Antiplatelet agents maintain arteriovenous fistula and graft function in patients receiving hemodialysis

A nationwide case-control study

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: In this study, we evaluated the effects of various medications on the patency of vascular access (VA) for hemodialysis.

METHODS: We analyzed data from the Longitudinal Health Insurance Database of Taiwan. We adopted a case-control study design within a cohort of patients who had received regular hemodialysis between 2002 and 2012; 34,354 patients with first VA failure were identified, and the duration from VA creation date to the first VA failure date was calculated. We then classified these patients into two groups, namely arteriovenous fistula (AVF, n = 25,933) and arteriovenous graft (AVG, n = 8,421). Each group was further divided into two subgroups, namely short-term (<1 year) and long-term (≥1 year) patency.

RESULTS: The risk factors for early VA failure were age ≥65 years, diabetes mellitus, hyperlipidemia, cerebral vascular disease, congestive heart failure, peripheral artery disease, and sepsis. Male sex, hypertension, cancer, and peptic ulcer were associated with early AVF failure. Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95% confidence interval [CI]: 0.703-0.796, p < 0.0001) and 0.810 (95% CI: 0.728-0.901, p = 0.0001), respectively. A significant decrease in the VA failure risk was observed with an increase in the cumulative defined daily dose of antiplatelet agents.

CONCLUSION: This nationwide study demonstrated that some risk factors were associated with early VA failure and that the use of antiplatelet agents prevented the loss of VA patency in a dose-response manner. Thus, antiplatelet drugs should be routinely administered to high-risk patients receiving dialysis.

Original languageEnglish
Pages (from-to)e0206011
JournalPLoS One
Volume13
Issue number10
DOIs
Publication statusPublished - 2018

Fingerprint

hemodialysis
fistula
Platelet Aggregation Inhibitors
Arteriovenous Fistula
case-control studies
blood vessels
Grafts
Blood Vessels
Renal Dialysis
Case-Control Studies
Transplants
Vascular Patency
Health insurance
Dialysis
Medical problems
Confidence Intervals
confidence interval
risk factors
Peripheral Arterial Disease
cerebrovascular disorders

Cite this

@article{df0048852b7e4c58aa7f17b31ff7137c,
title = "Antiplatelet agents maintain arteriovenous fistula and graft function in patients receiving hemodialysis: A nationwide case-control study",
abstract = "BACKGROUND: In this study, we evaluated the effects of various medications on the patency of vascular access (VA) for hemodialysis.METHODS: We analyzed data from the Longitudinal Health Insurance Database of Taiwan. We adopted a case-control study design within a cohort of patients who had received regular hemodialysis between 2002 and 2012; 34,354 patients with first VA failure were identified, and the duration from VA creation date to the first VA failure date was calculated. We then classified these patients into two groups, namely arteriovenous fistula (AVF, n = 25,933) and arteriovenous graft (AVG, n = 8,421). Each group was further divided into two subgroups, namely short-term (<1 year) and long-term (≥1 year) patency.RESULTS: The risk factors for early VA failure were age ≥65 years, diabetes mellitus, hyperlipidemia, cerebral vascular disease, congestive heart failure, peripheral artery disease, and sepsis. Male sex, hypertension, cancer, and peptic ulcer were associated with early AVF failure. Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95{\%} confidence interval [CI]: 0.703-0.796, p < 0.0001) and 0.810 (95{\%} CI: 0.728-0.901, p = 0.0001), respectively. A significant decrease in the VA failure risk was observed with an increase in the cumulative defined daily dose of antiplatelet agents.CONCLUSION: This nationwide study demonstrated that some risk factors were associated with early VA failure and that the use of antiplatelet agents prevented the loss of VA patency in a dose-response manner. Thus, antiplatelet drugs should be routinely administered to high-risk patients receiving dialysis.",
author = "Yung-Ho Hsu and Yu-Chun Yen and Yi-Chun Lin and Li-Chin Sung",
year = "2018",
doi = "10.1371/journal.pone.0206011",
language = "English",
volume = "13",
pages = "e0206011",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

TY - JOUR

T1 - Antiplatelet agents maintain arteriovenous fistula and graft function in patients receiving hemodialysis

T2 - A nationwide case-control study

AU - Hsu, Yung-Ho

AU - Yen, Yu-Chun

AU - Lin, Yi-Chun

AU - Sung, Li-Chin

PY - 2018

Y1 - 2018

N2 - BACKGROUND: In this study, we evaluated the effects of various medications on the patency of vascular access (VA) for hemodialysis.METHODS: We analyzed data from the Longitudinal Health Insurance Database of Taiwan. We adopted a case-control study design within a cohort of patients who had received regular hemodialysis between 2002 and 2012; 34,354 patients with first VA failure were identified, and the duration from VA creation date to the first VA failure date was calculated. We then classified these patients into two groups, namely arteriovenous fistula (AVF, n = 25,933) and arteriovenous graft (AVG, n = 8,421). Each group was further divided into two subgroups, namely short-term (<1 year) and long-term (≥1 year) patency.RESULTS: The risk factors for early VA failure were age ≥65 years, diabetes mellitus, hyperlipidemia, cerebral vascular disease, congestive heart failure, peripheral artery disease, and sepsis. Male sex, hypertension, cancer, and peptic ulcer were associated with early AVF failure. Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95% confidence interval [CI]: 0.703-0.796, p < 0.0001) and 0.810 (95% CI: 0.728-0.901, p = 0.0001), respectively. A significant decrease in the VA failure risk was observed with an increase in the cumulative defined daily dose of antiplatelet agents.CONCLUSION: This nationwide study demonstrated that some risk factors were associated with early VA failure and that the use of antiplatelet agents prevented the loss of VA patency in a dose-response manner. Thus, antiplatelet drugs should be routinely administered to high-risk patients receiving dialysis.

AB - BACKGROUND: In this study, we evaluated the effects of various medications on the patency of vascular access (VA) for hemodialysis.METHODS: We analyzed data from the Longitudinal Health Insurance Database of Taiwan. We adopted a case-control study design within a cohort of patients who had received regular hemodialysis between 2002 and 2012; 34,354 patients with first VA failure were identified, and the duration from VA creation date to the first VA failure date was calculated. We then classified these patients into two groups, namely arteriovenous fistula (AVF, n = 25,933) and arteriovenous graft (AVG, n = 8,421). Each group was further divided into two subgroups, namely short-term (<1 year) and long-term (≥1 year) patency.RESULTS: The risk factors for early VA failure were age ≥65 years, diabetes mellitus, hyperlipidemia, cerebral vascular disease, congestive heart failure, peripheral artery disease, and sepsis. Male sex, hypertension, cancer, and peptic ulcer were associated with early AVF failure. Antiplatelet therapy increased the AVF and AVG patency times with adjusted odds ratios of 0.748 (95% confidence interval [CI]: 0.703-0.796, p < 0.0001) and 0.810 (95% CI: 0.728-0.901, p = 0.0001), respectively. A significant decrease in the VA failure risk was observed with an increase in the cumulative defined daily dose of antiplatelet agents.CONCLUSION: This nationwide study demonstrated that some risk factors were associated with early VA failure and that the use of antiplatelet agents prevented the loss of VA patency in a dose-response manner. Thus, antiplatelet drugs should be routinely administered to high-risk patients receiving dialysis.

U2 - 10.1371/journal.pone.0206011

DO - 10.1371/journal.pone.0206011

M3 - Article

VL - 13

SP - e0206011

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 10

ER -