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Gardezi AI, Karim MS, Rosenberg JE, Scialla JJ, Banerjee T, Powe NR, Shafi T, Parekh RS, Yevzlin AS, Astor BC. Markers of mineral metabolism and vascular access complications: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. Hemodial Int 2019; 24:43-51. [PMID: 31789482 DOI: 10.1111/hdi.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Vascular access dysfunction is a major cause of morbidity in patients with end-stage renal disease (ESRD) on chronic hemodialysis. The effects of abnormalities in mineral metabolism on vascular access are unclear. In this study, we evaluated the association of mineral metabolites, including 25-hydroxy vitamin D (25(OH)D) and fibroblast growth factor-23 (FGF-23), with vascular access complications. METHODS We included participants from the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study who were using an arteriovenous fistula (AVF; n = 103) or arteriovenous graft (AVG; n = 116). Serum levels of 25(OH)D, FGF-23, parathyroid hormone (PTH), calcium, phosphorus, C-reactive protein (CRP) and interleukin-6 (IL-6) were assessed from stored samples. Participants were followed for up to 1 year or until a vascular access intervention or replacement. FINDINGS A total of 24 participants using an AVF and 43 participants using an AVG experienced access intervention. Those with 25(OH)D level in the lowest tertile (<11 ng/mL) had an increased risk of AVF intervention compared to those with higher 25(OH)D levels (adjusted relative hazard [aHR] = 3.28; 95% confidence interval [CI]: 1.31, 8.20). The highest tertile of FGF-23 (>3750 RU/mL) was associated with greater risk of AVF intervention (aHR = 2.56; 95% CI: 1.06, 6.18). Higher PTH was associated with higher risk of AVF intervention (aHR = 1.64 per SD of log(PTH); 95% CI: 1.02, 2.62). These associations were not observed in participants using an AVG. None of the other analytes were significantly associated with AVF or AVG intervention. DISCUSSION Low levels of 25(OH)D and high levels of FGF-23 and PTH are associated with increased risk of AVF intervention. Abnormalities in mineral metabolism are risk factors for vascular access dysfunction and potential therapeutic targets to improve outcomes.
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Affiliation(s)
- Ali I Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Muhammad S Karim
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joel E Rosenberg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Julia J Scialla
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tanushree Banerjee
- Department of Medicine, University of California, San Francisco, California, USA
| | - Neil R Powe
- Department of Medicine, University of California, San Francisco, California, USA
| | - Tariq Shafi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Canada
| | | | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Oprea A, Molnar A, Scridon T, Mircea PA. Digital pressure in haemodialysis patients with brachial arteriovenous fistula. Indian J Med Res 2019; 149:376-383. [PMID: 31249203 PMCID: PMC6607816 DOI: 10.4103/ijmr.ijmr_415_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives : The pathophysiological mechanisms involved in distal pressure changes following arteriovenous fistula (AVF) creation in patients with end-stage renal disease (ESRD) are not completely understood. This study was aimed to assess digital pressure changes post-AVF creation and to identify the factors that might influence these changes in ESRD patients. Methods : In this prospective study, 41 patients with ESRD underwent AVF creation. Basal digital pressure (BDP), digital brachial index (DBI), calcium, phosphorus and blood urea levels were assessed preoperatively. BDP, DBI, vein and artery diameters, and AVF blood flow were also evaluated at one and two month(s) post-AVF creation. Results : Mean BDP significantly decreased from 131.64±25.86 mmHg (baseline) to 93.15±32.14 and 94.53±32.90 mmHg at one and two months post-AVF creation, respectively (P <0.001). Mean DBI significantly decreased one month post-AVF creation versus baseline (0.70±0.18 vs. 0.89±0.17 mm, P <0.001) and remained similar at two versus one month(s) postoperatively (0.70±0.23 vs. 0.70±0.18 mm). At both postoperative timepoints, no correlation between DBI decrease and increased artery and vein diameters or fistula blood flow was observed. Mean DBI difference between patients with previous ipsilateral access versus those without was not significant from pre to one month postoperatively. No correlation was observed between baseline phosphorus, calcium and blood urea nitrogen and DBI changes. Interpretation & conclusions : Our findings suggest that decrease in distal pressure following AVF creation may not be influenced by the arterial remodelling degree, vein diameter or fistula flow. In uraemic patients, those with low calcium and/or increased phosphorus, no association between these parameters and DBI changes could be observed.
