Effect of Transdermal Nitroglycerin (NTG) Cream on Postdialysis Parameters on Brescia-Cimino Arteriovenous Fistula (AVF)

Background: Important factor in AVF failure is inadequate blood flow through access.NTG cream[made up of 25mg Injection NTG+5gm NIVEA cream(as the base is same in NTG ointment & nivea cream & this decision of making this combination has been made because of unavailability of NTG ointment in the market)] at the point of vascular access at wrist on AVF to increase blood flow by vasodilation & prevent thrombosis by inhibiting platelet aggregation.Aim is to evaluate the changes in post dialysis parameters after application of NTG cream on AVF. Methods: 86 patients came to the Nephrology Department at Mahtma Gandhi University of Medical Sciences & Technology,Jaipur,India between October 2023 to March 2024,whom had fistula as the initial vascular access for hemodialysis were placed into 2 groups;study group(n=43) & control group(n=43).Study group received NTG cream application 24 hour prior to dialysis at 8 hourly(such 3 application) & also 1 hour prior coming for dialysis,& advised to continue the same for 4 weeks.The control group received no application.In both groups the blood flow rate(Qb),ultrafiltrate rate(UFR),blood output at the drainage vein,urea reduction ratio(URR)measured after 4 weeks. Results: The distribution were according to age,gender,duration of dialysis & native disease was almost similar in both groups(Table 1).All fistulas were functioning well immediately after operation.During the study no patient had any reaction to the NTG including nausea,hypotension,or headache.In the study group,Qb[from 150ml/min to 250ml/min maximum 300ml/min],UFR,and blood output at the drainage vein,URR(increased from 0.55 to maximum 0.67) were significantly increased after 4 weeks of NTG cream application.In control group,all parametes were unchanged. Conclusion: The most important factors in performing AVF are good surgical technique & patent central veins.However adequate blood flow cannot be established even in the presence of these factors so,in this study of NTG cream application showen significant improvement in study group,whereas there was no change in control group. Patients age, gender, duration of hemodialysis, native diseases, post dialysis parameters. - Age(Years) Gender(F/M) Duration of hemodialysis(Months) Diabetes mellitus Hypertension Obstructive Nephropathy Post dialysis parameters Control group 46+/-7 8/35 7+/-2.5 29 11 3 Qb(ml/min)-140+/-25UF(ml)-2.5+/-1.0URR-0.36+/-0.04 Study group 49+/-9 10/33 8+/-3.5 31 10 2 Qb(ml/min)-260+/-20UF(ml)-3.5+/-0.4URR-0.55+/-0.12 Qb-blood flow, UF-Ultrafiltrate, URR-urea reduction ratio