The Effect of Aspirin on Preventing Vascular Access Dysfunction in Incident Hemodialysis Patients: A Prospective Cohort Study in Korean Clinical Research Centers for End-Stage Renal Disease (CRC for ESRD)
- 주제(키워드) aspirin , vascular access failure , incident hemodialysis
- 주제(기타) Medicine, General & Internal
- 설명문(일반) [Kim, Chan Ho] Catholic Kwandong Univ, Dept Internal Med, Int St Marys Hosp, Coll Med, Incheon 22711, South Korea; [Oh, Hyung Jung] Ewha Womans Univ, Mokdong Hosp, Ewha Inst Convergence Med, Seoul 07985, South Korea; [Kim, Yon Su] Seoul Natl Univ Med, Dept Internal Med, Seoul 03080, South Korea; [Kim, Yong-Lim] Kyungpook Natl Univ, Dept Internal Med, Sch Med, Daegu 41944, South Korea; [Chang, Jae Hyun] Gachon Univ, Dept Internal Med, Gil Med Ctr, Sch Med, Incheon 21565, South Korea; [Ryu, Dong-Ryeol] Ewha Womans Univ, Sch Med, Dept Internal Med, Seoul 07985, South Korea; [Ryu, Dong-Ryeol] Ewha Womans Univ, Tissue Injury Def Res Ctr, Seoul 07985, South Korea
- 등재 SCIE, SCOPUS
- OA유형 Green Published, Green Submitted, gold
- 발행기관 MDPI
- 발행년도 2019
- URI http://www.dcollection.net/handler/ewha/000000160041
- 본문언어 영어
- Published As http://dx.doi.org/10.3390/jcm8050677
- PubMed https://pubmed.ncbi.nlm.nih.gov/31091750
초록/요약
Background: Aspirin is often prescribed empirically to improve the patency of hemodialysis (HD) vascular access. Therefore, this study aimed to investigate the impact of aspirin on the survival of vascular access in incident HD patients with arteriovenous fistula (AVF) or arteriovenous graft (AVG). Methods: A prospective cohort of 881 incident HD patients was enrolled between 2009 and 2014. The primary outcome was defined as the first AVF/AVG intervention or salvage procedure, including percutaneous transluminal angioplasty or surgery for vascular access failure. Cox analyses were performed to determine the association between aspirin usage and the occurrence of the primary outcome. Results: The mean age of the patient group was 57.9 +/- 13.4, and 63.8% of the patients were male. Aspirin was prescribed in 241 (27.4%) patients, and the median follow-up duration was 30 months. During follow-up, 180 (20.4%) patients experienced the primary outcome event. Univariate analysis showed that age, gender, presence of diabetes mellitus (DM), preexisting peripheral arterial disease, and the type of vascular access used (AVG versus AVF) were significantly associated with the development of the primary outcome. However, aspirin usage from the baseline was not significantly associated with primary outcome events (hazard ratio (HR): 1.16; 95% confidence interval (CI): 0.84-1.60; p = 0.378). Multivariate analysis showed that gender, the presence of DM, and the type of vascular access were still significantly associated with the occurrence of the primary outcome. Moreover, we did not observe the protective effect of taking aspirin on primary vascular access failure, even in subgroup analyses stratified according to gender, the presence of DM, and the type of vascular access. Conclusion: Physicians should carefully consider when they prescribe aspirin for the prevention of primary vascular access failure in Korean incident HD patients. In addition, larger prospective interventional studies are needed to elucidate the effect of aspirin on vascular access failure.
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