemodialysis (HD). Fistula patency has been improved by exposure to Far Infrared light (FIR).

    OBJECTIVE: To investigate whether a single FIR treatment could alter blood velocity, AVF diameter or inflammatory markers. METHODS: Thirty patients with a native AVF in the forearm were included. Each patient was his/her own control. Ultrasound (US) examinations were performed before and after a single FIR treatment.

    RESULTS: A single FIR treatment resulted in a significant increase in blood velocity over the AV fistula from a mean of 2.1 +/- 1.0 m/s to 2.3 +/- 1.0 m/s (p = 0.02). The diameter of the arterialized vein became wider; 0,72 cm +/- 0.02 to 0,80 cm +/- 0.02, (p = 0.006). The increase in fistula blood velocity correlated positively with base line serum-urate p = 0.004) and the increase in venous diameter with the base line plasma orosomucoid concentration (p = 0.005).

    CONCLUSIONS: This study shows that a single FIR treatment significantly increased AVF blood velocity and vein diameter. Thus, one FIR treatment can help maturation of AVF in the early postoperative course.

  • 22.
    Hadimeri, Ursula
    et al.
    Skaraborg Hosp, Skövde, Sweden.
    Warme, Anna V. B.
    Skaraborg Hosp, Skövde, Sweden.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A Single Treatment, Using Far Infrared Light, Increased Blood Flow and AV-Fistula Diameter2014In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 29, no Suppl. 3, p. 258-258Article in journal (Other academic)
  • 23. Hadimeri, Ursula
    et al.
    Wärme, Anna
    Nasic, Salmir
    Fransson, Sven-Göran
    Wigelius, Ann
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results2019In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040Article in journal (Refereed)
    Abstract [en]

    Objective: To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems.

    Material and methods: In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function.

    Results: Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses.

    Conclusion: Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.

  • 24.
    Holmberg, Benny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Andersson, Christer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stegmayr, Bernd G
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    There is no benefit of atorvastatin for patients with severe renal impairment independent if they have DM or notArticle in journal (Other academic)
  • 25.
    Holmberg, Benny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, M
    Bucht, B
    Crougneau, V
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dimeny, E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ekspong, A
    Granroth, B
    Gröntoft, KC
    Hadimeri, H
    Ingman, B
    Isaksson, B
    Johansson, G
    Lindberger, K
    Lundberg, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mikaelsson, L
    Olausson, E
    Persson, B
    Welin, D
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wikdahl, AM
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Safety and efficacy of atorvastatin in patients with severe renal dysfunction2005In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 6, p. 503-510Article in journal (Refereed)
  • 26.
    Holmberg, Benny
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd G
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cardiovascular conditions in hemodialysis patients may be worsened by extensive interdialytic weight gain2009In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    The risk of death is increased for hemodialysis (HD) patients compared with age-matched healthy subjects, the main reason for this being cardiovascular conditions. This prospective study investigated whether the burden of interdialytic weight gain (IDWG) was of importance for cardiovascular end points and survival. A total of 97 HD patients were studied. The end points included death (reasons given), acute myocardial infarction, or coronary vascular intervention. The extent of ultrafiltration was measured at predefined follow-up points. The IDWG was calculated as ultrafiltration/body weight given in weight%. The burden of IDWG was analyzed. End points occurred in 77 (79%) of the patients during the 5-year study period. The extent of IDWG was higher in those with end points due to cardiovascular reasons (3.77 weight% vs. 3.19 P<0.001), cardiac reasons (P<0.001), congestive heart failure (P<0.01), aortic aneurysm, and intracerebral bleeding (P<0.024). To reduce the risk for cardiovascular events, it is important to avoid too extensive IDWG in HD patients.

