The role of antiplatelet therapy on arteriovenous fistula malfunctioning among hemodialysis patients
DOI:
https://doi.org/10.56056/amj.2023.220Keywords:
Antiplatelet therapy, Arteriovenous fistula, Hemodialysis, MalfunctioningAbstract
Background and objectives: The vascular access of choice for hemodialysis is the Arteriovenous fistula. A functional vascular access is required for a successful hemodialysis performance. The aim of the study is to examine the effect of antiplatelet therapy on arteriovenous fistula malfunctioning among hemodialysis patients.
Methods: A cross-sectional study on 78 end-stage renal disease patients who undergone hemodialysis and had arteriovenous fistula was conducted. The data were collected during the period of 1st April 2020 to 1st April 2021, taking information about socio-demographic data of the patients such as age, gender, past medical history and hemodialysis status.
Results: The mean age of patients was 63.87 (± 8.44) years; most of them were female and smokers. Only 17.9% of the patients were not on erythropoietin, while the rest were taking 8000 IU/week (55.1%) or 4000 IU/week (26.9%). After one year of having arteriovenous fistula, more than half (52.6%) of the patients developed arteriovenous fistula malfunctioning in the form of stenosis (17.95%) or thrombosis (34.62%). There were significant statistical associations between arteriovenous fistula malfunctioning and comorbidities, type of anti-platelet and use of erythropoietin. However, non-significant statistical association was found between the development of arteriovenous fistula malfunctioning and gender, duration of hemodialysis and smoking.
Conclusions: Antiplatelet therapy and lower doses of erythropoietin use is associated with lower arteriovenous fistula malfunctioning. Prior to the arteriovenous fistula creation, patients should be assessed appropriately.
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References
Fan P, Lee C, Liu S, et al. Preventing arteriovenous shunt failure in hemodialysis patients: a population?based cohort study. J Thromb Haemost. 2019. 17(1): 77-87.
Allon M. Hemodialysis arteriovenous graft dysfunction and failure. 2021, UpToDate, Wolters Kluwer. Available from: https://www.uptodate.com/contents/hemodialysis-arteriovenous-graft-dysfunction-and-failure/print
Zouaghi MK, Lammouchi MA, Hassan M, et al. Determinants of patency of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transpl. 2018. 29(3): 615-22.
Jayroe H, Foley K. Arteriovenous Fistula. 2021; Available from: https://www.ncbi.nlm.nih.gov/books/NBK559213/.
Wen M, Li Z, Li J, et al. Risk factors for primary arteriovenous fistula dysfunction in hemodialysis patients: a retrospective survival analysis in multiple medical centers. Blood Cells Mol Dis. 2019. 48(3): 276-82.
Ghorbani A, Aalamshah M, Shahbazian H, Ehsanpour A, Aref A. Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients. Indian J. Nephrol. 2009. 19(2): 57-61.
Beathard GA. Primary failure of the hemodialysis arteriovenous fistula. 2014, Wolters Kluwer. Available from: https://www.uptodate.com/contents/primary-failure-of-the-hemodialysis-arteriovenous-fistula/print.
De Marchi S, Falleti E, Giacomello R, et al. Risk factors for vascular disease and arteriovenous fistula dysfunction in hemodialysis patients. J Am Soc Nephrol. 1996. 7(8): 1169-77.
Mousa AY, Patterson W, Abu-Halimah S, et al. Patency in arteriovenous grafts in hemodialysis patients. Vasc Endovascular Surg. 2013. 47(6): 438-43.
Ghorbani A, Jasemi-Zergani F. Ticlopidine to prevent primary arteriovenous fistula failure in hemodialysis patients; a randomized controlled trial. J. Ren. Inj. Prev. 2013. 2(3): 109-11.
Wärme A, Hadimeri U, Hadimeri H, Nasic S, Stegmayr B. High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis. Clin. Hemorheol. Microcirc. 2019. 71(1): 53-7.
Wärme A, Hadimeri H, Nasic S, Stegmayr B. The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis. BMC Nephrol. 2021. 22(1): 1-10.
Jeong HY, Ko EJ, Kim SH, Lee MJ, Cho HJ, Yang DH, et al. Administration of a High-Dose Erythropoietin-Stimulating Agent in Hemodialysis Patients is Associated with Late Arteriovenous Fistula Failure. Yonsei Med J. 2017; 58(4): p. 793-9. 10.3349/ymj.2017.58.4.793.
FDA. FDA Drug Safety Communication: Modified dosing recommendations to improve the safe use of Erythropoiesis-Stimulating Agents (ESAs) in chronic kidney disease. 2011; Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-modified-dosing-recommendations-improve-safe-use-erythropoiesis.
Palmer SC, Di Micco L, Razavian M, et al. Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis. Am. J. Kidney Dis. 2013. 61(1): 112-22.
Coleman CI, Tuttle LA, Teevan C, Baker WL, White CM, Reinhart KM. Antiplatelet agents for the prevention of arteriovenous fistula and graft thrombosis: a meta analysis. Int J Clin Pract. 2010. 64(9): 1239-44.
Li Y, Cui W, Wang J, Zhang C, Luo T. Factors associated with dysfunction of autogenous arteriovenous fistula in patients with maintenance hemodialysis: a retrospective study. Ann Palliat Med. 2021; 10(4):4047-54.
Locham S, Beaulieu RJ, Dakour-Aridi H, Nejim B, Malas MB. Role of antiplatelet therapy in the durability of hemodialysis access. Journal of J. Nephrol. 2018. 31(4): 603-11.
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