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- Title
Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes.
- Authors
Wang, Ke; Zelnick, Leila R.; Imrey, Peter B.; deBoer, Ian H.; Himmelfarb, Jonathan; Allon, Michael D.; Cheung, Alfred K.; Dember, Laura M.; Roy-Chaudhury, Prabir; Vazquez, Miguel A.; Kusek, John W.; Feldman, Harold I.; Beck, Gerald J.; Kestenbaum, Bryan; Zelnick, Leila R; Imrey, Peter B; deBoer, Ian H; Allon, Michael D; Cheung, Alfred K; Dember, Laura M
- Abstract
<bold>Background: </bold>The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. However, approximately half of AVFs fail to mature. The use of angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) exerts favorable endothelial effects and may promote AVF maturation. We tested associations of ACE-I and ARBs, CCBs, beta-blockers, and diuretics with the maturation of newly created AVFs.<bold>Methods: </bold>We evaluated 602 participants from the Hemodialysis Fistula Maturation Study, a multi-center, prospective cohort study of AVF maturation. We ascertained the use of each medication class within 45 days of AVF creation surgery. We defined maturation outcomes by clinical use within 9 months of surgery or 4 weeks of initiating hemodialysis.<bold>Results: </bold>Unassisted AVF maturation failure without intervention occurred in 54.0% of participants, and overall AVF maturation failure (with or without intervention) occurred in 30.1%. After covariate adjustment, CCB use was associated with a 25% lower risk of overall AVF maturation failure (95% CI 3%-41% lower) but a non-significant 10% lower risk of unassisted maturation failure (95% CI 23% lower to 5% higher). ACE-I/ARB, beta-blocker, and diuretic use was not significantly associated with AVF maturation outcomes. None of the antihypertensive medication classes were associated with changes in AVF diameter or blood flow over 6 weeks following surgery.<bold>Conclusions: </bold>CCB use may be associated with a lower risk of overall AVF maturation failure. Further studies are needed to determine whether CCBs might play a causal role in improving AVF maturation outcomes.
- Subjects
ARTERIOVENOUS fistula; KIDNEY diseases; CALCIUM antagonists; KIDNEY function tests; PATIENTS
- Publication
American Journal of Nephrology, 2018, Vol 48, Issue 1, p56
- ISSN
0250-8095
- Publication type
journal article
- DOI
10.1159/000491828