Adriana J van Ballegooijen1, Leila Zelnick2, Andrew N Hoofnagle3, Naomi M Hamburg4, Cassiane Robinson-Cohen2, Prabir Roy-Chaudhury5, Alfred K Cheung6, Yan-Ting Shiu6, Ian H de Boer2, Jonathan Himmelfarb2, Gerald Beck7, Peter B Imrey7, John W Kusek8, Bryan Kestenbaum2. 1. Kidney Research Institute, University of Washington, Seattle, WA; VU University Amsterdam, Amsterdam, the Netherlands. Electronic address: hanne.van.ballegooijen@vu.nl. 2. Kidney Research Institute, University of Washington, Seattle, WA. 3. Department of Laboratory Medicine, University of Washington, Seattle, WA. 4. Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA. 5. Division of Nephrology, University of Arizona, Tucson, AZ. 6. Division of Nephrology, University of Utah School of Medicine, Salt Lake City, UT. 7. Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH. 8. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Abstract
BACKGROUND: Disturbances in vitamin D metabolism are common in patients with end-stage renal disease and may contribute to vascular dysfunction. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: We evaluated 558 of 602 participants at baseline of the Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study of a cohort of patients with chronic kidney disease awaiting arteriovenous fistula (AVF) creation surgery. FACTOR: 4 vitamin D metabolites measured with liquid chromatography-tandem mass spectroscopy from samples obtained within 4 weeks prior to AVF surgery. OUTCOMES: Vasodilator functions and measurements of arterial stiffness. MEASUREMENTS: Trained HFM Study personnel measured brachial artery flow-mediated dilation, nitroglycerin-mediated dilation, and carotid-femoral and carotid-radial pulse wave velocities (PWVs) prior to AVF creation. We evaluated associations after basic adjustment for sex, age, and clinical site and more fully adjusted additionally for baseline education, smoking, body mass index, diabetes, dialysis status, and medication use. RESULTS: Mean participant age was 55±13 (SD) years and 65% were receiving maintenance dialysis. None of the vitamin D metabolites were significantly associated with flow-mediated dilation, carotid-femoral PWV, or carotid-radial PWV in basic or fully adjusted analyses. Higher serum concentrations of bioavailable vitamin D and 1,25-dihydroxyvitamin D were associated with 0.62% and 0.58% greater nitroglycerin-mediated dilation values, respectively, in basic models; however, these associations were no longer statistically significant with full adjustment. There were no significant associations of vitamin D metabolites with carotid-femoral or carotid-radial PWV in fully adjusted analyses. LIMITATIONS: Cross-sectional ascertainment of vitamin D metabolites and vascular functions late during the course of kidney disease. CONCLUSIONS: Serum concentrations of vitamin D metabolites are not associated with vasodilator functions or vascular stiffness at baseline in a cohort study of patients with chronic kidney disease awaiting AVF creation surgery. Laboratory measurements of vitamin D metabolites are unlikely to provide useful information regarding vascular functions in this setting.
BACKGROUND: Disturbances in vitamin D metabolism are common in patients with end-stage renal disease and may contribute to vascular dysfunction. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: We evaluated 558 of 602 participants at baseline of the Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study of a cohort of patients with chronic kidney disease awaiting arteriovenous fistula (AVF) creation surgery. FACTOR: 4 vitamin D metabolites measured with liquid chromatography-tandem mass spectroscopy from samples obtained within 4 weeks prior to AVF surgery. OUTCOMES: Vasodilator functions and measurements of arterial stiffness. MEASUREMENTS: Trained HFM Study personnel measured brachial artery flow-mediated dilation, nitroglycerin-mediated dilation, and carotid-femoral and carotid-radial pulse wave velocities (PWVs) prior to AVF creation. We evaluated associations after basic adjustment for sex, age, and clinical site and more fully adjusted additionally for baseline education, smoking, body mass index, diabetes, dialysis status, and medication use. RESULTS: Mean participant age was 55±13 (SD) years and 65% were receiving maintenance dialysis. None of the vitamin D metabolites were significantly associated with flow-mediated dilation, carotid-femoral PWV, or carotid-radial PWV in basic or fully adjusted analyses. Higher serum concentrations of bioavailable vitamin D and 1,25-dihydroxyvitamin D were associated with 0.62% and 0.58% greater nitroglycerin-mediated dilation values, respectively, in basic models; however, these associations were no longer statistically significant with full adjustment. There were no significant associations of vitamin D metabolites with carotid-femoral or carotid-radial PWV in fully adjusted analyses. LIMITATIONS: Cross-sectional ascertainment of vitamin D metabolites and vascular functions late during the course of kidney disease. CONCLUSIONS: Serum concentrations of vitamin D metabolites are not associated with vasodilator functions or vascular stiffness at baseline in a cohort study of patients with chronic kidney disease awaiting AVF creation surgery. Laboratory measurements of vitamin D metabolites are unlikely to provide useful information regarding vascular functions in this setting.
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