For reducing arteriovenous fistula (AVF) failure in hemodialysis patients, neither fish oil supplementation nor aspirin use was an effective treatment option, according to a study published in JAMA Internal Medicine.
Ashley B Irish, MD, from the Fiona Stanley Hospital in Murdoch, Australia, and colleagues identified 1,415 adults aged 19 years and older with stage 4 or 5 chronic kidney disease who either received or planned to receive hemodialysis within 12 months and were scheduled for AVF surgery. A total of 567 patients were randomized to fish oil (n = 284) or placebo (n = 283), and 536 were included in the analysis. A total of 406 participants were randomized to aspirin (n = 203) or matching placebo (n = 203). Research was conducted between 2008 and 2014 at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. Participants were observed for 12 months after AVF creation.
The researchers’ objective was to determine whether fish oil supplementation or aspirin use was effective in reducing AVF failure. Fistula failure includes a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months.
AVF failure occurred in 128 of 270 (47%) participants assigned to fish oil and 125 of 266 (47%) assigned to placebo. The proportion of events in the fish oil and placebo groups was similar for each of the 3 individual components of AVF failure: thrombosis (60 [22%] vs 61 [23%]), AVF abandonment (51 [19%] vs 58 [22%]), and cannulation failure (108 [40%] vs 104 [39%]).
In participants randomized to aspirin or matching placebo, AVF failure was similar (87 [45%] vs 83 [43%]). Aspirin compared with placebo did not reduce the risk of AVF thrombosis (38 [20%] vs 35 [18%]), AVF abandonment (46 [24%] vs 35 [18%]), or cannulation failure (73 [38%] vs 74 [38%]).
“This study suggests that neither fish oil nor aspirin can be recommended for the prevention of AVF failure and that additional strategies to reduce the high AVF rate are required,” the authors said.
- Irish AB, Viecelli AK, Hawley CM, et al. Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis. JAMA Intern Med. 3 January 2017. doi:10.1001/jamainternmed.2016.8029