Effect of Omega-3 Fatty Acids on Kidney Function after Myocardial Infarction

Abstract

Background and objectives Kidney function gradually decreases with age, and myocardial infarction accelerates this deterioration. Omega-3 (n-3) fatty acids may slow down the decline of kidney function. The effect of marine and plant-derived n-3 fatty acids on kidney function in patients after myocardial infarction was examined.Design, setting, participants, & measurements In the Alpha Omega Trial, 2344 patients with history of myocardial infarction ages 60-80 years old (81% men) were randomized to one of four trial margarines. The patients received an additional targeted amount of 400 mg/d eicosapentaenoic acid and docosahexaenoic acid, 2 g/d a-linolenic acid, eicosapentaenoic acid-docosahexaenoic acid plus a-linolenic acid, or placebo for 40 months. Serum cystatin C and serum creatinine were assessed at baseline and after 40 months. Creatinine-cystatin C-based GFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration equation.Results Patients consumed 19.9 g margarine/d, providing an additional 239 mg/d eicosapentaenoic acid with 159 mg/d docosahexaenoic acid, 1.99 g/d a-linolenic acid, or both in the active treatment groups. After 40 months, compared with baseline, mean (6SD) creatinine-cystatin C-based GFR was 26.9 (612.6), 24.8 (613.4), 26.2 (612.8), and 26.0 (613.0) ml/min per 1.73 m 2 in the placebo, eicosapentaenoic acid-docosahexaenoic acid, a-linolenic acid, and eicosapentaenoic acid-docosahexaenoic acid plus a-linolenic acid groups, respectively. After 40 months, in patients receiving eicosapentaenoic acid-docosahexaenoic acid compared with placebo, the decline in creatinine-cystatin C-based GFR was 2.1 less (95% confidence interval, 0.6 to 3.6; P,0.01) ml/min per 1.73 m 2 ; other comparisons were not statistical significant. Odds ratios (95% confidence intervals) of incident CKD (,60 ml/min per 1.73 m 2 ) and rapid decline of kidney function ($3 ml/min per year) for eicosapentaenoic acid-docosahexaenoic acid compared with placebo were 0.83 (0.58 to 1.18) and 0.85 (0.67 to 1.08), respectively.Conclusions Long-term supplementation with 400 mg/d eicosapentaenoic acid-docosahexaenoic acid provides a small beneficial effect on kidney function in patients with a history of myocardial infarction.

The Association between Marine n-3 Polyunsaturated Fatty Acid Levels and Survival after Renal Transplantation

“…Along with traditional CVD risk factors, post-transplant immunosuppressive treatment (24), pretransplant uremia (25), and renal graft function (18) constitute important risk factors for CVD in RTRs. Favorable effects of marine n-3 PUFA supplementation have been shown in diabetic nephropathy and IgA nephritis (26,27), and renal functions were better preserved with marine n-3 PUFA supplementation in patients with a history of MI (28). We found a steeper decline in renal function during the first 5 years after transplantation in patients with low levels of marine n-3 PUFAs, indicating potential renoprotective effects of marine n-3 PUFAs.…”

Nutrients, Nutraceuticals and Xenobiotics Affecting Renal Health

“…Similarly, in a meta-analysis of 17 trials, reduction in proteinuria with n-3 PUFA supplementation (0.7 to 5.1 g/day) was greater than in controls, while GFR decline was not modified by n-3 PUFA supplementation [87]. Interestingly, in the Alpha Omega Trial, a low level of EPA and DHA were given together with the trial margarine for 40 months, amounting a total of 400 mg/day, which corresponds to two servings of fatty fish/week: the supplementation had pronounced effects in slowing GFR decline of CKD patients [88]. No differences in GFR were observed between patients receiving 2.1 g/day omega-3 fish oil and controls [89].…”

Niacin and Progression of CKD

“…Despite the controversial mechanism of action of CETP inhibitors, 2 other CETP-inhibitor drugs are in clinical trials (evacetrapib 37 and anacetrapib 38 ), and their potential benefit is unknown. Fenofibrate 39-45 and omega 3 fatty acids 46 have been shown to have a modest renoprotective effect in terms of AER reduction or GFR decline. However, fibrates increase the risk for myopathy and rhabdomyolysis 47 in patients with CKD and thus cannot be considered seriously for reducing residual risk in patients with CKD.…”