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Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling
BACKGROUND: Chronic kidney disease (CKD) is a highly comorbid condition with significant effects on vascular health and remodeling. Upper extremity veins are important in end-stage kidney disease (ESKD) due to their potential use to create vascular accesses. However, unlike arteries, the contributio...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676677/ https://www.ncbi.nlm.nih.gov/pubmed/36419492 http://dx.doi.org/10.3389/fcvm.2022.1005030 |
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author | Labissiere, Xochilt Zigmond, Zachary M. Challa, Akshara Montoya, Christopher Manzur-Pineda, Karen Abraham, Amalia Tabbara, Marwan Salama, Alghidak Pan, Yue Salman, Loay H. Yang, Xiaofeng Vazquez-Padron, Roberto I. Martinez, Laisel |
author_facet | Labissiere, Xochilt Zigmond, Zachary M. Challa, Akshara Montoya, Christopher Manzur-Pineda, Karen Abraham, Amalia Tabbara, Marwan Salama, Alghidak Pan, Yue Salman, Loay H. Yang, Xiaofeng Vazquez-Padron, Roberto I. Martinez, Laisel |
author_sort | Labissiere, Xochilt |
collection | PubMed |
description | BACKGROUND: Chronic kidney disease (CKD) is a highly comorbid condition with significant effects on vascular health and remodeling. Upper extremity veins are important in end-stage kidney disease (ESKD) due to their potential use to create vascular accesses. However, unlike arteries, the contribution of CKD-associated factors to the chronic remodeling of veins has been barely studied. METHODS: We measured morphometric parameters in 315 upper extremity veins, 131 (85% basilic) from stage 5 CKD/ESKD patients and 184 (89% basilic) from non-CKD organ donors. Associations of demographic and clinical characteristics with intimal hyperplasia (IH) and medial fibrosis were evaluated using multivariate regression models. RESULTS: The study cohort included 33% females, 30% blacks, 32% Hispanics, and 37% whites. Over 60% had hypertension, and 25% had diabetes independent of CKD status. Among kidney disease participants, 26% had stage 5 CKD, while 22 and 52% had ESKD with and without history of a previous arteriovenous fistula/graft (AVF/AVG), respectively. Intimal hyperplasia was associated with older age (β = 0.13 per year, confidence interval [CI] = 0.002–0.26), dialysis vintage > 12 months (β = 0.22, CI = 0.09–0.35), and previous AVF/AVG creation (β = 0.19, CI = 0.06–0.32). Upper quartile values of IH were significantly associated with diabetes (odds ratio [OR] = 2.02, CI = 1.08–3.80), which demonstrated an additive effect with previous AVF/AVG history and longer vintage in exacerbating IH. Medial fibrosis also increased as a function of age (β = 0.17, CI = 0.04–0.30) and among patients with diabetes (β = 0.15, CI = 0.03–0.28). Age was the predominant factor predicting upper quartile values of fibrosis (OR = 1.03 per year, CI = 1.01–1.05) independent of other comorbidities. CONCLUSION: Age and diabetes are the most important risk factors for chronic development of venous IH and fibrosis independent of CKD status. Among kidney disease patients, longer dialysis vintage, and history of a previous AVF/AVG are strong predictors of IH. |
format | Online Article Text |
id | pubmed-9676677 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-96766772022-11-22 Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling Labissiere, Xochilt Zigmond, Zachary M. Challa, Akshara Montoya, Christopher Manzur-Pineda, Karen Abraham, Amalia Tabbara, Marwan Salama, Alghidak Pan, Yue Salman, Loay H. Yang, Xiaofeng Vazquez-Padron, Roberto I. Martinez, Laisel Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Chronic kidney disease (CKD) is a highly comorbid condition with significant effects on vascular health and remodeling. Upper extremity veins are important in end-stage kidney disease (ESKD) due to their potential use to create vascular accesses. However, unlike arteries, the contribution of CKD-associated factors to the chronic remodeling of veins has been barely studied. METHODS: We measured morphometric parameters in 315 upper extremity veins, 131 (85% basilic) from stage 5 CKD/ESKD patients and 184 (89% basilic) from non-CKD organ donors. Associations of demographic and clinical characteristics with intimal hyperplasia (IH) and medial fibrosis were evaluated using multivariate regression models. RESULTS: The study cohort included 33% females, 30% blacks, 32% Hispanics, and 37% whites. Over 60% had hypertension, and 25% had diabetes independent of CKD status. Among kidney disease participants, 26% had stage 5 CKD, while 22 and 52% had ESKD with and without history of a previous arteriovenous fistula/graft (AVF/AVG), respectively. Intimal hyperplasia was associated with older age (β = 0.13 per year, confidence interval [CI] = 0.002–0.26), dialysis vintage > 12 months (β = 0.22, CI = 0.09–0.35), and previous AVF/AVG creation (β = 0.19, CI = 0.06–0.32). Upper quartile values of IH were significantly associated with diabetes (odds ratio [OR] = 2.02, CI = 1.08–3.80), which demonstrated an additive effect with previous AVF/AVG history and longer vintage in exacerbating IH. Medial fibrosis also increased as a function of age (β = 0.17, CI = 0.04–0.30) and among patients with diabetes (β = 0.15, CI = 0.03–0.28). Age was the predominant factor predicting upper quartile values of fibrosis (OR = 1.03 per year, CI = 1.01–1.05) independent of other comorbidities. CONCLUSION: Age and diabetes are the most important risk factors for chronic development of venous IH and fibrosis independent of CKD status. Among kidney disease patients, longer dialysis vintage, and history of a previous AVF/AVG are strong predictors of IH. Frontiers Media S.A. 2022-11-07 /pmc/articles/PMC9676677/ /pubmed/36419492 http://dx.doi.org/10.3389/fcvm.2022.1005030 Text en Copyright © 2022 Labissiere, Zigmond, Challa, Montoya, Manzur-Pineda, Abraham, Tabbara, Salama, Pan, Salman, Yang, Vazquez-Padron and Martinez. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Labissiere, Xochilt Zigmond, Zachary M. Challa, Akshara Montoya, Christopher Manzur-Pineda, Karen Abraham, Amalia Tabbara, Marwan Salama, Alghidak Pan, Yue Salman, Loay H. Yang, Xiaofeng Vazquez-Padron, Roberto I. Martinez, Laisel Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title | Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title_full | Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title_fullStr | Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title_full_unstemmed | Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title_short | Vein morphometry in end-stage kidney disease: Teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
title_sort | vein morphometry in end-stage kidney disease: teasing out the contribution of age, comorbidities, and vintage to chronic wall remodeling |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676677/ https://www.ncbi.nlm.nih.gov/pubmed/36419492 http://dx.doi.org/10.3389/fcvm.2022.1005030 |
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