title: The association of mineral metabolism with vascular access patency.
abstract: Declining kidney function leads to progressively dysregulated mineral homeostasis and contributes to vascular calcification and a pro-inflammatory milieu, both of which play a critical role in loss of dialysis vascular access patency. We designed this study to examine the relationship between markers of bone and mineral metabolism, vitamin D replacement medications, and vascular access outcomes. We hypothesized that higher levels of calcium, phosphorous, parathyroid hormone (PTH), and albumin are independently associated with vascular access patency and that vitamin D supplementation is associated with lower risk of access failure.
  
  
  
  We abstracted data on 204 consecutive patients referred for angiographic evaluation of their permanent arteriovenous access over a 25-month period. We followed patients from the time of access salvage until subsequent referral for access failure.
  
  
  
  The incidence of vascular access failure did not differ by serum phosphorus, PTH, calcium, calcium-phosphorus product or albumin level. Patients receiving any vitamin D replacement therapy, however, had a lower incidence of access failure compared to those receiving no therapy. Those receiving vitamin D3 therapy with or without paricalcitol (Zemplar, Abbot Laboratories, Abbot Park, IL) or calcitriol had an adjusted HR = 0.18 compared to those receiving no vitamin D therapy.
  
  
  
  This study suggests a relationship between vitamin D3 usage and better vascular access patency, independent of the effect of vitamin D on PTH. Though this relationship needs more rigorous investigation prior to clinical application, the known differences in the pro- and anti-inflammatory effects of various vitamin D metabolites provide a potential mechanism for these clinical observations.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Rosenberg
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Department of Biochemistry, University of Wisconsin, Madison, Wisconsin - USA.
authors.forename: Hector F
authors.initials: HF
authors.lastname: Deluca
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin - USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002118:Calcium / Q000097:blood; D002762:Cholecalciferol / Q000627:therapeutic use; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D065840:Protective Factors; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D000075462:Serum Albumin, Human / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014807:Vitamin D / Q000097:blood* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; D002762:Cholecalciferol; D010758:Phosphorus; D002118:Calcium; D000075462:Serum Albumin, Human