Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: a randomized clinical trial

Irish, Ashley B., Viecelli, Andrea K., Hawley, Carmel M., Hooi, Lai-Seong, Pascoe, Elaine M., Paul-Brent, Peta-Anne, Badve, Sunil V., Mori, Trevor A., Cass, Alan, Kerr, Peter G., Voss, David, Ong, Loke-Meng and Polkinghorne, Kevan R. (2017) Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: a randomized clinical trial. Frontiers in Immunology, 177 2: 184-193. doi:10.1001/jamainternmed.2016.8029


Author Irish, Ashley B.
Viecelli, Andrea K.
Hawley, Carmel M.
Hooi, Lai-Seong
Pascoe, Elaine M.
Paul-Brent, Peta-Anne
Badve, Sunil V.
Mori, Trevor A.
Cass, Alan
Kerr, Peter G.
Voss, David
Ong, Loke-Meng
Polkinghorne, Kevan R.
Title Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: a randomized clinical trial
Journal name Frontiers in Immunology   Check publisher's open access policy
ISSN 1664-3224
Publication date 2017-02-01
Sub-type Article (original research)
DOI 10.1001/jamainternmed.2016.8029
Open Access Status Not yet assessed
Volume 177
Issue 2
Start page 184
End page 193
Total pages 10
Place of publication Lausanne, Switzerland
Publisher Frontiers Research Foundation
Collection year 2018
Language eng
Formatted 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. ?-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 (100mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks.

Main outcomes and measures: The primary outcomewas 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 1 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 1 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 21 Mar 2017, 00:25:23 EST by Web Cron on behalf of Learning and Research Services (UQ Library)