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Biomedical subjects

B Hylander

Publications and source records attributed to B Hylander.

At least 19 recordsLinked to original sources
PubMed2000

Survival of patients who have been on a waiting list for renal transplantation.

INTRODUCTION: Survival of transplanted patients is generally much better than for those on dialysis. This comparison is, however, incorrect, as in order to be accepted for renal transplantation the patient has to be in a relatively good condition and in addition transplanted patients are usually younger. We compared survival of all renal replacement therapy (RRT) patients who had undergone an identical medical check-up, been accepted, and put on the waiting list for cadaveric-kidney transplantation at Huddinge University hospital. A comparison with patients who were transplanted with a kidney from a living related donor (LD) is also included. METHODS: All patients (n=608) accepted and on the waiting list for renal transplantation between January 1987 and April 1996 formed the basis of the study. Follow-up was terminated on 31 December 1997. Survival was recorded from the date that the patients were accepted and put on the waiting list. As long as the patient was not transplanted and remained on dialysis treatment, survival was considered as 'survival on dialysis', and if transplanted, subsequent survival was defined as 'survival after cadaveric-kidney transplantation'. A patient who had been transplanted remained in that group for the rest of the observation period even if the transplantation had failed and the patient had to go back to dialysis after the surgery. RESULTS: Five-year survival was considerably better after LD-kidney transplantation (94%), than after cadaveric-kidney transplantation (76%) or on chronic dialysis (60%). Cox hazard regression analysis gave an age-adjusted relative risk for death of 0.46 for LD-transplanted and 1.49 for remaining on dialysis compared with cadaveric-transplanted patients. Transplanted patients, however, experienced a higher mortality during the first year after the transplantation than patients still on dialysis. CONCLUSIONS: LD-kidney transplantation is clearly associated with a superior survival. Mortality is relatively high after cadaveric-kidney transplantation, especially during the first months after surgery. Nevertheless, in the long term cadaveric kidney transplanted patients have a better survival than those remaining on dialysis.

Cadaver↗
PubMed1999

An international study of patient compliance with hemodialysis.

CONTEXT: International differences in compliance of patients undergoing hemodialysis are poorly characterized and could contribute to international survival differences. OBJECTIVE: To compare international differences in patient compliance with hemodialysis treatments. DESIGN: A prospective observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996. SETTING AND PATIENTS: Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis, 1 center in Sweden with 84 patients, and 4 centers in Japan with 194 patients participated in the prospective observational study. In the cross-sectional survey, nurses and nephrologists from the United States (n = 49), Japan (n = 21), and Sweden (n = 16) responded to questions regarding the compliance of their patients undergoing hemodialysis. MAIN OUTCOME MEASURES: Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments. RESULTS: Of 415 US patients, 147 missed 699 treatments over a 6-month period (28.1 missed treatments per 100 patient-months or 2.3% of all prescribed treatments). During a 3-month period, there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden (P<.001). In the cross-sectional survey, the mean (SD) estimated percentage of patients missing a treatment per month was 4% (3%) for the United States, 0% for Japan, and 0.1% (3%) for Sweden (P<.001). CONCLUSIONS: Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients. The implications of these results for international differences in survival deserve further study.

Cross-Sectional Studies↗
PubMed1999

Increased levels of transforming growth factor beta 1 and basic fibroblast growth factor in patients on CAPD: a study during non-infected steady state and peritonitis.

