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Effectiveness of beraprost sodium in maintaining vascular access patency in patients on hemodialysis

  • Nephrology - Original Paper
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Abstract

Purpose

Hemodialysis vascular access dysfunction, mostly attributed to neointimal hyperplasia, is a major cause of morbidity and hospitalization in patients on hemodialysis. It has been reported that prostaglandin I2 has pleiotropic effects including anti-platelet, vasodilating, anti-inflammatory, and anti-atherogenic properties. In addition, several studies have shown that prostaglandin I2 can inhibit neointimal formation after vascular injury. This study aimed to investigate the effects of beraprost sodium, an oral synthetic analog of prostaglandin I2, on vascular access patency in patients on hemodialysis who experienced primary hemodialysis vascular access failure.

Methods

Fifty-five patients with end-stage renal disease who were on hemodialysis were prospectively selected for this study. Twenty-three patients were assigned to be treated with 120 µg/day of beraprost sodium, while remaining patients (n = 32) were assigned to a control group. The primary outcome was primary unassisted vascular access patency at 2 years.

Results

The incidence of primary unassisted patency at 2 years was 83% in the beraprost sodium group and 38% in the control group (p = 0.001). Analysis of covariables indicated that this effect occurred mainly as a result of beraprost sodium administration. No life-threatening adverse event or severe bleeding was recorded in any of the groups.

Conclusions

Our data indicated that an oral prostaglandin I2 analog, beraprost sodium, is effective and safe for the maintenance of vascular access patency in patients on hemodialysis with primary vascular access failure.

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References

  1. Kassam H, Sun Y, Adeniyi M, Agaba EI, Martinez M, Servilla KS, Raj DS, Murata GH, Tzamaloukas AH (2011) Hospitalizations before and after initiation of chronic hemodialysis. Hemodial Int 15(3):341–349

    Article  PubMed  Google Scholar 

  2. Lok CE, Foley R (2013) Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol 8(7):1213–1219

    Article  PubMed  Google Scholar 

  3. Roy-Chaudhury P, Kelly BS, Miller MA, Reaves A, Armstrong J, Nanayakkara N, Heffelfinger SC (2001) Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts. Kidney Int 59(6):2325–2334

    Article  CAS  PubMed  Google Scholar 

  4. Roy-Chaudhury P, Arend L, Zhang J, Krishnamoorthy M, Wang Y, Banerjee R, Samaha A, Munda R (2007) Neointimal hyperplasia in early arteriovenous fistula failure. Am J Kidney Dis 50(5):782–790

    Article  PubMed  Google Scholar 

  5. NKF/KDOQI (2006) 2006 Update vascular access. Guideline 4: detection of access dysfunction: monitoring, surveillance, and diagnostic testing. Am J Kidney Dis 48(Suppl. 1):S176–S247

    Google Scholar 

  6. Leivaditis K, Panagoutsos S, Roumeliotis A, Liakopoulos V, Vargemezis V (2014) Vascular access for hemodialysis: postoperative evaluation and function monitoring. Int Urol Nephrol 46(2):403–409

    Article  PubMed  Google Scholar 

  7. Polkinghorne KR, Lau KK, Saunder A, Atkins RC, Kerr PG (2006) Does monthly native arteriovenous fistula blood-flow surveillance detect significant stenosis—a randomized controlled trial. Nephrol Dial Transplant 21(9):2498–2506

    Article  PubMed  Google Scholar 

  8. Ram SJ, Nassar R, Work J, Abreo K, Dossabhoy NR, Paulson WD (2008) Risk of hemodialysis graft thrombosis: analysis of monthly flow surveillance. Am J Kidney Dis 52(5):930–938

    Article  PubMed  Google Scholar 

  9. Yevzlin AS, Conley EL, Sanchez RJ, Young HN, Becker BN (2006) Vascular access outcomes and medication use: a USRDS study. Semin Dial 19(6):535–539

    Article  PubMed  Google Scholar 

  10. Palmer SC, Di Micco L, Razavian M, Craig JC, Ravani P, Perkovic V, Tognoni G, Graziano G, Jardine M, Pellegrini F, Nicolucci A, Webster A, Strippoli GF (2013) Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis. Am J Kidney Dis 61(1):112–122

    Article  CAS  PubMed  Google Scholar 

  11. Komori K, Ishii T, Odashiro T, Itoh H, Mawatari K, Okadome K, Sugimachi K (1995) Eicosapentanoic acid reduces the intimal thickening of autogenous vein grafts and enhances endothelium-derived relaxing factor. J Surg Res 59(6):747–753

