Effect of three sources of long-chain fatty acids on the plasma fatty acid profile, plasma prostaglandin E2 concentrations, and pruritus symptoms in hemodialysis patients

Abstract

Patients with chronic renal failure exhibit plasma fatty acid patterns indicative of essential fatty acid deficiency. The plasma fatty acid profile of 25 hemodialysis patients with a history of pruritus symptoms indicated lower 20:3n-9 (eicosatrienoic acid), 20:4n-6 (arachidonic acid), and 20:5n-3 (eicosapentaenoic acid) concentrations; a higher 18:1n-9 (oleic acid) concentration; and above-normal ranges of prostaglandin E2 (PGE2) compared with 22 subjects chosen from a normal population. No significant difference in 22:6n-3 (docosahexaenoic acid) was shown between the hemodialysis patients and the normal subjects. The dietary intake of 20:5n-3 was higher and that of 18:1n-9 lower in the patients compared with the normal population group. In this 8-wk double-blind study the hemodialysis patients were randomly assigned to receive daily supplements of 6 g ethyl ester of either fish oil, olive oil, or safflower oil. At the end of 8 wk of treatment the fish oil group (FO group) had a greater decrease in 18:1n-9 (P < 0.05), greater increases in 20:5n-3 and 22:6n-3 (P < 0.01), and trends toward a greater decrease in 20:4n-6, a greater increase in PGE2 concentrations, and greater improvement in pruritus scores (0.10 > P > 0.05) compared with the other two groups. The increases in 20:5n-3 and 22:6n-3 in the FO group indicate compliance with fish oil supplementation. Results indicate that hemodialysis patients have abnormal fatty acid profiles and increased PGE2 values. Fish oil intervention changes the fatty acid profile and may improve the symptoms of pruritus.

Plasma Fatty Acid Composition in Continuous Ambulatory Peritoneal Dialysis Patients: An Increased Omega-6/Omega-3 Ratio and Deficiency of Essential Fatty Acids

“…12 These abnormalities could be related to the abnormal FA profile and resulting abnormal prostaglandin synthesis. 15 In this study, we have found a significant decrease in plasma DHA levels in CAPD patients whereas no significant difference between plasma EPA levels of the groups was noticed.…”

“…However, Ristić et al 3 have found that EPA and DHA levels were significantly lower in hemodialysis patients than in the control subjects. Also, Peck et al 15 have found that EPA level was significantly lower in hemodialysis patients than in the control subjects but they have found no difference between DHA levels of the groups.…”

Therapeutic Effects of Omega-3 Fatty Acids on Chronic Kidney Disease-Associated Pruritus: a Literature Review

“…Disparate disease states obtaining clinical benefits from omega-3 supplementation included dyslipidemia, hypertension, IgA nephropathy, HD access thrombosis/stenosis, cardiovascular diseases, oxidative stress, immune response and inflammation, malnutrition, depression, and uremic pruritus. 23,[25][26][27] Three randomized controlled trials have shown a significant improvement in pruritus symptoms in CKD patients who took omega-3 supplement compared to omega-6, omega-9, and placebo supplementation, 10,15,17 while a small pilot uncontrolled study failed to demonstrate beneficial effect of omega-3 supplement on symptoms of uremic pruritus.…”

“…In this section, we present fully the results of the published related studies in a chronological order. In the study of Peck et al 15 on 25 HD patients, randomized into three equal groups, oral daily intake of 6 g omega-3 fatty acid esters for 8 weeks produced a greater decrease in the serum concentration of arachidonic acid and greater increase in prostaglandin E 2 (PGE 2 ) concentration than the equal supplemental dose of olive oil and safflower oil. Based on subjective assessment of severity and distribution of pruritus symptoms, patients receiving omega-3 fatty acids experienced greater relief of pruritus than those treated with olive oil or safflower oil.…”

Review of the Effects of Omega-3 Supplementation in Dialysis Patients

“…These studies also report conflicting effects on cytokine and arteriosclerotic risk factor levels, such as IL-6, soluble IL-2 receptors, C-reactive protein, and homocysteine (69,78). Three randomized studies (one placebo controlled) did find that omega-3 supplementation shunted leukocyte production away from proinflammatory (e.g., leukotriene B 4 ) to much less or anti-inflammatory eicosanoid products (e.g., leukotriene B 5 ) (48,81,82). In summary, although the biologic mechanisms underlying fish oil's effects on inflammation and immunity are well understood, the clinical effects, particularly using modest doses, need to be defined more clearly.…”