title: Treatment of vitamin D deficiency/insufficiency with ergocalciferol is associated with reduced vascular access dysfunction in chronic hemodialysis patients.
abstract: Vitamin D deficiency or insufficiency is highly prevalent among patients with chronic kidney disease (CKD). This study aims to determine the relationship between vitamin D and frequency of vascular access dysfunction (VAD) in hemodialysis (HD) patients. We reviewed medical records of all HD patients who had serum 25-hydroxyvitamin D (25OHD) levels at 4 outpatient dialysis facilities between January 2011 and January 2012. Patients were included if they were ≥18 years of age, had been on maintenance dialysis for ≥3 months, and had native arteriovenous fistula or synthetic polytetrafluoroethylene grafts for dialysis access. Patients with catheters were excluded. 25-Hydroxyvitamin D levels <30 ng/mL were documented in 183 patients (86%). Median and interquartile range [Q1, Q3] of 25OHD level was 16 [11, 25] ng/mL. Among 213 dialysis patients, 102 had VAD. Median 25OHD level was significantly lower in patients who had VAD than in those without VAD (14.5 [10, 22] vs. 19 [12, 27.5] ng/mL; P = 0.003). There was significant association between VAD and the lowest quartile relative to the highest quartile of 25OHD level. A 25OHD level <12 ng/mL was associated with more than doubling of risk for VAD (OR 2.56; 95% CI [1.05-6.23], P < 0.05). Of 213 patients, 140 were treated with ergocalciferol and 73 were not treated. Treatment was associated with significant reduction in VAD (OR = 0.36; 95% CI [0.19-0.68], P = 0.002). Vitamin D deficiency or insufficiency is an independent risk factor for VAD in HD patients; its treatment with ergocalciferol is associated with decreased VAD.
authors: Nephrology Division, Department of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors: Gaurav
authors: G
authors: Agarwal
authors: Nephrology Division, Department of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors: Karina
authors: K
authors: Vasquez
authors: Nephrology Division, Department of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors: Neena
authors: N
authors: Penagaluru
authors: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors: Jonathan
authors: J
authors: Gelfond
authors: Nephrology Division, Department of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
authors: Wajeh Y
authors: WY
authors: Qunibi
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004872:Ergocalciferols / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000188:drug therapy*
chemical_list: D050071:Bone Density Conservation Agents; D004872:Ergocalciferols
keywords: Access; cardiovascular disease; dialysis; ergocalciferol; vitamin D