Document Type : Original Article
Authors
- . Afsoon Emami Naini 1
- . Nooshin Keyvandarian 1
- . Mojgan Mortazavi 1
- . Shahram Taheri 1
- . Sayed Mohsen Hosseini 2
1 Department of Internal Medicine, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Biostatistics and Epidemiology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Objective: Hypertension and hyperlipidemia are two major risk factors for cardiovascular disease
in continuous ambulatory peritoneal dialysis (CAPD) patients. This study was designed to investigate
the effect of omega-3 fatty acids on blood pressure (BP) and serum lipids in CAPD patients.
Methods: This study was a randomized double‑blind clinical trial in which 90 CAPD patients
were randomly assigned to either the omega‑3 or the placebo group. Patients in omega‑3
group received 3 g/day omega‑3 for 8 weeks, whereas patients in the control group received
placebo. At baseline and at the end of 8 weeks, the patients’ BP was controlled, and serum
biochemistry was measured.
Findings: Mean systolic BP decreased (–22.2 ± 14.2 mmHg) in the omega‑3 group at the end
of the study while in the placebo group increased (+0.5 ± 30.2 mmHg) (P < 0.0001). Mean
diastolic BP of the omega‑3 group decreased more (–11.95 ± 11.9 mmHg) comparing with
the placebo group (–1.1 ± 17.3 mmHg) (P = 0.001). There were no significant differences
between the two groups in mean changes in serum triglyceride, and total, high‑density
lipoprotein, and low‑density lipoprotein cholesterol.
Conclusion: The results of this study indicate that omega‑3 reduced BP significantly but
had no effect on lipid profile in our CAPD patients.
Keywords
Atlas of Chronic Kidney Disease and End‑Stage Renal Disease
in the United States. Bethesda, MD: National Institutes of
Health, National Institute of Diabetes and Digestive and
Kidney Diseases; 2012. p. 260. Available from: http://www.
usrds.org/2012/pdf/v2_ch5_12.pdf.
2. Friedman A, Moe S . R e v i e w o f t h e e f f e c t s o f
omega‑3 supplementation in dialysis patients. Clin J Am Soc
Nephrol 2006;1:182‑92.
3. Rangel‑Huerta OD, Aguilera CM, Mesa MD, Gil A. Omega‑3
long‑chain polyunsaturated fatty acids supplementation on
inflammatory biomakers: A systematic review of randomised
clinical trials. Br J Nutr 2012;107 Suppl 2:S159‑70.
4. KremerJM, Jubiz W, MichalekA, Rynes RI, Bartholomew LE,
Bigaouette J, et al. Fish‑oil fatty acid supplementation in active
rheumatoid arthritis. A double‑blinded, controlled, crossover
study. Ann Intern Med 1987;106:497‑503.
5. 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.
6. 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;107:2646‑52.
7. Harris WS. N‑3 fatty acids and serum lipoproteins: Human
studies. Am J Clin Nutr 1997;65 5 Suppl: 1645S‑54.
8. Appel LJ, Miller ER 3rd, Seidler AJ, Whelton PK. Does
supplementation of diet with ‘fish oil’ reduce blood pressure?
A meta‑analysis of controlled clinical trials. Arch Intern Med
1993;153:1429‑38.
9. Ho M, Maple C, Bancroft A, McLaren M, Belch JJ. The
beneficial effects of omega‑3 and omega‑6 essential fatty acid
supplementation on red blood cell rheology. Prostaglandins
Leukot Essent Fatty Acids 1999;61:13‑7.
10. K/DOQI Workgroup. K/DOQI clinical practice guidelines for
cardiovascular disease in dialysis patients. Am J Kidney Dis
2005;45 4 Suppl 3:S1‑153.
11. Singer P, Berger I, Lück K, Taube C, Naumann E, Gödicke W.
Long‑term effect of mackerel diet on blood pressure, serum
lipids and thromboxane formation in patients with mild
essential hypertension. Atherosclerosis 1986;62:259‑65.
12. Cabo J, Alonso R, Mata P. Omega‑3 fatty acids and blood
pressure. Br J Nutr 2012;107 Suppl 2:S195‑200.
13. Vernaglione L, Cristofano C, Chimienti S., Omega-3
polyunsaturated fatty acids and proxies of cardiovascular
disease in hemodialysis: a prospective cohort study. J Nephrol
2008;21:99-105.
14. Simopoulos AP. Omega‑3 fatty acids and cardiovascular
disease: The epidemiological evidence. Environ Health Prev
Med 2002;6:203‑9.
15. Donnelly SM, Ali MA, Churchill DN. Effect of n‑3 fatty acids
from fish oil on hemostasis, blood pressure, and lipid profile
of dialysis patients. J Am Soc Nephrol 1992;2:1634‑9.
16. Dasgupta A, Kenny MA, Ahmad S. Abnormal fatty acid
profile in chronic hemodialysis patients: Possible deficiency
of essential fatty acids. Clin Physiol Biochem 1990;8:238‑43.
17. Varga Z, Kárpáti I, Paragh G, Buris L, Kakuk G. Relative abundance of some free fatty acids in plasma of uremic
patients: Relationship between fatty acids, lipid parameters,
and diseases. Nephron 1997;77:417‑21.
18. Madsen T, Christensen JH, Svensson M, Witt PM, Toft E,
Schmidt EB. Marine n‑3 polyunsaturated fatty acids in patients
with end‑stage renal failure and in subjects without kidney
disease: A comparative study. J Ren Nutr 2011;21:169‑75.
19. Knapp HR, FitzGerald GA. The antihypertensive effects
of fish oil. A controlled study of polyunsaturated fatty
acid supplements in essential hypertension. N Engl J Med
1989;320:1037‑43.
20. Bao DQ, Mori TA, Burke V, Puddey IB, Beilin LJ. Effects
of dietary fish and weight reduction on ambulatory blood
pressure in overweight hypertensives. Hypertension
1998;32:710‑7.
21. Pei J, Zhao Y, Huang L, Zhang X, Wu Y. The effect of n‑3
polyunsaturated fatty acids on plasma lipids and lipoproteins
in patients with chronic renal failure – A meta‑analysis of
randomized controlled trials. J Ren Nutr 2012;22:525‑32.
22. 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.
23. Stark KD, Park EJ, Maines VA, Holub BJ. Effect of a fish‑oil
concentrate on serum lipids in postmenopausal women
receiving and not receiving hormone replacement therapy
in a placebo‑controlled, double‑blind trial. Am J Clin Nutr
2000;72:389‑94.
24. Mori TA, Burke V, Puddey IB, Watts GF, O’Neal DN, Best JD,
et al. Purified eicosapentaenoic and docosahexaenoic acids
have differential effects on serum lipids and lipoproteins, LDL
particle size, glucose, and insulin in mildly hyperlipidemic
men. Am J Clin Nutr 2000;71:1085‑94.
25. Ewers B, Riserus U, Marckmann P. Effects of unsaturated
fat dietary supplements on blood lipids, and on markers of
malnutrition and inflammation in hemodialysis patients. JRen
Nutr 2009;19:401‑11.
26. Kasim‑Karakas SE, HerrmannR, AlmarioR. Effects of omega‑3
fatty acids on intravascular lipolysis of very‑low‑density
lipoproteins in humans. Metabolism 1995;44:1223‑30.
27. Tinker LF, Parks EJ, Behr SR, Schneeman BO, Davis PA. (n‑3)
fatty acid supplementation in moderately hypertriglyceridemic
adults changes postprandial lipid and apolipoprotein B
responses to a standardized test meal. J Nutr 1999;129:1126‑34.
28. 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