Statins Improve Long Term Patency of Arteriovenous Fistula for Hemodialysis

Abstract

The protective effects of statins against stenosis for permanent hemodialysis access have been repeatedly demonstrated in animal studies, but remain controversial in human studies. This study aims to evaluate the association between statin use and permanent hemodialysis access patency using a nationwide hemodialysis cohort. A total of 9862 pairs of statin users and non-users, matched by age and gender, were selected for investigation from 75404 new hemodialysis patients during 2000–2008. The effect of statins on permanent hemodialysis access patency was evaluated using Cox proportional hazards models. Compared with non-users, statin users had an overall 18% risk reduction in the composite endpoint in which angioplasty and recreation were combined (adjusted hazard ratio = 0.82 [95%CI, 0.78–0.87]) and 21% in recreation of permanent hemodialysis access (adjusted hazard ratio = 0.79 [95%CI, 0.69–0.80]). Specifically, the protective effect was found for arteriovenous fistula (adjusted hazard ratio = 0.78[95% CI, 0.73–0.82] for composite endpoint and 0.74 [95% CI, 0.69–0.80] for vascular recreation), but not for arteriovenous grafts (adjusted hazard ratio = 1.10 [95% CI, 0.98–1.24] and 0.94 [95% CI, 0.83–1.07]). Statins possess a protective effect for arteriovenous fistula against the recreation of permanent hemodialysis access. The results provide a pharmaco-epidemiologic link between basic research and clinical evidence.

The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis

“…The presence of multiple risk factors may dictate the construction of an alternative access; however, in the absence of randomised trials, the level of evidence would be low and grade of recommendation weak. In view of the association between dyslipidaemia and primary and primary assisted patency, and the controversial effect of statins, 22,23 recommendation grade for statin use would also be weak. Nevertheless, functionality rates also affect the cost effectiveness of the procedure and should be taken into account during pre-operative planning, 24 while similar recommendations may be applicable for patients with poor FSP rates, for example less than 25% at 1 year, at the additional cost of multiple maintenance angioplasty and/or thrombectomy procedures.…”

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…304 Statins have pleiotropic beneficial actions besides lipid lowering but non-randomised studies and nationwide cohort analysis report contradictory results regarding their effects on VA patency rates. 314,315 As previously described, most recommendations are based on clinical experience, but interventions that clearly improve VA maturation and suitability for HD are needed. 164…”

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

“…Patients administered warfarin showed worse primary graft patency (RR, 1.33; P = 0.037). Statin treatment could be associated with reduced neointimal proliferation, vascular inflammation, and improved AVF dysfunction [137][138][139]. A Cochrane review reported that antiplatelet treatment can improve the 1-month patency rates of AVFs and AVGs [140].…”