    Article  CAS  PubMed  Google Scholar 

  12. Himmelfarb J, Couper L (1997) Dipyridamole inhibits PDGF- and bFGF-induced vascular smooth muscle cell proliferation. Kidney Int 52(6):1671–1677

    Article  CAS  PubMed  Google Scholar 

  13. Huang P, Hawthorne WJ, Peng A, Angeli GL, Medbury HJ, Fletcher JP (2001) Calcium channel antagonist verapamil inhibits neointimal formation and enhances apoptosis in a vascular graft model. Am J Surg 181(6):492–498

    Article  CAS  PubMed  Google Scholar 

  14. Janardhanan R, Yang B, Vohra P, Roy B, Withers S, Bhattacharya S, Mandrekar J, Kong H, Leof EB, Mukhopadhyay D, Misra S (2013) Simvastatin reduces venous stenosis formation in a murine hemodialysis vascular access model. Kidney Int 84(2):338–352

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Melian EB, Goa KL (2002) Beraprost: a review of its pharmacology and therapeutic efficacy in the treatment of peripheral arterial disease and pulmonary arterial hypertension. Drugs 62(1):107–133

    Article  CAS  PubMed  Google Scholar 

  16. Fetalvero KM, Martin KA, Hwa J (2007) Cardioprotective prostacyclin signaling in vascular smooth muscle. Prostaglandins Other Lipid Mediat 82(1–4):109–118

    Article  CAS  PubMed  Google Scholar 

  17. Yagi T, Oishi M, Matsuda H, Ishikawa T, Okada Y, Endo A, Ishido N, Fujisawa K, Matsuno T, Tanaka N (1998) Improvement of myointimal hyperplasia in a patient with transplant renal artery stenosis by oral PGI2. Transplant Proc 30(7):3043–3044

    Article  CAS  PubMed  Google Scholar 

  18. Todaka T, Yokoyama C, Yanamoto H, Hashimoto N, Nagata I, Tsukahara T, Hara S, Hatae T, Morishita R, Aoki M, Ogihara T, Kaneda Y, Tanabe T (1999) Gene transfer of human prostacyclin synthase prevents neointimal formation after carotid balloon injury in rats. Stroke 30(2):419–426

    Article  CAS  PubMed  Google Scholar 

  19. Imai H, Numaguchi Y, Ishii M, Kubota R, Yokouchi K, Ogawa Y, Kondo T, Okumura K, Murohara T (2007) Prostacyclin synthase gene transfer inhibits neointimal formation by suppressing PPAR delta expression. Atherosclerosis 195(2):322–332

    Article  CAS  PubMed  Google Scholar 

  20. Gotch FA (2001) Evolution of the single-pool urea kinetic model. Semin Dial 14(4):252–256

    Article  CAS  PubMed  Google Scholar 

  21. Krivitski NM (1995) Theory and validation of access flow measurement by dilution technique during hemodialysis. Kidney Int 48(1):244–250

    Article  CAS  PubMed  Google Scholar 

  22. Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE, North American Vascular Access Consortium (2011) Standardized definitions for hemodialysis vascular access. Semin Dial 24(5):515–524

    Article  PubMed Central  PubMed  Google Scholar 

  23. Dixon BS, Beck GJ, Vazquez MA, Greenberg A, Delmez JA, Allon M, Dember LM, Himmelfarb J, Gassman JJ, Greene T, Radeva MK, Davidson IJ, Ikizler TA, Braden GL, Fenves AZ, Kaufman JS, Cotton JR Jr, Martin KJ, McNeil JW, Rahman A, Lawson JH, Whiting JF, Hu B, Meyers CM, Kusek JW, Feldman HI, DAC Study Group (2009) Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med 360(21):2191–2201

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Schmitz PG, McCloud LK, Reikes ST, Leonard CL, Gellens ME (2002) Prophylaxis of hemodialysis graft thrombosis with fish oil: double-blind, randomized, prospective trial. J Am Soc Nephrol 13(1):184–190

    CAS  PubMed  Google Scholar 

  25. Lok C, Moist L, Hemmelgarn BR, Tonelli M, Vazquez MA, Dorval M, Oliver M, Donnelly S, Allon M, Stanley K, Fish Oil Inhibition of Stenosis in Hemodialysis Grafts (FISH) Study Group (2012) Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial. JAMA 307(17):1809–1816