  • 27.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, G
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Blood lines conduct leakage current during haemodialysis: a potential safety risk during first failure, especially for patients with central dialysis catheter as access.2005In: Medical and Biological Engineering and Computing, ISSN 0140-0118, E-ISSN 1741-0444, Vol. 43, no 6, p. 731-738Article in journal (Refereed)
  • 28.
    Jonsson, Per
    et al.
    Department of Biomedical Engineering, University Hospital, Umeå, Sweden.
    Forsberg, Ulf
    Department of Internal Medicine, University Hospital, Umeå, Sweden.
    Niklasson, Johan
    Department of Internal Medicine, University Hospital, Umeå, Sweden.
    Stegmayr, Bernd G.
    Department of Internal Medicine, University Hospital, Umeå, Sweden.
    Electrical current leakage during hemodialysis may increase blood-membrane interaction2001In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 24, no 3, p. 136-139Article in journal (Refereed)
    Abstract [en]

    During hemodialysis blood - membrane interaction causes complement activation. During dialysis there may be an electrical current leakage to the dialyzer, especially if there is a broken ground or a defect in another electrical device coupled to the patient.

    This study investigated whether an electric current of 1.5 mA DC could alter blood membrane interaction as measured by changes in C3d in the blood. Such a high current leakage could occur because there is no protection in the dialysis machine (Class 1B) against auxiliary current leakage. Such a current could come from a defective external device in contact with the patient during hemodialysis.

    Materials: A dialysis machine (Fresenius 2008C) with a filled blood-line system containing about 350 ml whole blood from each of 8 different donors was used in vitro. Each of the eight test-runs also contained 1000 U added heparin. The dialysis procedure was performed using hemophan membranes (GFS +12, Gambro) with bicarbonate and potassium 3.0 (D210, Gambro) as dialysate. Two electric poles were placed in the blood line, before and after the dialyzer (connected in parallel) and the ground was placed at entry and exit of the dialysate fluid coming from the machine to the dialysis filter. C3d was measured before the start of “dialysis” and at 15, 30, 45 and 60 min, during dialysis. Thereafter the 1.5 mA current was switched on and additional samples were drawn at 75 and 90 min. The mean C3d values were calculated. Paired non-parametric statistical analyses were performed.

    Results: There was a significant and continuous increase in C3d as compared to the “predialysis” level. The increase during 0 to 30 minutes was greater than that from 30 to 60 minutes (p=0.018); the increase in C3d during 60 to 90 min, was greater than that from 30 to 60 min (p=0.018) and there was no difference between the 0 to 30 and the 60 to 90 min increases.

    Conclusions: A current, used in this study, was able to induce a blood membrane interaction during in vitro dialysis. Even a weaker current leakage might have such adverse effects and similar interactions seem possible during regular dialysis depending on the extent of the leakage.

  • 29.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Forsberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    EVALUATION OF AIR MICRO BUBBLES IN DIALYSIS SYSTEMS IN VITRO2014In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 63, no 5, p. A61-A61Article in journal (Other academic)
  • 30.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Forsberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Response to letter to the editor.2007In: Artif Organs, ISSN 0160-564X, Vol. 31, no 12, p. 913-4Article in journal (Refereed)
  • 31.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Karlsson, Lars
    Forsberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gref, Margareta
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Stegmayr, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Air bubbles pass the security system of the dialysis device without alarming.2007In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 31, no 2, p. 132-139Article in journal (Refereed)
  • 32.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Karlsson, M
    Wiklund, U
    Jensen, Steen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Measurement of cardiac rhythm in connection to haemodialysis with focus on a possible interference due to leakage current: a pilot study of patients in chronic haemodialysisArticle in journal (Refereed)
  • 33.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindmark, Lorentz
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Karlsson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundberg, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Formation of Blood Foam in the Air Trap During Hemodialysis Due to Insufficient Automatic Priming of Dialyzers2018In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 42, no 5, p. 533-539Article in journal (Refereed)
    Abstract [en]