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Affiliation(s)
- Alexandru Oprea
- Department of Cardiovascular Surgery, "Niculae Stancioiu" Heart Institute, Cluj-Napoca, Romania
| | - Adrian Molnar
- Department of Cardiovascular Surgery, "Niculae Stancioiu" Heart Institute, Cluj-Napoca, Romania
| | - Traian Scridon
- Department of Cardiovascular Surgery, "Niculae Stancioiu" Heart Institute, Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- Department of Gastroenterology, Emergency Clinical County Hospital, University of Medicine & Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Agarwal G, Vasquez K, Penagaluru N, Gelfond J, Qunibi WY. Treatment of vitamin D deficiency/insufficiency with ergocalciferol is associated with reduced vascular access dysfunction in chronic hemodialysis patients. Hemodial Int 2015; 19:499-508. [DOI: 10.1111/hdi.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gaurav Agarwal
- Nephrology Division; Department of Medicine; The University of Texas Health Science Center San Antonio; San Antonio Texas USA
| | - Karina Vasquez
- Nephrology Division; Department of Medicine; The University of Texas Health Science Center San Antonio; San Antonio Texas USA
| | - Neena Penagaluru
- Nephrology Division; Department of Medicine; The University of Texas Health Science Center San Antonio; San Antonio Texas USA
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics; The University of Texas Health Science Center San Antonio; San Antonio Texas USA
| | - Wajeh Y. Qunibi
- Nephrology Division; Department of Medicine; The University of Texas Health Science Center San Antonio; San Antonio Texas USA
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Moon JY, Lee HM, Lee SH, Lee TW, Ihm CG, Jo YI, Han SW, Shin SG. Hyperphosphatemia is associated with patency loss of arteriovenous fistula after 1 year of hemodialysis. Kidney Res Clin Pract 2015; 34:41-6. [PMID: 26484018 PMCID: PMC4570653 DOI: 10.1016/j.krcp.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The patency of arteriovenous access is important for stable and effective hemodialysis, and long-term technical survival is best achieved with a native arteriovenous fistula (AVF). However, maintaining AVF patency remains a challenge. This study was designed to determine the independent prognostic factors for AVF patency according to hemodialysis duration. METHODS The primary study end point was unassisted patency of the AVF, which was defined as the time from the first fistula surgery to the first AVF failure. AVF failure was defined as an event that required percutaneous intervention or surgery to revise or replace the fistula, which occurred at least 2 months after fistula formation. RESULTS We enrolled 478 patients with a mean age of 55.5±14.0 years, and mean duration of dialysis was 2.5±2.1 years. There were 109 cases (22.8%) of AVF failure. The factors related to AVF patency differed according to hemodialysis duration. Using a Cox-adjusted model, we observed a significant correlation between the incidence of AVF failure and diabetes within the initial 12 months of hemodialysis. Uncontrolled hyperphosphatemia (mean serum phosphorus>5.5 mg/dL during hemodialysis) was associated with patency loss of AVF after 1 year of hemodialysis. CONCLUSION Various factors were associated with the development of patency loss of AVF as hemodialysis duration differed, and a preventive role of hyperphosphatemia control in AVF survival needs further clinical study.
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Affiliation(s)
- Ju-Young Moon
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyae Min Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Tae-Won Lee
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Chun-Gyoo Ihm
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea
| | - Young-Il Jo
- Division of Nephrology, Department of Internal Medicine, Konkuk University, Seoul, Korea
| | - Sang-Woong Han
- Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sug-Gyun Shin
- Division of Nephrology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea
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Abstract
PURPOSE Very scarce data exist regarding the relationship between differential white blood cell (WBC) counts and primary arteriovenous fistula (AVF) failure. Thus, the current study aimed to investigate the specific relationship between primary AVF failure and differential WBC counts.
METHODS Sociodemographic, clinical, and laboratory parameters including automatically determined complete blood counts of the patients (from medical records and hospital charts) prior to AVF fistula surgery were recorded. Primary AVF failure was described as a complication of the AVF before the first successful cannulation for HD treatment.
RESULTS In total 94 patients (Male/Female: 49/45, Aged: 50.9 ± 15.0 years) were included. Ferritin, high sensitive C-reactive protein (hs-crp), total WBC count, neutrophil count, red cell distribution width (RDW) were higher in patients with primary AVF failure compared to patients without primary AVF failure. Logistic regression analysis showed that presence of diabetes (OR = 3.654, p = 0.035), RDW (OR = 0.449, p = 0.033) and ferritin (OR = 1.097, p = 0.021) were independently related with primary AVF failure.