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Chang HH, Chang YK, Lu CW, Huang CT, Chien CT, Hung KY, Huang KC, Hsu CC (2016) Statins improve long term patency of arteriovenous fistula for hemodialysis. Sci Rep 6:22197

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Fujita T, Fuke Y, Satomura A, Hidaka M, Ohsawa I, Endo M, Komatsu K, Ohi H (2001) PGl2 analogue mitigates the progression rate of renal dysfunction improving renal blood flow without glomerular hyperfiltration in patients with chronic renal insufficiency. Prostaglandins Leukot Essent Fatty Acids 65(4):223–227

    Article  CAS  PubMed  Google Scholar 

  28. Owada A, Suda S, Hata T (2002) Effect of long-term administration of prostaglandin I(2) in incipient diabetic nephropathy. Nephron 92(4):788–796

    Article  CAS  PubMed  Google Scholar 

  29. Moriya H, Ishioka K, Honda K, Oka M, Maesato K, Ikee R, Hidaka S, Ohtake T, Kobayashi S (2010) Beraprost sodium, an orally active prostaglandin I(2) analog, improves renal anemia in hemodialysis patients with peripheral arterial disease. Ther Apher Dial 14(5):472–476

    Article  CAS  PubMed  Google Scholar 

  30. Ay Y, Kara I, Ay NK, Aydin C, Koksal C, Gorur DA, Findik O (2013) The effect of iloprost on renal function in patients with critical limb ischemia. Curr Ther Res Clin Exp 75:33–38

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Abacilar AF, Atalay H, Dogan OF (2015) Oral prostacycline analog and clopidogrel combination provides early maturation and long-term survival after arteriovenous fistula creation: a randomized controlled study. Indian J Nephrol 25(3):136–142

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. NKF/KDOQI (2006) 2006 Update Vascular Access. Guideline 2: Selection and Placement of Hemodialysis Access. Am J Kidney Dis 48(Suppl. 1):S179–S247

    Google Scholar 

  33. Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor M, Wanner C, ter Wee P, Vanholder R (2007) EBPG on Vascular Access. Nephrol Dial Transplant 22(Suppl 2):ii88–ii117

    PubMed  Google Scholar 

  34. DeSilva RN, Patibandla BK, Vin Y, Narra A, Chawla V, Brown RS, Goldfarb-Rumyantzev AS (2013) Fistula first is not always the best strategy for the elderly. J Am Soc Nephrol 24(8):1297–1304

    Article  PubMed Central  PubMed  Google Scholar 

  35. Miller CD, Robbin ML, Allon M (2003) Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 63(1):346–352

    Article  PubMed  Google Scholar 

  36. Zarkowsky DS, Arhuidese IJ, Hicks CW, Canner JK, Qazi U, Obeid T, Schneider E, Abularrage CJ, Freischlag JA, Malas MB (2015) Racial/ethnic disparities associated with initial hemodialysis access. JAMA Surg 150(6):529–536

    Article  PubMed  Google Scholar 

  37. Aitken E, Jackson A, Kong C, Coats P, Kingsmore D (2014) Renal function, uraemia and early arteriovenous fistula failure. BMC Nephrol 15:179

    Article  PubMed Central  PubMed  Google Scholar 

  38. Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A (2016) Arteriovenous fistula in dialysis patients: factors implicated in early and late AVF maturation failure. Surgeon 14(5):294–300

    Article  PubMed  Google Scholar 

  39. Park HS, Kim WJ, Kim YK, Kim HW, Choi BS, Park CW, Kim YO, Yang CW, Kim YL, Kim YS, Kang SW, Kim NH, Jin DC (2016) Comparison of outcomes with arteriovenous fistula and arteriovenous graft for vascular access in hemodialysis: a prospective cohort study. Am J Nephrol 43(2):120–128

    Article  CAS  PubMed  Google Scholar 

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Funding

This study is not associated with financial support.

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Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Jeju National University, School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju City, Jeju, 63241, Republic of Korea

    Miyeon Kim, Ji Ung Kim & HyunWoo Kim

  2. Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea

    So Mi Kim

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  1. Miyeon Kim
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Correspondence to HyunWoo Kim.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the Declaration of Helsinki 1964 and its later amendments or comparable ethical standards.

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Kim, M., Kim, J.U., Kim, S.M. et al. Effectiveness of beraprost sodium in maintaining vascular access patency in patients on hemodialysis. Int Urol Nephrol 49, 1287–1295 (2017). https://doi.org/10.1007/s11255-017-1586-y

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  • DOI: https://doi.org/10.1007/s11255-017-1586-y

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