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

Abstract

Chronic dialysis patients experience a host of conditions that limit quality and length of life, and recent therapeutic strategies have had only modest success in ameliorating many of these problems. By mediating cell membrane function and structure and the synthesis of lipid mediators such as eicosanoids, omega-3 fatty acids may offer dialysis patients a host of therapeutic benefits. Omega-3 fatty acids are derived primarily from dietary sources, and cold-water fish is the main source of eicosapentanoic and docosahexanoic acids, the two major bioactive omega-3 fatty acids. Studies of omega-3 supplementation in dialysis patients describe salutary effects on triglyceride levels, dialysis access patency, and perhaps uremic pruritus and oxidative stress. In contrast, the putative hematologic, antihypertensive, anti-inflammatory, and antiarrhythmic effects are not as well documented. Adverse effects generally have been limited to gastrointestinal complaints. Unfortunately, the preponderance of published studies are characterized by suboptimal study design, small sample sizes, supraphysiologic omega-3 doses that may be difficult to consume for extended periods, little long-term follow-up, and a lack of confirmation of compliance. Not surprising, the 2005 National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients recommend further research in this field. In summary, although preliminary data suggest that omega-3 fatty acids may have clinical benefits, formal recommendations encouraging omega-3 supplementation of dialysis patients are premature until long-term and adverse effects are better defined.

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

“…However, accumulating evidence proposes that the fish oil-derived bioactive fatty acids, particularly EPA and DHA, provide a host of multiple health benefits for patients with advanced kidney disease. 23 Omega-3 polyunsaturated fatty acids (omega-3 PUFA) have been used as part of the human diet for many years. 24 The three main omega-3 PUFA, namely EPA, docosapentaenoic acid, and DHA are long chain (twenty or more carbons in length), polyunsaturated (two or more double bonds) in which one of double bonds exists in third carbon location from the methyl terminus ("n-3" or "omega-3").…”

“…25 Omega-3 PUFA supplementation have demonstrated promises in the general population in modulating multiple disease processes including the inflammatory and immune processes, the progression of arteriosclerosis and cardiovascular problems, cardiac arrhythmias, rheology, hypertension, and dyslipidemia. 23 However, despite the potential for various clinical benefits, omega-3 supplementation is neither used nor routinely recommended in the CKD population. Likely, this may be related partly to a general lack of awareness from the biochemical and clinical benefits of omega-3 supplementation.…”

“…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.…”

Omega-3 intake in people with epilepsy under regular hemodialysis program: here to stay

“…It provided evidence that fish oil may reduce the risk of SUDEP in epilepsy 27 , which was also confirmed experimentally [28][29][30] . In dialysis, omega-3 FAs have been clinically and experimentally assessed due to their proven benefits in advanced chronic kidney disease (CKD), such as renoprotection in IgA nephropathy, cardioprotection via a variety of mechanisms including triglyceride levels and blood pressure reduction, maintenance of dialysis access patency, sparing of inflammation-associated muscle loss, and reduced mortality 17,31,32 . In these lines, we fully agree with this and have recently confirmed it in a trial (Rui Alberto Gomes, PhD Thesis -unpublished data).…”

“…It also calls the attention for clinical trials designed to evaluate the effects of omega-3 FAs supplementation on cardiovascular risk and outcomes 17,[31][32][33] . It is important to note that sudden cardiac death is the most common cause of death in ESRD individuals under regular dialysis program usually caused by ventricular arrhythmias, such as ventricular tachycardia and fibrillation 34 .…”