Long-term influence of continuous ambulatory peritoneal dialysis (CAPD) on concentrations of transforming growth factor beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) in the peritoneal effluent, and the effect of peritonitis on these cytokines were investigated. TGF-beta1 and bFGF were assayed in effluent samples from dialysate bags collected during the initial week of treatment with CAPD and at 5 months. To determine the effect of peritonitis, dialysate bags were collected on admission to the hospital and on days 3 and 10 and also during non-infected steady state. Serum was drawn prior to infection and on days 1 and 10. TGF-beta1 increased more than threefold during the longitudinal follow-up period, median concentrations of 35 pg/ml to 106 pg/ml (P<0.05). No change in bFGF was seen during this initial 5 months. TGF-beta1 was increased on the first day of peritonitis (median concentration 169 pg/ml) and reached its maximum on day 3 of infection, (median concentration 216 pg/ml) (P<0.05 vs non-infected state, median concentration 39 pg/ml). Basic FGF reached a maximum on day three of infection (median concentration 7.7 pg/ml; P=0.01 vs non-infected state) and then slowly declined. In conclusion, TGF-beta1 is influenced by CAPD treatment per se, and together with bFGF is increased during peritonitis, indicating its importance in the peritoneum and its potential involvement in the development of tissue fibrosis and eventually ultrafiltration failure.

Adult↗
PubMed1999

Taste buds and neuronal markers in patients with chronic renal failure.

OBJECTIVE: To study the number of taste buds and, with the use of specific markers for peripheral nervous tissue, to study the neuronal pattern in taste buds from 36 patients with chronic renal failure (CRF), 19 renal transplant recipients, and 40 healthy subjects. Of the patients with CRF, 17 patients had not started dialysis, 12 patients were on peritoneal dialysis, and 7 patients were on hemodialysis. DESIGN: From all subjects, two or three fungiform papillae were collected from the anterior part of the tongue. Cryostat sections were cut and inspected under light microscopy to determine the presence of taste buds. The sections were subsequently incubated with primary rabbit antibodies against protein gene product 9.5, substance P, and nerve growth factor receptor. RESULTS: Using these antibodies, no differences between the groups were observed. However, patients with CRF had fewer taste buds than control subjects. CONCLUSION: No immunohistochemical differences were observed between patients with CRF and healthy controls. However, patients with CRF had significantly fewer fungiform taste buds, suggesting an important factor contributing to the well-known impairment of taste acuity in this patient group.

Adult↗
PubMed1998

Granulocyte stimulating factor in patients on peritoneal dialysis and LPS stimulated peripheral blood mononuclear cells.

Dialysate and serum levels of granulocyte-colony stimulating factor (G-CSF), granulocyte macrophage colony stimulating factor (GM-CSF) and leukemia inhibitory factor (LIF) were analyzed in patients with continuous ambulatory peritoneal dialysis (CAPD). Samples from the peritoneal effluent and from serum were obtained during the first months of dialysis and during peritonitis from the first three dialysate bags drained on the day of admittance and form nightbags on days three and ten. Serum samples were drawn on days one and ten. On the first day of infection G-CSF was detected in twelve out of fifteen samples in the dialysate and reached its peak median level, 443 pg/ml, in the first drained bag and thereafter decreased significantly. Also in serum a peak, 190 pg/ml, was observed on the first day. LIF was found in six of ten analyzed dialysate samples, with a peak median level of 77 pg/ml on day one, while only four of ten patients had detectable GM-CSF. Peripheral blood mononuclear cells from non-infected CAPD patients were stimulated with lipopolysaccharide and G-CSF levels in the supernatants increased significantly (P < 0.05) after 6 h stimulation. We conclude that G-CSF is produced locally in the dialysate during the acute stage of peritonitis and to a lesser extent also systemically. These findings are in line with G-CSF production after LPS stimulation of peripheral blood mononuclear cells.

Acute Disease↗
PubMed1998

Difference in the blood monocyte phenotype between uremic patients and healthy controls: its relation to monocyte differentiation into macrophages in the peritoneal cavity.

