Beneficial Effects of 6-Month Supplementation with Omega-3 Acids on Selected Inflammatory Markers in Patients with Chronic Kidney Disease Stages 1-3

The vicious circle of chronic kidney disease and hypertriglyceridemia: What is first, the hen or the egg?

Chronic kidney disease (CKD) is documented to cause alterations in lipid metabolism, and this was considered a potent driver of increased cardiovascular risk. Among the diverse alteration of lipid traits in CKD, research endeavours have predominantly concentrated on low-density lipoproteins (LDL) in view of the potent pro-atherogenic role of these lipoprotein particles and the demonstration of protective cardiovascular effect of reducing LDL. However, few studies have focused on the metabolism of triglyceride-rich lipoproteins and even fewer on their role in causing kidney damage. Therefore, the comprehensive description of the impact of hypertriglyceridemia (HTG) in CKD pathophysiology remains largely undetermined. This reflects the difficulty of disentangling the independent role of triglycerides (TG) in the complex, bidirectional relationship between TG and kidney disease. Abnormal neutral lipid accumulation in the intrarenal vasculature and renal cells eventually due to HTG may also promote glomerular injury, throughout mechanisms including oxidative stress, mitochondrial dysfunction and proinflammatory responses. While epidemiological and experimental evidence suggests a potential role of TG in kidney damage, the causal mechanisms and their clinical relevance remain unclear, representing a significant area for future investigation. This review aims to highlight the intricate interplay between TG metabolism and kidney disease, shedding light on the mechanisms through which HTG may influence kidney functionality.

Renal Safety Assessment of Lipid-Lowering Drugs: Between Old Certainties and New Questions

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Quantitative and qualitative changes in plasma lipoprotein profiles are frequently associated with CKD and represent a significant risk factor for CVD in patients with CKD. Guidelines from the European Society of Cardiology and the European Atherosclerosis Society classify CKD as a condition with high or very high cardiovascular risk and set specific low-density lipoprotein cholesterol targets. Conventional lipid-lowering therapies (LLTs), such as statins, ezetimibe, and fibrates, can control CKD-associated dyslipidemia and, to some extent, prevent major atherosclerotic events in patients with CKD, but their use in clinical practice presents challenges because of the potential renal safety concerns. In recent years, novel therapies with the ability to lower both low-density lipoprotein cholesterol and triglycerides have been introduced to the market (e.g., proprotein convertase subtilisin/kexin type 9 inhibitors, bempedoic acid, lomitapide, volanesorsen) to improve our ability to control lipid abnormalities. However, their impact on kidney functionality has not been fully elucidated. The aim of this review was to examine the renal safety profiles of various LLTs, with special reference to novel medications, and to highlight important considerations and guidance for the use of these medications in overt CKD or in patients with some degree of renal function impairment. We underscore the lack of a comprehensive understanding of kidney safety, particularly for novel LLT therapies, and strongly emphasize the importance of future dedicated research to fully assess the safety and efficacy of these agents in patients with kidney abnormalities.

The effects of omega-3 fatty acids supplementation on hemoglobin, hematocrit, and platelet levels of patients with ESRD condition undergoing dialysis

Background

Concomitant inflammation may boost the cardiovascular complications in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Omega-3 fatty acids may have certain health benefits in HD patients. The aim of this study was to investigate the effects of omega-3 fatty acids supplementation on hematocrit (HCT), hemoglobin (HB) level and platelet (PLT) counts of HD patients.

Methods

A randomized controlled trial was conducted on HD patients at a private dialysis center in Rasht, Iran. Three omega-3 fatty acid supplement capsules (3 g/d) were administered daily for two months to patients in the intervention group (n = 55). The control group (n = 60) were given three placebo capsules containing medium chain triglyceride (MCT) oil, similar to the supplemental dose of the intervention group at the same period. Three parameters of HCT, HB and PLT were measured at baseline and after the intervention.

