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.
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Arteriovenous Fistula
/ drug therapy
Aspirin
/ therapeutic use
Double-Blind Method
Drug Therapy, Combination
Female
Fish Oils
/ administration & dosage
Humans
Kidney Failure, Chronic
/ prevention & control
Male
Middle Aged
Prospective Studies
Vascular Patency
/ drug effects
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
14
08
2018
accepted:
18
02
2019
entrez:
27
3
2019
pubmed:
27
3
2019
medline:
18
12
2019
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30913208
doi: 10.1371/journal.pone.0213274
pii: PONE-D-18-23443
pmc: PMC6435148
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Fish Oils
0
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0213274Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Hemodial Int. 2016 Jan;20(1):5-14
pubmed: 26201992
JAMA. 2008 May 14;299(18):2164-71
pubmed: 18477783
Radiology. 2016 May;279(2):620-9
pubmed: 26694050
Semin Dial. 2011 Sep-Oct;24(5):515-24
pubmed: 21906166
Nephrology (Carlton). 2017 Oct;22(10):823-824
pubmed: 27188542
Atherosclerosis. 2012 Apr;221(2):536-43
pubmed: 22317966
Klin Wochenschr. 1974 Apr 1;52(7):348-9
pubmed: 4600820
N Engl J Med. 1989 Feb 2;320(5):265-71
pubmed: 2783477
JAMA. 2012 May 2;307(17):1809-16
pubmed: 22550196
J Am Soc Nephrol. 2013 Oct;24(10):1668-77
pubmed: 23847278
Am J Kidney Dis. 2018 Jun;71(6):793-801
pubmed: 29429750
J Am Soc Nephrol. 2005 Jan;16(1):201-9
pubmed: 15563567
Am J Kidney Dis. 2018 May;71(5):677-689
pubmed: 29398178
Am J Kidney Dis. 2018 Mar;71(3):382-391
pubmed: 29203125
Science. 1988 Jul 22;241(4864):453-6
pubmed: 3393911
BMC Nephrol. 2009 Jan 21;10:1
pubmed: 19159453
Nephrol Dial Transplant. 2010 Nov;25(11):3755-63
pubmed: 20400451
Arterioscler Thromb Vasc Biol. 1997 Feb;17(2):279-86
pubmed: 9081682
Br J Clin Pharmacol. 2013 Mar;75(3):645-62
pubmed: 22765297
Nephrology (Carlton). 2016 Mar;21(3):217-28
pubmed: 26205903
Kidney Int. 2003 Jan;63(1):323-30
pubmed: 12472799
Clin J Am Soc Nephrol. 2013 May;8(5):810-8
pubmed: 23371955
J Am Soc Nephrol. 2006 Apr;17(4):1112-27
pubmed: 16565259
JAMA Intern Med. 2017 Feb 1;177(2):184-193
pubmed: 28055065
BMC Nephrol. 2015 Jun 27;16:89
pubmed: 26116581
Nephron. 1986;43(3):196-202
pubmed: 3724927
Kidney Int. 2006 Oct;70(8):1413-22
pubmed: 16883317
Am J Kidney Dis. 2018 May;71(5):690-700
pubmed: 29478866