Drug does not increase suitability for dialysis of surgically-enlarged blood vessels

However, among the 86 percent of fistulas assessed for suitability for use during dialysis, the percentage with suitability failure was high and did not differ between the clopidogrel group and the placebo group (61.8 percent vs. 59.5 percent, respectively).

“In conclusion, clopidogrel reduces the incidence of early thrombosis of new arteriovenous fistulas but does not increase the proportion that become suitable for dialysis. The high rate of fistula suitability failure observed in this large trial conducted at centers with a particular interest in hemodialysis vascular access provides a compelling argument for additional efforts to identify mechanisms underlying fistula maturation failure, criteria for selecting suitable candidates for fistula creation, and interventions to enhance fistula maturation,” the authors write.

(JAMA. 2008;299[18]:2164-2171. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Randomized Trials in Hemodialysis Patients

In an accompanying editorial, Marcello Tonelli, M.D., S.M., F.R.C.P.C., of the University of Alberta and Institute of Health Economics, Edmonton, Canada, discusses the results regarding the use of clopidogrel for hemodialysis patients.

“This important study has immediate implications for clinicians. Nephrologists can be reasonably confident that clopidogrel should not be prescribed for patients undergoing fistula creation because it does not lead to clinically meaningful benefit. In fact, routinely prescribing clopidogrel might actually be counterproductive because it might prolong the survival of immature fistulas that would otherwise have thrombosed, thus delaying referral for a repeat attempt at establishing vascular access. Whether clopidogrel improves patency in fistulas that have already matured is unknown. However, it seems likely that clopidogrel may not prove useful in this setting because thrombosis of an established fistula is almost always a sign of significant underlying stenosis requiring angioplasty. Speculation aside, the findings of Dember et al suggest that clopidogrel cannot currently be recommended to improve maturation or patency of arteriovenous fistulas.”

(JAMA. 2008;299[18]:2205-2207. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

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