Results

The PLT count decreased in the intervention group compared to the control group (173.38 ± 74.76 vs. 227.68 ± 86.58 103/mm3, F = 4.83, P = 0.03). No significant change was found on the levels of HCT and HB parameters between the two groups after the intervention.

Conclusion

Omega-3 supplementation in HD patients may decrease the risk of forming blood clots in the blood vessels. Further studies are warranted.

Omega-3 supplementation effects on cardiovascular risk and inflammatory profile in chronic kidney disease patients in hemodialysis treatment: An intervention study

BACKGROUND AND AIMS

Chronic Kidney Disease (CKD) is characterized by slow, progressive, and irreversible kidney function loss and the disease itself and hemodialysis treatment can predispose an inflammatory state that increased cardiovascular complications, being one of major mortality causes in kidney patients. The study purpose was to evaluate nutritional profile and impacts of w-3 fatty acid supplementation on inflammatory parameters and cardiovascular events risk in patients with CKD undergoing hemodialysis treatment.

METHODS

Non-randomized clinical trial, patients with CKD were randomly grouped into a control (n = 29) and supplemented (n = 30) group. Supplemented group patients were instructed to consume two w-3 capsules a day (2g/day) for 8 weeks for further analysis of pre- and post-supplementation C-reactive protein (CRP) and other blood parameters. To nutritional status assessment, anthropometric and bioelectrical impedance data were measured, carried out close to supplementation start.

RESULTS

59 patients were evaluated, 49.1% (n = 29) were overweight and 70.7% (n = 41) had high percentage of body fat. Comparing control versus supplemented groups after supplementation serum CRP levels have reduced, no differences were observed (p = 0.716) nevertheless there was reduction in cardiovascular events risk according to C-reactive protein classification (p = 0.004). Ferritin levels have improved in all groups. Changes in the levels of other biochemical markers hemoglobin, hematocrit, urea, creatinine, and Kt/v have happened. However, group that received w-3 showed an improvement in serum albumin levels (p = 0.014), in addition to demonstrating greater adequacy classification of albumin after supplementation (p = 0.022).

CONCLUSION

Omega-3 supplementation have caused an improvement in albumin plasma levels suitableness in Chronic Kidney Disease patients, however, it did not demonstrate statistical effects to reducing CRP levels, although this helped to reduce cardiovascular risk.

Plasma and urinary F2-isoprostane markers of oxidative stress are increased in cats with early (stage 1) chronic kidney disease

OBJECTIVES

Oxidative stress contributes to chronic kidney disease (CKD) progression in humans and rodent models; F2-isoprostanes (F2-IsoPs) are established biomarkers of oxidative stress. Our primary aim was to evaluate plasma F2-IsoPs in cats with International Renal Interest Society stage 1 and 2 CKD, compared with healthy cats, and to determine whether plasma and urinary F2-IsoPs are equivalent biomarkers. The secondary aim was to assess whether consumption of a renal diet enriched in omega-3 fatty acids led to improvements in plasma and urinary F2-IsoPs.

METHODS

Plasma and urinary F2-IsoPs were measured in 24 cats with stage 1 or 2 CKD, and 12 unaffected controls aged ⩾6 years. Twelve CKD cats were re-evaluated after feeding a commercial renal diet for at least 4 weeks.

RESULTS

Median plasma F2-IsoPs were significantly higher in stage 1 CKD (96.2 pg/ml), early stage 2 CKD (83.2 pg/ml) and late stage 2 CKD (80.8 pg/ml) compared with healthy cats (22.8 pg/ml; P = 0.03-0.002). Median urinary F2-IsoPs were significantly higher in cats with stage 1 CKD (231.2 pg/mg) compared with healthy cats (152.5 pg/mg) or cats with late stage 2 CKD (124.8 pg/mg; P = 0.01). Plasma F2-IsoPs remained increased, while urinary F2-IsoPs fell with transition from stage 1 to stage 2 CKD. Feeding a commercial renal diet led to significant decreases in plasma F2-IsoPs in the small group of cats with stage 1 CKD (25-75% decrease) compared with cats with stage 2 CKD (20% decrease to 53% increase; P = 0.01).

