BACKGROUND: Surgically created arteriovenous (AV) grafts are the most common type of hemodialysis vascular access in the United States, but fail frequently due to the development of @entity1211 . The Dialysis Access Consortium (DAC) @entity37303 Prevention of Access Stenosis Trial tests the hypothesis that @entity37303 (containing @entity4341 and @entity117 ) can prevent @entity850 and prolong survival of arteriovenous grafts. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled trial that will enroll 1056 subjects over four years with one-half year follow-up. Subjects undergoing placement of a new AV graft for hemodialysis are randomized to treatment with @entity37303 or placebo immediately following access surgery. The primary outcome is primary unassisted patency defined as the time from access placement until @entity715 or an access procedure carried out to maintain or restore patency. The major secondary outcome is cumulative access patency. Monthly access flow monitoring is incorporated in the study design to enhance detection of a hemodynamically significant @entity850 before it leads to @entity715 . RESULTS: This paper describes the key issues in trial design, broadly including: 1) ethical issues surrounding the study of a clinical procedure that, although common, is no longer the clinical intervention of choice; 2) acceptable risk ( @entity548 ) from the primary intervention; 3) inclusion of subjects already receiving a portion of the study intervention; 4) inclusion of subjects with incident rather than prevalent qualifying clinical conditions; 5) timing of the study intervention to balance safety and efficacy concerns; and 6) the selection of primary and secondary study endpoints. CONCLUSIONS: This is the first, large, multicenter trial evaluating a pharmacologic approach to prevent AV graft @entity850 and failure, an important and costly problem in this @entity1 population. Numerous design issues were addressed in implementing the trial and these will form a roadmap for future trials in this area.

Design of the Dialysis Access Consortium (DAC) XXXX Prevention Of Access Stenosis Trial.

@entity1 :: ('9606', 'Species') :: ['patient'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity4341 :: ('MESH:D004176', 'Chemical') :: ['dipyridamole'] @entity37303 :: ('MESH:C047634', 'Chemical') :: ['Aggrenox'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombosis'] @entity850 :: ('MESH:D003251', 'Disease') :: ['stenosis', 'access stenosis'] @entity1211 :: ('MESH:D054556', 'Disease') :: ['venous stenosis']
@entity37303 :: (MESH:C047634,Chemical) :: ['Aggrenox']