    We were encouraged to investigate the reasons for large amounts of foam observed in bloodlines during hemodialysis (HD). Foam was visible in the venous air trap within the Artis Gambro dialysis device. Estimates of the extent of foam were graded (0no foam, 10extensive foam) by two persons that were blind to the type of dialyzer used. Thirty-seven patients were involved in the dialysis procedures. Consecutive dialyses were graded using dialyzers from Fresenius Medical Care (CorDiax dialyzers that were used for high flux HDFX80 and FX100, and for hemodiafiltrationFX1000). The extracorporeal circuit was primed automatically by dialysate using Gambro Artis software 8.15 006 (Gambro, Dasco, Medolla Italy, Baxter, Chicago, IL, USA). The priming volume recommended by the manufacturer was 1100 mL, whereas our center uses 1500 mL. Extensive amounts of blood foam were visual in the air traps. Although the manufacturer recommended extension of priming volume up to 3000 mL, this did not eliminate the foam. Microbubble measurement during HD revealed the air to derive from the dialyzers. When changing to PF210H dialyzers (Baxter) and using a priming volume of 1500 mL, the foam was significantly less (P<0.01). The extent of foam correlated with the size of the FX-dialyzer surface (P=0.002). The auto-priming program was updated to version 8.21 by the manufacturer and the extent of foam in the air trap using FX dialyzers was now reduced and there was no longer a difference between FX and PF dialyzers, although less foam was still visible in the venous air trap during several dialyses. In conclusion, this study urgently calls attention to blood foam development in the venous air trap when using Artis devices and priming software 8.15 in combination with Fresenius dialyzers. Updated auto-priming software (version 8.21) of Artis should be requested to reduce the extent of foam for the Fresenius dialyzers. Other interactions may also be present. We recommend further studies to clarify these problems. Meanwhile caution is warranted for the combined use of dialysis devices and dialyzers with incompatible automatic priming.

  • 34.
    Jonsson, Per
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd G
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Current leakage in hemodialysis machines may be a safety risk for patients.2000In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 24, no 12, p. 977-981Article in journal (Refereed)
  • 35. Karpman, Diana
    et al.
    Fehrman-Ekholm, Ingela
    Bárány, Peter
    Békássy, Zivile
    Brandström, Per
    Bruchfeld, Annette
    Celsi, Gianni
    Chromek, Milan
    Clyne, Naomi
    Fellström, Bengt
    Hansson, Sverker
    Haraldsson, Börje
    Nevéus, Tryggve
    Rippe, Bengt
    Sartz, Lisa
    Segelmark, Mårten
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Norrlands universitetssjukhus.
    Stenvinkel, Peter
    Westman, Kerstin
    NT-rådets ställningstagande till eculizumab är oacceptabelt2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no DI3FArticle in journal (Other (popular science, discussion, etc.))
  • 36.
    Kyrk, Tobias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bechara, Alex
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Skagerlind, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Heparin and albumin as part of the priming solution limits exposure to anticoagulation during hemodialysis: in vitro studies2014In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 37, no 10, p. 734-740Article in journal (Refereed)
    Abstract [en]

    Background: Hemodialysis patients who are subject to increased risk of hemorrhage may need specific dialysis regimes to avoid bleeding. The aim of this study was to determine in vitro which of various anticoagulation options were most beneficial.

    Materials and method: 60 in vitro hemodialyses (HD) were performed in parallel using blood from healthy donors. The dialysis circuits were rinsed with either 1 L of 0.9% NaCl alone (n = 6), or with 1 L saline and the addition of either 5 mL 20% albumin (Alb, n = 6), 5,000 U of heparin (Hep, n = 6), Hep and Alb in combination (HA, n = 30), 20,000 U of Hep and Alb (4H-A, n = 6), and finally Hep and 20 mL 20% albumin (H-4A, n = 6). The blood was recirculated for a maximum of 192 min. Clotting was graded.

    Results: A 192 min dialysis was completed with all series of HA, 4H-A, and H-4A, all with a slight grade of clotting. In contrast to the above settings (p = 0.002, Fisher's test), a total clotting of the dialysis circuit occurred for all series using the NaCl rinsing alone (median time to stop: 21, range: 18-27 min, p = 0.026 compared to the HA setting) and for the Alb rinsing (median 26, range: 19-35 min, p = 0.028).

