Angiotensin receptor blockers and antiplatelet agents are associated with improved primary patency after arteriovenous hemodialysis access placement

Jackson, Rubie Sue; Sidawy, Anton N.; Amdur, Richard L.; Khetarpal, Akhil; Macsata, Robyn A.

doi:10.1016/j.jvs.2011.06.028

Cited by 15 publications

(20 citation statements)

References 29 publications

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“…Jackson et al reported that ARB prolongs primary patency in both AVF and AVG groups [12], whereas the DOPPS study [13] showed that there’s no relationship between ARB and vascular access patency, neither in AVF or AVG. However, there is a relatively low rate of ARB use in the DOPPS population (3.8% in AVG group, and 4.1% in AVF group).…”

Section: Discussionmentioning

confidence: 99%

“…Many strategies have been surveyed in order to prolong vascular access patency, including meticulous pre-operative planning [7], newer design of vascular access [8], stent implantation [9,10], far infrared therapy [11], and pharmacotherapy [12–16]. Among pharmacotherapy, some cardioprotective antihypertensive agents have drawn attention recently, including angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB) and calcium channel blocker (CCB).…”

Section: Introductionmentioning

confidence: 99%

“…Theoretically, ACE-I, ARB and CCB could increase vascular access patency through inhibiting venous neointimal hyperplasia, an important mechanism of arteriovenous fistula (AVF) and arteriovenous graft (AVG) failure [17–21]. However, the results of these drugs on clinical studies were still controversial [12,13,16,22–24]. The aim of this study is to evaluate whether ACE-I, ARB, and CCB could have impact on long-term vascular access patency.…”

Section: Introductionmentioning

confidence: 99%

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Angiotensin Converting-Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers Are Associated with Prolonged Vascular Access Patency in Uremic Patients Undergoing Hemodialysis

et al. 2016

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BackgroundVascular access failure is a huge burden for patients undergoing hemodialysis. Many efforts have been made to maintain vascular access patency, including pharmacotherapy. Angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), and calcium channel blocker (CCB) are known for their antihypertensive and cardio-protective effects, however, their effects on long-term vascular access patency are still inconclusive.Design, setting, participants and measurementsWe retrospectively enrolled patients commencing maintenance hemodialysis between January 1, 2000, and December 31, 2006 by using National Health Insurance Research Database in Taiwan. Primary patency was defined as the date of first arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation to the time of access thrombosis or any intervention aimed to maintain or re-establish vascular access patency. Cox proportional hazards models were used to adjust the influences of patient characteristics, co-morbidities and medications.ResultsTotal 42244 patients were enrolled in this study, 37771 (89.4%) used AVF, 4473 (10.6%) used AVG as their first long term dialysis access. ACE-I, ARB, and CCB use were all associated with prolonged primary patency of AVF [hazard ratio (HR) 0.586, 95% confidence interval (CI) 0.557–0.616 for ACE-I use; HR 0.532, CI 0.508–0.556 for ARB use; HR 0.485, CI 0.470–0.501 for CCB use] and AVG (HR 0.557, CI 0.482–0.643 for ACE-I use, HR 0.536, CI 0.467–0.614 for ARB use, HR 0.482, CI 0.442–0.526 for CCB use).ConclusionsIn our analysis, ACE-I, ARB, and CCB were strongly associated with prolonged primary patency of both AVF and AVG. Further prospective randomized studies are still warranted to prove the causality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Angiotensin Converting-Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers Are Associated with Prolonged Vascular Access Patency in Uremic Patients Undergoing Hemodialysis

et al. 2016

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“…The RAAS plays an important role in vascular proliferation via induction of extracellular matrix and smooth muscle cell proliferation . Based on predominantly preclinical studies, RAAS blockade by ACEI or ARB has been shown to reduce intimal hyperplasia formation, promote vasodilation and prevent platelet activation and adhesion (Figure ).…”

