|Year : 2019 | Volume
| Issue : 3 | Page : 634-639
|Effect of high-dose Omega 3 on lipid profile and inflammatory markers in chronic hemodialysis children
Zein Abdellatif Omar1, Belal Abdelmohsen Montser2, Mohamed Ahmed Reda Farahat3
1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menofia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menofia, Egypt
3 Department of Quality, Manshea Sultan Hospital, Menoufia University, Menofia, Egypt
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|Date of Submission||03-Feb-2018|
|Date of Decision||14-Mar-2018|
|Date of Acceptance||18-Mar-2018|
|Date of Web Publication||26-Jun-2019|
| Abstract|| |
Atherosclerosis, cardiovascular diseases (CVDs), and inflammation are important problems in chronic kidney disease (CKD) patients on chronic hemodialysis (HD). Prevention of CKD patients of CVD can lower the mortality rate in them. Omega 3 may help in the treatment of inflammation and lipid abnormalities in end-stage renal disease (ESRD) patients on chronic HD. This study aimed to evaluate the effect of high-dose Omega 3 on lipid profile and inflammatory markers in ESRD children on chronic HD. This clinical trial was conducted on 49 ESRD children on chronic HD selected from pediatric HD unit of Menoufia University Hospital. The study was conducted for a period of three months. The selected children were supplemented with 2000-mg Omega 3 tablets daily; lipid profile and inflammatory markers were assessed at the beginning and at the end of the study. Supplementation with high-dose Omega 3 resulted in a highly statistically significant decrease in total cholesterol, triglyceride, low-density lipoprotein, interleukin-6, C- reactive protein levels and a highly statistically significant increase in high-density lipoprotein (P <0.001). The differences between hemoglobin, platelets, iron profile, parathyroid hormone, albumin, phosphorus, calcium, potassium, sodium, and efficiency of dialysis before and after Omega 3 supplementation were not statistically significant (P >0.05). Supplementation with highdose Omega 3 caused significant improvement in lipid profile and inflammatory markers of children on chronic HD.
|How to cite this article:|
Omar ZA, Montser BA, Farahat MA. Effect of high-dose Omega 3 on lipid profile and inflammatory markers in chronic hemodialysis children. Saudi J Kidney Dis Transpl 2019;30:634-9
|How to cite this URL:|
Omar ZA, Montser BA, Farahat MA. Effect of high-dose Omega 3 on lipid profile and inflammatory markers in chronic hemodialysis children. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2019 Jul 15];30:634-9. Available from: http://www.sjkdt.org/text.asp?2019/30/3/634/261337
| Introduction|| |
Chronic kidney disease (CKD) patients are at high risk for cardiovascular diseases (CVDs) due to chronic inflammation, dyslipidemia, malnutrition and atherosclerosis. About 50% of endstage renal disease (ESRD) patients on chronic hemodialysis (HD) have elevated inflammatory marker levels. Omega 3 is found in fish oil and is an unsaturated fatty acid with two or three strains that the human body cannot produce., People who consume fish have lower risk for hyperlipidemia, their Omega 3 and high-density lipoprotein (HDL) levels are higher, and their level of low-density lipoprotein (LDL) is lower than others. Omega 3 also improves the body’s natural anti-inflammatory response, which counteracts the progression of CVD. Administration of high-dose Omega 3 might cause gastrointestinal complaints (e.g., fishy aftertaste, nausea, and stomach upset). This clinical trial conducted on 49 ESRD children on chronic HD aimed to evaluate the effect of high-dose Omega 3 (2 g/day) for three months on their lipid profile and inflammatory markers.
