Background The major mechanisms of arteriovenous graft (AVG) failure due to intimal hyperplasia (IH) are smooth muscle cell proliferation and inflammation. Therefore, carvedilol may improve AVG primary patency because of its anti-proliferative and anti-inflammatory activities. Methods The data of end-stage renal disease patients receiving regular hemodialysis were collected from the National Health Insurance Research database. The end point was the first percutaneous transluminal angioplasty (PTA) for AVG failure or death during a follow-up period of two years or the end of 2013. The analysis was calculated with Cox proportional hazard model. Results There were 3028 patients treated with carvedilol and 13,704 patients not treated with carvedilol. According to a univariate analysis, the carvedilol group was younger, received more anti-hypertensive medications and platelet aggregation inhibitors, and had higher rates of diabetes mellitus and hyperlipidemia but had lower rates of hypotension and smoking. According to a multivariate analysis, after controlling for covariates, the use of carvedilol for more than 84 days reduced the probability of a first PTA for AVG failure by 9% compared with no use of carvedilol (p = 0.021), but the use of carvedilol for 1 to 84 days did not. Conclusion The results of this study indicate that the use of carvedilol for more than 84 days improves the primary patency of AVGs, but the use of carvedilol for less than 84 days does not.

中文翻译：

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卡维地洛对动静脉移植物初始通畅的影响

背景 由于内膜增生 (IH) 导致动静脉移植 (AVG) 失败的主要机制是平滑肌细胞增殖和炎症。因此，由于卡维地洛的抗增殖和抗炎活性，卡维地洛可能会改善 AVG 的初级通畅率。方法从国家医保研究数据库中收集定期血液透析的终末期肾病患者资料。终点为随访两年或 2013 年底首次因 AVG 失败或死亡而进行的经皮腔内血管成形术 (PTA)。分析采用 Cox 比例风险模型计算。结果卡维地洛治疗3028例，卡维地洛未治疗13704例。根据单变量分析，卡维地洛组更年轻，接受更多的抗高血压药物和血小板聚集抑制剂，糖尿病和高脂血症的发生率较高，但低血压和吸烟的发生率较低。根据多变量分析，在控制协变量后，与不使用卡维地洛相比，使用卡维地洛超过 84 天使 AVG 失败的首次 PTA 的概率降低 9%（p = 0.021），但使用卡维地洛1 到 84 天没有。结论 本研究结果表明，卡维地洛的使用时间超过 84 天可以改善 AVG 的主要通畅率，但卡维地洛的使用时间少于 84 天则没有。控制协变量后，与不使用卡维地洛相比，使用卡维地洛超过 84 天使第一次 PTA AVG 失败的概率降低了 9%（p = 0.021），但使用卡维地洛 1 至 84 天确实如此不是。结论 本研究结果表明，卡维地洛的使用时间超过 84 天可以改善 AVG 的主要通畅率，但卡维地洛的使用时间少于 84 天则没有。控制协变量后，与不使用卡维地洛相比，使用卡维地洛超过 84 天使第一次 PTA AVG 失败的概率降低了 9%（p = 0.021），但使用卡维地洛 1 至 84 天确实如此不是。结论 本研究结果表明，卡维地洛的使用时间超过 84 天可以改善 AVG 的主要通畅率，但卡维地洛的使用时间少于 84 天则没有。