Association Between Vascular Access Dysfunction and Subsequent Major Adverse Cardiovascular Events in Patients on Hemodialysis

Kuo, Te Hui; Tseng, Chien Tzu; Lin, Wei; Chao, Jo Yen; Wang, Wei Ming; Li, Chung‐Yi; Wang, Ming Cheng

doi:10.1097/md.0000000000001032

Cited by 19 publications

(16 citation statements)

References 47 publications

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“… 13 25 In the current study, Qa moderately and positively correlated with CI, which is in agreement with the findings of a previous study. Kuo et al 26 reported a significant association of vascular access dysfunction with subsequent major adverse CV events in chronic HD patients. These findings imply that lower Qa levels may be correlated with vascular access dysfunction, lower cardiac function and subsequent CV or cerebrovascular events.…”

Section: Discussionmentioning

confidence: 99%

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Wu¹,

Lin

et al. 2017

BMJ Open

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ObjectivesTo investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients.DesignObservational cohort study.SettingSingle centre.ParticipantsAdult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged <18 years and had Qa levels of ≥2000mL/min. A total of 378 adult chronic HD patients were eventually enrolled for the study.InterventionsThe selected patients were evaluated with Qa and cardiac index (CI). They were divided into four groups according to three Qa cut-off points (500, 1000 and 1500 mL/min).Primary and secondary outcome measuresShort-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality.ResultsQa was positively correlated with CI (r=0.48, p<0.001). A Qa level of <1000 mL/min was independently associated with 1-year all-cause mortality (adjusted OR, 6.04; 95% CI 1.64 to 22.16; p=0.007). Kaplan-Meier analysis revealed that the cumulative incidence rates of all-cause and vascular mortality were significantly higher in the patients with a Qa level of <1000 mL/min (log-rank test; all p<0.01). Furthermore, a Qa level of <1000 mL/min was independently associated with long-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders.ConclusionsQa is moderately correlated with cardiac function, and a Qa level of <1000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic HD patients.

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Section: Discussionmentioning

confidence: 99%

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Wu¹,

Lin

et al. 2017

BMJ Open

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“…Vascular endothelial dysfunction, i.e., decreased NO production and reduced NO bioactivity, is considered a predictor for the development and progression of vascular diseases, 24,25 and a pivotal risk factor for cardiovascular events in patients with metabolic syndrome. 26 Impairment of vasorelaxation in response to NO occurs in the arteries of SHRSP.ZF rats with metabolic disorders. [20][21][22] The present study demonstrated that PNS enhances NO-dependent vasorelaxation in SHRSP.ZF rat arteries and that ginsenoside Rb 1 might be involved in this PNS-mediated effect.…”

Section: Discussionmentioning

confidence: 99%

Panax notoginseng saponins ameliorate impaired arterial vasodilation in SHRSP.Z‐Lepr^fa/lzmDmcr rats with metabolic syndrome

Sun

Kagota

et al. 2016

Clin Exp Pharma Physio

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Panax notoginseng saponins (PNS) are major components of Panax notoginseng, a herb with established clinical efficacy against vascular diseases. SHRSP.Z-Lepr(fa) /IzmDmcr (SHRSP.ZF) rats, a new animal model for metabolic syndrome, display an impaired vasorelaxation response in aortas and mesenteric arteries that is mediated by nitric oxide (NO). This study investigated whether PNS and its components can ameliorate this vascular dysfunction in SHRSP.ZF rats. In an in vitro study, in the presence or absence of PNS and its components, vasodilation in response to nitroprusside was determined from myographs under isometric tension conditions in aortas and mesenteric arteries from male SHRSP.ZF rats at 18-20 weeks of age. In an in vivo study, PNS (30 mg/kg per day) was orally administered to SHRSP.ZF rats from 8 to 20 weeks of age. In vitro treatment with PNS and Ginsenoside Rb1 increased nitroprusside-induced relaxation of aortas and mesenteric arteries in SHRSP.ZF rats. The PNS-induced increase was not affected by a nitric oxide (NO) synthase inhibitor or endothelium denudation. Relaxation in response to a cell-permeable cGMP analogue was increased by PNS, but cGMP accumulation by nitroprusside was not altered. In vivo treatment with PNS in SHRSP.ZF rats lowered blood pressure and increased relaxation and the expression of soluble guanylyl cyclase protein in arteries, without affecting metabolic abnormalities. These results indicate that PNS causes an increase in vasodilation in response to NO and a decrease in blood pressure, resulting in protection against vascular dysfunction in SHRSP.ZF rats. PNS might be beneficial in alleviating impaired vasodilation in metabolic syndrome.

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“…A recent study demonstrated that VA dysfunction was significantly associated with an increased risk of major adverse CV events (MACE) [40] . The investigators showed that the presence of VA dysfunction was associated with a higher risk of developing MACE in a dose-gradient pattern.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients

Kim

Lee²,

Oh³

et al. 2016

Am J Nephrol

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Background: Vascular access (VA) is essential for hemodialysis (HD) patients, and its dysfunction is a major complication. However, little is known about outcomes in patients with recurrent VA dysfunction. We explored the influence of recurrent VA dysfunction on cardiovascular (CV) events, death and VA abandonment. Methods: This is a single-center, retrospective study conducted in patients who underwent VA surgery between 2009 and 2014. VA dysfunction was defined as VA stenosis or thrombosis requiring intervention after the first successful cannulation. Patients with ≥2 interventions within 180 days were categorized as having recurrent VA dysfunction. Outcomes were analyzed using Cox proportional hazards model before and after propensity score matching. Results: Of 766 patients (ages 59.6 ± 14.3 years, 59.7% male), 10.1% were in the recurrent VA dysfunction group. Most baseline parameters after matching were similar between the recurrent and non-recurrent groups. A total of 213 propensity score-matched patients were followed for 28.7 ± 15.8 months, during which 46 (21.6%), 30 (14.1%) and 14 (6.6%) patients had de novo CV outcomes, died and abandoned VA, respectively. Recurrent VA dysfunction after adjustment remained an independent risk factor for CV events (adjusted hazards ratio (aHR), 2.71; 95% CI 1.48-4.98; p = 0.001). Moreover, recurrent VA dysfunction predicted composite all-cause mortality (ACM)/CV events (aHR 1.99; 95% CI 1.21-3.28; p = 0.007). Conclusions: Recurrent VA dysfunction was a novel independent risk factor for CV and composite ACM/CV events in HD patients, but not for VA abandonment. Patients with recurrent vascular dysfunction should be carefully monitored not only for VA patency but also for CV events.

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Association Between Vascular Access Dysfunction and Subsequent Major Adverse Cardiovascular Events in Patients on Hemodialysis

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Cited by 19 publications

References 47 publications

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Panax notoginseng saponins ameliorate impaired arterial vasodilation in SHRSP.Z‐Lepr^fa/lzmDmcr rats with metabolic syndrome

Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients

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Association Between Vascular Access Dysfunction and Subsequent Major Adverse Cardiovascular Events in Patients on Hemodialysis

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 47 publications

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Panax notoginseng saponins ameliorate impaired arterial vasodilation in SHRSP.Z‐Leprfa/lzmDmcr rats with metabolic syndrome

Recurrent Vascular Access Dysfunction as a Novel Marker of Cardiovascular Outcome and Mortality in Hemodialysis Patients

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Panax notoginseng saponins ameliorate impaired arterial vasodilation in SHRSP.Z‐Lepr^fa/lzmDmcr rats with metabolic syndrome