title: Vascular access outcomes and medication use: a USRDS study.
abstract: Several medications have been proposed to improve hemodialysis (HD) vascular access outcomes based on potentially favorable anticoagulant, antiplatelet, or pleiotropic properties. The purpose of this study was to evaluate the relationship between medication use and vascular access patency in a group of HD patients. We conducted a historical cohort study of the US Renal Data System Dialysis Mortality and Morbidity Wave II study to identify patients with an arteriovenous fistula (AVF), polytetrafluoroethylene (PTFE) graft, or a permanent catheter for vascular access. Cox regression analysis, adjusted for age, gender, race, history of coronary artery disease, peripheral vascular disease, or coronary artery bypass graft, was used to model the hazard ratio (HR) of permanent vascular access failure. Of the 2001 HD patients in the Wave II study, 901 (45%) were included in the analysis. PTFE graft patency was greater for males (HR, 0.73; 95% CI 0.53-1.00, p = 0.05) and for older individuals (HR, 0.99; 95% CI 0.98-1.00, p = 0.02). Treatment with antiplatelet medications, ticlopidine and dipyridamole (HR, 3.54; 95% CI 1.07-11.76; p = 0.04), or aspirin (HR, 2.49; 95% CI 1.31-4.73; p = 0.005) was associated with significantly worse AVF patency. Antiplatelet agents had a significant negative association with access patency in this cohort. In contrast to other published data, it was difficult to identify any beneficial effect of specific medications on access patency.
authors.affiliation: School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53713, USA. asy@medicine.wisc.edu
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.forename: Emily L
authors.initials: EL
authors.lastname: Conley
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Becker
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011138:Polytetrafluoroethylene; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011138:Polytetrafluoroethylene