A VIECELLI1,2, E PASCOE2, C HAWLEY1,2, K POLKINGHORNE3, T MORI4, D JOHNSON1,2, A IRISH4
1Princess Alexandra Hospital, Brisbane, Australia, 2University of Queensland, Brisbane, Australia, 3Monash Medical Centre, Melbourne, Australia, 4University of Western Australia, Perth, Australia
Aim: As part of the FAVOURED Study, we examined the effect of fish oil and aspirin on arteriovenous fistula (AVF) interventions and central venous catheter (CVC) use.
Background: Successful creation of an AVF is limited by early thrombosis and maturation failure requiring interventions and/or placement of CVC. These complications may be reduced by pleotropic effects of fish oil upon vascular biology and inflammation, and platelet inhibition by aspirin.
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 1 day pre-surgery and continued for 12 weeks. Pre-specified secondary outcomes included rates of rescue interventions for AVF thrombosis, non-rescue interventions, and the frequency and duration of CVC requirements within 12 months of access creation.
Results: The mean age was 55 years, 64% were male and 47% diabetic. Fish oil supplementation significantly reduced the overall rate of access interventions compared to placebo (0.82 vs 1.14 interventions/1000 patient-days, incident rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54-0.97, p=0.03), driven by a reduction in rescue interventions (0.09 vs 0.17 interventions/1000 patient-days, IRR 0.53, 95% CI 0.34-0.84). Similarly, low-dose aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27-0.78) but not overall intervention rates (IRR 0.84, 95% CI 0.59-1.19). Half of the participants required a CVC and neither fish oil nor aspirin reduced the frequency or duration of CVC requirements compared to placebo.
Conclusion: Fish oil and aspirin given for 3 months both independently reduced intervention rates in newly created AVF but they had no significant effects on CVC requirements. Reduction in access interventions benefits patients, reduces costs and warrants further study.
Dr Andrea Viecelli is a Nephrologist in Brisbane and enrolled in a PhD examining strategies for improving vascular access outcomes in patients on haemodialysis. She is a lead investigator in the FAVOURED study, an international, randomised controlled trial of fish oil and aspirin for preventing arteriovenous fistula failure. She is also a member of the Coordinating Committee for the global Standardised Outcomes in Nephrology (SONG) initiative, which aims to improve the relevance and reliability of evidence informing clinical decision-making by developing core outcomes across the spectrum of kidney disease based on shared priorities of patients, clinicians, researchers and policy makers.