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Consistent Aspirin Use Associated with Improved Arteriovenous Fistula Survival among Incident Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study

Takeshi Hasegawa^*,,, Stacey J. Elder, Jennifer L. Bragg-Gresham, Ronald L Pisoni, Shin Yamazaki, Tadao Akizawa^||, Michel Jadoul^¶, Rayner C. Hugh^**, Friedrich K Port, and Shunichi Fukuhara

^* Division of Nephrology, Fujiyoshida Municipal Hospital, Yamanashi, Japan; Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan; Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan; Arbor Research Collaborative for Health, Ann Arbor, Michigan; ^|| Division of Nephrology, Showa University School of Medicine, Tokyo, Japan; ^¶ Université Catholique de Louvain, Cliniques Universitaires St-Luc, Bruxelles, Belgium; and ^** Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom

Correspondence: Dr. Takeshi Hasegawa, Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Konoe-cho Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan. Phone: 81-75-753-4646; Fax: 81-75-753-4644; Email: tahasegawa-npr{at}umin.net

Background and objectives: The relationship between aspirin use and arteriovenous fistula (AVF) survival has been lacking. The aim of this study was to evaluate the association between AVF survival and aspirin use.

Design, setting, participants, & measurements: Data on 2815 incident hemodialysis patients (on dialysis 30 d) using an AVF at enrollment into the Dialysis Outcomes and Practice Patterns Study between 1996 and 2004 were analyzed. Cox regression was used to examine the association between aspirin use and the risk of final AVF failure, first AVF failure, and a gastrointestinal bleeding event. Aspirin use was determined at baseline and one year later. Patients using aspirin at baseline and one year later were considered consistent aspirin users. All models accounted for facility clustering effects and were adjusted for age, race, gender, body mass index, prior permanent access failure, prior placement of a catheter, 10 comorbid conditions, laboratory data, and other medications, and stratified by regions.

Results: Consistent aspirin use was significantly related to a lower risk of final AVF failure. Facility-level analysis, which may reduce confounding by indication, also showed a nearly significant trend of reduced risk of final AVF failure with greater prevalence of consistent aspirin use within dialysis facilities (P for trend = 0.07). The occurrence of a new gastrointestinal bleeding event during the study period was not associated with aspirin use.

Conclusions: These results suggest that consistent aspirin use may be beneficial for AVF survival among incident hemodialysis patients.