The Nitric Oxide Problem: Can Proton Pump Inhibitors Delay Fistula Maturation?

Abstract

Abstract INTRODUCTION: We have previously shown that the position and presence of a hemodialysis catheter will delay maturation of the first fistula created for hemodialysis patients. Since that publication it has been suggested that the use of a proton pump inhibiter will adversely affect endothelial function. We therefore re-examined our data base to determine of the adverse effect of proton pump inhibiters on the endothelial would also delay fistula maturation. METHODS: This was the re-examination of a database from a prospective observational study of 808 patients who underwent the creation of an autologous arteriovenous fistula for their first hemodialysis access who were evaluated for the length of use of a temporary catheter. The variables studied for their effect upon catheter use included: location in the forearm or upper arm, age, the presence of diabetes, vascular disease or smoking history. To those variables we added the use of a proton pump inhibiter. FINDINGS: For upper arm fistulas, the use of a proton pump inhibiter appeared to delay upper arm fistula maturation (p=0.01) but not forearm maturation when in the presence of a long-term dialysis catheter (p=0.44). DISCUSSION: Proton pump inhibiter use may adversely affect or delay fistula maturation, but further study is needed.