Document Detail

Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial.
MedLine Citation:
PMID:  22550196     Owner:  NLM     Status:  MEDLINE    
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.
Charmaine E Lok; Louise Moist; Brenda R Hemmelgarn; Marcello Tonelli; Miguel A Vazquez; Marc Dorval; Matthew Oliver; Sandra Donnelly; Michael Allon; Kenneth Stanley;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  307     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-02     Completed Date:  2012-05-04     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1809-16     Citation Subset:  AIM; IM    
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MeSH Terms
Administration, Oral
Aged, 80 and over
Cardiovascular Diseases / etiology,  prevention & control
Constriction, Pathologic / prevention & control*
Dietary Supplements
Double-Blind Method
Fish Oils / administration & dosage*
Graft Occlusion, Vascular / prevention & control*
Kidney Failure, Chronic / therapy*
Middle Aged
Renal Dialysis*
Thrombosis / prevention & control
Vascular Patency / drug effects*
Grant Support
5UO1 DK082240/DK/NIDDK NIH HHS; K24 DK059818/DK/NIDDK NIH HHS; K24 DK59818-01/DK/NIDDK NIH HHS; R01 DK085027/DK/NIDDK NIH HHS; R34 DK094115/DK/NIDDK NIH HHS; //Canadian Institutes of Health Research
Reg. No./Substance:
0/Fish Oils
Charmaine E Lok / ; Matthew Oliver / ; Sandra Donnelly / ; Tabo Sikaneta / ; Jason Fung / ; George Wu / ; Danny Sapir / ; Tom Liu / ; Louise Moist / ; Serge Cournoyeur / ; Marc Dorval / ; Brenda Hemmelgarn / ; Marcello Tonelli / ; Miguel Vazquez / ; Michael Allon / ; Donald Brophy /
Comment In:
Nat Rev Nephrol. 2012 Jul;8(7):373   [PMID:  22614788 ]
JAMA. 2012 May 2;307(17):1859-60   [PMID:  22550201 ]

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