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Effect of carvedilol on arteriovenous graft primary patency
Yuan-Hsi Tseng1, Chia-Yen Liu2, Chuan-Pin Lee2
1Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan.
Insights
Carvedilol use exceeding 84 days significantly improves arteriovenous graft (AVG) patency in hemodialysis patients by reducing intimal hyperplasia. Shorter durations of carvedilol treatment did not show a similar benefit for AVG patency.
Area of Science:
- Vascular Surgery
- Nephrology
- Pharmacology
Background:
- Arteriovenous graft (AVG) failure is often caused by intimal hyperplasia (IH), driven by smooth muscle cell proliferation and inflammation.
- Carvedilol possesses anti-proliferative and anti-inflammatory properties that may mitigate IH and improve AVG patency.
Purpose of the Study:
- To investigate the effect of carvedilol on the primary patency of arteriovenous grafts in end-stage renal disease patients undergoing hemodialysis.
- To determine if the duration of carvedilol use influences its efficacy in preventing AVG failure.
Main Methods:
- Retrospective analysis of end-stage renal disease patients receiving hemodialysis from the National Health Insurance Research database.
- Follow-up for two years or until the end of 2013, with the primary endpoint being the first percutaneous transluminal angioplasty (PTA) for AVG failure or death.
- Cox proportional hazard model used for statistical analysis, comparing patients treated with carvedilol versus those not treated.
Main Results:
- A total of 16,732 patients were included (3028 treated with carvedilol, 13,704 controls).
- Multivariate analysis revealed that carvedilol use for over 84 days reduced the likelihood of PTA for AVG failure by 9% (p=0.021).
- Carvedilol use for 1 to 84 days did not significantly impact AVG failure rates.
Conclusions:
- Prolonged use of carvedilol (more than 84 days) is associated with improved primary patency of arteriovenous grafts.
- Short-term carvedilol treatment (1-84 days) does not confer a significant benefit in maintaining AVG patency.
Background:
The major mechanisms of arteriovenous graft (AVG) failure due to intimal hyperplasia (IH) are smooth muscle cell proliferation and inflammation. Therefore, carvedilol may improve AVG primary patency because of its anti-proliferative and anti-inflammatory activities.
Methods:
The data of end-stage renal disease patients receiving regular hemodialysis were collected from the National Health Insurance Research database. The end point was the first percutaneous transluminal angioplasty (PTA) for AVG failure or death during a follow-up period of two years or the end of 2013. The analysis was calculated with Cox proportional hazard model.
Results:
There were 3028 patients treated with carvedilol and 13,704 patients not treated with carvedilol. According to a univariate analysis, the carvedilol group was younger, received more anti-hypertensive medications and platelet aggregation inhibitors, and had higher rates of diabetes mellitus and hyperlipidemia but had lower rates of hypotension and smoking. According to a multivariate analysis, after controlling for covariates, the use of carvedilol for more than 84 days reduced the probability of a first PTA for AVG failure by 9% compared with no use of carvedilol (p = 0.021), but the use of carvedilol for 1 to 84 days did not.
Conclusion:
The results of this study indicate that the use of carvedilol for more than 84 days improves the primary patency of AVGs, but the use of carvedilol for less than 84 days does not.
