The effect of statin therapy on the formation of arteriovenous fistula stenoses and the rate of reoccurrence of previously treated stenoses

Abstract

Statins reduce inflammation in end-stage renal disease patients and improve endothelial function beyond cholesterol lowering. Despite this, statins do not improve the maturation rate, primary patency rate, and the cumulative survival of arteriovenous fistulas (AVFs). It is unknown if statins decrease the number of stenoses developing in AVFs or prolong the intervals between angioplasties needed to treat recurring stenoses. We conducted a retrospective chart review of our 265 active dialysis patients. The statin group was significantly more likely to be diabetic (64% vs. 43.6%) and treated with aspirin (64% vs. 40%) when compared to those not treated with statins (P=0.04 and 0.01). The mean time to first intervention (primary patency) was 16.5 months in statin users and 15.8 months in the nonstatin group (P=0.49) with standard deviations of ± 18.5 and 16.6 months, respectively. Statin use was not associated with a significant decrease in the number of stenoses diagnosed (P=0.28). The mean time between recurrent stenoses' angioplasties was 8.9 months in statin users and 7.3 months in the nonstatin patients (P=0.25). Aspirin users were more likely to have a decreased primary patency (rate ratio=1.65, P=0.03) compared with nonaspirin users. Patients who were prescribed aspirin developed 1.6 (P 0.01) times more stenoses than those not treated with aspirin. We report for the first time that statin therapy does not decrease the number of stenotic lesions developing in the AVF or prolong the interval between procedures required to treat recurrent stenoses.

The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis

“…The presence of multiple risk factors may dictate the construction of an alternative access; however, in the absence of randomised trials, the level of evidence would be low and grade of recommendation weak. In view of the association between dyslipidaemia and primary and primary assisted patency, and the controversial effect of statins, 22,23 recommendation grade for statin use would also be weak. Nevertheless, functionality rates also affect the cost effectiveness of the procedure and should be taken into account during pre-operative planning, 24 while similar recommendations may be applicable for patients with poor FSP rates, for example less than 25% at 1 year, at the additional cost of multiple maintenance angioplasty and/or thrombectomy procedures.…”

Pathogenesis and Prevention of Vascular Access Failure

“…Specifically, statin therapy did not improve access maturation [97] or primary access patency [96]. Similarly, a retrospective review of 265 patients, of which 90% were on either simvastatin or atorvastatin, found that statin therapy did not affect the number of stenotic lesions in AVFs or time to primary angioplasty [91]. Whereas a case-control study of 60 dialysis patients receiving either folic acid and/ or statin discovered improved primary patency in 35 patients with AVFs [34].…”

“…Statins have been shown to reduce inflammation in the ESKD population, while also improving endothelial function beyond the effect of cholesterol lowering [91]. There is experimental evidence that statins reduce neointimal hyperplasia and vascular remodeling, which appears to be mediated by the reduction of vascular endothelial growth factor-A and matrix metalloproteinase (MMP) [92], and promotion of vasodilatation (via endothelial derived NO) [93].…”

The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unfulfilled

“…A case–control study of 60 incident dialysis patients suggested a treatment benefit of folic acid and/or statin on primary patency loss of AVFs compared to nonuse . Several retrospective analyses suggested no significant benefits of statin use on primary or secondary patency of AVFs or AVGs, access maturation, stenosis formation, time to recurrent angioplasties or cumulative access survival (after excluding primary failure) . In summary, there is insufficient trial evidence to suggest a benefit of statin therapy on hemodialysis vascular access outcomes and RCT investigating statin effects on newly created arteriovenous access are needed.…”