Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency

Atul Sajgure, Arindam Choudhury, Ziauddin Ahmed, Devasmita Choudhury

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background. A patent vascular access is crucial for hemodialysis patients. Stenosis and thrombosis lead to access failure. Endothelial injury via angiotensin II may mediate a hyperplastic and prothrombotic response. Thus angiotensin II inhibition with angiotensin-converting enzyme inhibitors (ACEI) may prolong vascular access patency. This study determines the impact of ACEI use on access patency in both polytetrafluroethylene (PTFE) grafts and fistulas. Methods. Demographics, access history and medication use were reviewed in 266 accesses from four dialysis centres. Primary patency, date of surgery to date of first access failure, was determined. Excluded accesses had incomplete history or <30 day patency. Groups divided into ACEI and non-ACEI based on patient use of ACEI during access patency. Statistical methods included: unpaired Student t to compare continuous variables, Chi-square and Fisher's Exact test to compare proportions and evaluate for risk estimation, univariate and multivariate Cox regression to investigate variables associated with duration of access patency. Cox-adjusted survival and Hazard curves were obtained for significant variables. Results. Non-ACEI (PTFE) graft group included more males and older patients; however, when these covariates were adjusted during both univariate and multivariate regression, suggested, only ACEI use was associated with greater access patency duration, 671.7 days (ACEI) vs 460.0 days (non-ACEI), p = 0.012. ACEI group had fewer clotting events, 55% versus 71% (non-ACEI) group, p = 0.042. ACEI use had little effect on primary patency of the fistula however male gender increased time to fistula failure, p = 0.002. Conclusions. Retrospective evaluation suggests ACEI use in patients with PTFE grafts may prolong and maintain patency. Fistula patency is affected by gender with longer patency noted in males. Further prospective studies are necessary to confirm the role of ACEI in maintaining vascular access patency.

Original languageEnglish (US)
Pages (from-to)1390-1398
Number of pages9
JournalNephrology Dialysis Transplantation
Volume22
Issue number5
DOIs
StatePublished - May 2007

Fingerprint

Angiotensin-Converting Enzyme Inhibitors
Transplants
Enzyme Inhibitors
Fistula
Vascular Patency
Angiotensin II
History
Blood Vessels
Renal Dialysis
Dialysis
Pathologic Constriction
Thrombosis
Demography
Prospective Studies
Students
Survival
Wounds and Injuries

Keywords

  • Angiotensin converting enzyme inhibitors
  • Dialysis
  • Fistulas
  • Grafts
  • Patency
  • Thrombosis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency. / Sajgure, Atul; Choudhury, Arindam; Ahmed, Ziauddin; Choudhury, Devasmita.

In: Nephrology Dialysis Transplantation, Vol. 22, No. 5, 05.2007, p. 1390-1398.

Research output: Contribution to journalArticle

Sajgure, Atul ; Choudhury, Arindam ; Ahmed, Ziauddin ; Choudhury, Devasmita. / Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency. In: Nephrology Dialysis Transplantation. 2007 ; Vol. 22, No. 5. pp. 1390-1398.
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AB - Background. A patent vascular access is crucial for hemodialysis patients. Stenosis and thrombosis lead to access failure. Endothelial injury via angiotensin II may mediate a hyperplastic and prothrombotic response. Thus angiotensin II inhibition with angiotensin-converting enzyme inhibitors (ACEI) may prolong vascular access patency. This study determines the impact of ACEI use on access patency in both polytetrafluroethylene (PTFE) grafts and fistulas. Methods. Demographics, access history and medication use were reviewed in 266 accesses from four dialysis centres. Primary patency, date of surgery to date of first access failure, was determined. Excluded accesses had incomplete history or <30 day patency. Groups divided into ACEI and non-ACEI based on patient use of ACEI during access patency. Statistical methods included: unpaired Student t to compare continuous variables, Chi-square and Fisher's Exact test to compare proportions and evaluate for risk estimation, univariate and multivariate Cox regression to investigate variables associated with duration of access patency. Cox-adjusted survival and Hazard curves were obtained for significant variables. Results. Non-ACEI (PTFE) graft group included more males and older patients; however, when these covariates were adjusted during both univariate and multivariate regression, suggested, only ACEI use was associated with greater access patency duration, 671.7 days (ACEI) vs 460.0 days (non-ACEI), p = 0.012. ACEI group had fewer clotting events, 55% versus 71% (non-ACEI) group, p = 0.042. ACEI use had little effect on primary patency of the fistula however male gender increased time to fistula failure, p = 0.002. Conclusions. Retrospective evaluation suggests ACEI use in patients with PTFE grafts may prolong and maintain patency. Fistula patency is affected by gender with longer patency noted in males. Further prospective studies are necessary to confirm the role of ACEI in maintaining vascular access patency.

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