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Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial.

Abstract

CONTEXT
Synthetic arteriovenous grafts, an important option for hemodialysis vascular access, are prone to recurrent stenosis and thrombosis. Supplementation with fish oils has theoretical appeal for preventing these outcomes.
OBJECTIVE
To determine the effect of fish oil on synthetic hemodialysis graft patency and cardiovascular events.
DESIGN, SETTING, AND PARTICIPANTS
The Fish Oil Inhibition of Stenosis in Hemodialysis Grafts (FISH) study, a randomized, double-blind, controlled clinical trial conducted at 15 North American dialysis centers from November 2003 through December 2010 and enrolling 201 adults with stage 5 chronic kidney disease (50% women, 63% white, 53% with diabetes), with follow-up for 12 months after graft creation.
INTERVENTIONS
Participants were randomly allocated to receive fish oil capsules (four 1-g capsules/d) or matching placebo on day 7 after graft creation.
MAIN OUTCOME MEASURE
Proportion of participants experiencing graft thrombosis or radiological or surgical intervention during 12 months' follow-up.
RESULTS
The risk of the primary outcome did not differ between fish oil and placebo recipients (48/99 [48%] vs 60/97 [62%], respectively; relative risk, 0.78 [95% CI, 0.60 to 1.03; P = .06]). However, the rate of graft failure was lower in the fish oil group (3.43 vs 5.95 per 1000 access-days; incidence rate ratio [IRR], 0.58 [95% CI, 0.44 to 0.75; P < .001]). In the fish oil group, there were half as many thromboses (1.71 vs 3.41 per 1000 access-days; IRR, 0.50 [95% CI, 0.35 to 0.72; P < .001]); fewer corrective interventions (2.89 vs 4.92 per 1000 access-days; IRR, 0.59 [95% CI, 0.44 to 0.78; P < .001]); improved cardiovascular event-free survival (hazard ratio, 0.43 [95% CI, 0.19 to 0.96; P = .04]); and lower mean systolic blood pressure (-3.61 vs 4.49 mm Hg; difference, -8.10 [95% CI, -15.4 to -0.85]; P = .01).
CONCLUSIONS
Among patients with new hemodialysis grafts, daily fish oil ingestion did not decrease the proportion of grafts with loss of native patency within 12 months. Although fish oil improved some relevant secondary outcomes such as graft patency, rates of thrombosis, and interventions, other potential benefits on cardiovascular events require confirmation in future studies.
TRIAL REGISTRATION
isrctn.org Identifier: ISRCTN15838383.

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  • Authors

    Lok CE, Moist L, Hemmelgarn BR, Tonelli M, Vazquez MA, Dorval M, Oliver M, Donnelly S, Allon M, Stanley K, Fish Oil Inhibition of Stenosis in Hemodialysis Grafts (FISH) Study Group

    Institution

    University of Toronto, and Division of Nephrology, Department of Medicine, Toronto General Hospital, 8NU-844, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada. charmaine.lok@uhn.ca

    Source

    JAMA : the journal of the American Medical Association 307:17 2012 May 2 pg 1809-16

    MeSH

    Administration, Oral
    Adult
    Aged
    Aged, 80 and over
    Cardiovascular Diseases
    Constriction, Pathologic
    Dietary Supplements
    Double-Blind Method
    Female
    Fish Oils
    Graft Occlusion, Vascular
    Humans
    Kidney Failure, Chronic
    Male
    Middle Aged
    Renal Dialysis
    Thrombosis
    Vascular Patency

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22550196