AK VIECELLI1, EM PASCOE1, CM HAWLEY1, KR POLKINGHORNE2,TA MORI3, DW JOHNSON1, AB IRISH3, FOR THE OMEGA-3 FATTY ACIDS(FISH OILS) AND ASPIRIN IN VASCULAR ACCESS OUTCOMES IN RENAL DISEASE (FAVOURED) STUDY COLLABORATIVE GROUP
1School of Medicine, University of Queensland, Brisbane, Queensland; 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria; 3School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
Aim: To determine whether fish oil or aspirin reduce primary patency loss, the need for interventions and dialysis suitability failure of de-novo arteriovenous fistulae (AVF) as secondary and exploratory outcomes of the FAVOURED trial.
Background: Vascular access dysfunction contributes to the high morbidity and mortality of patients requiring haemodialysis. Treatments that improve the usability of AVF are lacking.
Methods: Adult patients with stage 4 or 5 chronic kidney disease currently receiving, or planned within 12 months to receive haemodialysis were randomly allocated to receive fish oil (4g/d) or matching placebo. A subset of 406 participants was randomized to receive aspirin (100mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks. The outcomes were primary patency loss within 12 months of access creation, need for interventions to assist maturation or maintain patency within 12 months, and late dialysis suitability failure (by 6 months post-surgery).
Results: The mean age of the 567 randomized participants was 55 years, 64% were male and 47% diabetic. Compared with placebo, fish oil had no significant effect on primary patency loss (81/266 [31%] vs 70/270 [26%], relative risk [RR] 0.85, 95% confidence interval [CI] 0.65-1.12), need for access interventions (52/266 [20%] vs 46/270 [17%], RR 0.87, 95% CI 0.611.25) or late dialysis suitability failure for participants on dialysis by 6 months (60/175 [34%] vs 65/181 [36%], RR 1.05, 95% CI 0.79-1.39). The risks of patency loss, interventions and dialysis suitability failure were similar between the aspirin and placebo arms.
Conclusions: Neither fish oil nor low-dose aspirin use reduced primary patency loss or the need for interventions within 12 months of surgery, or late dialysis suitability failure.