Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis

A randomized clinical trial

Ashley B. Irish, Andrea K Viecelli, Carmel M. Hawley, Lai Seong Hooi, Elaine M. Pascoe, Peta Anne Paul-Brent, Sunil V. Badve, Trevor A. Mori, A. Cass, Peter G. Kerr, David Voss, Loke Meng Ong, Kevan R. Polkinghorne

    Research output: Contribution to journalComment/debateResearch

    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.

    Original languageGerman
    Pages (from-to)172-173
    Number of pages2
    JournalNieren- und Hochdruckkrankheiten
    Volume46
    Issue number4
    Early online date3 Jan 2017
    Publication statusPublished - 1 Apr 2017

    Cite this

    Irish, A. B., Viecelli, A. K., Hawley, C. M., Hooi, L. S., Pascoe, E. M., Paul-Brent, P. A., ... Polkinghorne, K. R. (2017). Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: A randomized clinical trial. Nieren- und Hochdruckkrankheiten, 46(4), 172-173.
    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, A. ; Kerr, Peter G. ; Voss, David ; Ong, Loke Meng ; Polkinghorne, Kevan R. / Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis : A randomized clinical trial. In: Nieren- und Hochdruckkrankheiten. 2017 ; Vol. 46, No. 4. pp. 172-173.
    @article{3cc89c3efcfe4c69bde1aed5cd95c8f0,
    title = "Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: A randomized clinical trial",
    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.",
    author = "Irish, {Ashley B.} and Viecelli, {Andrea K} and Hawley, {Carmel M.} and Hooi, {Lai Seong} and Pascoe, {Elaine M.} and Paul-Brent, {Peta Anne} and Badve, {Sunil V.} and Mori, {Trevor A.} and A. Cass and Kerr, {Peter G.} and David Voss and Ong, {Loke Meng} and Polkinghorne, {Kevan R.}",
    year = "2017",
    month = "4",
    day = "1",
    language = "German",
    volume = "46",
    pages = "172--173",
    journal = "Nieren- und Hochdruckkrankheiten",
    issn = "0300-5224",
    publisher = "Dustri-Verlag Dr. Karl Feistle",
    number = "4",

    }

    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 2017, 'Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: A randomized clinical trial', Nieren- und Hochdruckkrankheiten, vol. 46, no. 4, pp. 172-173.

    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, A.; Kerr, Peter G.; Voss, David; Ong, Loke Meng; Polkinghorne, Kevan R.

    In: Nieren- und Hochdruckkrankheiten, Vol. 46, No. 4, 01.04.2017, p. 172-173.

    Research output: Contribution to journalComment/debateResearch

    TY - JOUR

    T1 - Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis

    T2 - A randomized clinical trial

    AU - Irish, Ashley B.

    AU - Viecelli, Andrea K

    AU - Hawley, Carmel M.

    AU - Hooi, Lai Seong

    AU - Pascoe, Elaine M.

    AU - Paul-Brent, Peta Anne

    AU - Badve, Sunil V.

    AU - Mori, Trevor A.

    AU - Cass, A.

    AU - Kerr, Peter G.

    AU - Voss, David

    AU - Ong, Loke Meng

    AU - Polkinghorne, Kevan R.

    PY - 2017/4/1

    Y1 - 2017/4/1

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=85019113795&partnerID=8YFLogxK

    M3 - Comment/debate

    VL - 46

    SP - 172

    EP - 173

    JO - Nieren- und Hochdruckkrankheiten

    JF - Nieren- und Hochdruckkrankheiten

    SN - 0300-5224

    IS - 4

    ER -