    Conclusions: Priming using HA, Hep, 4H-A, and H-4A reduced clotting and allowed 192 min of HD. Clinical studies need to confirm these data in vivo.

  • 37. Ladyzynski, Piotr
    et al.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. European Society of Artificial Organs.
    Vienken, Jörg
    Malchesky, Paul S
    Jan Maria Wojcicki (1946-2013): scientist, organizer, friend2014In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 38, no 4, p. 271-273Article in journal (Other academic)
  • 38.
    Laveborn, Emilie
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Skagerlind, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane2015In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 38, no 2, p. 69-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD).Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT.

    METHODS AND MATERIALS: 31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration.

    RESULTS: During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P ≤ .001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P ≤ .01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure.

    CONCLUSIONS: Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.

  • 39.
    Mahmood, Dana
    et al.
    Department of Internal Medicine, County Hospital in Östersund.
    Grubbström, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundberg, Lennart DI
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olivecrona, Gunilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Stegmayr, Bernd G
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lipoprotein lipase responds similarly to tinzaparin as to conventional heparin during hemodialysis2010In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 11, article id 33Article in journal (Refereed)
    Abstract [en]

    Background: Low molecular weight (LMW) heparins are used for anticoagulation during hemodialysis (HD). Studies in animals have shown that LMW-heparins release lipoprotein lipase (LPL) as efficiently as unfractionated (UF) heparin, but are less able to retard hepatic uptake of the lipase. This raises a concern that the LPL system may become exhausted by LMW-heparin in patients on HD. We have explored this in the setting of clinical HD.

    Methods: Twenty patients on chronic hemodialysis were switched from a primed infusion of UF-heparin to a single bolus of tinzaparin. There were long term follow up of variables for the estimation of dialysis efficacy as well as of the LPL release during dialysis and the subsequent impact on the triglycerides.

    Results: The LPL activity in blood was higher on tinzaparin at 40 but lower at 180 minutes during HD. These values did not change during the 6 month study period. There were significant correlations between the LPL activities in individual patients at the beginning and end of the 6 month study period and between the activities on UF-heparin and on tinzaparin, indicating that tissue LPL was not being exhausted. Triglycerides were higher during the HD-session with tinzaparin than UF-heparin. The plasma lipid/lipoprotein levels did not change during the 6 month study period, nor during a 2-year follow up after the switch from UF-heparin to tinzaparin. Urea reduction rate and Kt/V were reduced by 4 and 7% after 6 months with tinzaparin.

    Conclusion: Our data demonstrate that repeated HD with UF-heparin or tinzaparin does not exhaust the LPL-system.

  • 40.
    Mahmood, Dana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Makoveichuk, Elena
    Nilsson, Solveig
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, Gunilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Response of angiopoietin-like proteins 3 and 4 to haemodialysis2014In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 37, no 1, p. 13-20Article in journal (Refereed)
    Abstract [en]

    Background/Aim: Patients on chronic hemodialysis (cHD) have decreased activity of lipoprotein lipase (LPL). Angiopoietin-like proteins (ANGPTL) 3 and 4 have been shown to inactivate LPL. The aim of this study was to investigate the levels of the ANGPTLs in plasma of cHD-patients and to evaluate if cHD may alter these levels. Material and methods: Baseline data were collected from cHD patients (n = 23), and controls (n = 23) and samples were analyzed from 17 patients during low-flux or high-flux HD, and from ultrafiltrate (n = 5). The levels of ANGPTL3 and 4, LPL and triglycerides were studied in a cross-over design on cHD with local citrate compared to tinzaparin as anticoagulant. Results: The level of ANGPTL3 was higher than ANGPTL4 in patients and controls (p<0.01); the ANGPTL3 was 2.0 and ANGPTL4 was 3.3-fold higher in cHD versus controls. The levels of ANGPTL4 increased during cHD. After 180 min of HD the values had decreased again. When the dialysis was performed with high-flux filter, the mean level of ANGPTL4 at 180 min was below the value observed before cHD (p = 0.003). There was immunoreaction for ANGPTL4 in UFs when using high-flux, but not with low-flux, filter. ANGPTL3 was not detectable in UF. On cHD with citrate, no LPL activity was released into the blood. Conclusions: ANGPTL3 and ANGPTL4 were increased in HD patients. Anticoagulation with tinzaparin during cHD causes release of ANGPTL4 from tissues into blood. cHD using high-flux filters, to some extent, removed ANGPTL4. With citrate the levels of ANGPTL4 decreased.

