| Maintenance of adequate hemodialysis access. Prevention of neointimal hyperplasia. | |
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MedLine Citation:
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PMID: 8589464 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The maintenance of adequate hemodialysis vascular access is frequently complicated in the patient with polytetrafluoroethylene (PTFE) A-V hemodialysis grafts by venous anastomotic stenosis. This stenosis is caused by neointimal hyperplasia (NIH), a response to vascular injury. In this study, the authors prospectively analyzed the effect of a short-term regimen consisting of administration of two medications, heparin and low molecular weight dextran, on the development of NIH at the venous anastomosis in 79 patients with PTFE A-V hemodialysis grafts. In addition, they evaluated other parameters' effects on the development of NIH. In comparison with control subjects, heparin had some effect in minimizing the development of NIH in the PTFE grafts when evaluated radiologically at 3 months, although this effect was not statistically significant. Low molecular weight dextran, however, had no trend or statistically significant effect on this venous anastomotic narrowing. Interestingly, patient age, use of calcium channel blockers, and presence of diabetes mellitus (DM) all appeared to affect the development of NIH. Increasing age and use of calcium channel blockers was associated with decreased development of NIH; conversely, DM was associated with worsened NIH. In evaluation of access survival (time to first access failure), degree of venous anastomosis stenosis at 3 months was not predictive. Patient time on dialysis pre graft placement was the only measured parameter related to access failure. The method of dialysis pre graft placement (hemodialysis versus peritoneal dialysis) was not a significant factor in early access failure. Pharmacologic treatment of venous anastomotic narrowing in PTFE hemodialysis grafts due to NIH continues to be difficult. Short-term treatment with the tested medication failed to statistically affect NIH. Patient age, use of calcium channel blockers, and presence of DM were all factors in the development of NIH. Of measured parameters, time on dialysis pre graft placement was the only factor correlated with early access failure. In future treatment regimens, one should consider more prolonged treatment. In addition, noted risk factors should be considered when determining type of renal replacement therapy. |
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Authors:
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T E Taber; P S Maikranz; B W Haag; G M Gaylord; R S Dilley; K O Ehrman; P B Brown; D R Nelson; D C Kay; T L Roberts |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: ASAIO journal (American Society for Artificial Internal Organs : 1992) Volume: 41 ISSN: 1058-2916 ISO Abbreviation: ASAIO J. Publication Date: 1995 Oct-Dec |
Date Detail:
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Created Date: 1996-03-27 Completed Date: 1996-03-27 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9204109 Medline TA: ASAIO J Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 842-6 Citation Subset: IM |
Affiliation:
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Department of Nephrology, Methodist Hospital of Indiana, Community Hospitals of Indiana, Indianapolis, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aging / metabolism Analysis of Variance Anticoagulants / administration & dosage, pharmacology, therapeutic use* Arteriovenous Anastomosis / physiopathology* Calcium Channel Blockers / pharmacology Catheters, Indwelling / adverse effects, standards* Constriction, Pathologic / etiology, physiopathology, prevention & control Dextrans / administration & dosage, pharmacology, therapeutic use Diabetes Mellitus / physiopathology Endothelium, Vascular / drug effects, injuries, pathology* Female Fibrinolytic Agents / administration & dosage, pharmacology, therapeutic use* Heparin / administration & dosage, pharmacology, therapeutic use Humans Hyperplasia / complications, physiopathology, prevention & control Kidney Transplantation Linear Models Male Middle Aged Molecular Weight Polytetrafluoroethylene / adverse effects Renal Dialysis / adverse effects, standards* Risk Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Calcium Channel Blockers; 0/Fibrinolytic Agents; 9002-84-0/Polytetrafluoroethylene; 9004-54-0/Dextrans; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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