Efficacy of Polyunsaturated Fatty Acids on Inflammatory Markers in Patients Undergoing Dialysis: A Systematic Review with Network Meta-Analysis of Randomized Clinical Trials

Abstract

The effects of polyunsaturated fatty acids (PUFAs) on inflammatory markers among patients receiving dialysis have been discussed for a long time, but previous syntheses made controversial conclusion because of highly conceptual heterogeneity in their synthesis. Thus, to further understanding of this topic, we comprehensively gathered relevant randomized clinical trials (RCTs) before April 2019, and two authors independently extracted data of C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) for conducting network meta-analysis. Eighteen eligible RCTs with 962 patients undergoing dialysis were included in our study. The result showed that with placebo as the reference, PUFAs was the only treatment showing significantly lower CRP (weighted mean difference (WMD): −0.37, 95% confidence interval (CI): −0.07 to −0.68), but the CRP in PUFAs group was not significantly lower than vitamin E, PUFAs plus vitamin E, or medium-chain triglyceride. Although no significant changes were noted for hs-CRP and IL-6 levels, PUFAs showed the best ranking among treatments according to surface under the cumulative ranking. Therefore, PUFAs could be a protective option for patients receiving dialysis in clinical practice.

Kidney Inflammation, Injury and Regeneration

“…This Special Issue covers research articles that investigated the molecular mechanisms of inflammation [1][2][3] and injury [4,5] during different renal pathologies and renal regeneration [6], diagnostics using new biomarkers [7][8][9], and the effects of different stimuli like medication or bacterial components on isolated renal cells or in vivo models [10][11][12], all of which were summarized in a very simplified manner. Furthermore, this Special Issue contains important reviews that dealt with the current knowledge of cell death and regeneration [13,14], inflammation [15][16][17][18], and the molecular mechanisms of kidney diseases [19][20][21][22]. In addition, the potential of cell-based therapy approaches that use mesenchymal stromal/stem cells (MSCs) or their derivates is summarized [23][24][25].…”

“…MSCs predominantly act through secreted factors, including microRNAs that are contained within extracellular vesicles, cytoprotective effects anti-inflammatory effects, anti-apoptotic effects, and the suppression of oxidative stress. In addition, further reviews summarized the inflammation-mediated mechanisms or the inflammasome in various renal diseases [15][16][17][18]26,27]. Very interesting and new approaches shed a light on the role of non-coding RNAs, either in the progression of glomerular or tubulointerstitial kidney diseases [20] or as new therapeutic targets or biomarkers for fibrotic changes [29].…”

Effect of omega-3 fatty acids supplementation on cardio-metabolic and oxidative stress parameters in patients with chronic kidney disease: a systematic review and meta-analysis

“…In line with our results, Saglimbene et al in 2020 [ 37 ] demonstrated that omega-3 FAs intake might decrease cardiovascular mortality in hemodialysis patients, but it is uncertain whether omega-3 FAs intake reduces the risk of mortality or ESKD in subjects with CKD. Wu et al [ 38 ] also indicated that omega-3 FAs supplementation might improve inflammatory factors in dialysis patients. In previous systematic reviews, omega-3 FAs intake has beneficial effects on the Lipid profile of CKD patients [ 39 , 40 ].…”

The Impact of ω-6 and ω-3 fatty acids on lipoproteins in renal replacement therapy patients: A Network Meta-Analysis of Randomized Clinical Trials

“…In fact, clarifying such interventions improves the quality of the pooled results and provides a better understanding of PUFA effects in dialysis patients. [40] In our experience, different regimens should also be evaluated more precisely. For instance, Vitamin E, a fat-soluble antioxidant, was frequently used either in control group or placebo group in many studies.…”