Is AV fistula patency associated with angiotensin-converting enzyme (ACE) polymorphism and ACE inhibitor intake?
OBJECTIVE
Hemodialysis treatment requires a well-functioning vascular access. Access patency is limited by the development of venous intimal hyperplasia, which predisposes to fistula stenosis and subsequent thrombosis. In animal models, the renin-angiotensin system has a major role in the development of intimal hyperplasia. We investigated the association of the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) and arteriovenous fistula patency in hemodialysis patients.


METHODS
In a longitudinal study, 137 hemodialysis patients who had undergone creation of a primary AV fistula were genotyped. The main study endpoint was unassisted access patency (time from fistula placement to the first episode of access failure). In addition, the intake of drugs blocking the renin-angiotensin system was assessed.


RESULTS
Fistula patency 12 months after fistula creation was 72% (DD patients), 65% (ID patients), and 73% (II patients; p = 0.40). Long-term intake of ACE inhibitors or AT-1 antagonists failed to increase fistula patency (p = 0.33).


CONCLUSIONS
We suggest that pharmacological inhibition of the renin-angiotensin system is of limited value for prevention of arteriovenous fistula stenosis. Alternative strategies to prolong fistula patency should be studied.
Medical Department IV, Nephrology, University Homburg, DE-66421 Homburg, Germany. inghei@uniklinik-saarland.de
Gunnar H
GH
Heine
Christof
C
Ulrich
Hans
H
Köhler
Matthias
M
Girndt
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000235:genetics* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic; D006435:Renal Dialysis; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000235:genetics; D012307:Risk Factors; D014654:Vascular Patency / Q000187:drug effects / Q000235:genetics
D000806:Angiotensin-Converting Enzyme Inhibitors; D007703:Peptidyl-Dipeptidase A