  • 41.
    Mahmood, Dana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Solveig
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, Gunilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lipoprotein lipase activity is favoured by peritoneal dialysis compared to hemodialysis2014In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 74, no 4, p. 296-300Article in journal (Refereed)
    Abstract [en]

    Background. The lipoprotein lipase (LPL) pool is reduced by 50% in patients on hemodialysis (HD). LPL release by tinzaparin has not been investigated for peritoneal dialysis (PD). Therefore, the aim of this study was to investigate if tinzaparin differently alters the pool of LPL and triglyceride levels of patients on HD versus PD. Materials and methods. Thirty-two patients on chronic PD or HD were matched to nearest age and gender. In order to release and thereby estimate the endothelial pool of LPL, all patients received a bolus of tinzaparin (75 units/kg). Blood samples were drawn for analysis of LPL activity and triglycerides (TG) between the groups. Results. The peak level of LPL released at 40 min after tinzaparin was similar in PD and HD patients. At 180 min, a slightly higher median level of LPL activity was noted in the PD patients (6.1 mU/mL (n = 6) versus 3.4 mU/mL (n = 16), p = 0.005). The TG concentration in plasma at 40 min was reduced relatively more in the PD patients than in the HD patients (p < 0.05). At 180 min, TG had returned to start levels in HD patients while they were still lowered in PD patients. Conclusions. The negative effect of uraemia on the LPL pool in HD patients, known from other studies, here is shown to be similar in PD patients. Tinzaparin administration releases the LPL pool during each HD but does not cause an exhaustion of the LPL system over time. In contrast to HD, the LPL pool is not altered during PD.

  • 42.
    Mahmood, Dana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Solveig
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Olivecrona, Gunilla
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Physiological chemistry.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Post-heparin lipoprotein lipase activity is similar in patients on peritoneal dialysis compared to patients on haemodialysisManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Lipoprotein lipase (LPL) activity is known to be reduced in patients with chronic kidney disease (CKD). Heparin, given as a bolus at start of the haemodialysis(1), induces a release of LPL from its binding sites at endothelial surfaces of capillaries to blood. It is not clear if the levels of endothelial LPL between dialysis sessions remains lowered in patients on HD due to the necessary frequent heparinizations. The aim of this study was to see if the pool of heparin-releasable LPL activity differed between patients on HD compared to those on PD that do not need anticoagulation during dialysis.

    The study included 16 patients each on chronic PD or HD.  All patients received a bolus of low molecular weight heparin (tinzaparin 75 units/kg) intravenously to estimate the endothelial pool of LPL. Blood samples were drawn for analysis of LPL activity and triglycerides (TG) before and 40 and 180 minutes after the tinzaparin bolus.

    Results: The increase in median LPL activity at 40 min after tinzaparin was similar in PD and HD patients. At 180 minutes a slightly higher median level of LPL activity was noted in the PD patients (6.1 mU/mL (n=6) versus 3.4 mU/mL (n=16), p=0.005). The TG concentration in plasma at 40 min was reduced relatively more in the PD patients than in the HD patients. At 180 min TG had returned to start levels in HD patients while they were still below the start level in PD patients.

    Conclusion: Post-heparin LPL activity is similar in PD as in HD patients. This indicates that the endothelial LPL pool is not exhausted by repeated loss during each HD session.

