Effect of omega-3 supplementation on inflammatory parameters in patients on chronic ambulatory peritoneal dialysis

Authors

Department of Internal Medicine, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: End stage renal disease (ESRD) is a state of micro inflammation that attenuates patient's life span and quality of life. Inflammatory markers like interlukin 6 (IL-6) and C- reactive protein (CRP) can predict inflammatory state in ESRD patients. Dietary limitations are risk factors for omega-3 deficiency in these patients. Omega-3 supplementation is an attractive material that proposed in inflammation modulation. The aim of this study is evaluation of effect of omega-3 supplementation on IL-6 and CRP level in chronic ambulatory peritoneal dialysis (CAPD) patients.
Materials and Methods: This randomized controlled double-blind clinical trial is performed in 40 CAPD patients in two academic hospitals in Isfahan, Iran. One group received 1000 mg omega-3 capsule (each capsule contains 180 mg Eicosapentanoic and 120 mg Dosahexanoic acid) three times a day orally for 8 weeks (n = 20) and the other matched group by placebo (n = 20). Serum level of IL-6 and quantitative CRP (Q-CRP) were measured in beginning and the end of the study. Finally all data were analyzed by SPSS version 18.
Results: Mean age of patients was 53 years old in omega-3 group patients and 54 years old in placebo group. There were not any differences in CRP and IL-6 level in the beginning and the end of study between two groups (P: 0.81 and 0.10 for CRP and 0.26 and 0.23 for IL-6, respectively).
Conclusion: Omega-3 supplementation did not effect on inflammatory markers (Q-CRP and IL-6) in CAPD patients after 8 weeks.

Keywords

1.
Yao Q, Pecoits-Filho R, Lindholm B, Stenvinkel P. Traditional and non-traditional risk factors as contributors to atherosclerotic cardiovascular disease in end-stage renal disease. Scand J Urol Nephrol 2004;38:405-16.  Back to cited text no. 1
    
2.
Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C, et al. Cardiovascular mortality risk in chronic kidney disease: Comparison of traditional and novel risk factors. JAMA 2005;293:1737-45.  Back to cited text no. 2
    
3.
Stenvinkel P, Ketteler M, Johnson RJ, Lindholm B, Pecoits-Filho R, Riella M, et al. IL-10, IL-6, and TNF-alpha: Central factors in the altered cytokine network of uremia--the good, the bad, and the ugly. Kidney Int 2005;67:1216-33.  Back to cited text no. 3
    
4.
Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol 2013;9:255-65.  Back to cited text no. 4
    
5.
Locatelli F, Canaud B, Eckardt KU, Stenvinkel P, Wanner C, Zoccali C. Oxidative stress in end-stage renal disease: An emerging threat to patient outcome. Nephrol Dial Transplant 2003;18:1272-80.  Back to cited text no. 5
    
6.
Axelsson J, Qureshi AR, Suliman ME, Honda H, Pecoits-Filho R, Heimbu¨rger O, et al. Truncal fat mass as a contributor to inflammation in end-stage renal disease. Am J Clin Nutr 2004;80:1222-9.  Back to cited text no. 6
    
7.
Tavafi M. Diabetic nephropathy and antioxidants. J Nephropathol 2013;2:20-7.  Back to cited text no. 7
    
8.
Schwedler S, Filep J, Galle J, Wanner C, Potempa LA. C-Reactive Protein: A family of proteins to regulate cardiovascular function. Am J Kidney Dis 2006;47:212-22.  Back to cited text no. 8
    
9.
Pupim LB, Himmelfarb J, McMonagle E, Shyr Y, Ikizler TA. Influence of initiation of maintenance hemodialysis on biomarkers of inflammation and oxidative stress. Kidney Int 2004;65:2371-9.  Back to cited text no. 9
    
10.
Nasri H. Serum C reactive protein (CRP) in association with various nutritional parameters in maintenance hemodialysis patients. Bratisl Lek Listy 2005;106:390-5.  Back to cited text no. 10
    
11.
Jones S, Horiuchi S, Topley N, Yamamoto N, Fuller G. The soluble interleukin 6 receptor: Mechanisms of production and implications in disease. FASEB J 2001;15:43-58.  Back to cited text no. 11
    
12.
Memoli B, Romano G, D'Arcangelo R, Del Prete M, Esposito P, Procino A, et al. The Role of Interleukin-6 and of Its Soluble Receptors in the Biocompatibility of Dialysis Treatment. Semin Nephrol 2004;24:492-4.  Back to cited text no. 12
    
13.
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383-9.  Back to cited text no. 13
    
