Consistent aspirin use associated with improved arteriovenous fistula survival among incident hemodialysis patients in the dialysis outcomes and practice patterns study.
OBJECTIVE
The relationship between aspirin use and arteriovenous fistula (AVF) survival has been lacking. The aim of this study was to evaluate the association between AVF survival and aspirin use.


METHODS
Data on 2815 incident hemodialysis patients (on dialysis <or= 30 d) using an AVF at enrollment into the Dialysis Outcomes and Practice Patterns Study between 1996 and 2004 were analyzed. Cox regression was used to examine the association between aspirin use and the risk of final AVF failure, first AVF failure, and a gastrointestinal bleeding event. Aspirin use was determined at baseline and one year later. Patients using aspirin at baseline and one year later were considered consistent aspirin users. All models accounted for facility clustering effects and were adjusted for age, race, gender, body mass index, prior permanent access failure, prior placement of a catheter, 10 comorbid conditions, laboratory data, and other medications, and stratified by regions.


RESULTS
Consistent aspirin use was significantly related to a lower risk of final AVF failure. Facility-level analysis, which may reduce confounding by indication, also showed a nearly significant trend of reduced risk of final AVF failure with greater prevalence of consistent aspirin use within dialysis facilities (P for trend = 0.07). The occurrence of a new gastrointestinal bleeding event during the study period was not associated with aspirin use.


CONCLUSIONS
These results suggest that consistent aspirin use may be beneficial for AVF survival among incident hemodialysis patients.
Hasegawa
Takeshi
T
Division of Nephrology, Fujiyoshida Municipal Hospital, Yamanashi, Japan. tahasegawa-npr@umin.net
Elder
Stacey J
SJ
Bragg-Gresham
Jennifer L
JL
Pisoni
Ronald L
RL
Yamazaki
Shin
S
Akizawa
Tadao
T
Jadoul
Michel
M
Hugh
Rayner C
RC
Port
Friedrich K
FK
Fukuhara
Shunichi
S
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D005060:Europe; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009656:North America; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D013997:Time Factors; D014654:Vascular Patency / Q000187:drug effects*
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin