Nathan Birch

The Nebraska Medical Center, Omaha, Nebraska, United States

Are you Nathan Birch?

Claim your profile

Publications (2)2.99 Total impact

  • Nathan Birch · Jennifer Fillaus · Marius C Florescu
    [Show abstract] [Hide abstract]
    ABSTRACT: Statins reduce inflammation in end-stage renal disease patients and improve endothelial function beyond cholesterol lowering. Despite this, statins do not improve the maturation rate, primary patency rate, and the cumulative survival of arteriovenous fistulas (AVFs). It is unknown if statins decrease the number of stenoses developing in AVFs or prolong the intervals between angioplasties needed to treat recurring stenoses. We conducted a retrospective chart review of our 265 active dialysis patients. The statin group was significantly more likely to be diabetic (64% vs. 43.6%) and treated with aspirin (64% vs. 40%) when compared to those not treated with statins (P = 0.04 and 0.01). The mean time to first intervention (primary patency) was 16.5 months in statin users and 15.8 months in the nonstatin group (P = 0.49) with standard deviations of ±18.5 and 16.6 months, respectively. Statin use was not associated with a significant decrease in the number of stenoses diagnosed (P = 0.28). The mean time between recurrent stenoses' angioplasties was 8.9 months in statin users and 7.3 months in the nonstatin patients (P = 0.25). Aspirin users were more likely to have a decreased primary patency (rate ratio = 1.65, P = 0.03) compared with nonaspirin users. Patients who were prescribed aspirin developed 1.6 (P 0.01) times more stenoses than those not treated with aspirin. We report for the first time that statin therapy does not decrease the number of stenotic lesions developing in the AVF or prolong the interval between procedures required to treat recurrent stenoses.
    No preview · Article · Oct 2012 · Hemodialysis International
  • Marius C Florescu · Nathan Birch
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Mar 2012 · Seminars in Dialysis