ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1332

The Effect of Nitrate as a Vasodilator to Vascular Access Patency in Patients Undergoing Hemodialysis

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Yun, Kyu Sang, Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Kim, Juhee, Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Park, Hayne C., Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Cho, Ajin, Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Lee, Youngki, Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Choi, Sun Ryoung, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi, Korea (the Republic of)
  • Noh, Jung-woo, Chun & Cho's Medical Clinic & Dialysis Center, Seoul, Korea (the Republic of)
  • Kim, Do Hyoung, Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
Background

Maintaining the patency of vascular access (VA) is very important to achieve adequate hemodialysis (HD) dose in HD patients. Failure of vascular access is associated with morbidity and mortality. Thus, maintaining the patency of VA is challenging. In this study, we investigated the effects of nitrate as a vasodilator on VA patency in HD patients.

Methods

We investigated study on the Korean insurance claims data of the HD patients between January 2012 and December 2017. All patients divided into nitrate therapy group and no therapy group depending on whether nitrate was administered. The nitrate therapy group included only patients who received the drug for 30 days or more. The primary outcome was the primary patency of VA. Effect of nitrate treatment was examined using Kaplan Meier analysis and Cox proportional hazard, after adjusting for covariates.

Results

A total 7,428 participants were included in this study, and nitrate therapy was noted in 7.7% of total patients. 1,178 patients underwent the angioplasty. In Kaplan-Meier analysis, nitrate therapy was lower probability of angioplasty than non-user (log-rank, P<0.001). The risk of angioplasty was low in patients receiving mononitrate and nicorandil (hazard ratio (HR) 0.18, [95% confidence interval 0.07-0.45]; HR 0.15, [0.06-0.41]). But, dinitrate and molsidomine were not associated with the risk of angioplasty. Multivariate Cox proportional analysis revealed that nitrate therapy with mononitrate and nicorandil had a decreased risk of angioplasty after adjustment for age, sex, hypertension, and diabetes (HR 0.17, [0.05-0.53]; HR 0.14, [0.04-0.45]).

Conclusion

In this large national database, we showed that nitrates such as mononitrate and nocorandil were associated with improved primary patency in HD patients. Nitrate treatment may have a beneficial effect for maintaining vascular access patency in patients undergoing HD, and further research is needed to relate nitrate therapy to VA patency.