Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

the Hemodialysis Fistula Maturation Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation. Methods: Concentrations of fibroblast growth factor 23, parathyroid hormone, calcium, phosphate, and vitamin D metabolites: 1,25(OH) 2 D, 24,25(OH) 2 D, 25(OH)D, and bioavailable 25(OH)D were measured in pre-operative serum samples from 562 of 602 participants in the Haemodialysis Fistula Maturation Study, a multicentre, prospective cohort study of patients undergoing surgical creation of an autologous upper extremity AVF. Unassisted and overall AVF maturation were ascertained for 540 and 527 participants, respectively, within nine months of surgery or four weeks of dialysis initiation. Study personnel obtained vein segments adjacent to the portion of the vein used for anastomosis, which were processed, embedded, and stained for measurement of neointimal hyperplasia, calcification, and collagen deposition in the medial wall. Results: Participants in this substudy were 71% male, 43% black, and had a mean age of 55 years. Failure to achieve AVF maturation without assistance occurred in 288 (53%) participants for whom this outcome was determined. In demographic and further adjusted models, mineral metabolism markers were not significantly associated with vein histology characteristics, unassisted AVF maturation failure, or overall maturation failure, other than a biologically unexplained association of higher 24,25(OH) 2 D with overall failure. This exception aside, associations were non-significant for continuous and categorical analyses and relevant subgroups. Conclusions: Serum concentrations of measured mineral metabolites were not substantially associated with major histological characteristics of veins in patients undergoing AVF creation surgery, or with AVF maturation failure, suggesting that efforts to improve AVF maturation rates should increase attention to other processes such as vein mechanics, anatomy, and cellular metabolism among end stage renal disease patients.

Original languageEnglish (US)
Pages (from-to)719-728
Number of pages10
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume57
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Arteriovenous Fistula
Minerals
Veins
Renal Dialysis
Histology
Mechanics
Parathyroid Hormone
Serum
Chronic Renal Insufficiency
Upper Extremity
Vitamin D
Multicenter Studies
Chronic Kidney Failure
Fistula
Hyperplasia
Blood Vessels
Dialysis
Anatomy
Cohort Studies
Collagen

Keywords

  • Arteriovenous fistula
  • Chronic kidney disease
  • Haemodialysis
  • Mineral metabolism
  • Vein histology
  • Vitamin D

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation. / the Hemodialysis Fistula Maturation Study Group.

In: European Journal of Vascular and Endovascular Surgery, Vol. 57, No. 5, 01.05.2019, p. 719-728.

Research output: Contribution to journalArticle

the Hemodialysis Fistula Maturation Study Group. / Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation. In: European Journal of Vascular and Endovascular Surgery. 2019 ; Vol. 57, No. 5. pp. 719-728.
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abstract = "Background: The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation. Methods: Concentrations of fibroblast growth factor 23, parathyroid hormone, calcium, phosphate, and vitamin D metabolites: 1,25(OH) 2 D, 24,25(OH) 2 D, 25(OH)D, and bioavailable 25(OH)D were measured in pre-operative serum samples from 562 of 602 participants in the Haemodialysis Fistula Maturation Study, a multicentre, prospective cohort study of patients undergoing surgical creation of an autologous upper extremity AVF. Unassisted and overall AVF maturation were ascertained for 540 and 527 participants, respectively, within nine months of surgery or four weeks of dialysis initiation. Study personnel obtained vein segments adjacent to the portion of the vein used for anastomosis, which were processed, embedded, and stained for measurement of neointimal hyperplasia, calcification, and collagen deposition in the medial wall. Results: Participants in this substudy were 71{\%} male, 43{\%} black, and had a mean age of 55 years. Failure to achieve AVF maturation without assistance occurred in 288 (53{\%}) participants for whom this outcome was determined. In demographic and further adjusted models, mineral metabolism markers were not significantly associated with vein histology characteristics, unassisted AVF maturation failure, or overall maturation failure, other than a biologically unexplained association of higher 24,25(OH) 2 D with overall failure. This exception aside, associations were non-significant for continuous and categorical analyses and relevant subgroups. Conclusions: Serum concentrations of measured mineral metabolites were not substantially associated with major histological characteristics of veins in patients undergoing AVF creation surgery, or with AVF maturation failure, suggesting that efforts to improve AVF maturation rates should increase attention to other processes such as vein mechanics, anatomy, and cellular metabolism among end stage renal disease patients.",
keywords = "Arteriovenous fistula, Chronic kidney disease, Haemodialysis, Mineral metabolism, Vein histology, Vitamin D",
author = "{the Hemodialysis Fistula Maturation Study Group} and Kubiak, {Rachel W.} and Zelnick, {Leila R.} and Hoofnagle, {Andy N.} and Alpers, {Charles E.} and Terry, {Christi M.} and Shiu, {Yan Ting} and Cheung, {Alfred K.} and {de Boer}, {Ian H.} and Cassianne Robinson-Cohen and Michael Allon and Dember, {Laura M.} and Feldman, {Harold I.} and Jonathan Himmelfarb and Huber, {Thomas S.} and Prabir Roy-Chaudhury and Vazquez, {Miguel A.} and Kusek, {John W.} and Beck, {Gerald J.} and Imrey, {Peter B.} and Bryan Kestenbaum and H. Feldman and L. Dember and A. Farber and J. Kaufman and L. Stern and P. LeSage and C. Kivork and D. Soares and M. Malikova and M. Allon and C. Young and M. Taylor and L. Woodard and K. Mangadi and P. Roy-Chaudhury and R. Munda and T. Lee and R. Alloway and M. El-Khatib and T. Canaan and A. Pflum and L. Thieken and B. Campos-Naciff and T. Huber and S. Berceli and M. Jansen and G. McCaslin and Y. Trahan and W. Vongpatanasin and C. Hwang",
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TY - JOUR

T1 - Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

AU - the Hemodialysis Fistula Maturation Study Group

AU - Kubiak, Rachel W.

