SP587OMEGA-3 PUFA SUPPLEMENTATION TO PREVENT ARTERIOVENOUS FISTULA AND GRAFT FAILURE: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Arteriovenous (AV) access failure occurs frequently in people on haemodialysis (HD) and is associated with increased morbidity, mortality and healthcare costs. Use of omega-3 polyunsaturated fatty acids (omega-3 PUFA) may improve vascular access outcomes via pleiotropic effects on access maturation and function, but may be limited by bleeding complications. We evaluated the benefits and harms of omega-3 PUFA supplementation to prevent dialysis AV access complications in people requiring chronic HD. METHODS: Systematic review with meta-analysis of randomised controlled trials evaluating the efficacy and safety of omega-3 PUFA supplementation on AV access outcomes in adults requiring chronic HD. Trials were identified by highly-sensitive searches in Cochrane CENTRAL, MEDLINE, and Embase through 20 January 2017. Pre-specified outcomes were primary patency loss, bleeding, dialysis suitability failure (defined as an access that despite radiological or surgical interventions, cannot be used successfully for dialysis), access abandonment, interventions to maintain patency or assist maturation, gastrointestinal side effects, all-cause and cardiovascular mortality, hospitalisation, and treatment adherence. Treatment effects were summarised as relative risks (RR) with 95% confidence intervals (CI). Confidence in the evidence was assessed using GRADE. RESULTS: Five eligible trials comparing omega-3 PUFA supplementation with placebo were included in the meta-analysis (833 people) with an average follow-up time of 11.8 months. One trial (567 people) included people with a fistula and four included people with a graft. In moderate quality evidence, omega-3 PUFA supplementation reduced the risk of primary patency loss (3 trials, 761 people, RR 0.81, CI 0.68-0.98) but low quality evidence showed uncertain effects on access suitability for dialysis in a single trial (536 people, RR 0.95, CI 0.73-1.23), access abandonment (2 trials, 732 people, RR 0.78, CI 0.59-1.03), and need for interventions (2 trials, 732 people, RR 0.82, CI 0.64-1.04; Figure 1). Overall, risks of bleeding (4 trials, 794 people, RR 1.40, CI 0.78-2.49), gastrointestinal side effects (4 trials, 816 people, RR 1.22, CI 0.64-2.34), and all-cause mortality (4 trials, 799 people, RR 0.98, CI 0.51-1.86) were uncertain with low quality evidence. There was no evidence of heterogeneity in risk estimates based on access type (AV fistula or graft). Risk of bias was low overall. SP587 Figure
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.038 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".