Statins Improve Long Term Functional Radiocephalic Fistulas Success Rates in Diabetic Male Dialysis Patients
Meg Reeves, Michael F. Amendola, MD, Marc Posner, John Pfeifer, Ronald Davis.
VA Medical Center/VCU Health System, Richmond, VA, USA.
BACKGROUND:
Radiocephalic arteriovenous fistula (RC) creation has become the preferred first line access procedure for patients on hemodialysis. Analysis of diabetic rat arteriovenous fistula model1 has demonstrated improved fistula flow dynamics and endothelial function with statin medication use. We believe similar favorable outcomes will be seen in patients undergoing primary RC placement.
METHODS:
We retrospectively query our Veterans Administration Hospital dialysis access database from January 1, 2003 to December 31, 2011 to identify all diabetic patients who had primary RC fistula placement. We followed outcomes until July 30 2017 for an additional 67 to 145 months after RC placement. Patients were stratified into being on a statin medication or not at the time of RC creation. Outcomes examined including successful cannulation, functional utilization time (successful needle cannulation and usage on dialysis), rates of access thrombosis once cannulated and endovascular interventions per access. Kaplan-Meier analysis was used to compared the two groups.
RESULTS:
Total number 94 RC were performed in 88 diabetic male patients. 71 RC (74%) were on statins at the time of creation and 23 (26%) were not.
| Statin (n=70) | No Statin (n=23) | p value* | |
| Successful Cannulation | 32/71 (45%) | 9/23 (39%) | 0.63* |
| Functional Patency Once Accessed (mean days +/- SD) | 903 +/- 1037 | 951 +/- 1029 | 0.90† |
| Endovascular Interventions per Access (mean +/- SD) | 0.78 +/- 1.71 | 0.55 +/- 1.10 | 0.55† |
| Thrombosis Rate Once Accessed | 2/32 (6%) | 5/9 (55%) | 0.003* |
*Fisher’s Exact Test †Wilcoxon Rank Sum
BMI, hypertension, age, antiplatelet use, anticoagulation use, BUN, creatine, glucose, MCV, hemoglobin and percentage on dialysis at the time of study was not significantly different between the groups.
CONCLUSIONS:
Patients on statin at the time of RC creation had similar outcomes in terms of successful cannulation, functional patency rates and endovascular interventions. However, thrombosis rates were significantly reduced in patients on statins at the time of RC creation. These data should encourage primary statin at the time of RC creation in diabetic patients.
1Roan J, Fang S, Chang S, Hsu C, Huang C, Chiou M, Tsai Y, Lam C. Rosuvastatin improves vascular function of arteriovenous fistula in a diabetic rat model. J. Vasc, Surg. 2012; 56,5; 1381-9.
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