NDT Advance Access originally published online on January 31, 2007
Nephrology Dialysis Transplantation 2007 22(5):1390-1398; doi:10.1093/ndt/gfl821
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Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency
1Consultant Nephrologist, Sahyadri Specialty Hospital, Deccan Gymkhana, Pune, Maharashtra, India 411004, 2Assistant Professor Surgery, University of Virginia, Chief of Ambulatory Surgery, General/Vascular/Thoracic Surgery, Salem Veterans Affairs Medical Center, 1970 Roanoke Boulevard, Salem, VA 24153 USA and 3Associate Professor Medicine, Drexel University School of Medicine, Director of DCI Dialysis Unit, 245 North 15th Street, Philadelphia, PA 19129 USA
Correspondence and offprint requests to: Dr Devasmita Choudhury, Associate Professor Medicine, University of Texas Southwestern Medical School, Chief of Dialysis, Dallas Veterans Affairs Medical Center, 4500 South Lancaster Road, Dallas, TX 75216 USA Email: Devasmita.dev{at}med.va.gov
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Abstract |
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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.
Keywords: angiotensin converting enzyme inhibitors; dialysis; fistulas; grafts; patency; thrombosis
Received for publication: 12.10.06
Accepted in revised form: 19.12.06
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