Effects of cardiovascular medications on primary patency of hemodialysis arteriovenous fistula

Abstract

While the patency of vascular access is essential for hemodialysis patients, optimal pharmaceutical treatment to maintain arteriovenous fistula (AVF) patency remains lacking. As cardiovascular diseases are highly prevalent in patients with end-stage renal disease, various cardiovascular medications have also been used to maintain AVF patency. However, previous studies revealed inconsistent therapeutic effects and a comprehensive evaluation of this issue is needed. The present retrospective, longitudinal cohort study included patients receiving successful AVF creation. The evaluated cardiovascular medications included antiplatelet agents, antihypertensive agents, nitrates and nitrites, statins, dipyridamole, and pentoxifylline. The outcome was AVF primary patency. All laboratory data and medication profiles were recorded at baseline and followed at 3-month interval, until the end of the 2-year study period. Cox proportional regression model with time-dependent covariates was used to evaluate the risk for AVF patency loss. A total of 349 patients were included in the present study, in which 57% were men and the mean age was 65 ± 14 years. Among the included patients, 40% used antiplatelet agents, 27% used dipyridamole and 36% used statins at baseline. Of all the evaluated cardiovascular medications, only dipyridamole showed significant association with a higher risk for loss of AVF patency. To evaluate the effect of combination of antiplatelet agents and dipyridamole, the patients were classified into four groups, I: combine use of antiplatelet agents and dipyridamole, II: antiplatelet only, III: dipyridamole only; IV: none of both were used. Of the four groups, group IV

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

“…A retrospective, longitudinal cohort study of AVF patients investigated the association between AVF primary patency and the use of antiplatelet agents, antihypertensive agents, nitrates and nitrites, statins, dipyridamole and pentoxifylline. Of these medications, only dipyridamole showed a significant association with a higher risk of AVF patency loss, in particular, when combined with antiplatelet agents 32…”

“…Of these medications, only dipyridamole showed a significant association with a higher risk of AVF patency loss, in particular, when combined with antiplatelet agents. 32 …”

“…Of these medications, only dipyridamole showed a significant association with a higher risk of AVF patency loss, in particular, when combined with antiplatelet agents. 32 Several clinical investigations and trials have reported that statins, anticoagulants (warfarin) and antiplatelet drugs can reduce thrombosis and improve VA outcomes. However, inconsistencies remain regarding the effectiveness of prophylactic drugs in reducing the risk of VA failure.…”

Influence of renin–angiotensin system blockades on vascular access survival in patients on maintenance hemodialysis

“…A single-center study including 349 patients with newly created AVFs also failed to identify the beneficial effect of RASBs on AVF patency. 2 In a study of 121 patients with AVG, Gradzki observed better primary access failure in patients with angiotensin-converting enzyme inhibitors than those without the drug. 12 Saran et al analyzed the data of the Dialysis Outcomes and Practice Patterns Study cohort including 900 AVF and 1944 AVG.…”

“…Previous studies have evaluated the efficacy of some medications in improving vascular access-related outcomes; however, evidence of their efficacy is insufficient. 2,3 Renin-angiotensin system blockades (RASBs) are well-known blood pressure-lowering drugs. Previous studies have demonstrated their beneficial effects on cardiovascular system or vascular pathologies.…”