Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes

Ke Wang, Leila R. Zelnick, Peter B. Imrey, Ian H. Deboer, Jonathan Himmelfarb, Michael D. Allon, Alfred K. Cheung, Laura M. Dember, Prabir Roy-Chaudhury, Miguel A. Vazquez, John W. Kusek, Harold I. Feldman, Gerald J. Beck, Bryan Kestenbaum

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
Pages (from-to)56-64
Number of pages9
JournalAmerican Journal of Nephrology
Volume48
Issue number1
DOIs
StatePublished - Aug 1 2018

Fingerprint

Arteriovenous Fistula
Antihypertensive Agents
Calcium Channel Blockers
Angiotensin Receptor Antagonists
Renal Dialysis
Diuretics
Angiotensin-Converting Enzyme Inhibitors
Fistula
Blood Vessels
Cohort Studies
Prospective Studies

Keywords

  • Anti-hypertensive medications
  • Arteriovenous fistula maturation failure
  • Calcium channel blocker

ASJC Scopus subject areas

  • Nephrology

Cite this

Wang, K., Zelnick, L. R., Imrey, P. B., Deboer, I. H., Himmelfarb, J., Allon, M. D., ... Kestenbaum, B. (2018). Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes. American Journal of Nephrology, 48(1), 56-64. https://doi.org/10.1159/000491828

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 journalArticle

Wang, K, Zelnick, LR, Imrey, PB, Deboer, IH, Himmelfarb, J, Allon, MD, Cheung, AK, Dember, LM, Roy-Chaudhury, P, Vazquez, MA, Kusek, JW, Feldman, HI, Beck, GJ & Kestenbaum, B 2018, 'Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes', American Journal of Nephrology, vol. 48, no. 1, pp. 56-64. https://doi.org/10.1159/000491828
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. / Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes. In: American Journal of Nephrology. 2018 ; Vol. 48, No. 1. pp. 56-64.
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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.",
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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

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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

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