Renal Medicine
The overall purpose of our research is to study and evaluate various mechanisms behind impairment of kidney function to prevent kidney damage. In patients who have already developed chronic kidney disease and impaired kidney function, we study risk factors resulting from reduced kidney function to better delay and treat the complications caused by kidney failure and also improve treatment in severe kidney failure.
Description of our research
One in ten people have impaired kidney function or signs of kidney disease. The most common causes of chronic kidney disease are obesity, diabetes, high blood pressure and kidney inflammation (glomerulonephritis, IgA-nephritis).
The renal medicine research group therefore study possible mechanisms and treatment principles to counteract the onset and progression of common kidney diseases such as obesity, diabetes and IgA-nephritis. We study, among other things, the effects of obesity surgery, which leads to positive effects on kidney function, and within the research group, studies have been conducted to develop a new treatment for IgA-nephritis.
We also study various risk factors for the development of diabetic kidney disease. An important research area is cardiovascular complications in chronic kidney disease and after kidney transplantation, as kidney failure is associated with an increased risk of cardiovascular disease. In patients with impaired kidney function, there are a large number of non-traditional risk factors for cardiovascular disease such as insulin resistance, chronic inflammation and disorders of calcium-phosphate-vitamin D metabolism. This is studied in experimental, translational, clinical and epidemiological studies in which we follow up patients with impaired kidney function in electronic medical records and national registers.
To improve treatment for severe kidney disease, members in the research group have developed a decision support tool to improve fluid balance in patients with dialysis treatment (Recova), which is now being used in the clinic. Studies are also underway on how the immune system is activated during hemodialysis.
![MRI image of kidneys.](/images/18.7d5959a318f1578aa722f3e/1714110635573/Bild_njurar%20imaging_618x412.png)
Recova
Recova is a decision support system for dialysis care developed by researchers at the Uppsala University Hospital. The goal is to facilitate a correct assessment of the patient's fluid status so that neither too much nor too little fluid is removed during dialysis treatment.
Publications
Are there lost opportunities in chronic kidney disease?: A region-wide cohort study
Part of BMJ Open, 2024
- DOI for Are there lost opportunities in chronic kidney disease?: A region-wide cohort study
- Download full text (pdf) of Are there lost opportunities in chronic kidney disease?: A region-wide cohort study
Part of Upsala Journal of Medical Sciences, 2024
- DOI for A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels
- Download full text (pdf) of A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels
Part of KIDNEY360, p. 352-362, 2024
Subcutaneous adipose tissue dopamine D2 receptor expression is increased in prediabetes and T2D
Part of Endocrine, 2024
- DOI for Subcutaneous adipose tissue dopamine D2 receptor expression is increased in prediabetes and T2D
- Download full text (pdf) of Subcutaneous adipose tissue dopamine D2 receptor expression is increased in prediabetes and T2D
Part of Kidney International, p. 381-388, 2024
- DOI for Targeted-release budesonide modifies key pathogenic biomarkers in immunoglobulin A nephropathy: insights from the NEFIGAN trial
- Download full text (pdf) of Targeted-release budesonide modifies key pathogenic biomarkers in immunoglobulin A nephropathy: insights from the NEFIGAN trial
Part of Expert Review of Clinical Immunology, p. 699-710, 2023
- DOI for Budesonide delayed-release capsules to reduce proteinuria in adults with primary immunoglobulin A nephropathy
- Download full text (pdf) of Budesonide delayed-release capsules to reduce proteinuria in adults with primary immunoglobulin A nephropathy
Part of Kidney Medicine, 2023
- DOI for Cardiovascular Risk Following Conversion to Belatacept From a Calcineurin Inhibitor in Kidney Transplant Recipients: A Randomized Clinical Trial
