Fish oil and aspirin effects on arteriovenous fistula function

Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial

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

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Abstract

Background: Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements.

Methods: In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation.

Results: Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64% male, 45% diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54–0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95% CI 0.34–0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27–0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation.

Conclusion: Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.

Original languageEnglish
Article numbere0213274
Pages (from-to)1-20
Number of pages20
JournalPLoS One
Volume14
Issue number3
DOIs
Publication statusPublished - 26 Mar 2019

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aspirin
Fish Oils
fistula
Arteriovenous Fistula
Omega-3 Fatty Acids
kidney diseases
fish oils
blood vessels
Catheters
omega-3 fatty acids
Aspirin
Blood Vessels
Central Venous Catheters
catheters
Kidney
placebos
Placebos
Dialysis
confidence interval
thrombosis

Cite this

Viecelli, Andrea K. ; Polkinghorne, Kevan R. ; Pascoe, Elaine M. ; Paul-Brent, Peta Anne ; Hawley, Carmel M. ; Badve, Sunil V. ; Cass, Alan ; Hooi, Lai Seong ; Kerr, Peter G. ; Mori, Trevor A. ; Ong, Loke Meng ; Voss, David ; Johnson, David W. ; Irish, Ashley B. / Fish oil and aspirin effects on arteriovenous fistula function : Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial. In: PLoS One. 2019 ; Vol. 14, No. 3. pp. 1-20.
@article{268b322aad81455cad218b7c702ed7b6,
title = "Fish oil and aspirin effects on arteriovenous fistula function: Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial",
abstract = "Background: Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements. Methods: In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation. Results: Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64{\%} male, 45{\%} diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95{\%} confidence interval [CI] 0.54–0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95{\%} CI 0.34–0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95{\%} CI 0.27–0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation. Conclusion: Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.",
author = "Viecelli, {Andrea K.} and Polkinghorne, {Kevan R.} and Pascoe, {Elaine M.} and Paul-Brent, {Peta Anne} and Hawley, {Carmel M.} and Badve, {Sunil V.} and Alan Cass and Hooi, {Lai Seong} and Kerr, {Peter G.} and Mori, {Trevor A.} and Ong, {Loke Meng} and David Voss and Johnson, {David W.} and Irish, {Ashley B.}",
year = "2019",
month = "3",
day = "26",
doi = "10.1371/journal.pone.0213274",
language = "English",
volume = "14",
pages = "1--20",
journal = "PLoS One",
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Viecelli, AK, Polkinghorne, KR, Pascoe, EM, Paul-Brent, PA, Hawley, CM, Badve, SV, Cass, A, Hooi, LS, Kerr, PG, Mori, TA, Ong, LM, Voss, D, Johnson, DW & Irish, AB 2019, 'Fish oil and aspirin effects on arteriovenous fistula function: Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial', PLoS One, vol. 14, no. 3, e0213274, pp. 1-20. https://doi.org/10.1371/journal.pone.0213274

Fish oil and aspirin effects on arteriovenous fistula function : Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial. / Viecelli, Andrea K.; Polkinghorne, Kevan R.; Pascoe, Elaine M.; Paul-Brent, Peta Anne; Hawley, Carmel M.; Badve, Sunil V.; Cass, Alan; Hooi, Lai Seong; Kerr, Peter G.; Mori, Trevor A.; Ong, Loke Meng; Voss, David; Johnson, David W.; Irish, Ashley B.

In: PLoS One, Vol. 14, No. 3, e0213274, 26.03.2019, p. 1-20.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Fish oil and aspirin effects on arteriovenous fistula function

T2 - Secondary outcomes of the randomised omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) trial

AU - Viecelli, Andrea K.

AU - Polkinghorne, Kevan R.

AU - Pascoe, Elaine M.

AU - Paul-Brent, Peta Anne

AU - Hawley, Carmel M.

AU - Badve, Sunil V.

AU - Cass, Alan

AU - Hooi, Lai Seong

AU - Kerr, Peter G.

AU - Mori, Trevor A.

AU - Ong, Loke Meng

AU - Voss, David

AU - Johnson, David W.

AU - Irish, Ashley B.

PY - 2019/3/26

Y1 - 2019/3/26

N2 - Background: Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements. Methods: In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation. Results: Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64% male, 45% diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54–0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95% CI 0.34–0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27–0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation. Conclusion: Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.

AB - Background: Arteriovenous fistulas (AVF) for haemodialysis often experience early thrombosis and maturation failure requiring intervention and/or central venous catheter (CVC) placement. This secondary and exploratory analysis of the FAVOURED study determined whether omega-3 fatty acids (fish oils) or aspirin affected AVF usability, intervention rates and CVC requirements. Methods: In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting one day pre-surgery and continued for three months. Outcomes evaluated within 12 months included AVF intervention rates, CVC exposure, late dialysis suitability failure, and times to primary patency loss, abandonment and successful cannulation. Results: Final analyses included 536 participants randomised to fish oil or placebo (mean age 55 years, 64% male, 45% diabetic) and 388 randomised to aspirin or placebo. Compared with placebo, fish oil reduced intervention rates (0.82 vs 1.14/1000 patient-days, incidence rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54–0.97), particularly interventions for acute thrombosis (0.09 vs 0.17/1000 patient-days, IRR 0.53, 95% CI 0.34–0.84). Aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27–0.78). Neither agent significantly affected CVC exposure, late dialysis suitability failure or time to primary patency loss, AVF abandonment or successful cannulation. Conclusion: Although fish oil and low-dose aspirin given for 3 months reduced intervention rates in newly created AVF, they had no significant effects on CVC exposure, AVF usability and time to primary patency loss or access abandonment. Reduction in access interventions benefits patients, reduces costs and warrants further study.

UR - http://www.scopus.com/inward/record.url?scp=85063481480&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0213274

DO - 10.1371/journal.pone.0213274

M3 - Article

VL - 14

SP - 1

EP - 20

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 3

M1 - e0213274

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