Effect of cilostazol on arteriovenous fistula in hemodialysis patients / Efecto del cilostazol en una fístula arteriovenosa en pacientes en hemodiálisis

Background: The maturation and patency of permanent vascular access are critical in patients requiring hemodialysis. Although numerus trials have been attempted to achieve permanently patent vascular access, little have been noticeable. Cilostazol, a phosphodiesterase-3 inhibitor, has been shown to be effective in peripheral arterial disease including vascular injury-induced intimal hyperplasia. We therefore aimed to determine the effect of cilostazol on the patency and maturation of permanent vascular access. Methods: This single-center, retrospective study included 194 patients who underwent arteriovenous fistula surgery to compare vascular complications between the cilostazol (n=107) and control (n=87) groups. Results: The rate of vascular complications was lower in the cilostazol group than in the control group (36.4% vs. 51.7%; p=0.033), including maturation failure (2.8% vs. 11.5%; p=0.016). The rate of reoperation due to vascular injury after hemodialysis initiation following fistula maturation was also significantly lower in the cilostazol group than in the control group (7.5% vs. 28.7%; p<0.001). However, there were no significant differences in the requirement for percutaneous transluminal angioplasty (PTA), rate of PTA, and the interval from arteriovenous fistula surgery to PTA between the cilostazol and control groups. Conclusion: Cilostazol might be beneficial for the maturation of permanent vascular access in patients requiring hemodialysis. (AU)

Antecedentes: La maduración y la permeabilidad del acceso vascular permanente son fundamentales en los pacientes que requieren hemodiálisis. Aunque se han realizado numerosos ensayos para conseguir un acceso vascular permanentemente permeable, pocos han conseguido resultados destacables. El cilostazol, un inhibidor de la fosfodiesterasa 3, ha demostrado ser eficaz en la enfermedad arterial periférica, incluida la hiperplasia intimal inducida por lesiones vasculares. Por lo tanto, nuestro objetivo era determinar el efecto del cilostazol en la permeabilidad y la maduración del acceso vascular permanente. Métodos: Este estudio unicéntrico y retrospectivo incluyó 194 pacientes sometidos a una cirugía de fístula arteriovenosa para comparar las complicaciones vasculares entre los grupos de cilostazol (n=107) y de control (n=87). Resultados: La tasa de complicaciones vasculares fue menor en el grupo de cilostazol que en el grupo de control (36,4% frente a 51,7%; p=0,033), incluido el fracaso de la maduración (2,8% frente a 11,5%; p=0,016). La tasa de reintervención por lesión vascular tras el inicio de la hemodiálisis después de la maduración de la fístula también fue significativamente menor en el grupo de cilostazol que en el grupo de control (7,5% frente a 28,7%; p<0,001). Sin embargo, no hubo diferencias significativas en la necesidad de angioplastia transluminal percutánea (ATP), la tasa de ATP y el intervalo desde la cirugía de la fístula arteriovenosa hasta la ATP entre los grupos de cilostazol y de control. Conclusión: El cilostazol podría ser beneficioso para la maduración del acceso vascular permanente en pacientes que necesitan hemodiálisis. (AU)

Nondiabetic kidney diseases in type 2 diabetic patients.

BACKGROUND: The aim of this study was to evaluate the clinical characteristics of nondiabetic nephropathy in type 2 diabetes mellitus patients and to find a clinical significance of renal biopsy and immunosuppressive treatment in such a patient. METHODS: Renal biopsy results, clinical parameters, and renal outcomes were analyzed in 75 diabetic patients who underwent kidney biopsy at Chungnam National University Hospital from January 1994 to December 2010. RESULTS: The three most common reasons for renal biopsy were nephrotic range proteinuria (44%), proteinuria without diabetic retinopathy (20%), and unexplained decline in renal function (20.0%). Ten patients (13.3%) had only diabetic nephropathy (Group I); 11 patients (14.7%) had diabetic nephropathy with superimposed nondiabetic nephropathy (Group II); and 54 patients (72%) had only nondiabetic nephropathy (Group III). Membranous nephropathy (23.1%), IgA nephropathy (21.5%), and acute tubulointerstitial nephritis (15.4%) were the three most common nondiabetic nephropathies. Group III had shorter duration of diabetes and lesser diabetic retinopathy than Groups I and II (P=0.008). Group II had the lowest baseline estimated glomerular filtration rate (P=0.002), with the greatest proportion of renal deterioration during follow-up (median 38.0 months, P<0.0001). The patients who were treated with intensive method showed better renal outcomes (odds ratio 4.931; P=0.01). Absence of diabetic retinopathy was associated with favorable renal outcome in intensive treatment group (odds ratio 0.114; P=0.032). CONCLUSION: Renal biopsy should be recommended for type 2 diabetic patients with atypical nephropathy because a considerable number of these patients may have nondiabetic nephropathies. And intensive treatment including corticosteroid or immunosuppressants could be recommended for type 2 diabetic patients with nondiabetic nephropathy, especially if the patients do not have diabetic retinopathy.