CONCLUSIONS AND RELEVANCE

Oxidative stress is prominent in cats with stage 1 CKD. Plasma and urinary F2-IsoPs are not interchangeable biomarkers in cats with stage 2 CKD. Placebo-controlled studies are indicated to evaluate dietary or pharmacologic doses of omega-3 fatty acids on redox stress and progression of renal dysfunction in cats with stage 1 CKD.

The effect of omega-3 fatty acid supplementation on clinical and biochemical parameters of critically ill patients with COVID-19: a randomized clinical trial

BACKGROUND

Omega-3 polyunsaturated fatty acids (n3-PUFAs) may exert beneficial effects on the immune system of patients with viral infections. This paper aimed to examine the effect of n3-PUFA supplementation on inflammatory and biochemical markers in critically ill patients with COVID-19.

METHODS

A double-blind, randomized clinical trial study was conducted on 128 critically ill patients infected with COVID-19 who were randomly assigned to the intervention (fortified formula with n3-PUFA) (n = 42) and control (n = 86) groups. Data on 1 month survival rate, blood glucose, sodium (Na), potassium (K), blood urea nitrogen (BUN), creatinine (Cr), albumin, hematocrit (HCT), calcium (Ca), phosphorus (P), mean arterial pressure (MAP), O2 saturation (O2sat), arterial pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), base excess (Be), white blood cells (WBCs), Glasgow Coma Scale (GCS), hemoglobin (Hb), platelet (Plt), and the partial thromboplastin time (PTT) were collected at baseline and after 14 days of the intervention.

RESULTS

The intervention group had significantly higher 1-month survival rate and higher levels of arterial pH, HCO3, and Be and lower levels of BUN, Cr, and K compared with the control group after intervention (all P < 0.05). There were no significant differences between blood glucose, Na, HCT, Ca, P, MAP, O2sat, PO2, PCO2, WBCs, GCS, Hb, Plt, PTT, and albumin between two groups.

CONCLUSION

Omega-3 supplementation improved the levels of several parameters of respiratory and renal function in critically ill patients with COVID-19. Further clinical studies are warranted. Trial registry Name of the registry: This study was registered in the Iranian Registry of Clinical Trials (IRCT); Trial registration number: IRCT20151226025699N3; Date of registration: 2020.5.20; URL of trial registry record: https://en.irct.ir/trial/48213.

The use of omega-3 fatty acids in the treatment of oral diseases

Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been reported to exert important roles in the inflammatory response. There are many inflammatory diseases in dentistry which support the administration of ω-3 PUFAs as an adjunct therapy during the treatment of these diseases. The aim of this review was to evaluate the use of ω-3 PUFAs as an adjuvant therapy during the treatment of buccal diseases. The review showed that supplementation with ω-3 PUFAs was used for treatment of gingivitis, periodontal diseases, apical periodontitis, stomatitis, and orthodontic tooth movement. The results indicate that ω-3 PUFAs decreased the number of pro-inflammatory mediators in the gingival tissues of individuals with gingivitis and periodontitis. In apical periodontitis, the supplementation suppressed bone resorption and promoted bone formation in the periapical area of rats. During orthodontic movement, the supplementation showed a decrease of bone resorption in rats. It also showed that painful symptoms of recurrent aphthous stomatitis were alleviated in supplemented patients. In conclusion, the ω-3 PUFAs may be used as an adjuvant therapy in the treatment of inflammatory diseases that affect the oral cavity. However, more studies are required to elucidate the role of ω-3 PUFAs in decreasing oral cavity inflammatory processes.