  • 43.
    Mahmood, Dana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Haemodialysis with Tinzaparin Versus Dialysate Citrate as Anticoagulation2018In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 46, no 3, p. 257-263Article in journal (Refereed)
    Abstract [en]

    Anticoagulation with citrate-containing haemodialysate (cHD) is an alternative to tinzaparin haemodialysate (tHD). The study investigated whether cHD would differ when changed from tHD. The same 18 patients were their own controls followed up with cHD for 5 months. LDL-cholesterol decreased at the end of a cHD session (p = 0.01). Neutrophils (p = 0.013) and monocytes (p = 0.007) dropped more during a cHD session. During the follow-up period of cHD, approximately 50% needed additional tinzaparin. Before the cHD session could start, there was a lower total cholesterol at 2 weeks (p = 0.014) and LDL-cholesterol at 1 month (p = 0.011) versus an increase of LDL at 5 months (p = 0.02). Only patients without additional tinzaparin had a reduction of C-reactive protein (CRP) at 2 months of cHD (p < 0.05) but not later. Solely cHD seems possible only in half of the patients. A greater reduction in granulocytes and monocytes during cHD indicates a more extensive blood membrane interaction, while CRP may be lower.

  • 44. Matsuda, Kenichi
    et al.
    Fissell, Rachel
    Ash, Stephen
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Long-Term Survival for Hemodialysis Patients Differ in Japan Versus Europe and the USA. What Might the Reasons Be?2018In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 42, no 12, p. 1112-1118Article in journal (Other academic)
  • 45. Meert, Natalie
    et al.
    Schepers, Eva
    De Smet, Rita
    Argiles, Angel
    Cohen, Gerald
    Deppisch, Reinhold
    Drüeke, Tilman
    Massy, Ziad
    Spasovski, Goce
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Zidek, Walter
    Jankowski, Joachim
    Vanholder, Raymond
    Inconsistency of reported uremic toxin concentrations.2007In: Artif Organs, ISSN 0160-564X, Vol. 31, no 8, p. 600-11Article in journal (Refereed)
  • 46.
    Mortzell, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Berlin, G.
    Nilsson, T.
    Axelsson, C. G.
    Efvergren, M.
    Audzijoni, J.
    Griskevicius, A.
    Ptak, J.
    Blaha, M.
    Tomsova, H.
    Liumbruno, G. M.
    Centoni, P.
    Newman, E.
    Eloot, S.
    Dhondt, A.
    Tomaz, J.
    Witt, V.
    Rock, G.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Thrombotic microangiopathy2011In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 45, no 2, p. 119-123Article in journal (Refereed)
    Abstract [en]

    Thrombotic microangiopathy (TMA) is a histopathological feature of various diseases including thrombotic thrombocytopenic purpura (UP) and hemolytic uremic syndrome (HUS). There are many secondary causes of TMA, many of them could mimic TTP or HUS. This article presents a short overview on TMA. In conclusion TMA is the result of various etiology reasons and pathologic reactions with various clinical entities. It is important to focus on a thorough history including family history when deciding on a diagnosis. Analysis of ADAMTS 13 and ADAMTS 13-antibodies may help to decide continued therapy. (C) 2011 Elsevier Ltd. All rights reserved.

  • 47.
    Mörtzell, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Berlin, G.
    Nilsson, T.
    Axelsson, C. G.
    Efvergren, M.
    Audzijoni, J.
    Griskevicius, A.
    Ptak, J.
    Blaha, M.
    Tomsova, H.
    Liumbruno, G. M.
    Centoni, P.
    Newman, E.
    Eloot, S.
    Dhondt, A.
    Tomaz, J.
    Witt, V.
    Rock, G.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Analyses of data of patients with Thrombotic Microangiopathy in the WAA registry2011In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 45, no 2, p. 125-131Article in journal (Refereed)
    Abstract [en]