- Download full text (pdf) of Cardiovascular Risk Following Conversion to Belatacept From a Calcineurin Inhibitor in Kidney Transplant Recipients: A Randomized Clinical Trial
Bioimpedance analysis in patients with chronic kidney disease
Part of Journal of Renal Care, p. 147-157, 2023
- DOI for Bioimpedance analysis in patients with chronic kidney disease
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Part of BMJ Open, 2023
- DOI for Trends in renal function in Northern Sweden 1986-2014: data from the seven cross-sectional surveys within the Northern Sweden MONICA study
- Download full text (pdf) of Trends in renal function in Northern Sweden 1986-2014: data from the seven cross-sectional surveys within the Northern Sweden MONICA study
Part of Diabetes & Vascular Disease Research, 2023
- DOI for Health care registers can be instrumental for endpoint capture in clinical diabetes trials: example of microvascular complications in Swedish patients with type 2 diabetes
- Download full text (pdf) of Health care registers can be instrumental for endpoint capture in clinical diabetes trials: example of microvascular complications in Swedish patients with type 2 diabetes
Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A Randomized Clinical Trial
Part of Journal of the American Medical Association (JAMA), p. 1160-1160, 2023
Part of Hemodialysis International, p. 454-464, 2023
- DOI for Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study
- Download full text (pdf) of Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study
Part of Journal of Clinical Endocrinology and Metabolism, 2022
- DOI for Role of Estrogen and Its Receptors in Adipose Tissue Glucose Metabolism in Pre- and Postmenopausal Women
- Download full text (pdf) of Role of Estrogen and Its Receptors in Adipose Tissue Glucose Metabolism in Pre- and Postmenopausal Women
Part of JN. Journal of Nephrology, p. 493-503, 2022
- DOI for Estimation of kidney function in patients with primary neuromuscular diseases: is serum cystatin C a better marker of kidney function than creatinine?
- Download full text (pdf) of Estimation of kidney function in patients with primary neuromuscular diseases: is serum cystatin C a better marker of kidney function than creatinine?
Part of Upsala Journal of Medical Sciences, 2022
- DOI for Effect of spironolactone on vascular stiffness in hemodialysis patients: a randomized crossover trial
- Download full text (pdf) of Effect of spironolactone on vascular stiffness in hemodialysis patients: a randomized crossover trial
Part of Journal of Bone and Mineral Research, p. 649-659, 2022
- DOI for Real-World Effectiveness of Anti-Resorptive Treatment in Patients With Incident Fragility Fractures: The STORM Cohort – A Swedish Retrospective Observational Study
- Download full text (pdf) of Real-World Effectiveness of Anti-Resorptive Treatment in Patients With Incident Fragility Fractures: The STORM Cohort – A Swedish Retrospective Observational Study
Part of Hemodialysis International, p. 191-201, 2022
Part of BMC Nephrology, 2022
- DOI for Cost effectiveness of sodium zirconium cyclosilicate for the treatment of hyperkalaemia in patients with CKD in Norway and Sweden
- Download full text (pdf) of Cost effectiveness of sodium zirconium cyclosilicate for the treatment of hyperkalaemia in patients with CKD in Norway and Sweden
Part of European Heart Journal - Quality of Care and Clinical Outcomes, p. 31-38, 2022
- DOI for Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden
- Download full text (pdf) of Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden
Association of Serum Phosphate with Efficacy of Statin Therapy in Hemodialysis Patients
Part of American Society of Nephrology. Clinical Journal, p. 546-554, 2022
Part of Upsala Journal of Medical Sciences, 2022
- DOI for A third dose SARS-CoV-2 BNT162b2 mRNA vaccine results in improved immune response in hemodialysis patients
- Download full text (pdf) of A third dose SARS-CoV-2 BNT162b2 mRNA vaccine results in improved immune response in hemodialysis patients
Part of Translational Research, p. 105-121, 2022
- DOI for CDKN2C expression in adipose tissue is reduced in type II diabetes and central obesity: impact on adipocyte differentiation and lipid storage?
- Download full text (pdf) of CDKN2C expression in adipose tissue is reduced in type II diabetes and central obesity: impact on adipocyte differentiation and lipid storage?