The phenotypic alterations between blood monocytes from 11 patients with end-stage renal disease, who had been on peritoneal dialysis for less than one week, and blood monocytes from 10 healthy controls, were analyzed. In addition, peritoneal macrophages in the dialysate effluent were enclosed. Analysis of functional receptor density was performed using immunostaining and flow cytometry. The phenotypic characterization was selected to represent various biological functions such as adhesion, phagocytosis (CD11b/CD18, CD11c/CD18, CD16), antigen-presentation (HLA-DR, ICAM-1), differentiation (transferrin receptor, CD71), receptor for LPS (CD14) and initiation of the coagulation cascade (Tissue factor, CD142). The proportion of CD16-positive blood monocytes and the quantitative level of ICAM-1 were higher in the patient group, compared to healthy controls. A significant increase in the quantitative level of CD11b/CD18, CD11c/CD18, HLA-DR and ICAM-1, transferrin receptor, CD14 and CD16, was found on peritoneal macrophages, compared to monocytes, harvested both from the corresponding patients, as well as from healthy donors. In contrast, we did not find any significant differences in the expression of tissue factor between monocytes and peritoneal macrophages. In conclusion, phenotypic differences exist between monocyte populations in the blood circulation of CAPD patients, and healthy individuals. We also show that transmigration of monocytes into the peritoneal cavity implies a selective up-regulation of functional receptors, preferentially related to adhesion, and antigen-presentation in a steady-state situation in non-infected CAPD patients.

Adult↗
PubMed1997

Changes in patients' eating behavior: in the uremic state, on continuous ambulatory peritoneal dialysis treatment, and after transplantation.

Nineteen predialysis patients (group A) were studied before and after 3 to 6 months on continuous ambulatory peritoneal dialysis (CAPD) treatment. Six patients (group B) were studied during CAPD treatment and 3 to 6 months after transplantation. Nine uremic patients (group C) were studied before and 3 to 6 months after transplantation. The patients were invited to a single test meal by means of the universal eating monitor VIKTOR. An excess portion of hash was served on a plate placed on a hidden scale that was connected to a computer registering the eating process on line. The patients filled out visual analogue scales concerning appetite and food preferences before and after the test meal. The feeling of fullness before meals was greater in patients on CAPD than in patients in the predialytic state. Transplanted patients felt less full before meals compared with their ratings during the dialysis period. The median total intake of food was lower during dialysis than after transplantation. The palatability of the food was rated lower during dialysis compared with the ratings in the uremic state. Poor appetite and low intake during dialysis is still a problem, but improves after transplantation.

Adult↗
PubMed1996

Prognostic factors and treatment of severe ethylene glycol intoxication.

OBJECTIVE: Analysis of prognostic factors and treatment of a large epidemic of ethylene glycol intoxication. DESIGN: Retrospective case review comparing 16 survivors with 6 patients who died. SETTING: Cooperative study between county hospitals, a university hospital, and a poison information centre. PATIENTS AND PARTICIPANTS: Survival review of 36 serious cases and chart review of 17 cases. INTERVENTION: Time to initial treatment with intravenous fluids, sodium, bicarbonate, ethanol, and dialysis. MEASUREMENTS: Clinical data at admission and blood chemistry at 0, 24, 48, and 72 h. RESULTS: 6 of 36 patients (17%) died; 11 of 17 patients whose charts were reviewed survived and 3 had chronic renal failure. All but 2 patients had acute renal failure. Neither delay to admission, intravenous dialysis, HCO3 or alcohol was related to outcome. At admission more patients who subsequently died had seizures, were comatose, were more acidotic, and had lower base excess and higher potassium levels than those who survived. Urine contained oxalate crystals in 10 of 14 cases. At 24 h the potassium level was higher and the base excess lower in those who died. Blood ethylene glycol levels for the patients who died and survived were no different. All survivors were dialyzed, but 2 patients who died had no dialysis. No survivor needed chronic dialysis and none had organic brain lesions. CONCLUSION: In patients with severe ethylene glycol intoxication, severe acidosis, hyperkalemia, seizures, and coma at admission carry a dismal prognosis. We believe very large amounts of intravenous HCO3 should be used immediately for rapid correction of the metabolic acidosis. Intravenous ethanol and hemodialysis should be started early and continued until acidosis is corrected.

