title: Vascular Function at Baseline in the Hemodialysis Fistula Maturation Study.
abstract: End-stage renal disease is accompanied by functional and structural vascular abnormalities. The objective of this study was to characterize vascular function in a large cohort of patients with end-stage renal disease, using noninvasive physiological measurements, and to correlate function with demographic and clinical factors.
  
  
  
  We analyzed cross-sectional baseline data from the Hemodialysis Fistula Maturation Study, a multicenter prospective observational cohort study of 602 patients with end-stage renal disease from 7 centers. Brachial artery flow- and nitroglycerin-mediated dilation, carotid-femoral and -radial pulse wave velocity, and venous occlusion plethysmography were performed prior to arteriovenous fistula creation. Relationships of these vascular function measures with demographic, clinical, and laboratory factors were evaluated using linear mixed-effects models. Arterial function, as assessed by flow- and nitroglycerin-mediated dilation and carotid-femoral pulse wave velocity, worsened with increasing age and diabetes mellitus. Venous capacitance decreased with diabetes mellitus but not with age. Flow-mediated dilation was higher among patients undergoing maintenance dialysis than for those at predialysis, and a U-shaped relationship between serum phosphorus concentration and flow-mediated dilation was evident. Partial correlations among different measures of vascular function, adjusting for demographic factors, diabetes mellitus, and clinical center, were modest or essentially nonexistent.
  
  
  
  Multiple demographic and clinical factors were associated with the functions of vessels of different sizes and types in this large cohort of patients with end-stage renal disease. Low correlations between the different measures, controlling for demographic factors, diabetes mellitus, and center, indicated that these different types of vascular function otherwise vary heterogeneously across patients.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA ldember@upenn.edu.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Dember
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Imrey
authors.affiliation: Boston University School of Medicine, Boston, MA.
authors.forename: Mai-Ann
authors.initials: MA
authors.lastname: Duess
authors.affiliation: Boston University School of Medicine, Boston, MA.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
authors.forename: Milena
authors.initials: M
authors.lastname: Radeva
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Kraiss
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: University of Arizona, Tuscon, AZ.
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Christi M
authors.initials: CM
authors.lastname: Terry
authors.affiliation: University of Texas-Southwestern, Dallas, TX.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Vazquez
authors.affiliation: University of Texas-Southwestern, Dallas, TX.
authors.forename: Wanpen
authors.initials: W
authors.lastname: Vongpatanasin
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.affiliation: Boston University School of Medicine, Boston, MA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001916:Brachial Artery / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D010991:Plethysmography; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D014656:Vascular Surgical Procedures; D014664:Vasodilation / Q000502:physiology*; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: chronic kidney disease; end‐stage renal disease; flow‐mediated dilation; nitroglycerin‐mediated dilation; pulse wave velocity; vascular function; venous occlusion plethysmography