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

Abstract

Background Numerous randomized clinical trials (RCTs) and meta-analyses have assessed the effects of supplemental dietary polyunsaturated fatty acids (PUFAs) on levels of low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs), and LDL/HDL ratios in renal replacement therapy patients. However, the results have been ambiguous due to mixed reports of various nutrients used in the intervention group. We performed a network meta-analysis of randomized clinical trials to assess the effects of PUFAs on lipid profiles in renal replacement therapy patients. Methods RCTs performed prior to September 2020 were gathered from three databases. The means, standard deviations, and the number of cases for each arm were independently extracted by 2 authors for forming a network meta-analysis of LDL and HDL levels, and LDL/HDL ratios in random-effects model. Results Twenty-seven RCTs (n=1975) were included in this study. The pooled results revealed that the combination of omega-3 fatty acids (n-3) and omega-6 fatty acids (n-6) was significantly lower for the LDL (standardized mean difference [SMD]: −0.95, 95% confidence interval [CI]: −1.87 to −0.13) than the placebo, and the placebo resulted in significantly lower HDL than n-3 (SMD: −0.85, 95% CI: −1.50 to −0.20). There was no evidence of inconsistency or publication bias in the pooled results. Conclusions Collectively, PUFAs seems to be effective nutrients in controlling lipoprotein among renal replacement therapy patients. To be specific, n-3+n-6 improves LDL, and n-3 improves HDL and LDL/HDL. However, our data provide limited information on specific dosages of PUFAs to guide the clinical treatment of renal replacement therapy patients.