Acidosis↗
PubMed1996

Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-1 receptor antagonist in dialysate and serum from patients on continuous ambulatory peritoneal dialysis.

Dialysate and serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and IL-1-ra were investigated in 20 patients on continuous ambulatory peritoneal dialysis (CAPD), who altogether had 30 episodes of peritonitis. Bacterial growth was found in 25 (83%) of the dialysate samples. Staphylococcus epidermidis was the single most common microorganism, found in 44% of the culture-verified peritonitis. Samples from dialysate bags were obtained during the first month of dialysis and during peritonitis from the first three bags on day 1 (the day of admittance) and from night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. The peak concentrations of cytokines occurred on the first day of infection. In dialysates, TNF-alpha was elevated in 96% of the patients, with a peak median concentration of 160 pg/mL (range, <15 to 4,400 pg/mL). Seventy-five percent of the dialysates had elevated IL-1-beta, with the highest median level of 52 pg/mL (range, <10 to 940 pg/mL), whereas all patients had elevated IL-1 ra, with a peak median value of 10,300 pg/mL (range, 470 to 79,000 pg/mL). TNF-alpha, IL-1 beta, and IL-Ira were significantly higher than in corresponding noninfected samples (TNF-alpha median value, <15 pg/mL; IL-1 beta, <10 pg/mL; and IL-1-ra, 150 pg/mL; P < 0.0001, P < 0.002, and P < 0.001, respectively). In serum, elevated TNF-alpha levels were found in 92% of the episodes, but the median levels were less than one third of the corresponding lavage levels. IL-1-beta was detected in 8% of the episodes and, although IL-1-ra was found in 92% of the patients, the dialysate levels were more than 15 times higher. In dialysate, a correlation was observed for TNF-alpha and IL-Ira and also between IL-1-beta and IL-Ira. IL-1 beta and IL-1-ra also correlated with the previously analyzed IL-6, and IL-1-beta correlated with the previously analyzed IL-8. Patients infected with high virulent strains had higher cytokine levels as compared with those infected with low virulent strains. In conclusion, our study shows markedly elevated TNF-alpha, IL-1 beta, and IL-1-ra levels in the acute stage in CAPD patients with peritonitis.

Adult↗
PubMed1996

Energy intake in patients on continuous ambulatory peritoneal dialysis and haemodialysis.

OBJECTIVES: To compare patients on continuous ambulatory peritoneal dialysis (CAPD) with those on haemodialysis (HD) regarding food composition and energy intake. DESIGN: Prospective food recording during 5 consecutive days. SETTING: Nephrology section at a University hospital. SUBJECTS: Fifteen patients on CAPD and 15 patients on HD, matched for age, gender, duration of dialysis and body mass index (BMI). MAIN OUTCOME MEASURES: Percentage macronutrient energy composition, with and without inclusion of transperitoneal glucose uptake. Daily energy intake, both total and from the different macronutrients. RESULTS: The percentage contribution of the dietary macronutrients to the energy intake was about the same in the two dialysis groups, although the actual energy intake in CAPD patients was lower from all three macronutrients (P = 0.02-0.04). The mean intraperitoneal glucose load in CAPD patients was 159 g day-1, which is approximately equivalent to 2700 kJ. Inclusion of this additional energy (estimated uptake: 70% of the intraperitoneal energy load = 19% of total energy intake) significantly increased the carbohydrate fraction and decreased the protein and fat fractions (P < 0.0001). Furthermore, this inclusion resulted in almost identical values for total energy intake in the two groups (approximately 144 kJ kg-1 day-1) and, in CAPD patients, a significantly higher actual energy contribution from carbohydrates (P = 0.04). CONCLUSIONS: Transperitoneal energy intake more than compensates for the lower oral dietary energy intake seen in CAPD patients. Nevertheless, the level of total energy intake places both patient groups in the risk zone for developing malnutrition.

Adult↗
PubMed1996

Racial differences in the incidence of end-stage renal disease.

