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Long-Term Effectiveness of Cilostazol in Patients with Hemodialysis with Peripheral Artery Disease
Chung-Kuan Wu1,2, Chia-Hsun Lin2,3, Noi Yar4
1Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital.
Insights
Continuous cilostazol use in hemodialysis patients with peripheral artery disease significantly reduces emergency visits, hemorrhagic stroke, and cardiovascular events. This long-term treatment improves event-free survival rates.
Area of Science:
- Nephrology and Vascular Medicine
- Pharmacology and Therapeutics
Background:
- Peripheral artery disease (PAD) is a common complication in patients undergoing hemodialysis (HD).
- Managing vascular risks and healthcare utilization in this high-risk population is crucial.
Purpose of the Study:
- To evaluate the impact of continuous cilostazol treatment on emergency department (ED) visits, hospitalizations, and vascular outcomes.
- To assess long-term effects on mortality and specific vascular events in HD patients with PAD.
Main Methods:
- Retrospective cohort study of 558 adult patients on chronic HD for ≥90 days.
- Patients were categorized based on continuous or discontinued cilostazol use.
- Outcomes included ED visits, hospitalizations, mortality, and vascular events (angioplasty, bypass, amputation, stroke, cardiovascular events).
Main Results:
- Continuous cilostazol use was associated with lower incidence of ischemic stroke and cardiovascular events, and reduced mortality.
- Independent association found between continuous cilostazol use and lower risk of ED visits, hemorrhagic stroke, and cardiovascular events.
- Significantly higher rates of ED visit-free and cardiovascular event-free survival were observed with continuous cilostazol use.
Conclusions:
- Continuous cilostazol treatment in HD patients with PAD significantly lowers the risk of ED visits, hemorrhagic stroke, and cardiovascular events.
- Long-term cilostazol therapy improves event-free survival, demonstrating its therapeutic benefit in this cohort.
- The findings support the use of cilostazol for managing vascular complications in hemodialysis patients with PAD.
Aim:
The aim of this study was to investigate the effects of continuous cilostazol use on emergency department (ED) visits, hospitalizations, and vascular outcomes in patients with hemodialysis (HD) with peripheral artery disease (PAD).
Methods:
This retrospective cohort study recruited 558 adult patients, who had received chronic HD for at least 90 days between January 1, 2008 and December 31, 2012, from the National Health Insurance Research Database. Eligible patients were divided into two groups based on continuing or discontinuing cilostazol treatment. Outcome measures were ED visits, hospitalizations, mortality, and vascular outcomes such as percutaneous transluminal angioplasty, surgical bypass, lower leg amputation, ischemic stroke, hemorrhagic stroke, and cardiovascular events.
Results:
Patients with continuous cilostazol use had significantly higher prevalence of stroke, cancer, vintage, and the use of angiotensin receptor blocker and β-blocker, but significantly lower incidence of ischemic stroke and cardiovascular events, as well as lower mortality, than those without continuous cilostazol use (all p＜.05). Continuous cilostazol use was independently associated with lower risk of ED visits, hemorrhagic stroke, and cardiovascular events (adjusted hazard ratios: 0.79, 0.29, and 0.67; 95% confidence intervals: 0.62-0.98, 0.10-0.84, and 0.48-0.96, respectively; all p＜.05). Continuous cilostazol use was significantly associated with higher ED visit-free and cardiovascular event-free rates (log-rank test; p＜.05).
Conclusion:
Continuous treatment of cilostazol in patients with HD with PAD significantly decreases the risk of ED visits, hemorrhagic stroke, and cardiovascular events and improves ED visit-free and cardiovascular event-free rates during long-term follow-up.
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