Advertisement

Journal of Nephrology

, Volume 31, Issue 4, pp 603–611 | Cite as

Role of antiplatelet therapy in the durability of hemodialysis access

  • Satinderjit Locham
  • Robert J. Beaulieu
  • Hanaa Dakour-Aridi
  • Besma Nejim
  • Mahmoud B. Malas
Original Article

Abstract

Background

Antiplatelet therapy (APT) is often used on anecdotal grounds to improve vascular access patency. The aim of this study was to assess the role of APT in hemodialysis (HD) patients undergoing arteriovenous fistula (AVF) or graft (AVG) placement.

Methods

All patients in a large HD vascular qualitative initiative database (2011–2017) were included and divided into no antiplatelet therapy (no-APT) vs. any APT [aspirin (ASA) or P2Y12 inhibitors (PI)]. Multivariate [logistic (MLR) and Cox (MCR) regression] analyses were used as appropriate.

Results

A total of 24,847 patients undergoing HD access creation were identified (78% AVF). APT was noted among 49 and 46% of AVG and AVF patients, respectively. In MLR analysis, patients on no-APT vs. APT had a 12-fold increased risk of in-hospital mortality (odds ratio (OR) 11.79, [95% confidence interval 5.30–26.26]) and the risk of developing steal syndrome was higher among patients discharged on APT (OR 1.81, [1.19–2.76]). In patients undergoing AVF, primary patency (PP) was similar between APT and no-APT. However, in patients undergoing AVG, PP rates at 12 months were significantly higher for APT: ASA (47 vs. 41%) and PI (51 vs. 41%) than for no-APT (p = 0.008). At MCR analysis, the loss of PP at 12 months was 13% lower in ASA users (hazard ratio (HR) 0.87, [0.77–0.97], p = 0.02) and 24% lower in PI users (HR 0.76, [0.57–0.99], p = 0.046) compared to no-APT.

Conclusion

In a large national database, we showed that antiplatelet therapy was associated with lower in-hospital mortality. Aspirin and P2Y12-inhibitor use among AVG patients demonstrated improved PP rates compared to no antiplatelet therapy. We recommend the use of antiplatelet therapy especially in patients on AVG.

Keywords

AVF AVG Aspirin Clopidogrel 

Notes

Acknowledgements

No special funding was obtained to complete this study.

Compliance with ethical standards:

Conflict of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

VQI database contains de-identified data, the need for patient informed consent was waived and institution review board (IRB) approval was exempted by the IRB.

Supplementary material

40620_2018_490_MOESM1_ESM.docx (118 kb)
Supplementary material 1 (DOCX 117 KB)

