Document Detail


The role of mineral metabolism and inflammation on dialysis vascular access failure.
MedLine Citation:
PMID:  16868901     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Thrombosis of arteriovenous fistula (AVF) is the leading cause of vascular access (VA) loss usually due to silent stenosis. Therefore, assessment of relevant risk factors of VA monitoring may provide insight into potential therapeutic targets for stenosis and thrombosis. The aim of this study was to evaluate the influence of cardiovascular risk factors (including inflammation and mineral metabolism dysfunctions) on the failure of internal AVF in HD patients. 128 HD patients with internal AVF were included in the study and followed up for two years. At baseline, VA morphology and function were followed by Doppler ultrasonography and serum albumin, prealbumine, C-reactive protein, orosomucoid, calcium, phosphorus, parathyroid hormone, bone-type alkaline phosphatase, osteoprotegerin and receptor activator of nuclear factor ê ê B ligand were measured. At baseline, 50 stenoses were detected but none of them required any intervention. Age and biological parameters did not significantly differ between patients with or without VA stenosis. Over the two year- follow up, VA thrombosis occurred in 19 patients. Preexisting stenosis of VA was present in 9/19 patients (47.3% of cases) (chi-square = 3.708, p = 0.0538). Despite the low rate of events, phosphorus [1.75 (0.95-2.77) vs 1.42 (0.47-3.22) mmol/L, p = 0.0416], Calcium x Phosphorus product [4.00 (2.00-5.90) vs 3.40 (1.10-6.80) mmol(2)/L(2), p = 0.0676] and parathyroid hormone [165.00 (1.00-944.00) vs 79.50 (1.00-846.60) ng/L, p = 0.0814) levels were higher in the 19 thrombotic patients whereas all other biological parameters did not significantly differ. These results, which confirm that VA thrombosis occurs more frequently upon preexisting stenosis, also demonstrate that mineral metabolism disorders, compared to inflammation, may contribute to VA dysfunction leading to thrombosis.
Authors:
M Morena; J Y Bosc; I Jaussent; A M Dupuy; N Terrier; H Leray-Moragues; J L Flavier; F Maurice; C Delcourt; J P Cristol; B Canaud
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  7     ISSN:  1129-7298     ISO Abbreviation:  J Vasc Access     Publication Date:    2006 Apr-Jun
Date Detail:
Created Date:  2006-07-26     Completed Date:  2006-10-06     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  77-82     Citation Subset:  IM    
Affiliation:
Biochemistry Laboratory, Lapeyronie University Hospital, Montpellier, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical / adverse effects*
Blood Vessel Prosthesis Implantation / adverse effects*
Cohort Studies
Constriction, Pathologic / complications
Female
Graft Occlusion, Vascular / etiology*
Humans
Hyperparathyroidism / complications*
Inflammation / complications*
Male
Middle Aged
Renal Dialysis* / methods
Risk Factors
Thrombosis / etiology*
Vascular Patency
Veins / ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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