    Thrombotic Microangiopathy (TMA) is a histopathological feature of various diseases including thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The aim of this study was to investigate the outcome and prognostic variables of TMA-patients. Materials and methods: Data were consecutively retrieved from the WAA-apheresis registry (www.waa-registry.org) during 2003-2009. Included were all 120 patients (1237 procedures) who suffered from various forms of TMA, as registered by the ICD-10 code M31.1. Besides registry data, more extensive information was retrieved from the latest 64 patients. Adverse events of the TMA patients were compared to those of the other patients in the registry. Results: The mean age was 46 years (range 11-85 years, 57% women). In 72% therapeutic apheresis was due to an acute indication while a long-term indication was present in 28%. Plasma exchange was performed by centrifugation and filtration technique (95% and 4%, respectively), and immunoadsorption in 1% of the patients. Only fresh frozen plasma was used as replacement fluid in 69% of procedures. Adverse events were more frequent than in the general apheresis population (10% versus 5%, RR 1.9, CI 1.6-2.3). No death occurred due to apheresis treatment. Three percent of the procedures were interrupted. Bronchospasm and/or anaphylactic shock were present in two patients and one patient suffered from TRALI. At admission 26% were bedridden and needed to be fed. The risk of dying during the treatment period was significantly higher if the patient also suffered from a compromising disease, such as cancer. There was an inverse correlation between the ADAMTS13 level and the antibody titer (r = -0.47, p = 0.034). Conclusions: Patients with TMA have an increased risk for moderate and severe AE compared to the general apheresis population. Many patients were severely ill at admission. The prognosis is worse if the patient also has a severe chronic disease. Even slightly increased ADAMTS13-antibody titers seem to have a negative impact on the ADAMTS13 levels. (C) 2011 Elsevier Ltd. All rights reserved.

  • 48. Nguyen, T C
    et al.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Busund, R
    Bunchman, T E
    Carcillo, J A
    Plasma therapies in thrombotic syndromes.2005In: Int J Artif Organs, ISSN 0391-3988, Vol. 28, no 5, p. 459-65Article in journal (Other academic)
  • 49.
    Nilsson, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sperker, Wolfgang
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Schien, Claudia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Isaksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Medicinkliniken, Norrlands Universitetssjukhus, Umeå, Sweden.
    A surgical girdle postoperatively may prevent pain and tunnel infections of peritoneal dialysis patients2019In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040Article in journal (Refereed)
    Abstract [en]

    Aim: When performing acute onset dialysis after insertion of catheters for peritoneal dialysis, pain exists and tunnel infections may develop. This study investigated whether patients benefit from the use of a surgical girdle and specific dressing postoperatively to prevent pain and tunnel infections.

    Materials and Methods: In 85 consecutive patients, the development of tunnel infections was followed. The patients used a surgical girdle when they were in supine position from day 1 to day 3. The peritoneal dialysis catheter was fixed in a curvature avoiding stretch in the exit. A total of 53 patients participated in a retrospective questionnaire to evaluate abdominal pain within the first 3 days after surgery either with or without girdle. A visual analogue scale from 0 to 10 was used.

    Results: In 23 patients, data on pain both with and without the girdle could be recorded. Pain was relieved more when using the girdle versus no girdle (median day 1 3.0 vs 4.0, p < 0.001, n = 30, Wilcoxon paired). The development of tunnel infections during the latest 7-year period (exposure period 1487 months) showed a total of three episodes (one every 495 months) of which one caused a subsequent peritonitis, while the other two resolved after antibiotic therapy. Peritonitis episodes appeared at a mean of 37-month interval.

    Conclusion: The use a surgical girdle for 3 days postoperatively and a fixation of the peritoneal dialysis catheter in a curved loop relieves the pain and results in few tunnel infections and subsequent episodes of peritonitis.

  • 50. Norda, R
    et al.
    Knutson, F
    Berseus, O
    Akerblom, O
    Nilsson-Ekdahl, K
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Nilsson, B
    Unexpected effects of donor gender on the storage of liquid plasma.2007In: Vox Sang, ISSN 0042-9007, Vol. 93, no 3, p. 223-8Article in journal (Refereed)
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