Part of European Heart Journal Open, 2022
- DOI for NT-proBNP and stem cell factor plasma concentrations are independently associated with cardiovascular outcomes in end-stage renal disease hemodialysis patients
- Download full text (pdf) of NT-proBNP and stem cell factor plasma concentrations are independently associated with cardiovascular outcomes in end-stage renal disease hemodialysis patients
Part of European Journal of Preventive Cardiology, p. 1731-1739, 2022
Part of Upsala Journal of Medical Sciences, 2022
- DOI for Effects of lipid-lowering treatment intensity and adherence on cardiovascular outcomes in patients with a recent myocardial infarction: a Swedish register-based study
- Download full text (pdf) of Effects of lipid-lowering treatment intensity and adherence on cardiovascular outcomes in patients with a recent myocardial infarction: a Swedish register-based study
Part of Journal of the American Society of Nephrology, p. 829-838, 2022
Part of Biomedicines, 2022
- DOI for Novel Biomarkers Detected by Proteomics Predict Death and Cardiovascular Events in Hemodialysis Patients
- Download full text (pdf) of Novel Biomarkers Detected by Proteomics Predict Death and Cardiovascular Events in Hemodialysis Patients
Part of Upsala Journal of Medical Sciences, 2021
- DOI for Effects of spironolactone on extrasystoles and heart rate variability in haemodialysis patients: a randomised crossover trial
- Download full text (pdf) of Effects of spironolactone on extrasystoles and heart rate variability in haemodialysis patients: a randomised crossover trial
Part of Journal of Interferon and Cytokine Research, p. 283-290, 2021
Part of Biomolecules, 2021
- DOI for Albumin Urinary Excretion Is Associated with Increased Levels of Urinary Chemokines, Cytokines, and Growth Factors Levels in Humans
- Download full text (pdf) of Albumin Urinary Excretion Is Associated with Increased Levels of Urinary Chemokines, Cytokines, and Growth Factors Levels in Humans
Part of Advances in Therapy, p. 4695-4708, 2021
- DOI for Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors: A Retrospective Population-Based Cohort Study
- Download full text (pdf) of Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors: A Retrospective Population-Based Cohort Study
Humoral and cellular response to SARS-CoV-2 BNT162b2 mRNA vaccine in hemodialysis patients
Part of BMC Immunology, 2021
- DOI for Humoral and cellular response to SARS-CoV-2 BNT162b2 mRNA vaccine in hemodialysis patients
- Download full text (pdf) of Humoral and cellular response to SARS-CoV-2 BNT162b2 mRNA vaccine in hemodialysis patients
Burden of Treatment-Induced Peripheral Neuropathy in Patients with Multiple Myeloma in Sweden
Part of Acta Haematologica, p. 519-527, 2021
- DOI for Burden of Treatment-Induced Peripheral Neuropathy in Patients with Multiple Myeloma in Sweden
- Download full text (pdf) of Burden of Treatment-Induced Peripheral Neuropathy in Patients with Multiple Myeloma in Sweden
Osteoprotegerin predicts cardiovascular events in patients treated with haemodialysis
Part of Nephrology, Dialysis and Transplantation, p. 1162-1170, 2021
Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes
Part of New England Journal of Medicine, p. 2219-2229, 2020
Part of European Heart Journal - Quality of Care and Clinical Outcomes, p. 323-331, 2020
Part of Nephrology, Dialysis and Transplantation, p. 1002-1009, 2020
Part of Theranostics, p. 8665-8676, 2020
- DOI for Improved cardiovascular risk prediction in patients with end-stage renal disease on hemodialysis using machine learning modeling and circulating microribonucleic acids
- Download full text (pdf) of Improved cardiovascular risk prediction in patients with end-stage renal disease on hemodialysis using machine learning modeling and circulating microribonucleic acids
Part of Journal of Interferon and Cytokine Research, p. 71-74, 2020
Part of Clinical Kidney Journal, p. 116-122, 2020
- DOI for Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortar in haemodialysis patients from the AURORA trial
- Download full text (pdf) of Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortar in haemodialysis patients from the AURORA trial
Part of ESC Heart Failure, p. 2797-2806, 2020
- DOI for Patients with moderate chronic kidney disease without heart disease have reduced coronary flow velocity reserve.
- Download full text (pdf) of Patients with moderate chronic kidney disease without heart disease have reduced coronary flow velocity reserve.
