Key result
Continuous cilostazol in hemodialysis patients with PAD is linked to ~33% fewer CV events.
Why the study?
The effects of continuous cilostazol use on emergency department visits, hospitalizations, and vascular outcomes in hemodialysis patients with peripheral artery disease were unknown.
Does continuous cilostazol treatment reduce ED visits, hospitalizations, mortality, and vascular outcomes in adult patients with peripheral artery disease on chronic hemodialysis?
Cohort (n=558)
Does continuous cilostazol treatment reduce ED visits, hospitalizations, mortality, and vascular outcomes in adult patients with peripheral artery disease on chronic hemodialysis?
Continuous cilostazol use in hemodialysis patients with peripheral artery disease is associated with significantly reduced risks of cardiovascular events, hemorrhagic stroke, and emergency department visits.
Answers are grounded in this paper and cite their sources.
May support cilostazol in hemodialysis PAD; hypothesis-generating and requires RCTs before practice change.
AIM: The aim of this study was to investigate the effects of continuous cilostazol use on emergency department (ED) visits, hospitalizations, and vascular outcomes in patients with hemodialysis (HD) with peripheral artery disease (PAD). METHODS: This retrospective cohort study recruited 558 adult patients, who had received chronic HD for at least 90 days between January 1, 2008 and December 31, 2012, from the National Health Insurance Research Database. Eligible patients were divided into two groups based on continuing or discontinuing cilostazol treatment. Outcome measures were ED visits, hospitalizations, mortality, and vascular outcomes such as percutaneous transluminal angioplasty, surgical bypass, lower leg amputation, ischemic stroke, hemorrhagic stroke, and cardiovascular events. RESULTS: Patients with continuous cilostazol use had significantly higher prevalence of stroke, cancer, vintage, and the use of angiotensin receptor blocker and β-blocker, but significantly lower incidence of ischemic stroke and cardiovascular events, as well as lower mortality, than those without continuous cilostazol use (all p＜.05). Continuous cilostazol use was independently associated with lower risk of ED visits, hemorrhagic stroke, and cardiovascular events (adjusted hazard ratios: 0.79, 0.29, and 0.67; 95% confidence intervals: 0.62-0.98, 0.10-0.84, and 0.48-0.96, respectively; all p＜.05). Continuous cilostazol use was significantly associated with higher ED visit-free and cardiovascular event-free rates (log-rank test; p＜.05). CONCLUSION: Continuous treatment of cilostazol in patients with HD with PAD significantly decreases the risk of ED visits, hemorrhagic stroke, and cardiovascular events and improves ED visit-free and cardiovascular event-free rates during long-term follow-up.
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Wu et al. (2022) conducted a cohort in Hemodialysis with peripheral artery disease (n=558). Continuous cilostazol vs. Discontinuing cilostazol treatment was evaluated on ED visits, hospitalizations, mortality, and vascular outcomes (HR 0.79 (ED visits), 0.29 (hemorrhagic stroke), 0.67 (CV events), 95% CI 0.62-0.98, 0.10-0.84, 0.48-0.96, p=<0.05). Continuous cilostazol use in hemodialysis patients with peripheral artery disease significantly reduced the risk of ED visits (HR 0.79), hemorrhagic stroke (HR 0.29), and cardiovascular events (HR 0.67).
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