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Am J Kidney Dis. 2018 Jul;72(1):50-61. doi: 10.1053/j.ajkd.2017.11.017. Epub 2018 Feb 12.

Omega-3 Polyunsaturated Fatty Acid Supplementation to Prevent Arteriovenous Fistula and Graft Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Author information

1
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia. Electronic address: andrea.viecelli@health.qld.gov.au.
2
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
3
Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia; Department of Medicine and School of Public Health, Monash University, Melbourne, Victoria, Australia; Department of Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
4
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia.
5
School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
6
Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
7
The Children's Hospital at Westmead, Cochrane Kidney and Transplant, Centre for Kidney Research, Westmead, NSW, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Diaverum, Medical Scientific Office, Lund, Sweden; Diaverum Academy, Bari, Italy; University of Sydney, Sydney School of Public Health, Sydney, Australia.
8
Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
9
Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.

Abstract

BACKGROUND:

Arteriovenous access failure frequently occurs in people on hemodialysis and is associated with morbidity, mortality and large healthcare expenditures. Omega-3 polyunsaturated fatty acids (omega-3 PUFA) may improve access outcomes via pleiotropic effects on access maturation and function, but may cause bleeding complications.

STUDY DESIGN:

Systematic review with meta-analysis.

SETTING & POPULATION:

Adults requiring hemodialysis via arteriovenous fistula or graft.

SELECTION CRITERIA:

Trials evaluating omega-3 PUFA for arteriovenous access outcomes identified by searches in CENTRAL, MEDLINE, and Embase to 24 January 2017.

INTERVENTION:

Omega-3 PUFA.

OUTCOMES:

Primary patency loss, dialysis suitability failure, access abandonment, interventions to maintain patency or assist maturation, bleeding, gastrointestinal side-effects, all-cause and cardiovascular mortality, hospitalization, and treatment adherence. Treatment effects were summarized as relative risks (RR) and 95% confidence intervals (CI). Evidence was assessed using GRADE.

RESULTS:

Five eligible trials (833 participants) with a median follow-up of 12 months compared peri-operative omega-3 PUFA supplementation with placebo. One trial (n=567) evaluated treatment for fistulae and four (n=266) for grafts. Omega-3 PUFA supplementation prevented primary patency loss with moderate certainty (761 participants, RR 0.81, CI 0.68-0.98). Low quality evidence suggested, that omega-3 PUFA may have had little or no effect on dialysis suitability failure (536 participants, RR 0.95, CI 0.73-1.23), access abandonment (732 participants, RR 0.78, CI 0.59-1.03), need for interventions (732 participants, RR 0.82, CI 0.64-1.04), or all-cause mortality (799 participants, RR 0.99, CI 0.51-1.92). Bleeding risk (793 participants, RR 1.40, CI 0.78-2.49) or gastrointestinal side-effects (816 participants, RR 1.22, CI 0.64-2.34) from treatment were uncertain. There was no evidence of different treatment effects for grafts and fistulae.

LIMITATIONS:

Small number and methodological limitations of included trials.

CONCLUSIONS:

Omega-3 PUFA supplementation probably protects against primary loss of arteriovenous access patency, but may have little or no effect on dialysis suitability failure, access interventions or access abandonment. Potential treatment harms are uncertain.

KEYWORDS:

Fish oil; arteriovenous fistula (AVF); arteriovenous graft (AVG); arteriovenous vascular access; complications; functional access; hemodialysis (HD); meta-analysis; omega-3 polyunsaturated fatty acids (omega-3 PUFA); outcomes; patency; trials

PMID:
29395485
DOI:
10.1053/j.ajkd.2017.11.017

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