Effect of Omega-3 supplements on quality of life among children on dialysis: A prospective cohort study

Children with end stage renal disease (ESRD) are liable to various health disorders that possibly impair their quality of life (QoL). Low dietary intake of Omega-3 fatty acids also called marine n-3 fatty acid (n-3 FA) may be associated with health problems which are among the leading causes of impaired QoL.The objective of this study was to assess the effect of omega-3 Fatty acid (n-3 FA) supplements on quality of life among children on dialysis and to evaluate its use regarding adequacy of dialysis and inflammatory markers.A prospective cohort study was conducted on 31 hemodialysis children. Quality of life was measured for patients and an equal number of matched controls using the PedsQL Inventory where the higher the score the poorer is the quality of life. n-3FA supplementation had been given to the patients for 3 months to study its effects on QoL. Laboratory investigations like hemoglobin, lipid profile, inflammatory markers, and tests for adequacy of dialysis had been carried out.Patients had significantly higher QoL scores (42.22 ± 13.31) than controls (22.70 ± 1.31) (P < .001). Young ages showed higher score of physical functioning (18.23 ± 4.22) than older ones (13.92 ± 6.84) (P = .049). Females had significantly higher total QoL score (25.53 ± 6.61) than males (20.06 ± 7.09) (P = .010). The total QoL score was significantly lower post than pre administration of n-3FA (35.41 ± 10.36 vs 42.22 ± 13.31) (P < .001). Triglycerides and CRP were significantly lower post than pre n-3FA supplementation (160.64 ± 32.55 vs 169.35 ± 31.82) (P < .001) and (10.29 ± 4.39 vs 11.19 ± 4.83) (P = .006) respectively. Means of Kt/V and urea reduction ratio (URR) were significantly higher post (1.37 ± 0.09, 70.0 ± 5.99 respectively) than pre n-3FA (1.31 ± 0.07 and 65.25 ± 6.06 respectively) (P = .005, .001 respectively).Quality of life and adequacy of dialysis get improved after n-3FA supplementation among children on dialysis which encourages its testing for more patients to evaluate its long term effects and support its routine use.

Heart Rate Variability: A Potential Tool for Monitoring Immunomodulatory Effects of Parenteral Fish Oil Feeding in Patients With Sepsis

Fish oil, rich in the very-long chain omega (ω)-3 polyunsaturated fatty acids (PUFAs), has been found to have immunomodulatory effects in different groups of critically ill patients. In addition, its parenteral administration seems to attenuate the inflammatory response within 2 to 3 days. The activation of the cholinergic anti-inflammatory pathway has been suggested to mediate such immunoregulatory effects. As different experimental studies have convincingly illustrated that enhanced vagal tone can decrease pro-inflammatory cytokine secretion, novel monitoring tools of its activity at the bedside could be developed, to evaluate nutritional manipulation of immune response in the critically ill. Heart rate variability (HRV) is the variability of R-R series in the electrocardiogram and could be a promising surrogate marker of immune response and its modulation during fish oil feeding, rich in ω-3 PUFAs. Heart rate variability is an indirect measure of autonomic nervous system (ANS) output, reflecting mainly fluctuations in ANS activity. Through HRV analysis, different "physiomarkers" can be estimated that could be used as early and more accurate "smart alarms" because they are based on high-frequency measurements and are much more easy to get at the bedside. On the contrary, various "biomarkers" such as cytokines exhibit marked interdependence, pleiotropy, and their plasma concentrations fluctuate from day to day in patients with sepsis. In this respect, an inverse relation between different HRV components and inflammatory biomarkers has been observed in patients with severe sepsis and septic shock, whereas a beneficial effect of ω-3 PUFAs on HRV has been demonstrated in patients with cardiovascular diseases. Consequently, in this article, we suggest that a beneficial effect of ω-3 PUFAs on HRV and clinical outcome in patients with sepsis merits further investigation and could be tested in future clinical trials as a real-time monitoring tool of nutritional manipulation of the inflammatory response in the critically ill.