Initial Invasive or Conservative Strategy for Stable Coronary Disease
Part of New England Journal of Medicine, p. 1395-1407, 2020
Type B insulin resistance syndrome in a patient with type 1 diabetes
Part of Endocrinology, diabetes & metabolism case reports, 2020
- DOI for Type B insulin resistance syndrome in a patient with type 1 diabetes
- Download full text (pdf) of Type B insulin resistance syndrome in a patient with type 1 diabetes
Part of Renal failure, p. 400-404, 2020
- DOI for Day-to-day variation of the kidney proximal tubular injury markers urinary cystatin C, KIM1, and NGAL in patients with chronic kidney disease
- Download full text (pdf) of Day-to-day variation of the kidney proximal tubular injury markers urinary cystatin C, KIM1, and NGAL in patients with chronic kidney disease
Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
Part of Journal of Renal Care, p. 52-61, 2020
- DOI for Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
- Download full text (pdf) of Systematic fluid assessment in haemodialysis: Development and validation of a decision aid
Part of Upsala Journal of Medical Sciences, p. 281-292, 2020
- DOI for Implementation of a decision aid for recognition and correction of volume alterations (Recova®) in haemodialysis patients
- Download full text (pdf) of Implementation of a decision aid for recognition and correction of volume alterations (Recova®) in haemodialysis patients
Part of Nephrology, Dialysis and Transplantation, p. 1700-1711, 2020
Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis
Part of Disease Markers, 2020
- DOI for Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis
- Download full text (pdf) of Associations of Bone Turnover Markers with Cognitive Function in Patients Undergoing Hemodialysis
Part of Scientific Reports, 2020
- DOI for The association between Single Nucleotide Polymorphisms of Klotho Gene and Mortality in Elderly Men: The MrOS Sweden Study
- Download full text (pdf) of The association between Single Nucleotide Polymorphisms of Klotho Gene and Mortality in Elderly Men: The MrOS Sweden Study
Evaluating a New International Risk-Prediction Tool in IgA Nephropathy
Part of JAMA Internal Medicine, p. 942-952, 2019
Ongoing projects
Vascular Access for Hemodialysis, a Registrybased Study with Special Focus on Differences Between Sex and Regions
Dialysis access is an area of challenge and a factor that can improve quality of hemodialysis care and reduce patient mortality. This PhD project is based on registry data in the Swedish Renal Registry. Major research questions are type of vascular access in incident hemodialysis patients and complications and survival of the different types of vascular access and factors that can influence this.
Hemodialysis and Inflammation Focusing on Complement Activation and Circulating Microparticles
During dialysis treatment, the blood meets foreign surfaces. Even with today's biocompatible materials, however, reaction to the contact and inflammatory response are expected. The aim of this PhD-program is to identify processes that lead to or maintain systemic inflammation and complement activation observed in hemodialysis patients. In addition to plasma, protein deposits on used dialysis filters surfaces is studied. An ex-vivo study with an anti-FXII antibody as an anticoagulant in the dialysis circuit is planned.
Novel Cardiovascular Riskmarkers in Hemodialysis
The overall aim with this PhD project is to investigate the association between novel cardiovascular biomarkers and outcomes such as all-cause death, cardiovascular death, and cardiovascular events in patients on hemodialysis. In addition, the aim is to advance the understanding on what effect a hemodialysis treatment per se actually has on cardiac damage markers, iron metabolism and other biomarkers by evaluating the effect of a single dialysis session.
IgA Nephrapathy - Basic Studies and Novel Treatment
This ongoing PhD-program, is a joint venture between Uppsala and Västerås, and explores gut reactivity, microbiota, gut permeability, urine proteomics, complement activation and progression in IgAN and is a continuation of a long-term focus on gut mucosal reactivity in IgAN. The planned studies follow a treatment study in patients with IgA nephropathy using a corticosteroid compound acting primarily in the gut (budesonide) that demonstrated reduction in proteinuria and stabilization of renal function (GFR).
Recurrence of IgAN in Renal Transplants
This is new PhD-program aim to characterize patients with recurrence of IgAN after renal transplantation. The prime research question is what are the underlying mechanisms for recurrence and if there are any new means for prevention and treatment. A focus will be the influence of complement activation and the potential therapeutic role of complement inhibitors.