References

  1. 1.
    Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the united states. JAMA 298(17):2038–2047CrossRefPubMedGoogle Scholar
  2. 2.
    Sidawy AN, Spergel LM, Besarab A et al (2008) The society for vascular surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 48(5):S2–S25CrossRefGoogle Scholar
  3. 3.
    The national kidney foundation kidney disease outcomes quality initiative. https://www.kidney.org/professionals/guidelines. Updated 2016. Accessed 24 March 2017
  4. 4.
    Hicks CW, Canner JK, Arhuidese I et al (2015) Mortality benefits of different hemodialysis access types are age dependent. J Vasc Surg 61(2):449–456CrossRefPubMedGoogle Scholar
  5. 5.
    Malas MB, Canner JK, Hicks CW et al (2015) Trends in incident hemodialysis access and mortality. JAMA Surg 150(5):441–448CrossRefPubMedGoogle Scholar
  6. 6.
    Roy-Chaudhury P, Sukhatme VP, Cheung AK (2006) Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol 17(4):1112–1127CrossRefPubMedGoogle Scholar
  7. 7.
    Jagroop IA, Matsagas MI, Geroulakos G, Mikhailidis DP (2004) The effect of clopidogrel, aspirin and both antiplatelet drugs on platelet function in patients with peripheral arterial disease. Platelets 15(2):117–125CrossRefPubMedGoogle Scholar
  8. 8.
    Kaufman JS, Fiore L, Hasbargen JA, O’connor TZ, Perdriset G (2000) A pharmacodynamic study of clopidogrel in chronic hemodialysis patients. J Thromb Thrombolysis 10(2):127–131CrossRefPubMedGoogle Scholar
  9. 9.
    CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348(9038):1329–1339CrossRefGoogle Scholar
  10. 10.
    Saran R, Dykstra DM, Wolfe RA, Gillespie B, Held PJ, Young EW (2002) Association between vascular access failure and the use of specific drugs: The dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 40(6):1255–1263CrossRefPubMedGoogle Scholar
  11. 11.
    Tanner N, da Silva A (2016) Medical adjuvant treatment to improve the patency of arteriovenous fistulae and grafts: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 52(2):243–252CrossRefPubMedGoogle Scholar
  12. 12.
    Mousa AY, Patterson W, Abu-Halimah S et al (2013) Patency in arteriovenous grafts in hemodialysis patients. Vasc Endovasc Surg 47(6):438–443CrossRefGoogle Scholar
  13. 13.
    Paraskevas KI, Mikhailidis DP, Roussas N, Giannoukas AD (2012) Effect of antiplatelet agents, statins, and other drugs on vascular access patency rates. Angiology 63:5–8CrossRefPubMedGoogle Scholar
  14. 14.
    Dixon BS, Beck GJ, Dember LM et al (2011) Use of aspirin associates with longer primary patency of hemodialysis grafts. J Am Soc Nephrol 22(4):773–781CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ghorbani A, Aalamshah M, Shahbazian H, Ehsanpour A, Aref A (2009) Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients. Indian J Nephrol 19(2):57–61CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Dember LM, Beck GJ, Allon M et al (2008) Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 299(18):2164–2171CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Yevzlin AS, Conley EL, Sanchez RJ, Young HN, Becker BN (2006) Vascular access outcomes and medication use: a USRDS study. Semin Dial 19(6):535–539CrossRefPubMedGoogle Scholar
  18. 18.
    Osborn G, Escofet X, Da Silva A (2008) Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts. Cochrane Database Syst Rev 4:CD002786Google Scholar
  19. 19.
    Trimarchi H, Young P, Forrester M, Schropp J, Pereyra H, Freixas E (2006) Clopidogrel diminishes hemodialysis access graft thrombosis. Nephron Clin Pract 102(3–4):c128–c132PubMedGoogle Scholar
  20. 20.
    Cronenwett JL, Kraiss LW, Cambria RP (2012) The society for vascular surgery vascular quality initiative. J Vasc Surg 55(5):1529–1537CrossRefPubMedGoogle Scholar
  21. 21.
    Biondi-Zoccai GG, Lotrionte M, Agostoni P et al (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. Eur Heart J 27(22):2667–2674CrossRefPubMedGoogle Scholar
  22. 22.
    Htun P, Kan T, Mueller E et al (2014) Haemodialysis impairs clopidogrel but not aspirin responsiveness in patients with end-stage renal disease. Thromb Haemost 111(4):662–669CrossRefPubMedGoogle Scholar
  23. 23.
    Bouatou Y, Flora Samer C, Fontana P, Daali Y, Desmeules J (2015) Evidence-based choice of P2Y12 inhibitors in end stage renal disease patients: a mini-review. Curr Drug Metab 16(2):97–104CrossRefPubMedGoogle Scholar
  24. 24.
    Bonomini M, Sirolli V, Stuard S, Settefrati N (1999) Interactions between platelets and leukocytes during hemodialysis. Artif Organs 23(1):23–28CrossRefPubMedGoogle Scholar
  25. 25.
    Gawaz MP, Mujais SK, Schmidt B, Gurland HJ (1994) Platelet-leukocyte aggregation during hemodialysis. Kidney Int 46(2):489–495CrossRefPubMedGoogle Scholar
  26. 26.
    Vázquez E, Sánchez-Perales C, Ortega S et al (2017) Bleeding risk of antithrombotic treatment in patients on hemodialysis. J Cardiovasc Pharmacol 69(4):192–197CrossRefPubMedGoogle Scholar
  27. 27.
    Rocha A, Silva F, Queirós J, Malheiro J, Cabrita A (2012) Predictors of steal syndrome in hemodialysis patients. Hemodial Int 16(4):539–544CrossRefPubMedGoogle Scholar
  28. 28.
    Aspirin and subclavian steal syndrome—from FDA reports. eHealthMe Personalized Health Information Web site. https://www.ehealthme.com/ds/aspirin/subclavian-steal-syndrome/. Updated 2017. Accessed 18 Dec 2017
  29. 29.
    Sedov VM, Karpov SA, Alferov SV, Grinev KM (2013) Phenomenon of ischemic steal syndrome in patients with different arteriovenous fistulas for hemodialysis and its surgical correction. Vestn Khir Im I I Grek 172(6):51–55PubMedGoogle Scholar

Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Satinderjit Locham
    • 1
  • Robert J. Beaulieu
    • 3
  • Hanaa Dakour-Aridi
    • 1
  • Besma Nejim
    • 1
  • Mahmoud B. Malas
    • 1
    • 2
    • 3
  1. 1.Johns Hopkins Bayview Vascular and Endovascular Clinical Research CenterBaltimoreUSA
  2. 2.Center for Research Excellence and Clinical TrialsJohns Hopkins HospitalBaltimoreUSA
  3. 3.Johns Hopkins Medical InstitutionsBaltimoreUSA

Personalised recommendations