Sajgure Atul, Choudhury Arindam, Ahmed Ziauddin, Choudhury Devasmita
Sahyadri Specialty Hospital, Maharashtra, India, and University of Virginia, Salem Veterans Affairs Medical Center, VA 24153, USA.
Nephrol Dial Transplant. 2007 May;22(5):1390-8. doi: 10.1093/ndt/gfl821. Epub 2007 Jan 31.
A patent vascular access is crucial for hemodialysis patients. Stenosis and thrombosis lead to access failure. Endothelial injury via angiotensin II may mediate a hyperplastic and prothrombotic response. Thus angiotensin II inhibition with angiotensin-converting enzyme inhibitors (ACEI) may prolong vascular access patency. This study determines the impact of ACEI use on access patency in both polytetrafluroethylene (PTFE) grafts and fistulas.
Demographics, access history and medication use were reviewed in 266 accesses from four dialysis centres. Primary patency, date of surgery to date of first access failure, was determined. Excluded accesses had incomplete history or <30 day patency. Groups divided into ACEI and non-ACEI based on patient use of ACEI during access patency. Statistical methods included: unpaired Student t to compare continuous variables, Chi-square and Fisher's Exact test to compare proportions and evaluate for risk estimation, univariate and multivariate Cox regression to investigate variables associated with duration of access patency. Cox-adjusted survival and Hazard curves were obtained for significant variables.
Non-ACEI (PTFE) graft group included more males and older patients; however, when these covariates were adjusted during both univariate and multivariate regression, suggested, only ACEI use was associated with greater access patency duration, 671.7 days (ACEI) vs 460.0 days (non-ACEI), p=0.012. ACEI group had fewer clotting events, 55% versus 71% (non-ACEI) group, p=0.042. ACEI use had little effect on primary patency of the fistula however male gender increased time to fistula failure, p=0.002.
Retrospective evaluation suggests ACEI use in patients with PTFE grafts may prolong and maintain patency. Fistula patency is affected by gender with longer patency noted in males. Further prospective studies are necessary to confirm the role of ACEI in maintaining vascular access patency.
建立通畅的血管通路对血液透析患者至关重要。血管狭窄和血栓形成会导致通路失功。血管紧张素II介导的内皮损伤可能引发增生性和促血栓形成反应。因此，使用血管紧张素转换酶抑制剂（ACEI）抑制血管紧张素II可能会延长血管通路的通畅时间。本研究旨在确定使用ACEI对聚四氟乙烯（PTFE）移植物和自体动静脉内瘘血管通路通畅性的影响。
回顾了来自四个透析中心的266例血管通路患者的人口统计学资料、通路使用史和用药情况。确定初次通畅率，即从手术日期到首次通路失功的日期。排除病史不完整或通畅时间小于30天的血管通路。根据患者在血管通路通畅期间是否使用ACEI将其分为ACEI组和非ACEI组。统计方法包括：采用非配对t检验比较连续变量，采用卡方检验和Fisher精确检验比较比例并评估风险估计，采用单因素和多因素Cox回归分析与血管通路通畅持续时间相关的变量。对显著变量绘制Cox调整生存曲线和风险曲线。
非ACEI（PTFE）移植物组男性和老年患者较多；然而，在单因素和多因素回归分析中对这些协变量进行调整后发现，只有ACEI的使用与更长的血管通路通畅持续时间相关，ACEI组为671.7天，非ACEI组为460.0天，p = 0.012。ACEI组的凝血事件较少，为55%，而非ACEI组为71%，p = 0.042。ACEI的使用对自体动静脉内瘘的初次通畅率影响不大，然而男性性别会增加内瘘失功时间，p = 0.002。
回顾性评估表明，PTFE移植物患者使用ACEI可能会延长并维持血管通路的通畅。自体动静脉内瘘的通畅性受性别影响，男性的通畅时间更长。需要进一步的前瞻性研究来证实ACEI在维持血管通路通畅中的作用。
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