| Subjects and Methods|| |
This clinical trial was conducted on 49 ESRD children on chronic HD selected from pediatric HD unit of Menoufia University Hospital. The study was conducted for a period of three months (from January 2016 to April 2016). The selected 49 children were supplemented by 2000-mg (high dose) Omega 3 capsules (two capsules daily) (Omega 3 plus, SEDICO, Egypt) containing 360-mg eicosapentaenoic acid and 240-mg docosahexaenoic acid for three months in the form of capsules (containing 1 g Omega 3 for each capsule). The Ethics Committee of the Faculty of Medicine, Menoufia University, approved the study protocol, and informed written consent was obtained from each patient after informing him/her that administration of high-dose Omega 3 might cause gastrointestinal complaints (e.g., fishy aftertaste, nausea, and stomach upset). Inclusion criteria included glomerular filtration rate <10 mL/min/1.73 m2, age <18 years old, and a period of regular HD at least three sessions per week for at least three months before the study. Exclusion criteria were predialysis stages of CKD or a period of regular HD for <3 months before the study or patients on chronic peritoneal dialysis or having primary CVD. Blood samples were collected from all patients at the start and at the end of the study for the measurement of pre- and post-dialysis blood urea nitrogen (BUN), pre- and post-dialysis serum crea-tinine, hemoglobin, platelet count, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone, albumin, phosphorus (Po^, calcium (Ca), potassium (K), sodium (Na), lipid profile [serum triglyceride (TG), cholesterol level, HDL, and LDL], and inflammatory markers [interleukin-6 (IL-6) and C-reactive protein (CRP)].
| Statistical Analysis|| |
The IBM Statistical Package for the Social Sciences version 21.0 (IBM Corp, Armonk, NY, USA) was used for data analysis. Data were expressed by mean, range, standard deviation (SD), frequency, percentage, paired /-test, and Wilcoxon signed-rank test. P < 0.001 was considered statistically highly significant, and P >0.05 was considered statistically nonsignificant.
| Results|| |
Regarding personal characteristics and anthro-pometric measurements of the studied 49 patients, their age ranged from eight to 17 years, their mean age was 13.33 ± 2.44 years, the number of males was 24 (49%), the number of females was 25 (51%), the mean height was 132.73 ± 15.27 cm, 37 patients (75.5%) had height below -2 SD on Z score (stunted), the mean body mass index (BMI) was 17.04 ± 3 kg/m2, and 13 patients (26.5 %) had BMI below -2 SD on Z score [Table 1].
|Table 1: Personal characteristics and anthropometric measurements of the studied patients.|
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The most common cause of renal failure in the studied 49 patients was obstructive uropathy in 19 patients (38.7%), followed by unknown etiology in 16 patients (32.6%), glomerulonephritis in eight patients (16.3%), cystic kidney diseases in four patients (8.1%), and finally, cystinosis in two patients (4%) [Table 2].
No meaningful changes were found in blood pressure, hemoglobin, platelets, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone level, albumin, efficiency of dialysis [Kt/V and urea reduction ratio (URR)], PO4, Ca, K, and Na levels (P >0.05) [Table 3], although there was a highly statistically significant decrease in total cholesterol (TC), TG, LDL, IL-6, and CRP levels and a highly statistically significant increase in HDL level (P < 0.001) before and after supplementation with high-dose Omega 3 [Table 4].
|Table 3: Blood pressure, mean hemoglobin, platelets, iron profile, parathyroid hormone, albumin, efficiency of dialysis, phosphorus, calcium, potassium, and sodium before and after Omega 3 supplementation of the studied patients.|
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|Table 4: Lipid profile and inflammatory markers (interleukin-6 and С-reactive protein) before and after Omega 3 supplementation of the studied patients.|
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| Discussion|| |
ESRD has become a serious health problem; it is well known that patients with ESRD on dialysis die at a younger age than healthy population as a result of CVD.,, Omega 3 plays an important role in reducing inflammation and decreasing oxidative stress and has an antiarrhythmic effect in ESRD patients.
This clinical trial was conducted on 49 ESRD children on chronic HD; their age ranged from 8 to 17 years, their mean age was 13.33 ± 2.44 years, 75.5% of them had height below -2 SD on Z score (stunted), and 26.5% of them had BMI below -2 SD on Z score (wasted), which agree with Lotfy et al who reported in their study that 78% of CKD children on chronic HD had growth retardation. Furthermore, Smith et al in their study reported that the height of more than 35% of children with CKD was <-1.88 SD on Z score.
The most common cause of renal failure in the studied 49 patients was obstructive uro-pathy in 19 patients (38.7%), followed by unknown etiology in 16 patients (32.6%). The findings of Hari et al, Hogg et al, and AlEisa et al agreed with the present study findings that the most common cause of renal failure was obstructive uropathy, while 32% were found with unknown etiology, in contrary to the findings of Hogg et al and AlEisa et al, in which it is a smaller percentage which may be explained by the lack of health care awareness or diagnostic facilities in developing countries.