CONCLUSIONS Neither total WBC counts nor WBC subtypes were related with primary AVF failure. Higher RDW and ferritin levels had a prognostic value for development of primary AVF failure.
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Kaygin MA, Halici U, Aydin A, Dag O, Binici DN, Limandal HK, Arslan Ü, Kiymaz A, Kahraman N, Calik ES, Savur AI, Erkut B. The relationship between arteriovenous fistula success and inflammation. Ren Fail 2013; 35:1085-8. [DOI: 10.3109/0886022x.2013.815100] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zögg T, Brandstetter H. Complex assemblies of factors IX and X regulate the initiation, maintenance, and shutdown of blood coagulation. Prog Mol Biol Transl Sci 2011; 99:51-103. [PMID: 21238934 DOI: 10.1016/B978-0-12-385504-6.00002-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Blood hemostasis is accomplished by a complex network of (anti-)coagulatory and fibrinolytic processes. These physiological processes are implemented by the assembly of multiprotein complexes involving both humoral and cellular components. Coagulation factor X, and particularly, factor IX, exemplify the dramatic enhancement that is obtained by the synergistic interaction of cell surface, inorganic and protein cofactors, protease, and substrate. With a focus on structure-function relationship, we review the current knowledge of activity modulation principles in the coagulation proteases factors IX and X and indicate future challenges for hemostasis research. This chapter is organized by describing the principles of hierarchical activation of blood coagulation proteases, including endogenous and exogenous protease activators, cofactor binding, substrate specificities, and protein inhibitors. We conclude by outlining pharmaceutical opportunities for unmet needs in hemophilia and thrombosis.
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Lee YK, Koo JR, Kim JK, Park II, Joo MH, Yoon JW, Noh JW, Vaziri ND. Effect of Route of EPO Administration on Hemodialysis Arteriovenous Vascular Access Failure: A Randomized Controlled Trial. Am J Kidney Dis 2009; 53:815-22. [DOI: 10.1053/j.ajkd.2008.12.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 12/22/2008] [Indexed: 11/11/2022]
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Marcus RJ, Marcus DA, Sureshkumar KK, Hussain SM, McGill RL. Gender differences in vascular access in hemodialysis patients in the United States: developing strategies for improving access outcome. ACTA ACUST UNITED AC 2008; 4:193-204. [PMID: 18022587 DOI: 10.1016/s1550-8579(07)80040-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients undergoing chronic hemodialysis (HD) require placement of permanent vascular access with the creation of an arteriovenous fistula (AVF), an arteriovenous prosthetic graft (AVG), or a tunneled central venous catheter. AVFs provide greater long-term patency, fewer complications, and lower infection rates than do either AVGs or catheters. Despite these advantages, women continue to be underrepresented among AVF patients, possibly because of concerns about smaller vascular diameters and higher rates of early primary fistula failure in female HD patients. The numerous clinical benefits of AVF suggest that a greater effort should be made to promote AVF placement in women. OBJECTIVE This review analyzes risk factors for AVF failure in women and describes clinical strategies to improve AVF utilization and success for female HD patients. METHODS English-language publications were identified through a MEDLINE database search from January 1997 to March 2007, using the search terms arteriovenous fistula, vascular access, hemodialysis, female, and gender. Reference lists of identified articles were also reviewed. RESULTS There are significant benefits to using AVFs instead of AVGs or catheters in HD patients: greater long-term fistula patency, superior flow rates, and fewer complications. Vascular anatomical differences between the sexes contribute to the underutilization of AVF in women. AVF placement rates can be improved if patients and staff are adequately educated and provided with the tools to facilitate AVF placement. Noninvasive preoperative screening is important to identify superior access sites in women. Intraoperative monitoring of blood flow is a reliable predictor of early radiocephalic AVF patency. Routine postoperative vascular monitoring may improve overall success with AVF, and exercise may improve vascular diameter and may be even more beneficial for women, who may have smaller preoperative veins. CONCLUSIONS Concerns about smaller vascular diameters and reports of higher failure rates in women may prevent nephrologists and surgeons from considering AVF for female HD patients. The numerous advantages associated with AVF suggest that a greater effort should be made to increase its utilization in women. With appropriate motivation, care, and diligence by treating clinicians, the success of AVFs in women can approach the good results typically expected in men.
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Affiliation(s)
- Richard J Marcus
- Division of Nephrology and Hypertension, Allegheny General Hospital, and Department of Anesthesiology, University of Pittsburgh Medical Center, Pennsylvania 15212, USA.
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