@article{579a1649cba64c538a5ae8ce9c3dd058,
title = "Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes",
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.",
keywords = "Anti-hypertensive medications, Arteriovenous fistula maturation failure, Calcium channel blocker",
author = "Ke Wang and Zelnick, {Leila R.} and Imrey, {Peter B.} and Deboer, {Ian H.} and Jonathan Himmelfarb and Allon, {Michael D.} and Cheung, {Alfred K.} and Dember, {Laura M.} and Prabir Roy-Chaudhury and Vazquez, {Miguel A.} and Kusek, {John W.} and Feldman, {Harold I.} and Beck, {Gerald J.} and Bryan Kestenbaum",
note = "Funding Information: The HFM Study was funded by grants U01DK082218, U01DK082222, U01DK082232, U01DK082236, U01DK082240, U01DK082179, U01DK082189 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This study was partially supported by NIDDK grant K24DK103986. The members of the Hemodialysis Fistula Maturation Study Group are as follows: Chair, Steering Committee, University of Pennsylvania: H. Feldman; Clinical Centers, Boston University: L. Dember (principal investigator [PI]), A. Farber, J. Kaufman, L. Stern, P. LeSage, C. Kivork, D. Soares, M. Malikova; University of Alabama: M. Al-lon (PI), C. Young, M. Taylor, L. Woodard, K. Mangadi; University of Cincinnati: P. Roy-Chaudhury (PI), R. Munda, T. Lee, R. Alloway, M. El-Khatib, T. Canaan, A. Pflum, L. Thieken, B. Campos-Naciff; University of Florida: T. Huber (PI), S. Berceli, M. Jansen, G. McCaslin, Y. Trahan; University of Texas Southwestern: M. Vazquez (PI), W. Vongpatanasin, I. Davidson, C. Hwang, T. Light-foot, C. Livingston, A. Valencia, B. Dolmatch, A. Fenves, N. Hawkins; University of Utah: A. K. Cheung (PI), L. Kraiss, D. Ki-nikini, G. Treiman, D. Ihnat, M. Sarfati, Y.T. Shiu, C. Terry, I. Lavasani, M. Maloney, L. Schlotfeldt; University of Washington: J. Himmelfarb (PI), C. Buchanan, C. Clark, C. Crawford, J. Hamlett, J. Kundzins, L. Manahan, J. Wise; Data Coordinating Center, Cleveland Clinic: G. Beck (PI), J. Gassman, T. Greene, P. Imrey, L. Li, J. Alster, M. Li, J. MacKrell, M. Radeva, B.Weiss, K. Wiggins; histology core facility, University of Washington: C. Alpers (PI), Funding Information: This work was supported by R01DK094891 granted to Dr. Bryan Kestenbaum. Publisher Copyright: {\textcopyright} 2018 S. Karger AG, Basel. Copyright: All rights reserved.",
year = "2018",
month = aug,
day = "1",
doi = "10.1159/000491828",
language = "English (US)",
volume = "48",
pages = "56--64",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",
number = "1",
}