|Year : 2016 | Volume
| Issue : 2 | Page : 265-268
Effect of omega-3 supplementation on lipid profile and inflammatory markers in children on chronic hemodialysis
Ali M Elshafie, Mohammed H Bahbah, Fathia M Elnemr, Ghada M Elmeshad, Mohamed A Mohamed Elsayed
Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||08-Sep-2014|
|Date of Acceptance||16-Nov-2014|
|Date of Web Publication||18-Oct-2016|
Mohamed A Mohamed Elsayed
61 Portsaid Street, Quesna, 32631 Menoufia
Source of Support: None, Conflict of Interest: None
The aim of this study was to evaluate the effect of omega-3 supplementation on the lipid profile and inflammatory markers in children on chronic hemodialysis.
Children with end-stage renal disease on hemodialysis are at a high risk of adverse cardiovascular events. Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality in dialysis patients, Patients who are on hemodialysis have elevated serum levels of inflammatory markers. There is a growing interest in the application of omega-3 fatty acids in the prevention of cardiovascular disorders in dialysis patients. Omega-3 fatty acids have been postulated to reduce proinflammatory response, confer antithrombotic properties, improve lipid levels (particularly triglycerides), and improve endothelial function.
Materials and methods:
This clinical trial was conducted in 23 children with end-stage renal disease undergoing dialysis in the pediatric hemodialysis unit of Menoufia University Hospitals. The patients received 1 g omega 3 per day for 3 months. Blood samples were obtained from the patients studied before and at the end of the study for hemoglobin, ferritin, triglyceride, total cholesterol, LDL-c and HDL-c, and high specific-C-reactive protein measurement, and the differences were analyzed.
Of 23 patients, 12 were males and 11 were females, mean age 14.52 (8–18) years. There were statistically highly significant differences between the level of triglycerides before (148.86 ± 44.41 mg/dl), and after supplementation with omega-3 fatty acid (135.17 ± 45.99 mg/dl) (P<0.001). The differences found in hemoglobin, parathyroid hormone, ferritin, C-reactive protein, LDL-c, and HDL-c before and after supplementation with omega-3 fatty acid were not statistically significant (P> 0.05).
The use of omega 3 led to a significant decrease in serum levels of triglycerides in children on hemodialysis, and its use may be recommended in such patients.
Keywords: hemodialysis, inflammation, lipid, omega 3
|How to cite this article:|
Elshafie AM, Bahbah MH, Elnemr FM, Elmeshad GM, Mohamed 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
|How to cite this URL:|
Elshafie AM, Bahbah MH, Elnemr FM, Elmeshad GM, Mohamed Elsayed MA. Effect of omega-3 supplementation on lipid profile and inflammatory markers in children on chronic hemodialysis. Menoufia Med J [serial online] 2016 [cited 2020 Sep 29];29:265-8. Available from: http://www.mmj.eg.net/text.asp?2016/29/2/265/192431
| Introduction|| |
Chronic kidney disease (CKD) is a public health problem, and the prevalence rate is increasing worldwide. The high incidence of cardiovascular disease (CVD) in CKD patients is related to chronic inflammation, dyslipidemia, malnutrition, atherosclerosis, and vascular calcification .
Supplementation with omega-3 polyunsaturated fatty acids (ω-3 PUFAs) has been linked to reducing the risk of CVD . Dyerberg et al.  found that Greenland Inuit who consumed a diet including a high content of ω-3 PUFAs had low mortality from coronary heart disease. Subsequent studies found that ω-3 PUFAs intake is associated with a reduced risk of CVD . This cardioprotective effect of ω-3 PUFAs is explained by its ability to suppress inflammation, inhibit platelet activation/adhesion, and reduce thrombosis . The main effect of ω-3 PUFAs is reduction of triglyceride levels in patients with hypertriglyceridemia, which is associated with CVD . In addition, ω-3 PUFAs reduced oxidative stress and had the possibility to inhibit vascular calcification in human studies and a rat model .
Therefore, ω-3 PUFAs, which have several benefits in CVD, may be helpful to reduce CVD in CKD patients, who have a high prevalence rate of CVD .
| Materials and Methods|| |
This study was carried out in the Pediatric Hemodialysis Unit in the Pediatrics Department at Menoufia University Hospital during the period from January 2014 to April 2014.
The Ethics Committee of the Faculty of Medicine, Menoufia University, approved the study protocol, and informed written consent was obtained from each patient.
