Markers of mineral metabolism and vascular access outcomes in end-stage renal disease in Assiut University Hospitals: single-center study

Background Preserving functional vascular access is crucial for patients with end-stage renal disease undergoing hemodialysis, as its failure can lead to severe life-threatening consequences. Complications related to vascular access are a significant cause of hospital admissions. Recognizing predictive factors and therapeutic targets may help in designing effective preventive strategies. This study aims to investigate the association between vascular access complications and markers of mineral metabolism disturbances. Patients and methods This single-center prospective cohort study (2022–2024) included 100 adults with end-stage renal disease on regular hemodialysis referred for arteriovenous fistula (AVF) creation. A predialysis blood sample was collected for kidney function tests, electrolytes, mineral-metabolism markers [25-hydroxyvitamin D, intact parathyroid hormone, fibroblast growth factor 23 (FGF23)], lipid profile, and routine hematologic and inflammatory parameters. Postoperatively, patients were followed up to evaluate maturation and detect early complications, and classified into successful or failed AVF outcomes based on clinical assessment and Doppler ultrasonography. Results Among the studied patients, 45 achieved successful AVF maturation, whereas 55 experienced failure. Those with failed AVFs had significantly higher BMI ( P <0.001), magnesium ( P =0.009), intact parathyroid hormone ( P =0.007), and FGF23 levels ( P <0.001), with markedly lower vitamin D levels ( P <0.001). Correlation analysis demonstrated a strong negative association between FGF23 and AVF success ( r =–0.624, P <0.001), and a strong positive association between vitamin D and AVF success ( r =0.576, P <0.001). Multivariate regression analysis identified FGF23 (odds ratio=0.002, P =0.002) and vitamin D (odds ratio=1.186, P =0.001) as independent predictors of AVF outcomes. Conclusion High FGF23 and low vitamin D levels are key independent predictors of AVF failure in patients undergoing hemodialysis.