Effects of fish oil during hemodialysis on nutritional status and quality of life: a randomized double-blinded trial
Background: Supplementation of fish oil has been shown to exert beneficial effects in patients undergoing hemodialysis. The aim of this study was to investigate the efficacy of fish oil in improving the quality of life of these patients through a randomized, double-blinded clinical trial.
Methods: Among the 103 patients enrolled in the study, a total of 74 patients were randomized to receive fish oil (intervention group) or placebo (n=37 per group). Patients received identical soft-gel capsules, with each capsule containing either 1000 mg fish oil or placebo for 4 months. Personnel responsible for data collection and analyses were blinded to the grouping.
Results: The reduction of protein-energy wasting (PEW) in the intervention group was significantly more prominent compared to the placebo group (P=0.023). The intervention group demonstrated significant increase in midarm circumference, arm muscle circumference, and triceps skinfold thickness after fish oil intake. The intervention group also exhibited significant differences from the placebo group in creatinine, uric acid, and serum calcium levels. Significant improvement was seen regarding the physical role and energy/figure in the intervention group.
Conclusions: Our study demonstrated that fish oil intake in patient undergoing hemodialysis can significantly reduce PEW, and improve physical and biochemical parameters and quality of life, which could provide guidance to clinical management of these patients.
- Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016; 388(10053): 1459–544. doi: 10.1016/S0140-6736(16)31012-1
- Tonelli M, Agarwal S, Cass A, Garcia GG, Jha V, Naicker S, et al. How to advocate for the inclusion of chronic kidney disease in a national noncommunicable chronic disease program. Kidney Int 2014; 85(6): 1269–74. doi: 10.1038/ki.2012.488
- Anand S, Kondal D, Montez-Rath M, Zheng Y, Shivashankar R, Singh K, et al. Prevalence of chronic kidney disease and risk factors for its progression: a cross-sectional comparison of Indians living in Indian versus US cities. PLoS One 2017; 12(3): e0173554. doi: 10.1371/journal.pone.0173554
- Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 2015; 385(9981): 1975–82. doi: 10.1016/S0140-6736(14)61601-9
- Roberts MA, Polkinghorne KR, McDonald SP, Ierino FL. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. Am J Kidney Dis 2011; 58(1): 64–72. doi: 10.1053/j.ajkd.2011.01.024
- Lee DM, Knight-Gibson C, Samuelsson O, Attman PO, Wang CS, Alaupovic P. Lipoprotein particle abnormalities and the impaired lipolysis in renal insufficiency. Kidney Int 2002; 61(1): 209–18. doi: 10.1046/j.1523-1755.2002.00116.x
- Mori TA, Beilin LJ. Long-chain omega 3 fatty acids, blood lipids and cardiovascular risk reduction. Curr Opin Lipidol 2001; 12(1): 11–17. doi: 10.1097/00041433-200102000-00003
- Saglimbene VM, Wong G, van Zwieten A, Palmer SC, Ruospo M, Natale P, et al. Effects of omega-3 polyunsaturated fatty acid intake in patients with chronic kidney disease: systematic review and meta-analysis of randomized controlled trials. Clin Nutr 2019; 39(2): 358–68. doi: 10.1016/j.clnu.2019.02.041
- Friedman AN, Yu Z, Tabbey R, Denski C, Tamez H, Wenger J, et al. Low blood levels of long-chain n-3 polyunsaturated fatty acids in US hemodialysis patients: clinical implications. Am J Nephrol 2012; 36(5): 451–8. doi: 10.1159/000343741
- Saglimbene VM, Wong G, Ruospo M, Palmer SC, Campbell K, Larsen VG, et al. Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: the DIET-HD multinational cohort study. Clin Nutr 2019; 38(1): 429–37. doi: 10.1016/j.clnu.2017.11.020
- Donadio JV, Grande JP, Bergstralh EJ, Dart RA, Larson TS, Spencer DC. The long-term outcome of patients with IgA nephropathy treated with fish oil in a controlled trial. J Am Soc Nephrol 1999; 10(8): 1772–7.