AU - Zelnick, Leila R.

AU - Hoofnagle, Andy N.

AU - Alpers, Charles E.

AU - Terry, Christi M.

AU - Shiu, Yan Ting

AU - Cheung, Alfred K.

AU - de Boer, Ian H.

AU - Robinson-Cohen, Cassianne

AU - Allon, Michael

AU - Dember, Laura M.

AU - Feldman, Harold I.

AU - Himmelfarb, Jonathan

AU - Huber, Thomas S.

AU - Roy-Chaudhury, Prabir

AU - Vazquez, Miguel A.

AU - Kusek, John W.

AU - Beck, Gerald J.

AU - Imrey, Peter B.

AU - Kestenbaum, Bryan

AU - Feldman, H.

AU - Dember, L.

AU - Farber, A.

AU - Kaufman, J.

AU - Stern, L.

AU - LeSage, P.

AU - Kivork, C.

AU - Soares, D.

AU - Malikova, M.

AU - Allon, M.

AU - Young, C.

AU - Taylor, M.

AU - Woodard, L.

AU - Mangadi, K.

AU - Roy-Chaudhury, P.

AU - Munda, R.

AU - Lee, T.

AU - Alloway, R.

AU - El-Khatib, M.

AU - Canaan, T.

AU - Pflum, A.

AU - Thieken, L.

AU - Campos-Naciff, B.

AU - Huber, T.

AU - Berceli, S.

AU - Jansen, M.

AU - McCaslin, G.

AU - Trahan, Y.

AU - Vongpatanasin, W.

AU - Hwang, C.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation. Methods: Concentrations of fibroblast growth factor 23, parathyroid hormone, calcium, phosphate, and vitamin D metabolites: 1,25(OH) 2 D, 24,25(OH) 2 D, 25(OH)D, and bioavailable 25(OH)D were measured in pre-operative serum samples from 562 of 602 participants in the Haemodialysis Fistula Maturation Study, a multicentre, prospective cohort study of patients undergoing surgical creation of an autologous upper extremity AVF. Unassisted and overall AVF maturation were ascertained for 540 and 527 participants, respectively, within nine months of surgery or four weeks of dialysis initiation. Study personnel obtained vein segments adjacent to the portion of the vein used for anastomosis, which were processed, embedded, and stained for measurement of neointimal hyperplasia, calcification, and collagen deposition in the medial wall. Results: Participants in this substudy were 71% male, 43% black, and had a mean age of 55 years. Failure to achieve AVF maturation without assistance occurred in 288 (53%) participants for whom this outcome was determined. In demographic and further adjusted models, mineral metabolism markers were not significantly associated with vein histology characteristics, unassisted AVF maturation failure, or overall maturation failure, other than a biologically unexplained association of higher 24,25(OH) 2 D with overall failure. This exception aside, associations were non-significant for continuous and categorical analyses and relevant subgroups. Conclusions: Serum concentrations of measured mineral metabolites were not substantially associated with major histological characteristics of veins in patients undergoing AVF creation surgery, or with AVF maturation failure, suggesting that efforts to improve AVF maturation rates should increase attention to other processes such as vein mechanics, anatomy, and cellular metabolism among end stage renal disease patients.

AB - Background: The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation. Methods: Concentrations of fibroblast growth factor 23, parathyroid hormone, calcium, phosphate, and vitamin D metabolites: 1,25(OH) 2 D, 24,25(OH) 2 D, 25(OH)D, and bioavailable 25(OH)D were measured in pre-operative serum samples from 562 of 602 participants in the Haemodialysis Fistula Maturation Study, a multicentre, prospective cohort study of patients undergoing surgical creation of an autologous upper extremity AVF. Unassisted and overall AVF maturation were ascertained for 540 and 527 participants, respectively, within nine months of surgery or four weeks of dialysis initiation. Study personnel obtained vein segments adjacent to the portion of the vein used for anastomosis, which were processed, embedded, and stained for measurement of neointimal hyperplasia, calcification, and collagen deposition in the medial wall. Results: Participants in this substudy were 71% male, 43% black, and had a mean age of 55 years. Failure to achieve AVF maturation without assistance occurred in 288 (53%) participants for whom this outcome was determined. In demographic and further adjusted models, mineral metabolism markers were not significantly associated with vein histology characteristics, unassisted AVF maturation failure, or overall maturation failure, other than a biologically unexplained association of higher 24,25(OH) 2 D with overall failure. This exception aside, associations were non-significant for continuous and categorical analyses and relevant subgroups. Conclusions: Serum concentrations of measured mineral metabolites were not substantially associated with major histological characteristics of veins in patients undergoing AVF creation surgery, or with AVF maturation failure, suggesting that efforts to improve AVF maturation rates should increase attention to other processes such as vein mechanics, anatomy, and cellular metabolism among end stage renal disease patients.

KW - Arteriovenous fistula

KW - Chronic kidney disease

KW - Haemodialysis

KW - Mineral metabolism

KW - Vein histology

KW - Vitamin D

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