Taking omega-3 fatty acid supplements or low-dose aspirin is unlikely to reduce arteriovenous fistula (AVF) failure, according to a study.
Ashley B. Irish, MD, and colleagues reported a 47% AVF failure rate for both fish oil and placebo recipients at 12 months after AVF surgery. In the double-blind FAVOURED trial (Omega-3 Fatty Acids [Fish Oils] and Aspirin in Vascular Access Outcomes in Renal Disease CTRN12607000569404), they randomly assigned 567 patients from 35 hemodialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom to 4 g of omega-3 polyunsaturated fatty acid supplements (46% eicosapentaenoic acid and 38% docosahexaenoic acid) or matching placebo (olive oil) daily for 12 weeks following surgery. Adjusted results showed that fish oil supplementation failed to reduce fistula thrombosis (22% vs 23% of placebo recipients), abandonment (19% vs 22%), and cannulation failure (40% vs 39%).
With regard to low-dose aspirin, AVF failure rates were similarly high for the 406 patients randomly assigned to 100 mg of aspirin daily or placebo (45% vs 43%).
“This study suggests that neither fish oil nor aspirin can be recommended routinely for the prevention of arteriovenous fistula failure and that additional strategies to reduce the high arteriovenous fistula failure rate are required,” Dr Irish and colleagues concluded in a paper published online ahead of print in JAMA Internal Medicine. Findings from previous studies have been mixed and limited to patients receiving an arteriovenous graft for vascular access.
Nearly half of patients in this study had diabetes, which is a risk factor for conduit problems along with cardiovascular disease and peripheral vascular disease. These factors could have limited the benefits of fish oil supplementation.
Fish oil supplements were investigated for their purported abilities to decrease platelet aggregation, blood viscosity, and inflammation and promote vasodilation. Low-dose aspirin has demonstrated antiplatelet activity. Longer treatment durations and higher doses might have altered these results.