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Combination of aspirin and an anti-clotting drug reduces risk of dialysis access failure
May 21, 2009For the first time, a combination of aspirin and the anti-platelet drug dipyridamole has been shown to significantly reduce blockages and extend the useful life of new artery-vein access grafts used for hemodialysis, according to a study by the Dialysis Access Consortium (DAC). The study, supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, will be published in the May 21, 2009, New England Journal of Medicine.
Artery-vein access grafts, called arteriovenous (AV) grafts, fail most often due to narrowing of blood vessels (stenosis) at the graft site and subsequent clotting, which block the flow of blood. A blocked graft cannot be used for dialysis and is a major cause of worsening health in dialysis patients.
The DAC trial found that the combination treatment decreased the rate of loss of primary unassisted graft patency - the useful life of a graft before it becomes blocked the first time - by 18 percent and the rate of developing significant stenosis by 28 percent, compared to placebo. Previous smaller clinical trials of anti-clotting therapies failed to show that these drugs improve AV graft patency or that they could be used safely in dialysis patients.
"This drug combination provides a modest but important new therapy to keep AV grafts in good working order so patients can get the dialysis they need," said NIDDK Director Griffin P. Rodgers, M.D. "But clearly more research is needed to extend the useful life of AV grafts."
A total of 649 participants with new AV grafts were recruited for the trial at 13 clinical sites in the United States and were randomly assigned to treatment with dipyridamole plus aspirin or to a placebo. The trial took place over a period of five years.
"Our trial results show that we now have a drug therapy that significantly prolongs the viability of AV grafts," said Bradley S. Dixon, M.D., of the University of Iowa College of Medicine, Iowa City, and lead author of the study. "This is an important step forward as we proceed to develop therapies to improve dialysis patients' quality of life."
According to the 2008 U.S. Renal Data System Annual Data Report, more than half a million patients have kidney failure, 70 percent of whom are on dialysis. Costs for kidney failure are more than $30 billion. Annual costs of vascular access-related procedures in the United States have been estimated to exceed $1 billion. For more information on vascular access, visit: http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/index.htm.
NIH/National Institute of Diabetes and Digestive and Kidney Diseases
"This drug combination provides a modest but important new therapy to keep AV grafts in good working order so patients can get the dialysis they need," said NIDDK Director Griffin P. Rodgers, M.D. "But clearly more research is needed to extend the useful life of AV grafts."
A total of 649 participants with new AV grafts were recruited for the trial at 13 clinical sites in the United States and were randomly assigned to treatment with dipyridamole plus aspirin or to a placebo. The trial took place over a period of five years.
"Our trial results show that we now have a drug therapy that significantly prolongs the viability of AV grafts," said Bradley S. Dixon, M.D., of the University of Iowa College of Medicine, Iowa City, and lead author of the study. "This is an important step forward as we proceed to develop therapies to improve dialysis patients' quality of life."
According to the 2008 U.S. Renal Data System Annual Data Report, more than half a million patients have kidney failure, 70 percent of whom are on dialysis. Costs for kidney failure are more than $30 billion. Annual costs of vascular access-related procedures in the United States have been estimated to exceed $1 billion. For more information on vascular access, visit: http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/index.htm.
NIH/National Institute of Diabetes and Digestive and Kidney Diseases
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Women with chronic kidney disease more likely than men to go undiagnosed
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For dialysis patients, skinny is dangerous
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Kidney transplants generally safe for lupus patients
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Muscle weakness a common side effect of long stays in intensive care units
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Calculate benefit before dialysis for frail elders
Kidney specialists should weigh the potential quality of life for frail elders with end-stage renal disease (ESRD) in opting for dialysis over more conservative therapies, a nephrologist and a palliative care specialist suggest in an editorial in the New England Journal of Medicine.
Kidneys from deceased donors with acute renal failure expand donor pool
Kidneys recovered from deceased donors with acute renal failure (ARF) - once deemed unusable for transplant - appear to work just as well as kidneys transplanted from deceased donors who do not develop kidney problems prior to organ donation.
Few complications 1 year after aortic valve implantation
Research presented at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF), demonstrated an "exceptionally low" rate of complications one year after implantation of transcatheter aortic valve prostheses.
Link between depression, early stages of chronic kidney disease found by researchers
One in five patients with chronic kidney disease is depressed, even before beginning long-term dialysis therapy or developing end-stage renal disease, UT Southwestern Medical Center researchers have found.
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