Kim Miyeon, Kim Ji Ung, Kim So Mi, Kim HyunWoo
Division of Nephrology, Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
Int Urol Nephrol. 2017 Jul;49(7):1287-1295. doi: 10.1007/s11255-017-1586-y. Epub 2017 Apr 13.
Hemodialysis vascular access dysfunction, mostly attributed to neointimal hyperplasia, is a major cause of morbidity and hospitalization in patients on hemodialysis. It has been reported that prostaglandin I has pleiotropic effects including anti-platelet, vasodilating, anti-inflammatory, and anti-atherogenic properties. In addition, several studies have shown that prostaglandin I can inhibit neointimal formation after vascular injury. This study aimed to investigate the effects of beraprost sodium, an oral synthetic analog of prostaglandin I, on vascular access patency in patients on hemodialysis who experienced primary hemodialysis vascular access failure.
Fifty-five patients with end-stage renal disease who were on hemodialysis were prospectively selected for this study. Twenty-three patients were assigned to be treated with 120 µg/day of beraprost sodium, while remaining patients (n = 32) were assigned to a control group. The primary outcome was primary unassisted vascular access patency at 2 years.
The incidence of primary unassisted patency at 2 years was 83% in the beraprost sodium group and 38% in the control group (p = 0.001). Analysis of covariables indicated that this effect occurred mainly as a result of beraprost sodium administration. No life-threatening adverse event or severe bleeding was recorded in any of the groups.
Our data indicated that an oral prostaglandin I analog, beraprost sodium, is effective and safe for the maintenance of vascular access patency in patients on hemodialysis with primary vascular access failure.
血液透析血管通路功能障碍主要归因于内膜增生，是血液透析患者发病和住院的主要原因。据报道，前列腺素I具有多种作用，包括抗血小板、血管舒张、抗炎和抗动脉粥样硬化特性。此外，多项研究表明，前列腺素I可抑制血管损伤后的内膜形成。本研究旨在探讨前列腺素I的口服合成类似物贝拉普罗钠对初次血液透析血管通路失败的血液透析患者血管通路通畅性的影响。
前瞻性选取55例接受血液透析的终末期肾病患者进行本研究。23例患者被分配接受每日120μg贝拉普罗钠治疗，其余患者（n = 32）被分配至对照组。主要结局是2年时初次非辅助血管通路通畅率。
贝拉普罗钠组2年时初次非辅助通畅率为83%，对照组为38%（p = 0.001）。协变量分析表明，这种效果主要是由于服用贝拉普罗钠所致。任何一组均未记录到危及生命的不良事件或严重出血。
我们的数据表明，口服前列腺素I类似物贝拉普罗钠对于维持初次血管通路失败的血液透析患者的血管通路通畅是有效且安全的。
