Statin therapy is not associated with improved vascular access outcomes.
OBJECTIVE
Neointimal hyperplasia is the major cause of vascular access failure in hemodialysis patients. Statins reduce neointimal hyperplasia in experimental models, which may reduce access failure. The study presented here evaluated whether vascular access outcomes are superior in patients receiving statin therapy than in those not on statins.


METHODS
A prospective computerized vascular access database was retrospectively queried to determine the access outcomes of 601 patients receiving an upper-arm fistula or graft at a single large dialysis center.


RESULTS
Primary fistula failure was observed in 37% of patients on statin therapy versus 38% not on statin therapy. Primary graft failure occurred in 20% of patients on statin therapy versus 14% not on statin therapy. A multiple variable logistic regression analysis including statin use, diabetes, coronary artery disease, peripheral artery disease, sex, and age found that only sex predicted primary fistula failure and graft failure. After excluding primary failures, cumulative fistula survival was similar for patients with or without statin therapy (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.76 to 2.16). Likewise, cumulative graft survival was similar for statin therapy versus no statin therapy (HR 0.88; 95% CI 0.59 to 1.32). Using a multivariable survival analysis model to predict cumulative fistula survival, only age predicted fistula failure (HR 1.21 per decade; 95% CI 1.02 to 1.44). None of the variables in this model predicted cumulative graft survival.


CONCLUSIONS
Statin therapy is not associated with improved fistula or graft outcomes in patients with chronic kidney disease.
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Roberto
R
Pisoni
Jill
J
Barker-Finkel
Michael
M
Allo
D000328:Adult; D000367:Age Factors; D000368:Aged; D000407:Alabama; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors