Effects of N-3 PUFAs Supplementation on Insulin Resistance and Inflammatory Biomarkers in Hemodialysis Patients (original) (raw)
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Lipids in Health and Disease, 2014
Background: Dyslipidemia and abnormal phospholipid metabolism are frequent in uremic patients and increase their risk of cardiovascular disease (CVD): ω-3 polyunsaturated fatty acids (PUFAs) may reduce this risk in the general population. In this study we compared the plasma and erythrocyte cell membrane composition of PUFAs in a group of Caucasian hemodialysis (HD) patients and in a control group of healthy subjects and evaluated the erythrocyte/cell membrane fatty acid ratio as a marker of the dietary intake of phospholipids. The relationship between ω-3 and ω-6 fatty acids and the possible differences in PUFAs concentrations were also investigated. Methods and results: After obtaining a fully informed consent, a total of ninety-nine HD patients and 160 non uremic control subjects from "Tor Vergata" University Hospital were enrolled into the study. None of them took antioxidant drugs or dietary supplements for at least 90 days prior to the observation. Blood samples were analysed by gas-chromatographic coupled to a mass spectrometric detector. The daily intake of total calories, proteins, lipids and carbohydrates is significantly lower in HD patients than in controls (p < 0.001). Most plasma and erythrocyte PUFA were also reduced significantly in HD patients (p < 0.001). Conclusions: Our results suggest that many classes of PUFAs are lacking in HD patients, due to the removal of nutrients during the dialysis and to persistent malnutrition. A dietary treatment addressed to increase plasma ω-3 PUFAs and to optimize ω-6/ω-3 ratio may exert a protective action and reduce the risk of CVD in HD patient.
Effect of n-3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients
Nephrology, 2007
Nutrition as an aetiological factor participates a great deal in premature atherosclerosis in haemodialysis (HD) patients. The basic mechanisms of end-stage renal disease and premature atherosclerosis are connected with changes in cell functions at the membrane level. We investigated the red cell membrane fatty acids and the effects of fish oil supplements on nutritional status and inflammatory markers in HD patients. Methods: We examined 42 HD patients (mean age 55 1 8 years). The control group consisted of 16 healthy subjects of similar age and sex to the tested group. HD patients were administered supplements with 2.4 g of n-3 polyunsaturated fatty acids per day for 2 months. Before and after supplementation, we examined plasma lipids, cell membrane erythrocyte phospholipids content, serum albumin, haemoglobin, interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-a).
Clinical Journal of the American Society of Nephrology, 2006
Patients who are treated with chronic hemodialysis (HD) experience premature cardiovascular disease and an increased mortality. N-3 polyunsaturated fatty acids (PUFA) may be effective in the secondary prevention of cardiovascular disease, but the effects of n-3 PUFA has not previously been examined in HD patients. It was hypothesized that secondary prevention with n-3 PUFA would reduce the number of cardiovascular events and death in patients who are treated with chronic HD. A randomized, double-blind, placebo-controlled intervention trial compared the effect of n-3 PUFA and a control treatment as secondary prevention of cardiovascular events in HD patients. The primary outcome was a composite of total cardiovascular events and death. A total of 206 patients were randomly assigned to treatment with n-3 PUFA or control treatment and followed for 2 yr or until reaching a predefined end point. During the trial, 121 (59%) of 206 patients reached a primary end point. N-3 PUFA had no significant effect on the primary composite end point of cardiovascular events and death (62 versus 59; NS). In the n-3 PUFA group, a significant reduction was seen in the number of myocardial infarctions (four versus 13; P ؍ 0.036). This trial was limited by a relatively small number of patients and a large number of withdrawals. However, it is concluded that treatment with n-3 PUFA did not reduce the total number of cardiovascular events and death in this high-risk population. N-3 PUFA significantly reduced the number of myocardial infarctions as a secondary outcome, a finding that might be of clinical interest.
Essential polyunsaturated fatty acids, inflammation and mortality in dialysis patients
Nephrology Dialysis Transplantation, 2012
Background. Polyunsaturated fatty acids (PUFA) are essential nutrients with anti-inflammatory and cardioprotective properties. We investigated the association of essential dietary PUFA intake, reflected by plasma fatty acid composition, with inflammation and mortality in dialysis patients. Methods. We recruited 222 Swedish dialysis subjects (39% women) with median age of 57 years and average 12 months of dialysis vintage. Plasma phospholipid PUFA were assessed by gas-liquid chromatography. Overall mortality was assessed after 18.4 (10th-90th percentiles: 2.3-60) months of follow-up. Results. Linoleic acid (LA), Mead acid (MA), a-linolenic acid (ALA) and long-chain n-3 PUFA (LC n-3; the sum of eicosapentaenoic, docosapentaenoic and docosahexaenoic acids) represented 19.7, 0.26, 0.26 and 7.64% of all fatty acids in plasma, respectively. This may reflect an adequate n-3 PUFA intake. LA was negatively (b ¼ À0.21, P ¼ 0.004) but MA positively (b ¼ 0.25, P < 0.001) associated with interleukin (IL)-6 in multivariate analyses. Neither ALA nor LC n-3 were independently associated with IL-6. During follow-up, 61 deaths and 115 kidney transplants occurred. Fully adjusted competing risk models showed that every percent increase in the proportion of plasma LA was associated with 12% reduction in mortality risk before transplantation (hazard ratio 0.88, 95% confidence interval 0.79-0.99). MA was directly associated with mortality. Neither ALA nor LC n-3 predicted outcome.
