American Journal of Nephrology

Original Report: Patient-Oriented, Translational Research

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

Wang K.a · Zelnick L.R.a · Imrey P.B.b,c · deBoer I.H.a · Himmelfarb J.a · Allon M.D.d · Cheung A.K.e,f,g,h · Dember L.M.i,j · Roy-Chaudhury P.k,l · Vazquez M.A.m · Kusek J.W.n · Feldman H.I.i,j · Beck G.J.b,c · Kestenbaum B.a · the Hemodialysis Fistula Maturation Study Group

Author affiliations

aDepartment of Medicine, Kidney Research Institute, University of Washington, Seattle, WA, USA
bDepartment of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
cDepartment of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
dDivision of Nephrology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
eDivision of Nephrology and Hypertension, Salt Lake City, UT, USA
fDepartment of Bioengineering, University of Utah School of Medicine, Salt Lake City, UT, USA
gRenal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
hDepartment of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, China
iRenal-Electrolyte and Hypertension Division, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
jCenter for Clinical Epidemiology and Biostatistics and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
kDivision of Nephrology, University of Arizona Health Sciences and Banner University Medical Center, Tucson, AZ, USA
lMedical Service, Southern Arizona Veterans Affairs Healthcare System, Tucson, AZ, USA
mDivision of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
nDivision of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

Keywords: Arteriovenous fistula maturation failureCalcium channel blockerAnti-hypertensive medications

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Am J Nephrol 2018;48:56–64
https://doi.org/10.1159/000491828

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Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: April 30, 2018
Accepted: June 29, 2018
Published online: August 02, 2018
Issue release date: August 2018

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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.

© 2018 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: April 30, 2018
Accepted: June 29, 2018
Published online: August 02, 2018
Issue release date: August 2018

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

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