OBJECTIVE: To examine trends in the incidence of treated end-stage renal disease (ESRD) and variations between blacks and whites. DESIGN: Retrospective record reviews of all new patients > or = 15 years starting chronic dialysis during 1980-1988 at the Piedmont Dialysis Center, Forsyth County, North Carolina. RESULTS: The cumulative nine-year incidence rate for hypertensive ESRD was 570 per million, and for diabetic ESRD 497 per million. Among men, hypertensive ESRD accounted for the largest proportion of cases (39.2% and 28.4%, blacks and whites respectively), while diabetic ESRD contributed 33.9% of black female cases and 24.4% of white female cases. Compared to whites, blacks were at significantly increased risk, with an adjusted risk odds ratio (OR) of 4.4 (95% confidence interval (CI) 3.5-6.0) for all causes combined, 6.0 (CI 3.9-9.0) for hypertensive renal disease, 6.0 (CI 3.8-9.3) for renal disease due to insulin-dependent diabetes mellitus, and 12.2 (CI 6.9-21.7) due to non-insulin dependent diabetes mellitus (NIDDM). The greatest risk among blacks was seen in the 55-64 year age group, with ORs of 9.1 for all causes combined and 30.6 for hypertensive renal disease. The OR for renal disease due to NIDDM for black versus white women was 20.0 (CI 9.5-41.7). Compared to 1980, 1981, 1982 and 1983, increased incidence rates were seen in each year after 1984. CONCLUSION: These findings show even greater excess risk of ESRD among blacks than previously reported. The majority of the excess risk is seen for ESRD due to hypertension and diabetes, especially NIDDM. The reasons for the increased risk among blacks, and for the increasing incidence rates of ESRD are not known.

Adolescent↗
PubMed1996

Taste acuity in patients with chronic renal failure.

Taste acuity for the four primary tastes has previously been shown to be impaired in patients with chronic renal failure (CRF) and maintenance dialysis treatment, although data on CAPD (continuous ambulatory peritoneal dialysis) patients are insufficient. In a test group of 57 CRF patients and 57 healthy controls, matched for age, sex and body mass index (BMI, kg/m2) taste acuity for the four primary tastes was determined. Fourteen patients were on CAPD treatment and 12 patients on hemodialysis (HD). No patients or controls were diabetic, on antibiotic treatment or had a malignant disease. Taste tests were standardized and performed on dialysis-free days for HD-patients. Taste acuity for bitter and salt was significantly lower for preuremic patients compared to their controls. In CAPD-patients taste detection of bitter was impaired and in HD-patients detection of salty taste was impaired. In conclusion taste acuity is impaired in uremic patients and dialysis patients including CAPD. The mechanism for taste alterations remain to be explained.

Adult↗
PubMed1995

Typing of coagulase-negative staphylococci from peritonitis in CAPD-patients by the PhP-CS system and REA.

Coagulase-negative staphylococci (CNS) were the most common bacteria causing peritonitis in patients treated with continuous ambulatory peritoneal dialysis (CAPD). In order to investigate if the same clone was responsible for the peritonitis in the different patients and if the exit site was the source of infection we followed 68 patients on CAPD for 2 years. During this period 9 patients had 12 episodes of peritonitis caused by CNS. Cultures were taken from exit site and peritoneal fluid in all patients at peritonitis and during the first study year at monthly intervals. In each culture up to 10 isolates of CNS were randomly collected and frozen. All 437 CNS isolates from the patients with CNS peritonitis were typed using a biochemical typing method and 41 isolates identical by this method were further discriminated by a DNA fingerprinting method. Identical strains were in no case isolated from different patients, indicating that no virulent strain was spread between the patients. The isolates causing the peritonitis were never found at the exist sites before the first day of the peritonitis in any patient. In only two patients was the same strain found at the exit site and in the peritoneal fluid on the first day of peritonitis. It thus seems that no virulent clone of CNS was infecting the patients and we found no evidence of CNS at the exit site causing the peritonitis.

