OMEGA-3 PUFA SUPPLEMENTATION TO PREVENT ARTERIOVENOUS FISTULA AND GRAFT FAILURE: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

AK VIECELLI1, AB IRISH2, CM HAWLEY1, C LOK3, DW JOHNSON1, EM PASCOE1, G STRIPPOLI4, KP POLKINGHORNE5, TA MORI2, S PALMER6

1School of Medicine, University of Queensland, Brisbane, Queensland; 2School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia; 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 4Diaverum Medical Scientific Office, Lund, Sweden; 5Departments of Medicine & School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria; 6Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand

Aim: To evaluate benefits and harms of omega-3 polyunsaturated fatty acid (omega-PUFA) supplementation to prevent dialysis arteriovenous access complications.

Background: Arteriovenous access failure occurs frequently and is associated with morbidity, mortality and healthcare expenditure. Omega-3 PUFA may improve outcomes via pleiotropic effects on access maturation and function, but may cause bleeding complications.

Methods: Systematic review with meta-analysis of randomised controlled trials evaluating the efficacy and safety of omega-3 PUFA supplementation on arteriovenous access outcomes in adults requiring haemodialysis. Trials were identified by searches in CENTRAL, MEDLINE, and Embase through 20 January 2017. Pre-specified outcomes were primary patency loss,  bleeding, dialysis suitability failure, access abandonment, interventions to maintain patency or assist maturation, gastrointestinal side effects, all-cause and cardiovascular mortality, and hospitalisation. Treatment effects were summarised as relative risks (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using GRADE.

Results: Five eligible trials (833 people; 567 with fistulae, 266 with grafts) compared omega-3 PUFA supplementation with placebo. Omega-3 PUFA prevented primary patency loss with moderate certainty (RR 0.81, CI 0.68-0.98). Low quality evidence suggested, that omega-3 PUFA may have had little or no effect on dialysis suitability failure (RR 0.95, CI 0.73-1.23), access abandonment (RR 0.78, CI 0.59-1.03), need for interventions (RR 0.82, CI 0.64-1.04), or all-cause mortality (RR 0.99, CI 0.51-1.92). Bleeding risk (RR 1.40, CI 0.78-2.49) or gastrointestinal side-effects (RR 1.22, CI 0.64-2.34) were uncertain. There was no evidence of different treatment effects for grafts or fistulae.

Conclusions: Omega-3 PUFA supplementation probably protects against primary loss of arteriovenous access patency, but may have little or no effect on access interventions, dialysis suitability failure or access abandonment. Potential treatment harms are uncertain.

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