- Ferraro PM, Ferraccioli GF, Gambaro G, Fulignati P, Costanzi S. Combined treatment with renin–angiotensin system blockers and polyunsaturated fatty acids in proteinuric IgA nephropathy: a randomized controlled trial. Nephrology Dial Transplant 2008; 24(1): 156–60. doi: 10.1093/ndt/gfn454
- Hogg RJ. A randomized, placebo-controlled, multicenter trial evaluating alternate-day prednisone and fish oil supplements in young patients with immunoglobulin A nephropathy. Am J Kidney Dis 1995; 26(5): 792–6. doi: 10.1016/0272-6386(95)90445-x
- De Caterina R, Caprioli R, Giannessi D, Sicari R, Galli C, Lazzerini G, et al. n-3 fatty acids reduce proteinuria in patients with chronic glomerular disease. Kidney Int 1993; 44(4): 843–50. doi: 10.1038/ki.1993.320
- Djoussé L, Akinkuolie AO, Wu JHY, Ding EL, Gaziano JM. Fish consumption, omega-3 fatty acids and risk of heart failure: a meta-analysis. Clin Nutr 2012; 31(6): 846–53. doi: 10.1016/j.clnu.2012.05.010
- Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA 2012; 308(10): 1024–33. doi: 10.1001/2012.jama.11374
- Uchiyama-Tanaka Y, Mori Y. Effects of eicosapentaenoic acid supplementation on immunoglobulin A nephropathy. Ther Apher Dial 2010; 14(3): 303–7. doi: 10.1111/j.1744-9987.2009.00791.x
- Alexopoulos E, Stangou M, Pantzaki A, Kirmizis D, Memmos D. Treatment of severe IgA nephropathy with omega-3 fatty acids: the effect of a ‘very low dose’ regimen. Ren Fail 2004; 26(4): 453–9. doi: 10.1081/jdi-200026763
- Irish AB, Viecelli AK, Hawley CM, Hooi L-S, Pascoe EM, Paul-Brent P-A, et al. Effect of fish oil supplementation and aspirin use on arteriovenous fistula failure in patients requiring hemodialysis: a randomized clinical trial. JAMA Int Med 2017; 177(2): 184–93. doi: 10.1001/jamainternmed.2016.8029
- He L, Li M-S, Lin M, Zhao T-Y, Gao P. Effect of fish oil supplement in maintenance hemodialysis patients: a systematic review and meta-analysis of published randomized controlled trials. Eur J Clin Pharmacol 2016; 72(2): 129–39. doi: 10.1007/s00228-015-1976-y
- Painter P, Exercise PHD. A guide for people on dialysis. Rehabilitation Resource Center: Medical Education Institute, Inc., Madison 2000.
- Collins AJ, Hanson G, Umen A, Kjellstrand C, Keshaviah P. Changing risk factor demographics in end-stage renal disease patients entering hemodialysis and the impact on long-term mortality. Am J Kidney Dis 1990; 15(5): 422–32. doi: 10.1016/s0272-6386(12)70360-8
- Obi Y, Qader H, Kovesdy CP, Kalantar-Zadeh K. Latest consensus and update on protein-energy wasting in chronic kidney disease. Curr Opin Clin Nutr Metab Care 2015; 18(3): 254–62. doi: 10.1097/MCO.0000000000000171
- Khor B-H, Sahathevan S, Sualeheen A, Ali MSM, Narayanan SS, Chinna K, et al. Dietary fatty acid intake in hemodialysis patients and associations with circulating fatty acid profiles: a cross-sectional study. Nutrition 2019; 63–64: 14–21. doi: 10.1016/j.nut.2019.01.005
- Yan Y, Jiang W, Spinetti T, Tardivel A, Castillo R, Bourquin C, et al. Omega-3 fatty acids prevent inflammation and metabolic disorder through inhibition of NLRP3 inflammasome activation. Immunity 2013; 38(6): 1154–63. doi: 10.1016/j.immuni.2013.05.015
- Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr 2010; 93(2): 402–12. doi: 10.3945/ajcn.110.005611
- Kamolrat T, Gray SR. The effect of eicosapentaenoic and docosahexaenoic acid on protein synthesis and breakdown in murine C2C12 myotubes. Biochem Biophys Res Comm 2013; 432(4): 593–8. doi: 10.1016/j.bbrc.2013.02.041
- Carrero JJ, Stenvinkel P, Cuppari L, Ikizler TA, Kalantar-Zadeh K, Kaysen G, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr 2013; 23(2): 77–90. doi: 10.1053/j.jrn.2013.01.001
- Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, et al. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia–hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci 2011; 121(6): 267–78. doi: 10.1042/CS20100597
- Palmer RM, Wahle KWJ. Protein synthesis and degradation in isolated muscle. Effect of ω3 and ω6 fatty acids. Biochem J 1987; 242(2): 615–18. doi: 10.1042/bj2420615
- Khosla N, Steiner RW. The MDRD equation predicts peritoneal dialysis-delivered creatinine clearances from serum creatinine. Clin J Am Soc Nephrol 2009; 4(4): 798–803. doi: 10.2215/CJN.03870808
- Virga G, La Milia V, Russo R, Bonfante L, Cara M, Nordio M. Comparison between creatinine-based equations for estimating total creatinine clearance in peritoneal dialysis: a multicentre study. Nephrology Dial Transplant 2009; 25(1): 262–9. doi: 10.1093/ndt/gfp391
- Lauretani F, Maggio M, Pizzarelli F, Michelassi S, Ruggiero C, Ceda GP, et al. Omega-3 and renal function in older adults. Curr Pharm Des 2009; 15(36): 4149–56. doi: 10.2174/138161209789909719
- Moeinzadeh F, Shahidi S, Mortazavi M, Dolatkhah S, Kajbaf M, Haghjooy Javanmard S, et al. Effects of omega-3 fatty acid supplementation on serum biomarkers, inflammatory agents, and quality of life of patients on hemodialysis. Iran J Kidney Dis 2016; 10(6): 381–7.
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