In this clinical trial, there were no meaningful changes in blood pressure, hemoglobin, platelets, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone level, albumin, efficiency of dialysis (Kt/V and URR), P04, Ca, К, and Na levels (Ρ >0.05). The same results were reported by Taziki et al, Tayebi-Khosroshahi et al, and Svensson et al.
Supplementation of the studied patients with high-dose Omega 3 for three months resulted in a highly statistically significant decrease in TC, TG, LDL, IL-6, and CRP levels and a highly statistically significant increase in HDL (P <0.001). Similar results have been reported by El-Shinnawy et al in their study which reported that 4 g/day of Omega 3 in chronic HD adult patients for six months resulted in a significant decrease in serum TG level, TC level, and LDL together with an increase in HDL level. Furthermore, the findings of Goren et al, Panzetta et al, and Ando et al agreed with the present study findings that Omega 3 had a beneficial effect on the lipid profile of HD patients, but these results disagree with the study done by Elshafie et al who reported that 1 g Omega 3 per day for three months did not result in any statistically significant difference in LDL, HDL, and TC levels of chronic HD children. Furthermore, Omrani et al found that 1 g daily of Omega 3 for 10 weeks in chronic HD patients only showed significant decrease of serum TC level, but not other lipids. This difference in results may be due to the low dose of Omega 3 (1 g Omega 3) per day used by Elshafie et al and Omrani et al in their studies.
Tayyebi-Khosroshahi et al agreed with the present study results as they reported that 3 g of Omega 3 per day for three months in chronic HD patients showed a reduction of inflammatory markers (CRP and IL-6). Furthermore, Dashti et al reported in their study that 1800 mg of Omega-3 fatty acids per day for 4 months relatively improved high-sensitivity CRP and IL-6 of chronic HD patients. Furthermore, Daud et al reported that in chronic HD patients, 2.4 g Omega 3 after their routine dialysis session for six months had beneficial effects on CRP levels. Fiedler et al reported that using of only high doses of Omega 3 for a longer time could decrease inflammatory marker levels of CKD patients on regular HD.
| Conclusion|| |
Supplementation with high dose Omega 3 in this study population caused significant improvement of lipid profile and inflammatory markers of children on chronic hemodialysis. This needs to be evaluated in a larger multi centric study with long-term follow up to see if this leads to change in clinical outcomes such as cardiovascular events and infections.
Conflict of interest: None declared.
| References|| |
Mizobuchi M, Towler D, Slatopolsky E. Vascular calcification: The killer of patients with chronic kidney disease. J Am Soc Nephrol 2009;20:1453-64.
Jofré R, Rodriguez-Benitez P, López-Gómez JM, Pérez-Garcia R. Inflammatory syndrome in patients on hemodialysis. J Am Soc Nephrol 2006;17:S274-80.
Burr ML, Sweetham PM, Fehily AM. Diet and reinfarction. Eur Heart J 1994;15:1152-3.
Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: Evaluating the risks and the benefits. JAMA 2006;296: 1885-99.
Matsuyama W, Mitsuyama H, Watanabe M, et al.
Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD. Chest 2005;128:3817-27.
Colussi G, Catena C, Baroselli S, et al.
Omega-3 fatty acids: From biochemistry to their clinical use in the prevention of cardiovascular disease. Recent Pat Cardiovasc Drug Discov 2007;2:13-21.
Fetterman JW Jr., Zdanowicz MM. Therapeutic potential of n-3 polyunsaturated fatty acids in disease. Am J Health Syst Pharm 2009;66: 1169-79.
Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N
Engl J Med 1974;290:697-701.
Raine AE, Schwarz U, Ritz E. The Patients with Uremia: Hypertension and Cardiac Problems. Oxford: Oxford University Press; 1998. p. 1885-919.
Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic uremia. J Am Soc Nephrol 1999;10:1053-8.
Lee SM, An WS. Cardioprotective effects of ω -3 PUFAs in chronic kidney disease. Biomed Res Int 2013;2013:712949.
