Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

Rachel W Kubiak; Leila R Zelnick; Andy N Hoofnagle; Charles E Alpers; Christi M Terry; Yan-Ting Shiu; Alfred K Cheung; Ian H de Boer; Cassianne Robinson-Cohen; Michael Allon; Laura M Dember; Harold I Feldman; Jonathan Himmelfarb; Thomas S Huber; Prabir Roy-Chaudhury; Miguel A Vazquez; John W Kusek; Gerald J Beck; Peter B Imrey; Bryan Kestenbaum; Hemodialysis Fistula Maturation Study Group

doi:10.1016/j.ejvs.2019.01.022

Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

Eur J Vasc Endovasc Surg. 2019 May;57(5):719-728. doi: 10.1016/j.ejvs.2019.01.022. Epub 2019 Apr 15.

Authors

Rachel W Kubiak¹, Leila R Zelnick², Andy N Hoofnagle³, Charles E Alpers⁴, Christi M Terry⁵, Yan-Ting Shiu⁵, Alfred K Cheung⁵, Ian H de Boer², Cassianne Robinson-Cohen², Michael Allon⁶, Laura M Dember⁷, Harold I Feldman⁸, Jonathan Himmelfarb², Thomas S Huber⁹, Prabir Roy-Chaudhury¹⁰, Miguel A Vazquez¹¹, John W Kusek¹², Gerald J Beck¹³, Peter B Imrey¹⁴, Bryan Kestenbaum²; Hemodialysis Fistula Maturation Study Group

Collaborators

Hemodialysis Fistula Maturation Study Group:
H Feldman¹⁵, L Dember¹⁶, A Farber¹⁶, J Kaufman¹⁶, L Stern¹⁶, P LeSage¹⁶, C Kivork¹⁶, D Soares¹⁶, M Malikova¹⁶, M Allon¹⁷, C Young¹⁷, M Taylor¹⁷, L Woodard¹⁷, K Mangadi¹⁷, P Roy-Chaudhury¹⁸, R Munda¹⁸, T Lee¹⁸, R Alloway¹⁸, M El-Khatib¹⁸, T Canaan¹⁸, A Pflum¹⁸, L Thieken¹⁸, B Campos-Naciff¹⁸, T Huber¹⁹, S Berceli¹⁹, M Jansen¹⁹, G McCaslin¹⁹, Y Trahan¹⁹, M Vazquez²⁰, W Vongpatanasin²⁰, I Davidson²⁰, C Hwang²⁰, T Lightfoot²⁰, C Livingston²⁰, A Valencia²⁰, B Dolmatch²⁰, A Fenves²⁰, N Hawkins²⁰, A K Cheung²¹, L Kraiss²¹, D Kinikini²¹, G Treiman²¹, D Ihnat²¹, M Sarfati²¹, Y T Shiu²¹, C Terry²¹, I Lavasani²¹, M Maloney²¹, L Schlotfeldt²¹, J Himmelfarb²², C Buchanan²², C Clark²², C Crawford²², J Hamlett²², J Kundzins²², L Manahan²², J Wise²², G Beck²³, J Gassman²³, T Greene²³, P Imrey²³, L Li²³, J Alster²³, M Li²³, J MacKrell²³, M Radeva²³, B Weiss²³, K Wiggins²³, C Alpers²⁴, K Hudkins²⁴, T Wietecha²⁴, M Robbin²⁵, H Umphrey²⁵, L Alexander²⁵, C Abts²⁵, L Belt²⁵, J Vita²⁶, N Hamburg²⁶, M Duess²⁶, A Levit²⁶, H Higgins²⁷, S Ke, O Mandaci²⁷, C Snell²⁷, J Gravley²⁸, S Behnken²⁸, R Mortensen²⁸, G Chertow Chair²⁹, A Besarab²⁹, K Brayman²⁹, M Diener-West²⁹, D Harrison²⁹, L Inker²⁹, T Louis²⁹, W McClellan²⁹, J Rubin²⁹, J Kusek³⁰, R Star³⁰

Affiliations

¹ Kidney Research Institute, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA. Electronic address: [email protected].
² Kidney Research Institute, University of Washington, Seattle, WA, USA.
³ Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
⁴ Department of Pathology, University of Washington, Seattle, WA, USA.
⁵ Division of Nephrology & Hypertension, University of Utah and Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA.
⁶ Department of Vascular Surgery, University of Alabama, Birmingham, AL, USA.
⁷ Renal, Electrolyte & Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁸ Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁹ Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL, USA.
¹⁰ Division of Nephrology and the University of Arizona Kidney Disease Program, University of Arizona, Tucson, AZ, USA.
¹¹ Division of Nephrology, University of Texas Southwestern, Dallas, TX, USA.
¹² National Institutes of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urologic & Hematologic Diseases, Bethesda, MD, USA.
¹³ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
¹⁴ Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
¹⁵ Steering Committee, University of Pennsylvania, USA.
¹⁶ Clinical Centres, Boston University, USA.
¹⁷ University of Alabama, USA.
¹⁸ University of Cincinnati, USA.
¹⁹ University of Florida, USA.
²⁰ University of Texas Southwestern, USA.
²¹ University of Utah, USA.
²² University of Washington, USA.
²³ Data Coordinating Centre, Cleveland Clinic, USA.
²⁴ Histology Core Facility, University of Washington, USA.
²⁵ US Core Facility, University of Alabama at Birmingham, USA.
²⁶ Vascular Function Core Facility, Boston University, USA.
²⁷ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Biosample Repository, Fisher BioServices, USA.
²⁸ NIDDK DNA Repository, Fred Hutchinson Cancer Research Centre, USA.
²⁹ External Expert Panel, USA.
³⁰ NIDDK, USA.

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)₂D, 24,25(OH)₂D, 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)₂D 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.

MeSH terms

Adult
Aged
Arteriovenous Shunt, Surgical*
Biomarkers / blood
Calcification, Physiologic
Calcium / blood
Female
Fibroblast Growth Factor-23
Fibroblast Growth Factors / blood
Humans
Kidney Failure, Chronic / blood*
Kidney Failure, Chronic / therapy*
Male
Middle Aged
Minerals / blood*
Parathyroid Hormone / blood
Phosphates / blood
Renal Dialysis / methods*
Vascular Remodeling*
Veins / metabolism
Veins / pathology
Vitamin D / blood

Substances

Biomarkers
Minerals
Parathyroid Hormone
Phosphates
Vitamin D
Fibroblast Growth Factors
Fibroblast Growth Factor-23
Calcium

Abstract

MeSH terms

Substances

Grants and funding