Chao-Feng Lin1, Hung-Yi Chiou2, Ya-Hui Chang3, Ju-Chi Liu1, Yen-Ni Hung4, Ming-Tsang Chuang2, Li-Nien Chien5. 1. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. 2. School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. 3. Pharmacy Department of Mackay Memorial Hospital, Taipei, Taiwan. 4. School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan. 5. School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Abstract
PURPOSE: Hypnotic use might cause altered inflammatory processes, which have been suggested as being related to the mechanisms of arteriovenous fistula (AVF) failure. Therefore, we examined the association between the risk of AVF failure and hypnotic use in patients receiving hemodialysis (HD). METHODS: A nested case-control study was conducted using data from the National Health Insurance Research Database of Taiwan. From 34 165 HD patients, 3676 patients receiving percutaneous transluminal angioplasty or surgical thrombectomy for AVF failure were matched to 14 704 control patients according to sex, age (±1 year), and the year of initial HD therapy. The risk of AVF failure was estimated based on conditional logistic regression after adjustment for the timing of AVF creation, HD frequency, comorbidities, and prescribed medications. Hypnotic use was measured prior to the date of AVF failure of case patients and the date of pseudo-AVF failure of controls. RESULTS: Compared with matched controls, case patients were more likely to be exposed to hypnotics 30 days or an average daily defined dose > 0.5 within 90 days before the date of AVF failure, with an adjusted odds ratio of 1.21 (95% confidence interval [CI]: 1.09-1.35, p < 0.001) and 1.36 (95%CI: 1.13-1.63, p = 0.001), respectively. Risk of AVF failure associated with hypnotic use was also observed among HD patients who were male, were younger than 65 years, had hypertension, and did not use statins. CONCLUSIONS: Hypnotic use among HD patients was associated with an increased risk of AVF failure.
PURPOSE: Hypnotic use might cause altered inflammatory processes, which have been suggested as being related to the mechanisms of arteriovenous fistula (AVF) failure. Therefore, we examined the association between the risk of AVF failure and hypnotic use in patients receiving hemodialysis (HD). METHODS: A nested case-control study was conducted using data from the National Health Insurance Research Database of Taiwan. From 34 165 HDpatients, 3676 patients receiving percutaneous transluminal angioplasty or surgical thrombectomy for AVF failure were matched to 14 704 control patients according to sex, age (±1 year), and the year of initial HD therapy. The risk of AVF failure was estimated based on conditional logistic regression after adjustment for the timing of AVF creation, HD frequency, comorbidities, and prescribed medications. Hypnotic use was measured prior to the date of AVF failure of case patients and the date of pseudo-AVF failure of controls. RESULTS: Compared with matched controls, case patients were more likely to be exposed to hypnotics 30 days or an average daily defined dose > 0.5 within 90 days before the date of AVF failure, with an adjusted odds ratio of 1.21 (95% confidence interval [CI]: 1.09-1.35, p < 0.001) and 1.36 (95%CI: 1.13-1.63, p = 0.001), respectively. Risk of AVF failure associated with hypnotic use was also observed among HDpatients who were male, were younger than 65 years, had hypertension, and did not use statins. CONCLUSIONS: Hypnotic use among HDpatients was associated with an increased risk of AVF failure.