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I spend a lot of time knocking supplements for not having research behind them. It's important therefore to highlight when such research is done. Today we're looking at a very good study on whether fish oil supplements can help people who need regular outside access to their circulatory systems (for things like hemodialsys). Spolier alert: the fish oil didn't help.

If you want to read more, here's the paper we're covering: Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistula Failure in Patients Requiring Hemodialysis: A Randomized Clinical Trial

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I spend a lot of time knocking supplements for not having research behind them. It's important, therefore, to highlight when such research is done. This is Healthcare Triage News.


To the research! From JAMA Internal Medicine, Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistual Failure in Patients Requiring Hemodialysis: A Randomized Controlled Trial.

People who require hemodialysis need to have their blood cycled regularly. This often requires a permanent means for vascular access. Unfortunately, such access carries with it the risk of morbidity and mortality.

There are a number of ways to achieve permanent vascular access. In general, fistula are preferred to synthetic arteriovenous grafts or central venous catheters. AVFs take longer to mature before use, and have a much greater risk of early failure, though.

Some have theorised that omega-3 fatty acids, or fish oil, can help, and I'm quoting, not only inhibiting platelet aggregation, but also decreasing blood viscosity, improving red blood cell flexibility, promoting vaso-dilation, inhibiting smooth muscle cell proliferation, and reducing inflammation. Others theorised that aspirin might do similar things.

This trial wanted to see if either of these things was true. Researchers ran a double blinded, randomized controlled trial of participants with stage 4 or 5 kidney disease at 35 dialysis centers in Australia, Malaysia, New Zealand, and the UK. Participants were randomized to get fish oil, placebo, both or neither. Those that couldn't take aspirin, or who were already taking it and couldn't stop, were excluded from the randomization for aspirin, of course. The primary outcome of interest was failure of their fistula or a failure to be able to use the fistula.

This wasn't a small study. Of the 1,415 deemed eligible over the study period, 567 were randomized and included in the trial. Of these, an additional 406 were randomized to get aspirin or placebo as well.

Let's talk about fish oil first. The failure rate in both arms, intervention and placebo, was 47%. No difference at all. Fish oil didn't reduce fistula thrombosis or cannulation failures either. Aspirin didn't work either. The rate of failure was 45% in the aspirin arm, and 43% in the placebo arm.

I grant you that this is a pretty focused trial for a pretty specific cause, but we should respect the process and acknowledge the efforts. Fish oil and aspirin don't seem to prevent failures of arteriovenous fistulas in the year after surgery.

This is how you study supplements. You think fish oil is a miracle? Prove it. But, when it fails, own it. Consider changing your practice.


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