title: Randomized clinical trial of the use of glyceryl trinitrate patches to aid arteriovenous fistula maturation.
abstract: BACKGROUND
  Arteriovenous fistulas are critical for haemodialysis, but maturation rates remain poor. Experimental and anecdotal evidence has supported the use of transdermal glyceryl trinitrate (GTN) patches. The aim of this RCT was to determine whether use of a GTN patch aids arteriovenous fistula maturation.
  
  
  METHODS
  Patients referred for arteriovenous fistula formation were eligible. The GTN or placebo patch was applied immediately after surgery and left in situ for 24 h. The primary outcome measure was the change in venous diameter at 6 weeks after fistula formation. The secondary outcome measure was clinical fistula patency at 6 weeks.
  
  
  RESULTS
  Of 200 patients recruited (533 screened), 101 were randomized to the placebo group and 99 to the GTN group. Of these, 81 and 86 respectively completed surgery, and had follow-up data available at 6 weeks. Improvements in venous diameter were similar in the two groups: mean(s.d.) increase 2·3(1·9) mm in the placebo group compared with 2·2(1·8) mm in the GTN group (P = 0·704). The fistula failure rate did not differ significantly between the two groups: 23 per cent for placebo and 28 per cent for GTN (P = 0·596).
  
  
  CONCLUSIONS
  GTN transdermal patches used for 24 h after surgery did not improve arteriovenous fistula maturation.
  
  
  BACKGROUND
  NCT01685710 (http://www.clinicaltrials.gov).
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Field
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: McGrogan
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Marie
authors.affiliation: Departments of Renal Research, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Joinson
authors.affiliation: Departments of Renal Research, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Andujar
authors.affiliation: Departments of Renal Research, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dutton
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Krishnan
authors.affiliation: Department of Statistics, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hodson
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.|Renal and Pancreas Transplant Unit, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: D
authors.initials: D
authors.lastname: van Dellen
authors.affiliation: Departments of Renal Transplantation and Vascular Access Surgery, Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: N G
authors.initials: NG
authors.lastname: Inston
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005996:Nitroglycerin / Q000008:administration & dosage / Q000494:pharmacology*; D017063:Outcome Assessment, Health Care; D057968:Transdermal Patch; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014680:Veins / Q000187:drug effects* / Q000502:physiology
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin