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.

A double-blind, randomized, placebo-controlled pilot trial to evaluate safety and efficacy of vorapaxar on arteriovenous fistula maturation

“…Despite the small number of participants, the overall proportion of participants with functional maturation at 180 days ± 4 weeks after surgery was 46% and is similar to other trials or registries (~45%-60%). 2,23,24 In the US Renal Data System, 25 the median time to first use of matured AVF is 108 days-similar to our results of the six participants with functional AVF maturation within 180 days at 48, 76, 77, 84, 96, and 145 days.…”

Effects of cardiovascular medications on primary patency of hemodialysis arteriovenous fistula

“…This hypothesis was tested in the Hemodialysis Fistula Maturation Study, which included 602 patients on hemodialysis via AVF. However, the study showed that angiotensin I converting enzyme inhibitor and angiotensin II receptor blocker were not associated with improved AVF patency 33 . Consistent with this study, our findings also showed that angiotensin inhibitors were not associated with AVF patency.…”

Influence of renin–angiotensin system blockades on vascular access survival in patients on maintenance hemodialysis

“…Wang et al analyzed the data from a prospective multicenter cohort in the United States and included 602 patients with newly created AVFs. 11 They compared the access maturation according to various antihypertensive medications and revealed that calcium channel blockades resulted in better overall AVF maturation than other medications. However, the use of RASBs was not associated with AVF maturation.…”

“…As RASBs have such effects on blood vessels, they may have beneficial effects in vascular access‐related outcomes in patients on HD. However, results on the association between the use of RASBs and vascular access‐related outcomes are inconsistent, and further studies are needed to confirm the usefulness of RASBs 9–13 . Thus, we aimed to compare vascular access‐related outcomes according to the use of RASBs using a representative sample of patients on maintenance HD.…”