Efficacy of drug-coated balloon versus uncoated balloon for dysfunctional dialysis access: a systematic review and meta-analysis.

IF 2.2 4区医学 Q2 UROLOGY & NEPHROLOGY

Clinical and Experimental Nephrology Pub Date : 2025-02-24 DOI:10.1007/s10157-025-02642-7

Aarij Elahi, Momina Qamar, Fasih Mand Khan, Rameesha Babar, Muhammad Jawad Zahid, Muhammad Omar Ahmad, Shah Wali, Sharib Afzal, Moeen Ikram, Syed Ahsan Ali Shah, Mohammad Ebad Ur Rehman, Huzaifa Ahmad Cheema, Usama Anwar, Muhammad Mohid Tahir, Ioannis Bellos

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引用次数: 0

Abstract

Background: Dysfunctional vascular access is a major cause of morbidity and mortality in patients undergoing hemodialysis, affecting both arteriovenous fistulas and grafts. The most optimal strategy to restore long-term patency has not been established. This meta-analysis compares drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty for dysfunctional vascular access.

Methods: We performed a systematic literature search across multiple databases from inception to June 2024. Randomized-controlled trials (RCTs) comparing DCB and UCB in dialysis patients with dysfunctional vascular access were included. Risk ratios were pooled using a random-effects model.

Results: Twenty-seven RCTs (2645 patients) were included. Target lesion patency (TLP) at 6 months was significantly superior in the DCB group (RR 1.22, 95% CI 1.07-1.39, p = 0.003). The two regimens were comparable for TLP at 3 months (RR 1.14, p = 0.24) and 12 months (RR 1.14, p = 0.10). The two regimens were comparable in terms of circuit patency rate, target-lesion revascularization, and all-cause mortality.

Conclusion: DCB has significantly superior TLP and a comparable risk of mortality to UCB. Further research is warranted to identify factors affecting outcomes following DCB angioplasty for dysfunctional dialysis access.

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药物包被球囊与未包被球囊对功能障碍透析通路的疗效：系统回顾和荟萃分析。

背景：血管通路功能障碍是血液透析患者发病和死亡的主要原因，影响动静脉瘘和移植物。恢复长期通畅的最佳策略尚未确定。本荟萃分析比较了药物包被球囊（DCB）和非包被球囊（UCB）血管成形术治疗功能障碍血管通路的效果。方法：我们对多个数据库进行了系统的文献检索，检索时间从成立到2024年6月。随机对照试验（rct）比较了血管通路功能障碍透析患者的DCB和UCB。使用随机效应模型汇总风险比率。结果：纳入27项随机对照试验（rct），共2645例患者。DCB组6个月时靶病变通畅（TLP）明显优于DCB组（RR 1.22, 95% CI 1.07-1.39, p = 0.003）。两种方案在3个月（RR 1.14, p = 0.24）和12个月（RR 1.14, p = 0.10）时的TLP具有可比性。两种方案在循环通畅率、靶病变血运重建和全因死亡率方面具有可比性。结论：DCB具有明显优于UCB的TLP和相当的死亡率风险。需要进一步的研究来确定DCB血管成形术治疗功能障碍透析通路后影响结果的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Nephrology UROLOGY & NEPHROLOGY-

CiteScore

4.10

自引率

4.30%

发文量

135

审稿时长

4-8 weeks

期刊介绍： Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.