Joy Walker, Jade S. Hiramoto, Philip Auyang, Hugh Alley, Michael Conte, David Lovett, Joseph Rapp, Christopher D. Owens
University of California San Francisco, San Francisco, CA.
OBJECTIVES: Plasma 25 hydroxycholecalciferol (vitamin D) has been associated with adverse cardiovascular outcomes in epidemiological studies. CKD is associated with loss of 1-α-hydroxylase and vitamin D deficiency (vitamin D deficiency). We hypothesized that vitamin D def is associated with increased mortality and decreased vascular access patency in patients undergoing permanent vascular access for end stage renal disease.
METHODS: Case series of 129 patients undergoing permanent vascular access surgery who also had concurrent plasma vitamin D levels. Vitamin D levels were considered deficient at <20ng/mL, insufficient at 21-29, and normal >30ng/mL. Mortality and vascular access patency were evaluated using multivariate logistic regression models.
RESULTS: The mean age was 66.6, 96.1% were male and 31.8% African American. 61.2% had diabetes mellitus. In the entire cohort 75.2% were either insufficient or deficient. Mean follow up time was 2.96 years during which there were 41 (31.8%) deaths and 79(64.75%) vascular access events. Vitamin D deficient patients tended to be younger (p=0.007), have higher total cholesterol (p=0.0002), and lower calcium levels (p=0.031). Despite their younger age, mortality was significantly higher in this group (p=0.008) and AVF patency was worse (p=0.015). Age, vitamin D def, CAD, HTN, albumin and HgbA1C were associated with mortality. In multivariate analysis vitamin D def. OR=4.26; (CI 1.37-13.28) p=0.012, CAD OR=3.56; (CI 1.24-10.24) p=0.018, age OR=1.08; (CI 1.03-1.15) p=0.002 and albumin OR=0.23 (CI 0.07-0.74) p=0.014 remained significant. Vitamin D deficiency, p=0.036 and low hematocrit, p=0.011 were independently associated with a loss of AVF patency.
CONCLUSIONS: Vitamin D deficiency is highly prevalent in patients undergoing vascular access procedures. Patients who are deficient have worse survival and more access related events. Further study is warranted to assess whether vitamin D repletion will improve outcomes in this population.
AUTHOR DISCLOSURES: H. Alley: Nothing to disclose; P. Auyang: Nothing to disclose; M. Conte: Nothing to disclose; J. S. Hiramoto: Nothing to disclose; D. Lovett: Nothing to disclose; C. D. Owens: Nothing to disclose; J. Rapp: Nothing to disclose; J. Walker: Nothing to disclose.
Posted April 2013