Drug-Coated Balloon Angioplasty in Hemodialysis Circuits: A Systematic Review and Meta-Analysis

To perform a systematic review and meta-analysis assessing patency outcomes following drug-coated balloon angioplasty (DCBA) in hemodialysis circuits.

MEDLINE and EMBASE systematic searches were performed from inception to November 2018 to identify comparative studies assessing DCBA vs plain old balloon angioplasty (POBA) in hemodialysis circuits. Abstract selection, data extraction, and quality assessment were performed by 2 independent reviewers. Primary outcome was loss of target lesion patency at 3, 6, 12, and 24 months for autogenous arteriovenous fistula (AVF), prosthetic arteriovenous graft (AVG), and hemodialysis-related central venous stenosis.

Twelve studies comprising 908 patients were included. There was a significant improvement in patency among AVF after DCBA vs POBA at 3, 6, 12, and 24 months (odds ratio 0.58 [95% confidence interval, 0.36-0.94]; odds ratio 0.40 [95% confidence interval 0.23-0.70]; odds ratio 0.39 [95% confidence interval, 0.25-0.61]; and odds ratio 0.20 [95% confidence interval, 0.07-0.62]). This benefit persisted on subgroup analysis of randomized controlled trials (RCTs) only. Meta-analysis of results specific to AVG could not be performed, as only 1 RCT was identified that favored DCBA. Hemodialysis-associated central vein stenosis did not demonstrate a significant difference in patency rates between DCBA and POBA on meta-analysis. Twelve-month mortality and same-day complication rates did not differ between arms.

Significant improvement in patency was identified with DCBA in AVF at 3, 6, 12, and 24 months. A single comparative study identified benefit of DCBA use in the AVG group. No significant benefit was identified with DCBA for central stenosis.