ACE inhibitors improve survival of vascular grafts in hemodialysis patients

NEW YORK (Reuters Health) – Hemodialysis patients using ACE inhibitors appear to be protected against vascular access complications, according to findings published in the December issue of the American Journal of Kidney Diseases.

Dr. Joseph M. Messana, of the University of Michigan Health System, in Ann Arbor, and a multicenter team retrospectively examined the effects of ACE inhibitor use on vascular access graft survival in hemodialysis patients who received polytetrafluoroethylene (PTFE) grafts at their center from January 1, 1995, through October 31, 1999.

During this period, 19 patients using ACE inhibitors received 25 grafts while 68 patients not using ACE inhibitors received a total of 96 grafts. During follow-up (1 month to 5 years), 10 of 25 grafts failed in the ACE inhibitor group and 62 of 95 failed in the non-ACE inhibitor group.

"We observed a remarkably strong and statistically significant association between the use of ACE inhibitors and prolongation of primary PTFE access survival," the investigators say. The relative risk for graft failure was 53% lower in the ACE inhibitor group than in patients not using ACE inhibitors (p < 0.03), and even lower after adjusting for comorbidities.

While the study was not designed to examine the mechanisms of the protective effect of ACE inhibitors in this population, Dr. Messana and colleagues note several possibilities, "including inhibition of intimal hyperplasia, vascular smooth muscle cell proliferation and migration, and extracellular matrix deposition." In addition, they note, "ACE inhibitors may improve regional blood flow as a result of the increased cardiac output associated with afterload reduction."

The findings support the need for a larger, prospective study to confirm the benefits and assess the potential risks associated with more widespread use of ACE inhibitors in this population.

Am J Kidney Dis 2001;38:1240-1244.

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