No Reduction in AVF Failure with Fish Oil and Aspirin

Treatment with fish oil and/or aspirin does not reduce the risk of arteriovenous fistula (AVF) failure, reports a randomized trial in JAMA Internal Medicine.

The “Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease” (FAVOURED) study included 567 patients at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. All patients had stage 4 or 5 chronic kidney disease and were undergoing surgical AVF creation.

Patients were randomly assigned to receive fish oil, 4 g/d, or placebo. A subset of 406 patients were further assigned to aspirin, 100 mg/d, or placebo. Study treatments began 1 day before surgery and continued for 12 weeks. At 12 months, a composite endpoint of fistula thrombosis or abandonment or cannulation failure was assessed.

The fistula failure rate was 47% in patients assigned to fish oil or placebo, with no difference in the composite outcome or its individual components. There was also no difference between the aspirin and placebo groups: fistula failure rate 45% and 43%, respectively. Adverse events, including bleeding, were similar between groups.

Fish oil and aspirin have differing effects that might make them useful for reducing the high rates of early thrombosis and maturation failure in AVFs. However, the FAVOURED results show no significant difference in AVF failure over 12 months, with either fish oil, aspirin, or the combination of the two. The high failure rate of nearly 50% emphasizes the urgent need to improve AVF outcomes [Irish AB, et al. Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: a randomized clinical trial. JAMA Intern Med 2017; doi:10.1001/jamainternmed.2016.8029].

February 2017 (Vol 9, Number 2)