Acute Rise of Omega-3 Polyunsaturated Fatty Acids During Hemodialysis Treatment
Journal of Renal Nutrition, 2008
Objective-Hemodialysis patients have an extremely high rate of cardiac arrhythmia-induced sudden cardiac death, though the risk during the hemodialysis procedure is curiously low. Higher blood content of long chain omega-3 polyunsaturated fatty acids (PUFA) is believed to reduce the risk of sudden cardiac death. We performed this study to measure the effect of a single standard hemodialysis treatment on plasma and erythrocyte omega-3 PUFA levels in chronic hemodialysis patients.
Journal of Renal Nutrition
Objective: Alterations in the balance between serum n-3 and n-6 polyunsaturated fatty acids (PUFAs) is predictive of cardiovascular events among hemodialysis patients, although little is known about the serum ratio of n-6 arachidonic acid (AA) to n-6 dihomo-g-linoleic acid (DGLA) in renal failure. We hypothesized that AA/DGLA ratio is altered in hemodialysis patients resulting in poor clinical outcomes. Methods: This was a single center cohort study in an urban area in Japan with cross-sectional analyses. Subjects were 517 hemodialysis patients and 122 control subjects. The main exposure was serum AA/DGLA ratio, and the main outcome measures were allcause mortality and cardiovascular events during 5 years. Results: The hemodialysis patients showed a higher median (interquartile range) AA/DGLA ratio than the control subjects (6.46 [5.22-7.81] versus 4.56 [3.74-6.34], P , .001). In a Cox proportional hazard model adjusted for age, sex, dialysis duration, diabetic nephropathy, prior cardiovascular disease, and the ratio of serum n-3 polyunsaturated fatty acids (eicosapentaenoic acid plus docosahexaenoic acid) to AA, the higher quartiles of AA/DGLA ratio were associated with higher risk for all-cause mortality with hazard ratios (95% confidence interval) of 1.50 (0.84-2.76) for quartile 2, 2.10 (1.18-3.86) for quartile 3, and 2.02 (1.10-3.78) for quartile 4 compared with quartile 1. AA/DGLA ratio showed a similar association with the risk of cardiovascular events. Conclusions: AA/DGLA ratio was elevated in patients with end-stage renal disease requiring hemodialysis, and a high AA/DGLA ratio was an independent predictor of poor clinical outcomes in this population.
Abnormal lipid metabolism and oxidative stress in hemodialysis patients
Journal of Artificial Organs, 2001
Oxidative stress is enhanced in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). Bioincompatibility represents an important source of reactive oxygen species. HD patients exhibit altered antioxidative defenses, and antioxidative vitamins such as vitamin E and C are altered in uremia. Frequently, HD patients also suffer from atherosclerotic cardiac disease. We previously reported that low-density lipoprotein (LDL) of HD patients is rich in malondialdehyde (MDA), an end product of lipid peroxidation. MDA-rich LDL is thought to be an atherogenic lipoprotein because of its enhancement of macrophage foam-cell formation. We conducted a controlled study for 2 years comparing the effects of a vitamin E-coated cellulose membrane dialyzer and an ordinary cellulose membrane dialyzer on lipid metabolism and the progress of atherosclerosis. LDL MDA and oxidized LDL (ox-LDL) were measured in HD patients by using these two types of dialyzers. Plasma vitamin E and lipid concentrations were also evaluated. Aortic calcification index (ACI) was evaluated by CT scan to assess the progress of atherosclerosis before and every year after initiation of the treatment. The use of a vitamin E-coated cellulose membrane dialyzer for 6 months, 1 year, and 2 years resulted in a significant reduction in LDL-MDA and ox-LDL compared with that obtainal with the use of the ordinary cellulose membrane dialyzer. The treatment with a vitamin E-coated dialyzer significantly reduced the percent increase in ACI after 24 months as compared with control. There were no significant differences in plasma vitamin E and lipid concentrations between the two groups. These results suggest that
Journal of Renal Nutrition, 2009
Objective: Membrane fatty acid composition plays an important role in the cellular function. Erythrocyte fatty acid composition mirrors that of myocardium and is influenced by diet. Earlier studies have shown significant alterations of membrane fatty acid composition in ethnically mixed patients with end-stage renal disease. Given the impact of ethnic and dietary factors, we sought to examine membrane fatty acid composition in an ethnically homogeneous end-stage renal disease population residing in a coastal region of Korea with high fish consumption.
Effects of Ω3 Fatty Acid Supplement on Anemia and Hematologic Factors in Hemodialysis Patients
2010
Background and Aim: Anemia is one of the major risk factors for cardiovascular disease (CVD) in hemodialyzed patients. Therefore, the present study was designed to investigate the effects of 3 fatty acid supplement on anemia and hematologic factors in hemodialysis patients. Materials and Methods: The study was a double-blind randomized clinical trial on 34 hemodialysis patients. The patients in the 3 fatty acid supplement group received 2080 mg 3 fatty acid daily for 10 weeks, while the placebo group received placebo for the same period. At baseline and the end of 10 th week of the study, blood hemoglobin, hematocrit, red blood cells, MCV, MCH, MCHC and serum CRP were measured. Statistical analysis of the data was performed using chi-square, t-test, paired t-test and ANOVA. Results: The mean age and duration of dialysis were 50 ± 18 years and 23 ± 25 months in the 3 fatty acid group and 50 ± 17 years and 28 ± 18 months in the placebo group, respectively. During this study, no significant difference was observed between the two groups in mean changes of blood hemoglobin, hematocrit, red blood cells, MCV, MCH, MCHC and serum CRP. Conclusion: The results of the present study indicate that 3 fatty acid supplement has no effect on hematologic factors and anemia in hemodialysis patient.