Statins Usage At Arteriovenous Graft Placement Does Not Improve Outcomes In Diabetic Patients
Diana Otoya, MD, Kedar S. Lavingia, MD, Marc Posner, MD, Luke Wolfe, MS, Michael F. Amendola, MD, MEHP.
Virginia Commonwealth Univsersity, Richmond, VA, USA.
OBJECTIVES: Previous diabetic arteriovenous fistula animal model indicates improved flow dynamics with use of HMG-CoA-Reductase Inhibitors (statin). We have confirmed few thrombosis events in our patients on statins at the time of radiocephalic arteriovenous fistula. We predict similar favorable outcomes in diabetic patients undergoing arteriovenous graft (AVG) placements.
METHODS: A Veterans Administration Hospital dialysis access database over a four-year period (May 22, 2014 to May 22, 2018) to identify all diabetic patients who had AVG placement in the upper extremity. We followed outcomes until December 15, 2019. Patients were stratified into statin medication usage (+statin) or not (-statin) at the time of AVG placement. Outcomes examined included successful cannulation, functional patency (successful needle cannulation and usage on dialysis), thrombosis events and endovascular interventions per access. We also examined previous access procedures and patient demographics. T-test* and Fishers Exact** test were utilized.
RESULTS: A total of 51 AVG were placed in 47 male patients (63.5% of all AVG patients during the same time period). Fifteen patients were not on statins at the time of AVG placement. Clinical outcomes summarized in Table 1.
Factors not found to be different between the two groups included hypertension, smoking history, platelet, BUN, hemoglobin, antiplatelet prescription, previous arteriovenous access, BMI, glucose, creatinine, hemoglobin, MCV, platelet, central catheter use, mortality nor anticoagulation.
Contrary to what has been described in animal arteriovenous fistula models and retrospective analysis of arteriovenous fistulas in clinical practice, there does not appear to be a distinct advantage with statin use at the time of AVG placement. Statin use does not seem to affect rates of successful cannulation, functional patency times nor thrombosis rates. These data should encourage further investigation of statins and their role in hemodialysis access.
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