Statin Therapy and Hemodialysis Vascular Access-Were We Bringing a Knife to a Gunfight and Were Hoping to Win?
ABSTRACT Vascular access dysfunction is a major contributor to end stage renal disease patient morbidity, and the cost of maintaining it is staggering. Any intervention able to improve the vascular access maturation rate and/or patency would be significant progress. Based on the anti-inflammatory and vascular beneficial effects demonstrated in non-end stage renal disease patients, we were hoping that statin use might provide the much needed improvement in the hemodialysis vascular access outcome. The reality proved disappointing. The statins failed to improve every aspect of hemodialysis vascular access studied. The present editorial discusses the current data regarding the effect of statins on vascular access and attempts to explain their lack of success.
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ABSTRACT: Background: Thrombosis of hemodialysis vascular access represents a major medical and economic burden. Omega-3 fatty acids play an important modulatory role in the immune and inflammatory responses and the progression of arteriosclerosis. Fish oils have been demonstrated to have anti-platelet effects, and reduce intimal hyperplasia in autogenous grafts. Such effects may improve arteriovenous fistula (AVF) and arteriovenous graft (AVG) patency. Objective: To determine the effect of fish oil on native AVF and synthetic graft patency in chronic hemodialysis patients. Patients and Methods: Prospective Case control study conducted on 80 chronic hemodialysis patients selected from El-Maadi Liver & Kidney Transplantation Hospital in Egypt. The study was conducted through a period of time spanning 6 months. Patients were divided randomly into two groups, group (1) composed of 40 hemodialysis patients receiving four Omega-3 fatty acids capsules/day (1-g per capsule) for the 6-months duration of the study and group (2) composed of 40 hemodialysis patients not receiving omega-3 fatty acids. Full clinical examination of AVF and grafts was done to all patients in every hemodialysis session during the six months period of the study. Angiography was done whenever indicated. Results: 82.5% out of our patients were having AVF as their vascular access while the remaining 17.5% were having AVG. There was highly significant statistical decrease in serum triglyceride, total cholesterol and LDL levels in group (1) compared to group (2) over the 6 months period (p<0.001). Highly significant statistical increase in HDL level and URR in group (1) compared to group (2) over the 6 months period (p <0.001). Angiography was done to 8 indicated patients (10%), 3 patients in group (1) (7.5%) and 5 patients in group (2) (12.5%).Conclusion: Fish oil leads to significant decrease in serum triglyceride level, total cholesterol level and LDL together with increase in HDL level in chronic hemodialysis patients. Vascular access blood flow also changed but not in a significant manner. [Howayda El-Shinnawy, Walid Bichari, Yahya Makkeyah, Maha Behairy, Ahmed Shabaan. Effect Of Omega-3 Fatty Acids On Vascular Access Patency In Chronic Hemodialysis Patients. Life Sci J 2015;12(1):82-88]. (ISSN:1097-8135). http://www.lifesciencesite.com. 12Life Science Journal 01/2015; 12(1). · 0.17 Impact Factor