The Obese Kidney - Potential Mechanisms and Effects of Weight Loss
In this PhD-program, proposed and novel mechanisms that could be part of the development of obesity-related glomerulopathy and the impact of weight loss induced by low-calorie diet and bariatric surgery on kidney function in severely obese patients without concomitant diabetes or hypertension are evaluated. This is done in the POEM-cohort and in an exploratory single center study with a before-and-after study design where the effects on kidney function induced by rapid weigth loss induced by a combination of a 4-week standardized low-calorie diet (LCD) and bariatric surgery in an ordinary clinical setting.
Svensk Njurmedicinsk biobank - An Important Infrastrutoe in Future Biomarker Research
All eligible patients who are kidney-biopsied are included in a national healthcare-integrated biobank with follow-up data suitable for: 1) exploratory biomarker studies, 2) development and validation of risk assessment algorithms and 3) future clinical studies of “master protocol” design. Sample management is adapted so that analyzes of complement activation, microparticles, biological aging and various "omics" methods can be applied. Centers: Uppsala, Västerås, Gävle, Linköping, Umeå, Gothenburg, Region Skåne.
Human Artery Proteomics in Uraemia
In the development of cardiovascular disease, extensive changes take place in the function and structure of the target organs and these changes can be characterized by changes in protein type and amount of protein in the organs. In kidney transplantation, the patient's own artery (usually the external iliac artery) is perforated with a “vessel punch” in order to be able to connect the transplant's artery to the patient's. We study the protein composition of this vessel piece (which has been in a uremic environment) with the aim to identify proteins that characterize processes leading to accelerated cardiovascular disease. This knowledge can lead to new, targeted treatments that prevent cardiovascular disease in kidney patients.
Recova - Recognition and Correction of Volume Alterations
Achieving optimal management of fluid status is a key objective in dialysis. Recova® is a tool for early recognition and correction of volume alterations in hemodialysis patients, which combines systematic clinical assessment of fluid status with bioimpedance measurement in target weight determination. The Recova tool was develop in a former PhD project. The tool is now being implemented in clinical care and effects on patient’s quality of life (QoL), hospitalization and other parameters are being evaluated. In addition, an upscale with a staggered entry approach to other dialysis clinics in Sweden is planned, to prospectively evaluate the Recova-tool regarding fluid management in hemodialysis
Experimental Studies of Human Adipose and Muscle Tissue-focus Perirenal Tissue
Previous research has identified adipose tissue not only as a storage place for energy, but also as a highly active endocrine organ producing and secreting several hormones but also other peptides and enzymes. This is an exploratory study to identify molecular mechanisms that may play a key role in the function of human adipose tissue and to increase our understanding of the interaction between adipose tissue and kidney - the adipo-renal axis. This is done by characterizing and exploring five different fat depots related to the kidney and muscle tissue from health kidney donors to explore similarities and differences between adipose tissue and muscle with a specific focus on brown adipose tissue.
Available resources
Network for Clinical Renal Medicine Treatment Research
In 2020, a national “Clinical network for chronic kidney disease research” was initiated with a steering group of the network with representatives from all university hospitals in Sweden and representatives of the Swedish Renal Registry. Current multi-center studies within stroke anticoagulation/ prophylaxis and new treatment options för chronic kidney disease are ongoing.
For more information, please contact Maria Eriksson Svensson or Hans Furuland
Biobanks and Databases
Biobanks have been collected from the AURORA and ALERT randomized controlled trials and the Århus hemodialysis cohort and have been used to analyze genomic aberrations in inflammation-related genes as well as telomere length in DNA material, and shown a striking relationship to the degree of inflammation, oxidative stress, fetuin levels and patient survival. Currently, post hoc analyses of databases and biobanks are ongoing and largely based upon new biomarkers generated from the use of PEA technology. In addition, development of risk prediction algorithms leading to development of risk predictors for renal transplant and dialysis patients are ongoing.
For more information regarding these databases and biobanks, please contact Bengt Fellström.
Contact
- If you are interested in kidney medical research, please contact
- Maria Svensson