Lotfy HM, Sabry SM, Ghobrial EE, Abed SA. The effect of regular hemodialysis on the nutritional status of children with end-stage renal disease. Saudi J Kidney Dis Transpl 2015;26:263-70.
] [Full text]
Smith JM, Stablein DM, Munoz R, Hebert D, McDonald RA. Contributions of the transplant registry: The 2006 annual report of the North American pediatric renal trials and collaborative studies (NAPRTCS). Pediatr Transplant 2007;11:366-73.
Hari P, Singla IK, Mantan M, et al.
Chronic renal failure in children. Indian Pediatr 2003; 40:1035-42.
Hogg RJ, Furth S, Lemley KV, et al.
National kidney foundation’s kidney disease outcomes quality initiative clinical practice guidelines for chronic kidney disease in children and adolescents: Evaluation, classification, and stratification. Pediatrics 2003;111:1416-21.
Al-Eisa A, Naseef M, Al-Hamad N, Pinto R, Al-Shimeri N, Tahmaz M. Chronic renal failure in Kuwaiti children: An eight-year experience. Pediatr Nephrol 2005;20:1781-5.
Taziki O, Lessan-Pezeshki M, Akha O, Vasheghani F. The effect of low dose omega-3 on plasma lipids in hemodialysis patients. Saudi J Kidney Dis Transpl 2007;18:571-6.
] [Full text]
Tayebi-Khosroshahi H, Dehgan R, Habibi Asl B, et al.
Effect of omega-3 supplementation on serum level of homocysteine in hemodialysis patients. Iran J Kidney Dis 2013;7:479-84.
Svensson M, Schmidt EB, Jørgensen KA, Christensen JH. The effect of n-3 fatty acids on lipids and lipoproteins in patients treated with chronic haemodialysis: A randomized placebo-controlled intervention study. Nephrol Dial Transplant 2008;23:2918-24.
El-Shinnawy H, Bichari W, Makkeyah Y, Behairy M, Shabaan A. Effect of omega-3 fatty acids on vascular access patency in chronic hemodialysis patients. Life Sci J 2015;12:82-8.
Goren A, Stankiewicz H, Goldstein R, Drukker A. Fish oil treatment of hyperlipidemia in children and adolescents receiving renal replacement therapy. Pediatrics 1991;88:265-8.
Panzetta O, Cominacini L, Garbin U, et al.
Increased susceptibility of LDL to in vitro
oxidation in patients on maintenance hemodialysis: Effects of fish oil and vitamin E administration. Clin Nephrol 1995;44:303-9.
Ando M, Sanaka T, Nihei H. Eicosapentanoic acid reduces plasma levels of remnant lipoproteins and prevents in vivo
peroxidation of LDL in dialysis patients. J Am Soc Nephrol 1999;10:2177-84.
Elshafie AM, Bahbah MH, Elnemr FM, Elmeshad GM, Elsayed MA. Effect of omega-3 supplementation on lipid profile and inflammatory markers in children on chronic hemodialysis. Menoufia Med J 2016;29:265-8. [Full text]
Omrani HR, Pasdar Y, Raisi D, Najafi F, Esfandiari A. The effect of omega-3 on serum lipid profile in hemodialysis patients. J Renal Inj Prev 2015;4:68-72.
Tayyebi-Khosroshahi H, Houshyar J, Dehgan-Hesari R, et al.
Effect of treatment with omega-3 fatty acids on C-reactive protein and tumor necrosis factor-alfa in hemodialysis patients. Saudi J Kidney Dis Transpl 2012;23: 500-6. [Full text]
Dashti SK, Afshin G, Mohammad RK, et al.
Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients. Daru 2014;22:11.
Daud ZA, Tubie B, Adams J, et al.
Effects of protein and omega-3 supplementation, provided during regular dialysis sessions, on nutritional and inflammatory indices in hemodialysis patients. Vasc Health Risk Manag 2012;8:187-95.
Fiedler R, Mall M, Wand C, Osten B. Shortterm administration of omega-3 fatty acids in hemodialysis patients with balanced lipid metabolism. J Ren Nutr 2005;15:253-6.
Zein Abdellatif Omar
Department of Pediatrics, Faculty of Medicine, Menoufia University, Menofia
[Table 1], [Table 2], [Table 3], [Table 4]
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