van Ballegooijen Adriana J, Zelnick Leila, Hoofnagle Andrew N, Hamburg Naomi M, Robinson-Cohen Cassiane, Roy-Chaudhury Prabir, Cheung Alfred K, Shiu Yan-Ting, de Boer Ian H, Himmelfarb Jonathan, Beck Gerald, Imrey Peter B, Kusek John W, Kestenbaum Bryan
Kidney Research Institute, University of Washington, Seattle, WA; VU University Amsterdam, Amsterdam, the Netherlands.
Kidney Research Institute, University of Washington, Seattle, WA.
Am J Kidney Dis. 2017 Jun;69(6):805-814. doi: 10.1053/j.ajkd.2017.01.049. Epub 2017 Mar 27.
Disturbances in vitamin D metabolism are common in patients with end-stage renal disease and may contribute to vascular dysfunction.
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.
4 vitamin D metabolites measured with liquid chromatography-tandem mass spectroscopy from samples obtained within 4 weeks prior to AVF surgery.
Vasodilator functions and measurements of arterial stiffness.
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.
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.
Cross-sectional ascertainment of vitamin D metabolites and vascular functions late during the course of kidney disease.
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.
维生素D代谢紊乱在终末期肾病患者中很常见，可能导致血管功能障碍。
横断面研究。
我们在血液透析内瘘成熟（HFM）研究的基线阶段评估了602名参与者中的558名，该研究是一项针对等待动静脉内瘘（AVF）创建手术的慢性肾病患者队列的7中心前瞻性队列研究。
在AVF手术前4周内采集的样本中，用液相色谱 - 串联质谱法测量4种维生素D代谢物。
血管舒张功能和动脉僵硬度测量值。
训练有素的HFM研究人员在创建AVF之前测量肱动脉血流介导的舒张、硝酸甘油介导的舒张以及颈股和颈桡脉搏波速度（PWV）。我们在对性别、年龄和临床部位进行基本调整后评估了相关性，并在进一步对基线教育程度、吸烟、体重指数、糖尿病、透析状态和药物使用进行全面调整后进行了评估。
参与者的平均年龄为55±13（标准差）岁，65%的人正在接受维持性透析。在基本或全面调整分析中，没有一种维生素D代谢物与血流介导的舒张、颈股PWV或颈桡PWV有显著相关性。在基本模型中，生物可利用维生素D和1,25 - 二羟基维生素D的血清浓度较高分别与硝酸甘油介导的舒张值高0.62%和0.58%相关；然而，在全面调整后，这些相关性不再具有统计学意义。在全面调整分析中，维生素D代谢物与颈股或颈桡PWV没有显著相关性。
在肾病病程后期对维生素D代谢物和血管功能进行横断面确定。
在一项针对等待AVF创建手术的慢性肾病患者队列的研究中，维生素D代谢物的血清浓度在基线时与血管舒张功能或血管僵硬度无关。在这种情况下，维生素D代谢物的实验室测量不太可能提供有关血管功能的有用信息。
