Affiliations 

  • 1 Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
  • 2 Department of Nephrology, Monash Medical Centre, Melbourne, Australia
  • 3 Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia
  • 4 Menzies School of Health Research, Charles Darwin University, Darwin, Australia
  • 5 Department of Medicine and Hemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
  • 6 Medical School, University of Western Australia, Perth, Australia
  • 7 Department of Nephrology, Penang Hospital, Georgetown, Malaysia
  • 8 Middlemore Renal Services, Middlemore Hospital, Auckland, New Zealand
  • 9 The George Institute for Global Health, Sydney, Australia
PLoS One, 2019;14(3):e0213274.
PMID: 30913208 DOI: 10.1371/journal.pone.0213274

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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