Association Between Mineral Metabolism Abnormalities and Vascular Access Complications Among Maintenance Hemodialysis Patients in Ethiopia.

BACKGROUND

Chronic kidney disease-mineral and bone disorder (CKD-MBD) contributes to vascular calcification and cardiovascular morbidity among maintenance hemodialysis patients. Mineral metabolism abnormalities, particularly hyperphosphatemia and secondary hyperparathyroidism, may adversely affect vascular access patency and increase vascular access-related complications. However, data from sub-Saharan Africa remain limited. This study evaluated the association between abnormalities in mineral metabolism and vascular access complications among maintenance hemodialysis patients in Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 302 maintenance hemodialysis patients in Addis Ababa, Ethiopia. Sociodemographic, clinical, and laboratory data were collected using structured questionnaires and medical record review. Mineral metabolism parameters included serum calcium, serum phosphorus, and intact parathyroid hormone (iPTH) levels. Vascular access complications were assessed clinically and from dialysis records. Multivariable logistic regression analysis was performed to identify factors independently associated with vascular access complications.

RESULTS

The mean age of participants was 52.6 ± 14.2 years, and 59.0% were male. Vascular access complications were identified in 72 (23.8%) participants. Hyperphosphatemia, hypocalcemia, and elevated iPTH were present in 28.0%, 27.7%, and 47.4% of patients, respectively. Patients with vascular access complications had significantly higher mean serum phosphorus levels and iPTH concentrations compared with those without complications (p < 0.05). In multivariable analysis, hyperphosphatemia (adjusted odds ratio [AOR] = 2.41, 95% CI: 1.32-4.39), elevated iPTH (AOR = 2.87, 95% CI: 1.58-5.21), and dialysis duration > 24 months (AOR = 1.94, 95% CI: 1.08-3.47) were independently associated with vascular access complications.

CONCLUSIONS

Abnormalities in mineral metabolism were significantly associated with vascular access complications among maintenance hemodialysis patients in Ethiopia. Hyperphosphatemia and elevated iPTH emerged as important independent predictors of vascular access dysfunction. Strengthening CKD-MBD management and optimizing mineral metabolism control may help reduce vascular access complications and improve dialysis outcomes in resource-limited settings.