Pharmacologic Intervention to Prevent Hemodialysis Vascular Access Thrombosis

Diskin, Charles J.; Stokes, Thomas J.; Pennell, Andrew T

doi:10.1159/000187272

Cited by 49 publications

(28 citation statements)

References 134 publications

(153 reference statements)

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“…However, we have not begun to address those questions nor have we even established a protective effect; that can only be achieved by a large-scale prospective study, similar to those performed in the investigation of aortic wall aneurysms [4][5][6]. Since doxycycline also has an effect on preventing smooth muscle migration, proliferation and intimal hypertrophy [10], similar to the ideal drugs that we hypothesized to prevent access thrombosis [11], perhaps doxycycline should also be included in future studies designed to prevent vascular access thrombosis. Although teeth discoloration, nausea and abdominal bloating have been reported as side effects in previous aortic aneurysm studies in non-uraemic patients, we found doxycycline to be well tolerated and appropriate for investigation in haemodialysis patients.…”

Section: Discussionmentioning

confidence: 99%

Doxycycline may reduce the incidence of aneurysms in haemodialysis vascular accesses

Diskin

Stokes

Dansby

et al. 2005

Nephrology Dialysis Transplantation

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Background. Doxycycline can prevent aortic aneurysms through the inhibition of enzymes that degrade vessel walls. We investigated whether haemodialysis patients who had received one or more courses of doxycycline were at less risk for aneurysms in their vascular accesses than those who had received other antibiotics. Methods. Three hundred and eight patients undergoing chronic maintenance hemodialysis were evaluated for aneurysm formation after exposure to doxycycline or another antibiotic. Conditional forward logistical analysis using Cox proportional hazards test (SPSS) was performed to determine the potential significance of differences of aneurysm formation between the two groups. Results. Patients who had received doxycycline appeared to be at lower risk than the control group, but the effect was most obvious in those patients with synthetic grafts. Conclusions. Doxycycline may have the ability to reduce aneurysm formation in haemodialysis vascular accesses and a large prospective study is warranted.

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Section: Discussionmentioning

confidence: 99%

Doxycycline may reduce the incidence of aneurysms in haemodialysis vascular accesses

Diskin

Stokes

Dansby

et al. 2005

Nephrology Dialysis Transplantation

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“…Unfortunately, much of these data are anecdotal and involve a very small number of patients (63). Dipyridamole (64) and fish oil (65) have been shown to prevent stenosis and thrombosis in PTFE dialysis grafts (primary prevention) in randomized clinical trials, whereas angiotensin-converting enzyme inhibitors have been shown to be of benefit in retrospective registry analyses (66).…”

Section: Currently Available Systemic Agentsmentioning

confidence: 99%

Hemodialysis Vascular Access Dysfunction: A Cellular and Molecular Viewpoint

Roy-Chaudhury¹

2006

Journal of the American Society of Nephrology

171

281

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Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. The major cause of hemodialysis vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia. Despite the magnitude of the clinical problem, however, there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. The reasons for this are two-fold. First there has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. Second, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This review therefore (1) briefly examines the different forms of hemodialysis vascular access that are available, (2) describes the pathology and pathogenesis of hemodialysis vascular access dysfunction in both polytetrafluoroethylene grafts and native arteriovenous fistulae, (3) reviews recent concepts about the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction, (4) summarizes novel experimental and clinical therapies that could potentially be used in the setting of hemodialysis vascular access dysfunction, and, finally, (5) offers some broad guidelines for future innovative translational and clinical research in this area that hopefully will reduce the huge clinical morbidity and economic costs that are associated with this condition.

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“…We have previously reported the benefits of ω–3 fatty acids in a prospective study [1]. We have also recently reviewed the current hypotheses regarding the pathophysiology of vascular access thrombosis after which we outlined other potential avenues of pharmacologic intervention in an effort to alter the course of that pathophysiology and thereby improve long-term vascular patency [2]. Many of those medications with theoretical potential are routinely prescribed for dialysis patients, and we felt that the identification of the most clinically promising of those drugs might aid in the construction of a future randomized prospective study.…”

Section: Introductionmentioning

confidence: 99%

“…However, the potential seems to depend greatly upon the type of access. Only pentoxifylline which may inhibit exposure of vascular adhesion molecules [2] induced by tumor necrosis factor [7] in addition to its better known effects on RBC rheology and platelet adhesion [2] was potentially effective in more than one access type. That is not surprising considering that the pathophysiology of access thrombosis may be different depending upon the access type.…”

Section: Introductionmentioning

confidence: 99%