Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistula Failure in Patients Requiring Hemodialysis: A Randomized Clinical Trial
Irish AB, Viecelli AK, Hawley CM, Hooi LS, Pascoe EM, Paul-Brent PA, Badve SV, Mori TA, Cass A, Kerr PG, Voss D, Ong LM, Polkinghorne KR, Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group
JAMA internal medicine · 79 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2017-01-05 · JAMA Intern Med · vol. 177 · issue 2 · p. 184
- Publisher
- American Medical Association
- Cited
- 105 citations · more than 100% of similar papers · 19.0× the field average
- Impact
- Top 10% most cited in its field
- References
- 89 works
- Access
- Free to read
- Research areas
- Central Venous Catheters and Hemodialysis · Coconut Research and Applications · Fatty Acid Research and Health
- Keywords
- Medicine, Hemodialysis, Aspirin, Arteriovenous fistula, Fish oil, Surgery, Intensive care medicine, Internal medicine, Fish <Actinopterygii>, Cardiology, Fishery
- MeSH
- humans, kidney failure, chronic, constriction, pathologic, graft occlusion, vascular, aspirin, fish oils, fibrinolytic agents, treatment outcome, renal dialysis, arteriovenous shunt, surgical, administration, oral, double-blind method, vascular patency, dietary supplements, adult, middle aged, female, male
14 authors
From AU, MY, NZ
- Ashley Bruce Irish · correspondingThe University of Western Australia; Fiona Stanley Hospital
- Andrea Katharina ViecelliThe University of Queensland; Princess Alexandra Hospital
- Carmel Mary HawleyThe University of Queensland; Princess Alexandra Hospital
- Lai Seong HooiSultanah Aminah Hospital
- Elaine M. PascoeThe University of Queensland; Kidney Health Australia
- Peta‐Anne Paul‐BrentThe University of Queensland; Kidney Health Australia
Abstract
Importance
Vascular access dysfunction is a leading cause of morbidity and mortality in patients requiring hemodialysis. Arteriovenous fistulae are preferred over synthetic grafts and central venous catheters due to superior long-term outcomes and lower health care costs, but increasing their use is limited by early thrombosis and maturation failure. ω-3 Polyunsaturated fatty acids (fish oils) have pleiotropic effects on vascular biology and inflammation and aspirin impairs platelet aggregation, which may reduce access failure.
Objective
To determine whether fish oil supplementation (primary objective) or aspirin use (secondary objective) is effective in reducing arteriovenous fistula failure.
Design, setting, and participants
The Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) study was a randomized, double-blind, controlled clinical trial that recruited participants with stage 4 or 5 chronic kidney disease from 2008 to 2014 at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. Participants were observed for 12 months after arteriovenous fistula creation.
Interventions
Participants were randomly allocated to receive fish oil (4 g/d) or matching placebo. A subset (n = 406) was also randomized to receive aspirin (100 mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks.
Main outcomes and measures
The primary outcome was fistula failure, a composite of fistula thrombosis and/or abandonment and/or cannulation failure, at 12 months. Secondary outcomes included the individual components of the primary outcome.
Results
Of 1415 eligible participants, 567 were randomized (359 [63%] male, 298 [53%] white, 264 [47%] with diabetes; mean [SD] age, 54.8 [14.3] y). The same proportion of fistula failures occurred in the fish oil and placebo arms (128 of 270 [47%] vs 125 of 266 [47%]; relative risk [RR] adjusted for aspirin use, 1.03; 95% CI, 0.86-1.23; P = .78). Fish oil did not reduce fistula thrombosis (60 [22%] vs 61 [23%]; RR, 0.98; 95% CI, 0.72-1.34; P = .90), abandonment (51 [19%] vs 58 [22%]; RR, 0.87; 95% CI, 0.62-1.22; P = .43), or cannulation failure (108 [40%] vs 104 [39%]; RR, 1.03; 95% CI, 0.83-1.26; P = .81). The risk of fistula failure was similar between the aspirin and placebo arms (87 of 194 [45%] vs 83 of 194 [43%]; RR, 1.05; 95% CI, 0.84-1.31; P = .68).
Conclusions and relevance
Neither fish oil supplementation nor aspirin use reduced failure of new arteriovenous fistulae within 12 months of surgery.
Trial registration
anzctr.org.au Identifier: CTRN12607000569404.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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