Adult↗
PubMed1995

Subcutaneous epoetin beta in renal anemia: an open multicenter dose titration study of patients on continuous peritoneal dialysis.

OBJECTIVE: To establish dose requirements (target hemoglobin > 100 g/L) and safety of subcutaneously administered epoetin beta. DESIGN: Open multicenter study. PATIENTS: Forty-five anemic patients (21 female, 24 male; mean age 55 years; range 20-79 years) who had been on continuous peritoneal dialysis for 1-157 months (mean 24 months). Thirty patients required blood transfusions during the year prior to the study. Mean hemoglobin concentration pretreatment was 75 g/L (range 57-89 g/L). INTERVENTION: After a pretreatment period of two weeks, 60 IU kg-1 week-1 divided into three weekly doses of epoetin beta was administered subcutaneously. The dose was increased by 60 IU kg-1 week-1 after ten weeks, and when necessary, every fourth week in patients with hemoglobin levels below 100 g/L. MAIN OUTCOME MEASURES: Hemoglobin concentration. Analysis of factors affecting the response to epoetin beta. Safety of epoetin beta. RESULTS: Thirty-eight of the 45 patients completed six months and 21 patients completed one year in the study. Twenty-six patients reached hemoglobin 100 g/L within six months and 8 patients did later on. The mean hemoglobin concentration after three months was 93 g/L (range 64-144 g/L) and after six months was 99 g/L (range 59-130 g/L; mean epoetin beta dose 122 IU kg-1 week-1). During the second six-month period of the study, hemoglobin levels were stable in most patients. After one year, the mean hemoglobin was 110 g/L (range 84-153 g/L) and the mean epoetin beta dose was 107 IU kg-1 week-1. Prolonged correction time and impaired response to epoetin were observed in patients with infections or hemorrhages and in patients with low hemoglobin concentration before starting epoetin treatment. Iron deficiency was controlled by iron supplementation, either orally or, in 10 patients, intravenously. Increased blood pressure, requiring intensified antihypertensive treatment, was observed in 13 patients. CONCLUSIONS: Continuous peritoneal dialysis patients with moderate anemia (Hb 75-90 g/L) and without complicating disorders can be managed with subcutaneous doses of epoetin < 120 IU kg-1 week-1. The epoetin beta dose should be adjusted after the first month of treatment since most patients required higher doses than the initial 60 IU kg-1 week-1.

Anemia↗
PubMed1995

Social support and health-related quality of life in black and white dialysis patients.

OBJECTIVES: To identify factors associated with health-related quality of life (HRQoL) in end stage renal disease (ESRD) patients treated with dialysis, and to identify potential racial differences in HRQoL. DESIGN: Cross-sectional study. SAMPLE/SETTINGS: 256 dialysis patients; 72 black women, 59 black men, 61 white women, and 64 white men at Piedmont Dialysis Center, a university-affiliated dialysis center in northwest North Carolina. METHODS: Information was obtained on perceived social support, social networks, blood chemistries, blood pressure, cause of renal failure, treatment-related factors, and socioeconomic factors. HRQoL indicators included two measures of life satisfaction, limitations in leisure-time activities, and Karnofsky's Physical Functioning Scale. RESULTS: On all HRQoL indicators, blacks consistently rated their HRQoL better than whites. In univariate analyses, lack of social support was consistently related to poorer HRQoL. In multivariate regression analyses, good social support and black race were the two strongest predictors of more positive responses to each of the HRQoL indicators, after controlling for the effects of the other investigated factors. With respect to the Karnofsky scale, younger age and fewer medications taken were additional significant predictors of better functioning. CONCLUSIONS: HRQoL was consistently rated better among blacks than among whites. In addition, perceived social support exerted a strong, independent influence on objectively and subjectively measured HRQoL of ESRD patients.

Black or African American↗