Associations of fish oil and vitamin B and E supplementation with cardiovascular outcomes and mortality in people receiving haemodialysis: a review

Abstract

BackgroundCardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease. Research indicates that the Mediterranean diet is protective of cardiovascular disease in the general population. Components of this diet have been trialled in haemodialysis patients with the aim of reducing the risk of cardiovascular disease and improving associated risk factors. Components include fish, fruit and vegetables in the form of fish oil supplements and vitamin and antioxidant supplements. This narrative review provides an overview of observational studies, and interventional and randomised controlled trials examining the association of these supplements with cardiovascular outcomes in haemodialysis patients.MethodsWe reviewed the relevant literature by searching English-language publications in Web of Science and references from relevant articles published since 1992. Eight-seven abstracts were reviewed and 38 relevant articles were included.ResultsThe extant literature suggests that risk of mortality is reduced in patients with a higher fish intake and those with higher serum omega-3 fatty acid levels. However, the pathways by which risk of mortality is reduced have not been fully extrapolated. While only a few studies have examined the effect of vitamin B supplementation in haemodialysis patients, these studies suggest that supplementation alone does not reduce the risk of mortality. Finally, studies examining vitamin E supplementation have drawn inconsistent conclusions regarding its pro-oxidant or antioxidant effects. Differences between studies are likely due to methodological variations in regards to dose, route of administration and treatment duration.ConclusionsNutritional and dietary supplementation in haemodialysis patients is an area which requires larger, more methodologically robust randomised controlled trials to determine if risk of cardiovascular outcomes can be improved.

Lipids, Lipoprotein Distribution and Nutritional Parameters over the Ramadan Period in Hemodialysis Patients

“…In the case of these individuals, the dialysis regimen itself requires additional coordination with the fasting schedule during R. Additionally, HD patients are at an increased risk for cardiovascular disease (CVD) partly attributed to dyslipidemia, increased inflammation, and poor nutritional status [19,20,21,22,23], and they could promote low-density lipoprotein (LDL) oxidation, endothelial injury, and the accumulation of lipids in the artery wall [24]. On the other hand, a diet approach could be beneficial to control them [24,25]. The findings from several studies in Saudi Arabia report that poor nutritional status and high prevalence of malnutrition (among HD patients) are consistent with these observations [23,26,27].…”

Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study

“…Existing randomized controlled trials of higher dose n-3 PUFA supplementation in patients on hemodialysis have reported no significant effect on allcause mortality and arteriovenous fistula failure, but reduced risk of thrombosis in arteriovenous grafts and cardiovascular events [39e42]. None have assessed the impact of n-3 PUFA supplementation on cardiovascular mortality as the primary outcome in this population [26,27].…”

An outpatient department based observational study to review the pattern of utilization of proton pump inhibitors for their co-relation with the indications in a tertiary care centre

“…Antioxidants are not proven to be of survival benefit for any ailment till date. 20 Hence it can be inferred that the inclusion of antioxidants is for providing a placebo cum feel good factor. Inclusion of medicines in prescriptions that are not actually indicated or are of dubious benefit should be avoided.…”