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Cited by 146Central Venous Catheters and HemodialysisFatty Acid Research and HealthDialysis and Renal Disease Management

Effect of Fish Oil Supplementation on Graft Patency and Cardiovascular Events Among Patients With New Synthetic Arteriovenous Hemodialysis Grafts: A Randomized Controlled Trial

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Lok, Charmaine E.·2012·JAMA
DOI 10.1001/jama.2012.3473PMC PMC4046844
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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, C. E.
Affiliations
University of Toronto (CA)
Corresponding author
Lok, Charmaine E.
ORCID
Lok, Charmaine E.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2012-05-02
Volume
307
Issue
17
Pages
1809
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2012.3473
PMC
PMC4046844
OpenAlex
W2137858397
Cited by
146
References
60
Citations by year
2026: 7 · 2025: 4 · 2024: 9 · 2023: 2 · 2022: 11 · 2021: 6 · 2020: 2 · 2019: 11 · 2018: 10 · 2017: 16 · 2016: 11 · 2015: 15 · 2014: 13 · 2013: 19 · 2012: 10
FWCI
31.44
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r01dk085027-04)
  • Canadian Institutes of Health Research
  • National Institute of Diabetes and Digestive and Kidney Diseases (5UO1 DK082240, R01-DK085027, K24DK059818, U01DK082240, R34DK094115, K24-DK59818-01)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
fish oil supplementation, graft patency, graft thrombosis, graft stenosis, graft failure, cardiovascular events, chronic kidney disease, vascular access, omega-3 fatty acids, cardiovascular event-free survival, end-stage renal disease, eicosapentaenoic acid, docosahexaenoic acid
MeSH terms
Administration, Oral, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Constriction, Pathologic, Double-Blind Method, Female, Fish Oils, Graft Occlusion, Vascular, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Middle Aged, Thrombosis, Vascular Patency, Dietary Supplements

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