Abstract
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 56-64 |
| Number of pages | 9 |
| Journal | American Journal of Nephrology |
| Volume | 48 |
| Issue number | 1 |
| DOIs | |
| State | Published - Aug 1 2018 |
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Keywords
- Anti-hypertensive medications
- Arteriovenous fistula maturation failure
- Calcium channel blocker
ASJC Scopus subject areas
- Nephrology
Cite this
Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes. / 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.
In: American Journal of Nephrology, Vol. 48, No. 1, 01.08.2018, p. 56-64.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes
AU - Wang, Ke
AU - Zelnick, Leila R.
AU - Imrey, Peter B.
AU - Deboer, Ian H.
AU - Himmelfarb, Jonathan
AU - Allon, Michael D.
AU - Cheung, Alfred K.
AU - Dember, Laura M.
AU - Roy-Chaudhury, Prabir
AU - Vazquez, Miguel A.
AU - Kusek, John W.
AU - Feldman, Harold I.
AU - Beck, Gerald J.
AU - Kestenbaum, Bryan
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.
KW - Anti-hypertensive medications
KW - Arteriovenous fistula maturation failure
KW - Calcium channel blocker
UR - http://www.scopus.com/inward/record.url?scp=85051695194&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051695194&partnerID=8YFLogxK
U2 - 10.1159/000491828
DO - 10.1159/000491828
M3 - Article
C2 - 30071516
AN - SCOPUS:85051695194
VL - 48
SP - 56
EP - 64
JO - American Journal of Nephrology
JF - American Journal of Nephrology
SN - 0250-8095
IS - 1
ER -