The study included 28 patients with end-stage renal failure (ESRD) on regular hemodialysis three times weekly for at least 3 months before the start of the study; five of these patients were later excluded (three because of their age, they were older than 18 years of age, and another two because of noncompliance).
All patients were treated daily with 1000 mg (omega-3 plus) capsule containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexaenoic acid (DHA) for 3 months.
All the patients were chosen on the basis of the following criteria.
- ESRD with childhood onset of hemodialysis and age younger than 18 years.
- Regular hemodialysis, with at least three sessions a week.
- Duration of hemodialysis more than 3 months.
- Predialysis stages of CKD.
- Patients on chronic peritoneal dialysis.
- Patients on regular hemodialysis for less than 3 months.
- Primary (nonuremic) CVD.
- Metabolic disease (e.g. primary hyperparathyroidism).
- History of acute inflammatory conditions.
All the study patients received 1 g of omega-3 fatty acid per day (1 g omega-3 plus once a day) for 3 months.
Blood samples was taken from all patients for the measurement of lipid profile, high-sensitivity C-reactive protein (hs-CRP), complete blood count, serum levels of parathyroid hormone (PTH), iron, iron saturation, serum ferritin, and total calcium, and phosphorous before the start of the study and after 3 months at the end of the study.
The results are expressed as means ± SD. The collected data were analyzed by the SPSS-15 (SPSS Inc., Chicago, IL, USA) statistical software using a paired t-test or the Wilcoxon signed-rank test. P-values less than 0.05 were considered statistically significant.
| Results|| |
Overall, 23 patients completed the study; their mean age was 14.52 years, range (8–18 years). There were 12 (52.2%) males and 11 (47.8%) females ([Table 1]).
[Table 2],[Table 3],[Table 4],[Table 5] show a comparison of the variables studied before and after supplementation with omega-3 fatty acids.
|Table 2: Lipid profile of the patients studied before and after supplementation of omega-3|
Click here to view
|Table 4: Hemoglobin, ferritin, and iron saturation of the patients studied before and after supplementation of omega 3|
Click here to view
|Table 5: Ca, PO4, Ca × PO4, and PTH levels of the patients studied before and after supplementation of omega 3|
Click here to view
There were statistically highly significant differences between the level of triglycerides before, 148.86 ± 44.41 mg/dl, and after supplementation with omega-3 fatty acid, 135.17 ± 45.99 mg/dl (P < 0.001) ([Table 6]).
There was no statistically significant difference in the levels of hemoglobin (Hb), PTH, ferritin, total, LDL-c, and HDL-c before and after supplementation with omega-3 fatty acids (P>0.05).
The mean hs-CRP level was 6.25 ± 3.32 mg/dl before supplementation, which decreased to 5.59 ± 4.80 mg/l after supplementation; however, this was not statistically significant.
The reported side effects were nausea in three patients and occasional vomiting in one patient.
| Discussion|| |
Omega-3 fatty acids have shown promise in modifying a host of disease processes involving the inflammatory pathways, arteriosclerosis and CVD, cardiac dysrhythmias, and lipid regulation ,,.
Many studies have been carried out in adults with CRF on hemodialysis to evaluate the effect of omega-3 supplementation on the lipid profile and inflammatory markers; however, very little has been published on its effect in children.
In our study, in 23 children on chronic hemodialysis who received 1 g of omega-3 fatty acid daily for 3 months, triglyceride levels reduced significantly ([Table 2]); this result is in agreement with the study carried out by Taziki et al.  on 16 hemodialysis adult patients. It was shown that daily consumption of 2 g of omega-3 fatty acid for 3 months reduced triglyceride levels significantly and increased the level of HDL-c, but it did not alter the total cholesterol and LDL-c levels.
Also, in the study carried out by Movahedian et al.  on 42 hyperlipidemic male ESRD patients under regular hemodialysis, aged 35–70 years, who were treated with 2000 mg fish oil containing 360 mg EPA and 240 mg DHA daily for 3 months, it was found that on comparison of presupplementary and postsupplementary omega-3 fatty acid data, a significant reduction in the levels of triglyceride (25%) was observed.
Also, Svensson et al.  studied 206 hemodialysis adult patients in 11 hospitals in Denmark in a double-blinded clinical trial. They showed that daily intake of two 1.7 g capsules of omega 3 for 6 months led to a significant reduction in serum triglyceride levels without any clear effect on total cholesterol levels, HDL-c, and LDL-c.
In our study, [Table 3] shows that there was an insignificant reduction in the hs-CRP level in omega-3-treated patients, which is comparable with the study of Madsen et al. , who carried out a randomized, double-blind, placebo-controlled study. They found a trend toward a reduction in hs-CRP in the n-3 PUFA group, but there was no significant difference in hs-CRP levels when both groups were compared.
Bowden et al.  reported that consumption of 960 mg/day of EPA and 600 mg/day of DHA led to lower CRP levels. However, low-dose omega-3 fatty acids had no effect on the plasma hs-CRP levels.
Rasic-Milutinovic et al. studied the effects of omega-3 fatty acid (2.4 g/day) administered for 8 weeks in 35 patients with CRF on maintenance HD. There was a significant decrease in the levels of hs-CRP (P = 0.01).
The absence of a significant reduction in hs-CRP in our study may be because of the need for larger doses of omega 3 to exert its anti-inflammatory effect.
In our study, the difference in Hb, ferritin, PTH, total LDL-c, and HDL-c before and after supplementation with omega-3 fatty acid was not statistically significant (P>0.05); this also in agreement with studies carried out by Taziki et al. and Svensson et al.  that showed that levels of Hb, ferritin, PTH, total LDL-c, and HDL-c before and after supplementation with omega-3 fatty acid did not show significant differences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mizobuchi M, Towler D, Slatopolsky E. Vascular calcification: the killer of patients with chronic kidney disease. J Am Soc Nephrol 2009; 20: 1453–1464.
Marchioli R. Dietary supplementation with N-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. The Lancet 1999; 354:447–455.
Dyerberg J, Bang HO, Hjorne N. Fatty acid composition of the plasma lipids in Greenland eskimos. Am J Clin Nutr 1975; 28:958–966.
Hu FB, Bronner L, Willett WC, Stampfer MJ, Rexrode KM, Albert CM, et al.
Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002; 287:1815–1821.
An WS, Kim SE, Kim KH, Lee S, Park Y, Kim HJ, Vaziri ND Comparison of fatty acid contents of erythrocyte membrane in hemodialysis and peritoneal dialysis patients. J Ren Nutr 2009; 19:267–274.
Tomiyama H, Takazawa K, Osa S, Hirose K, Hirai A, Iketani T, et al.
Do eicosapentaenoic acid supplements attenuate age-related increases in arterial stiffness in patients with dyslipidemia?: a preliminary study. Hypertens Res 2005; 28:651–655.
An WS, Lee SM, Son YK, Kim SE, Kim KH, Han JY, et al.
Effect of omega-3 fatty acids on the modification of erythrocyte membrane fatty acid content including oleic acid in peritoneal dialysis patients. Prostaglandins Leukot Essent Fatty Acids 2012; 86:29–34.
Friedman A, Moe S. Review of the effects of omega-3 supplementation in dialysis patients. Clin J Am Soc Nephrol 2006; 1:182–192.
Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2002; 112:298–304.
Leaf A, Kang JX, Xiao YF, Billman GE. Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation 2003; 107: 2646–2652.
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; 18:571–576.
Movahedian A, Bordbar-Bonab S, Rahbani-Nobar M Mortazavi M, Fattahi S, Dolatkhah H. Effect of omega 3 fatty acids on serum lipid profile, malondialdehyde and paraoxonase activity in patients with end stage renal disease under regular hemodialysis. Int J Pharm Chem Res 2013; 2:2278–8700.
Svensson M, Schmidt EB, Jorgensen 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; 23:2918–2924.
Madsen T, Schmidt EB, Christensen JH. The effect of n-3 fatty acids on C-reactive protein levels in patients with chronic renal failure. J Ren Nutr 2007; 17:258–263.
Bowden RG, Wilson RL, Deike E, Gentile M. Fish oil supplementation lowers C-reactive protein levels independent of triglyceride reduction in patients with end-stage renal disease. Nutr Clin Pract 2009; 24: 508–512.
Rasic-Milutinovic Z, Perunicic G, Pljesa S, Gluvic Z, Sobajic S, Djuric I, Ristic D Effects of N-3 PUFAs supplementation on insulin resistance and inflammatory biomarkers in hemodialysis patients. Ren Fail 2007; 29: 321–329.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]