Prealbumin and Lipoprotein(a) in Hemodialysis: Relationships With Patient and Vascular Access Survival

Introduction: Dysfunction of vascular access is an important reason of morbidity for dialysis patients and it is a major factor affecting the economical burden of hemodialysis. The preferred type of vascular access is creation of an arteriovenous fistula (AVF). However, the problem of fistula maturation rate is still a challenge. Herein, we tried to search the role of hyperinsulinism and insulin resistance as a new predictor of primary AVF failure (pAVFF) that may be a cause of intimal damage. Methods: We included 119 patients (73 male and 46 female) with a diagnosis of end-stage renal disease (ESRD) who had undergone an AVF operation by a vascular surgeon. The AVF was examined for presence of thrill on the first postoperative day. A successful cannulation with two fistula needles with a blood flow of 250 mL/min for at least one complete dialysis session, after 4 weeks of AVF surgery was defined as functioning access. Insulin resistance in our patients was determined by the standard homeostasis model assessment (homa-IR). A logistic-regression analysis was performed to investigate the independent factors related with pAVFF. Findings: Detection of pAVFF occurred in 27 (22.7%) patients. The presence of thrill, amount of daily proteinuria, insulin levels, homa-IR, and serum albumin levels were found to be significantly different between patients with fistula failure and those without pAVFF. The logistic-regression analysis of preoperative factors revealed the following OR (odds ratio) and 95% CI values: homa-IR 1.205 (1.063-1.366) (p ¼ 0.004), serum albumin 0.398 (0.178-0.892) (p ¼ 0.025), and the amount of daily proteinuria 1.307 (1.012-1.688) (p ¼ 0.041). Even after addition of the presence of postoperative thrill on AVF, which was a postoperative strong clinical factor to the analysis, mean homa-IR and mean serum albumin continued to be independent predictors of pAVFF. Discussion: Insulin resistance or hyperinsulinism may be a significant cause of pAVFF, which emphasizes the role of endothelium in fistula dysfunction.

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“…2,12 However, the role of hyperinsulinism or insulin resistance, which is important in intimal hyperplasia or injury, has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

A novel factor for primary arteriovenous fistula failure: hyperinsulinism

Akın

Özmen

Kaya³

2016

Renal Failure

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“…Several risk factors of vascular access obstruction including diabetes mellitus, hypotension, hypoalbuminemia, anticardiolipin antibodies, increased serum levels of lipoprotein (a), and fibronectin have been reported (11,12), however, a significant percentage of vascular access obstruction remains unexplained. A hypercoagulable state caused by alterations of coagulation and fibrolytic factors frequently occurs in renal failure (13).…”

Section: Discussionmentioning

confidence: 99%

Anti-Heparin-Platelet Factor 4 Antibody is a Risk Factor for Vascular Access Obstruction in Patients Undergoing Hemodialysis

et al. 2003

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Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The prevalence of anti-heparin-platelet factor 4 antibodies was higher in hemodialysis patients than in normal subjects (8.8 vs 0.0%, p<0.05). The number of past episodes of vascular access obstruction per year was significantly higher in the anti-heparin-platelet factor 4 antibody positive group than antibody negative group. Anti-heparin-platelet factor 4 antibody positive patients experienced more frequent vascular access obstructions than control subjects. In conclusion, anti-heparin-platelet factor 4 antibody might be a risk factor for vascular access obstructions in patients with end-stage renal disease on maintenance hemodialysis.

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“…Creatinine, which reflects lean body mass, and serum albumin, which reflects visceral protein stores, have both been found to be inversely correlated with mortality in the hemodialysis population (2). A single measurement of transthyretin less than 30 mg/dl has been found to be an independent predictor of mortality in the hemodialysis population (4)(5)(6)22).…”

Section: Resultsmentioning

confidence: 99%

“…Serum transthyretin, also known as thyroxine-binding prealbumin or prealbumin, has been proposed as an early indicator of nutritional status in hemodialysis patients (4,6,13,14). In studies involving hemodialysis patients, transthyretin levels have been found to correlate Goldwasser et a.…”

Section: Transthyretin Levels and Nutritional Statusmentioning

confidence: 99%

“…These biochemical markers reflect long term malnutrition and may not accurately reflect early signs of inadequate protein and energy intake (1,3). A low serum level of transthyretin (formerly known as prealbumin) has also been shown to be an independent predictor of morbidity (4) and mortality (4)(5)(6) in the hemodialysis patient. Transthyretin levels are an early indicator of adequate or inadequate nutritional intake (7), an index for the provision of adequate nutritional support (7,8) and a marker for visceral protein anabolism (8).…”

Section: Introductionmentioning

confidence: 99%

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Serum transthyretin in hemodialysis patients : relationship to nutritional status

Duggan¹

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ii ACKNOWLEDGEMENTS I wish to thank the members of my committee for their helpful comments and patience.I would also like to thank the nurses and dialysis technicians at Complete Dialysis Care, Inc.for their help in obtaining timely and accurate laboratory specimens; Dr. Paulette Johnson for her statistical assistance; REN Laboratories for their support of this project; and especially the hemodialysis patients at Complete Dialysis Care, Inc. for agreeing to participate in this study. The validity of serum transthyretin as a nutrition assessment parameter in hemodialysis patients was investigated. Fifty-one subjects (39% male and 61 % female; 53% black, 28% white, 12% Hispanic, 7% Other) receiving hemodialysis for 30 24 months (mean SD) and a total of 36 26 months of renal replacement therapy were followed for six months. Serum transthyretin, albumin, BUN, creatinine, cholesterol, normalized protein catabolic rate (nPCR), KT/V, weight and 24 hour urine analysis were determined monthly. Etiologies of end stage renal disease were diabetic nephropathy (37%), hypertensive nephrosclerosis (37%). glomerulonephritis (12%), polycystic kidney disease (4%), lupus nephritis (4%), other causes (6%). A significant correlation was found between transthyretin and creatinine, albumin and loss of dry weight (p<0.05). Transthyretin levels <30 mg/dl were found to correlate with urine outputs > 240 cc/24 hours, predialysis BUN < 50 mg/dl and nPCR

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Prealbumin and Lipoprotein(a) in Hemodialysis: Relationships With Patient and Vascular Access Survival

Cited by 111 publications

References 39 publications

A novel factor for primary arteriovenous fistula failure: hyperinsulinism

A novel factor for primary arteriovenous fistula failure: hyperinsulinism

Anti-Heparin-Platelet Factor 4 Antibody is a Risk Factor for Vascular Access Obstruction in Patients Undergoing Hemodialysis

Serum transthyretin in hemodialysis patients : relationship to nutritional status

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