Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
Hemodial Int. 2023 Jul;27(3):231-240. doi: 10.1111/hdi.13080. Epub 2023 Apr 3.
Arteriovenous fistula (AVF) is a primary dialysis vascular access commonly used for maintaining hemodialysis (MHD) patients. Vitamin D (VD) is a fat-soluble steroid hormone that is closely related to vascular endothelial function. This study aimed to investigate the association between VD metabolites and AVF failure in patients undergoing HD.
This study included 443 HD patients using AVF between January 2010 and January 2020. The AVF operations in these patients were newly created by the same physician. We analyzed the AVF patency rates using the chi-square test. Univariate and multivariate logistic regression analyses were performed to explore risk factors for AVF failure. Survival analysis was performed to explore AVF survival at different serum 25-hydroxyvitamin D (25(OH)D) concentrations.
Logistic regression analyses showed that male sex; age; BMI; serum albumin, triglyceride, phosphorus, 25(OH)D, iPTH and hemoglobin levels, history of hypertension, CHD, diabetes, stroke, and antiplatelet drug use; and smoking habits were not risk factors for AVF failure. The failure incidence rates of AVF in subjects in the VD deficiency and non VD deficiency group were not statistically significant (25.0% vs. 30.8%, p = 0.344). The AVF failure incidence rates at 1, 3, and 5 years in the patients with 25(OH)D levels more than 20 ng/mL were 26%, 29%, and 37%, respectively, and the one-year AVF failure incidence rates were 27% in the patients with 25(OH)D levels less than 20 ng/mL. In addition, the Kaplan-Meier analysis suggested that the no significant differences were noted when calculating the cumulative survival rates of AVF between the two groups within 50 months of AVF using.
Our findings suggest that 25(OH)D deficiency is not associated with AVF failure incidence rates, and that 25(OH)D deficiency has no significant impact on long-term cumulative AVF survival rate.
动静脉瘘（AVF）是一种常用于维持血液透析（MHD）患者的主要透析血管通路。维生素 D（VD）是一种脂溶性类固醇激素，与血管内皮功能密切相关。本研究旨在探讨 HD 患者 VD 代谢物与 AVF 失败之间的关系。
本研究纳入 2010 年 1 月至 2020 年 1 月期间使用 AVF 的 443 例 HD 患者。这些患者的 AVF 手术均由同一位医生新创建。我们使用卡方检验分析 AVF 通畅率。进行单变量和多变量逻辑回归分析以探讨 AVF 失败的危险因素。生存分析用于探讨不同血清 25-羟维生素 D（25（OH）D）浓度下 AVF 的生存情况。
逻辑回归分析表明，男性；年龄；BMI；血清白蛋白、甘油三酯、磷、25（OH）D、iPTH 和血红蛋白水平、高血压、冠心病、糖尿病、中风和抗血小板药物使用史；以及吸烟习惯不是 AVF 失败的危险因素。VD 缺乏和非 VD 缺乏组的 AVF 失败发生率无统计学意义（25.0%比 30.8%，p=0.344）。25（OH）D 水平大于 20ng/mL 的患者 AVF 失败发生率在 1、3 和 5 年分别为 26%、29%和 37%，25（OH）D 水平小于 20ng/mL 的患者 AVF 失败发生率为 1 年为 27%。此外，Kaplan-Meier 分析表明，在 AVF 后 50 个月内，计算两组之间 AVF 的累积生存率时，没有发现显著差异。
我们的研究结果表明，25（OH）D 缺乏与 AVF 失败发生率无关，25（OH）D 缺乏对 AVF 的长期累积存活率无显著影响。
