NDT Advance Access originally published online on July 10, 2007
Nephrology Dialysis Transplantation 2007 22(12):3561-3567; doi:10.1093/ndt/gfm422
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Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients—a pilot study
1Division of Nephrology, Indiana University School of Medicine, Indianapolis IN, 2Department of Basic Medical Sciences, Purdue University, West Lafayette, 3Indiana University School of Medicine, Division of Biostatistics and 4Roudebush VAMC, Department of Medicine, Indianapolis, IN, USA
Correspondence and offprint requests to: Allon Friedman, MD, 1481 W. 10th St-111N, Indianapolis, IN 46202, USA. Email: allfried{at}ipui.edu
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Abstract |
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Background. We previously reported that haemodialysis patients have suboptimal blood levels of the cardioprotective omega-3 polyunsaturated fatty acids (n-3 PUFA) eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. In the present pilot study, we tested the hypothesis that supplementing haemodialysis patients for 12 weeks with the American Heart Association (AHA)-recommended fish oil dose would be well tolerated and efficacious in boosting blood n-3 PUFA levels and improving cardiovascular risk biomarkers.
Methods. Twenty-seven subjects were randomized in a 2 : 1 ratio to either 1.3 g of EPA + DHA daily or placebo.
Results. At baseline, 83% of subjects consumed inadequate dietary fish and had the following erythrocyte n-3 PUFA levels (mean ± SD,% weight)—EPA: 0.3 ± 0.2, DHA: 2.9 ± 2.0, and ratio of n-6/n-3 PUFA: 4.2 ± 1.3. Supplementation induced large increases in mean blood EPA and DHA levels (% increase, P-value vs placebo group): erythrocyte—EPA: +400%, P = 0.0018, DHA: +205%, P < 0.0001; plasma—EPA: +275%, P = 0.0003, DHA: +69%, P = 0.0352. Levels in the placebo group remained relatively unchanged. The omega-3 index, a value correlating with the level of cardioprotection, increased significantly in the fish oil group. A reduction in mean C-reactive protein levels (–3.3 ± 8.1 mg/l, P = 0.0282) and a trend towards lower triglyceride levels (–24 ± 74 mg/dl, P = 0.0783) were also observed in the active vs placebo group. Minimal side effects were noted.
Conclusions. Our preliminary observations that the AHA-recommended fish oil dose is well tolerated, efficacious and may improve surrogate markers of cardiovascular disease in haemodialysis patients paves the way for larger clinical trials to confirm a clinical benefit.
Keywords: C-reactive protein; fish oil; haemodialysis; n-3; omega-3; triglyceride
Received for publication: 10. 4.07
Accepted in revised form: 5. 6.07