Statins Protect against Thrombosis of Cannulated Radiocephalic Fistulas in Diabetic Patients

Autor: Michael F. Amendola, Megan Reeves, Ronald K. Davis, Marc P. Posner, Dongjin Suh, Luke G. Wolfe
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Statin
Time Factors
Databases
Factual
medicine.drug_class
medicine.medical_treatment
Psychological intervention
Arteriovenous fistula
030204 cardiovascular system & hematology
Risk Assessment
030218 nuclear medicine & medical imaging
Upper Extremity
03 medical and health sciences
0302 clinical medicine
Arteriovenous Shunt
Surgical
Renal Dialysis
Risk Factors
Internal medicine
medicine
Diabetes Mellitus
Humans
Survival analysis
Dialysis
Vascular Patency
Aged
Retrospective Studies
Aged
80 and over
business.industry
Curve analysis
Graft Occlusion
Vascular
Thrombosis
General Medicine
Stepwise regression
Middle Aged
Protective Factors
medicine.disease
Progression-Free Survival
United States
United States Department of Veterans Affairs
Radial Artery
Kidney Failure
Chronic
Surgery
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of vascular surgery. 75
ISSN: 1615-5947
Popis: INTRODUCTION Radiocephalic arteriovenous fistula (RCAVF) creation is the preferred first line hemodialysis access procedure. Analysis of diabetic rat arteriovenous fistula model indicates improved vascular function with HMG-CoA-Reductase Inhibitor (statin) use. We predict similar outcomes in diabetic patients undergoing primary RCAVF placement. METHODS A Veterans Administration Hospital dialysis access database over a fifteen-year period was queried identifying all RCAVF placements in diabetic patients. Patients were stratified into statin medication usage or not at RCAVF creation. Outcomes examined include rate of successful cannulation, functional patency duration, interventions per access, and rates of access thrombosis. Thrombosis-free survival of cannulated RCAVFs were compared using Kaplan-Meier method with log-rank analysis followed by univariate, stepwise logistic regression and ROC curve analysis. RESULTS Total number of 123 RCAVF cases were performed in 122 diabetic male patients. At the time of RCAVF placement, 92 cases were performed on patients that were taking statin medication and 31 cases were performed on patients that were not taking statin medication. There was no difference in terms of rate of successful cannulation, functional patency duration, and number of interventions per access between the statin and non-statin groups. However, rate of RCAVF thrombosis once accessed was significantly lower in the statin group compared to the non-statin group (p=0.0005). Kaplan-Meier survival curve for each group were compared using log-rank test to reveal that diabetic patients who were on statin therapy at the time of operation had significantly higher access survival over time against thrombosis once it was cannulated for dialysis treatment compared to those who were not on statin therapy (p=0.0003). Univariate, stepwise logistic regression model indicated statin use as the only significant factor associated with lack of thrombosis (p=0.05). CONCLUSIONS Statins appear to have protective effects against RCAVF thrombosis as predicted in animal models for diabetic patients undergoing primary RCAVF placements. There were similar functional outcomes in terms of rate of successful cannulation, functional patency duration, and number of interventions per access. These data should encourage further investigation of statins and their role in hemodialysis access.
Databáze: OpenAIRE
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