Section: Biological Rationale For Using Acei/arb To Improve Vascular mentioning

confidence: 99%

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Viecelli

Mori

Roy‐Chaudhury³

et al. 2017

Seminars in Dialysis

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In patients receiving hemodialysis, the provision of safe and effective vascular access using an arteriovenous fistula or graft is regarded as a critical priority by patients and health professionals. Vascular access failure is associated with morbidity and mortality, such that strategies to prevent these outcomes are essential. Inadequate vascular remodeling and neointimal hyperplasia resulting in stenosis and frequently thrombosis are critical to the pathogenesis of access failure. Systemic medical therapies with pleiotropic effects including antiplatelet agents, omega-3 polyunsaturated fatty acids (fish oils), statins, and inhibitors of the renin-angiotensin-aldosterone system (RAAS) may reduce vascular access failure by promoting vascular access maturation and reducing stenosis and thrombosis through antiproliferative, antiaggregatory, anti-inflammatory and vasodilatory effects. Despite such promise, the results of retrospective analyses and randomized controlled trials of these agents on arteriovenous fistula and graft outcomes have been mixed. This review describes the current understanding of the pathogenesis of arteriovenous fistula and graft failure, the biological effects of antiplatelet agents, fish oil supplementation, RAAS blockers and statins that may be beneficial in improving vascular access survival, results from clinical trials that have investigated the effect of these agents on arteriovenous fistula and graft outcomes, and it explores future therapeutic approaches combining these agents with novel treatment strategies.

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“…Agents such as fish oil and angiotensin-converting enzyme inhibitors have shown some effect in increasing the patency in AV grafts and fistulas [44] . Jackson et al [45] suggest that therapy with an ARB plus antiplatelet agent is associated with prolonged autogenous access primary patency and therapy with an ARB with or without antiplatelet agents is linked with prolonged prosthetic access primary patency. Although arterial image quality and vessel-to-background ratios were lower, NCE-MRA is considered as a feasible alternative to CE-MRA in patients with ESRD who need imaging of the upper extremity and central vasculature prior to dialysis access creation [46] .…”

Section: Permanent Vamentioning

confidence: 99%

Vascular access today

Pantelias

Grapsa²

2012

WJN

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The number of patients with chronic kidney disease requiring renal replacement therapy has increased worldwide. The most common replacement therapy is hemodialysis (HD). Vascular access (VA) has a key role for successful treatment. Despite the advances that have taken place in the field of the HD procedure, few things have changed with regards to VA in recent years. Arteriovenous fistula (AVF), polytetrafluoroethylene graft and the cuffed double lumen silicone catheter are the most common used for VA. In the long term, a number of complications may present and more than one VA is needed during the HD life. The most common complications for all of VA types are thrombosis, bleeding and infection, the most common cause of morbidity in these patients. It has been estimated that VA dysfunction is responsible for 20% of all hospitalizations. The annual cost of placing and looking after dialysis VA in the United States exceeds 1 billion dollars per year. A good functional access is also vital in order to deliver adequate HD therapy. It seems that the native AVF that Brescia and Cimino described in 1966 still remains the first choice for VA. The native forearm AVFs have the longest survival and require the fewest interventions. For this reason, the forearm AVF is the first choice, followed by the upper-arm AVF, the arteriovenous graft and the cuffed central venous catheter is the final choice. In conclusion, VA remains the most important issue for patients on HD and despite the technical improvements, a number of problems and complications have to be resolved.

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Angiotensin receptor blockers and antiplatelet agents are associated with improved primary patency after arteriovenous hemodialysis access placement

Cited by 15 publications

References 29 publications

Angiotensin Converting-Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers Are Associated with Prolonged Vascular Access Patency in Uremic Patients Undergoing Hemodialysis

Angiotensin Converting-Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers Are Associated with Prolonged Vascular Access Patency in Uremic Patients Undergoing Hemodialysis

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

Vascular access today

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