The Effect of Aspirin on Preventing Vascular Access Dysfunction in Incident Hemodialysis Patients: A Prospective Cohort Study in Korean Clinical Research Centers for End-Stage Renal Disease (CRC for ESRD)

Abstract

Background: Aspirin is often prescribed empirically to improve the patency of hemodialysis (HD) vascular access. Therefore, this study aimed to investigate the impact of aspirin on the survival of vascular access in incident HD patients with arteriovenous fistula (AVF) or arteriovenous graft (AVG). Methods: A prospective cohort of 881 incident HD patients was enrolled between 2009 and 2014. The primary outcome was defined as the first AVF/AVG intervention or salvage procedure, including percutaneous transluminal angioplasty or surgery for vascular access failure. Cox analyses were performed to determine the association between aspirin usage and the occurrence of the primary outcome. Results: The mean age of the patient group was 57.9 ± 13.4, and 63.8% of the patients were male. Aspirin was prescribed in 241 (27.4%) patients, and the median follow-up duration was 30 months. During follow-up, 180 (20.4%) patients experienced the primary outcome event. Univariate analysis showed that age, gender, presence of diabetes mellitus (DM), preexisting peripheral arterial disease, and the type of vascular access used (AVG versus AVF) were significantly associated with the development of the primary outcome. However, aspirin usage from the baseline was not significantly associated with primary outcome events (hazard ratio (HR): 1.16; 95% confidence interval (CI): 0.84–1.60; p = 0.378). Multivariate analysis showed that gender, the presence of DM, and the type of vascular access were still significantly associated with the occurrence of the primary outcome. Moreover, we did not observe the protective effect of taking aspirin on primary vascular access failure, even in subgroup analyses stratified according to gender, the presence of DM, and the type of vascular access. Conclusion: Physicians should carefully consider when they prescribe aspirin for the prevention of primary vascular access failure in Korean incident HD patients. In addition, larger prospective interventional studies are needed to elucidate the effect of aspirin on vascular access failure.

Uncommon Surgical Management by AVF between the Great Saphenous Vein and Anterior Tibial Artery for Old Radiocephalic AVF Failure

“…The patient's follow-up was monthly, consisting of ultrasonographic examination, flow measurement, and peak systolic velocity recording [16]. Postoperative ultrasonography is the examination of choice for monitoring the maturation of the AVF and diagnosing the complications [17]. As a thorough follow-up, medical treatment is also essential.…”

Vasodilator agents improve hemodialysis vascular access patency

“…In our report, aspirin use was not associated with VA patency, similar to the results from other studies. For example, Kim et al reported a large-scale prospective study in which aspirin did not show a protective effect on vascular patency [23] . In addition, the effect of clopidogrel for VA patency did not affect functional AV fistula significantly.…”

“…For example, Kim et al reported a large-scale prospective study in which aspirin did not show a protective effect on vascular patency. [ 23 ] In addition, the effect of clopidogrel for VA patency did not affect functional AV fistula significantly. Otherwise, the patients prescribed clopidogrel was associated with higher PTA risk in this study.…”

Expert consensus on the establishment and maintenance of native arteriovenous fistula

“…Taking aspirin had no protective effect on internal fistulas (including AVF and AVG). 59 A prospective, double-blind, randomized controlled trial in Australia included 567 adult CKD patients, who were divided into the fish oil group (fish oil vs. placebo) and aspirin group (aspirin vs. placebo). The results showed that within 12 months after AVF surgery, the use of fish oil did not reduce the primary failure rate of AVF (hazard ratio [HR] = 0.85, 95% CI: 0.65–1.12, P = 0.25).…”