14.
Tayyebi-Khosroshahi H, Houshyar J, Tabrizi A, Vatankhah AM, Razzagi Zonouz N, Dehghan-Hesari R. Effect of Omega-3 Fatty Acid on Oxidative Stress in Patients on Hemodialysis. Iran J Kidney Dis 2010;4:322-6.  Back to cited text no. 14
    
15.
Pekovic PG, Milutinovic RZ, Gluvic Z, Lackovic M, Medic DR, Glibetic M. Inflammation, nutritional status PUFA profile and outcome in hemodialysis patients. Arch Biol Sci 2012;64:1173-80.  Back to cited text no. 15
    
16.
Filiopoulos V, Hadjiyannakos D, Takouli L, Metaxaki P, Sideris P, Vlassopoulos D. Inflammation and oxidative stress in end-stage renal disease patients treated with hemodialysis or peritoneal dialysis. Int J Artif Organs 2009;32:872-82.  Back to cited text no. 16
    
17.
Taheri S, Keyvandarian N, Moeinzadeh F, Mortazavi M, Emami Naini AE. The effect of omega-3 fatty acid supplementation on oxidative stress in continuous ambulatory peritoneal dialysis patients. Adv Biomed Res 2014;3:143.  Back to cited text no. 17
[PUBMED]  Medknow Journal  
18.
Friedman A, Moe S. Review of the Effects of Omega-3 Supplementation in Dialysis Patients. Clin J Am Soc Nephrol 2006;1:182-92.  Back to cited text no. 18
    
19.
Stenvinkel P. Inflammatory and atherosclerosis interactions in the depleted uremic patients. Blood Purif 2001;19:53-61.  Back to cited text no. 19
    
20.
Li JJ, Fang CH. C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular disease. Med Hypotheses 2004;62:499-506.  Back to cited text no. 20
    
21.
Stenvinkel P. Inflammation in end-stage renal disease: The hidden enemy. Nephrol 2006;11:36-41.  Back to cited text no. 21
    
22.
Mortazavi M, Moeinzadeh F, Saadatnia M, Shahidi SH, McGee JC, Minagar A. Effect of agnesium Supplementation on Carotid Intima-Media Thickness and Flow-Mediated Dilatation among Hemodialysis Patients: A Double-Blind, Randomized, Placebo-Controlled Trial. Eur Neurol 2013;69:309-16.  Back to cited text no. 22
    
23.
Guo CH, Wang CL. Effects of Zinc Supplementation on Plasma Copper/Zinc Ratios, Oxidative Stress, and Immunological Status in Hemodialysis Patients. Int J Med Sci 2013;10:79-89.  Back to cited text no. 23
    
24.
Sahni N, Gupta KL. Dietary antioxidants and oxidative stress in predialysis chronic kidney disease patients. J Nephropathology 2012;1:134-42.  Back to cited text no. 24
    
25.
Hussein N, Ah-Sing E, Wilkinson P, Leach C, Griffin BA, Millward DJ. Long-chain conversion of [13C] linoleic acid and alpha-linolenic acid in response to marked changes in their dietary intake in men. J Lipid Re 2005;46:269-80.  Back to cited text no. 25
    
26.
De Caterina R, Cybulsky MI, Clinton SK, Gimbrone MA Jr, Libby P. The omega-3 fatty acid docosahexaenoate reduces cytokine-induced expression of proatherogenic and proinflammatory proteins in human endothelial cells. Arterioscler Thromb 1994;14:1829-36.  Back to cited text no. 26
    
27.
Calder PC. Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on 'Nutrition and autoimmune disease' PUFA, inflammatory processes and rheumatoid arthritis. Proceedings of the Nutrition Society 2008;67:409-18.  Back to cited text no. 27
    
28.
Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric- coated fish oil preparation on relapses in Crohn s disease. N Engl J Med 1996;334:1557-60.  Back to cited text no. 28
    
29.
Donadio JV Jr, Bergstralh EJ, Offord KP, Spencer DC, Holley KE. A controlled trial of fish oil in IgA nephropathy. Mayo Nephrology Collaborative Group. N Engl J Med 1994;331:1194-9.  Back to cited text no. 29
    
30.
Fetterman JW Jr, Zdanowicz MM. Therapeutic potential of n-3 polyunsaturated fatty acids in disease. Am J Health Syst Pharm 2009;66:1169-79.  Back to cited text no. 30
    
31.
Madsen T, Schmidt EB, Christensen JB. The effect of n-3 fatty acids on C- reactive protein levels in patients with chronic renal failure. J Ren Nutr 2007;17:258-63.  Back to cited text no. 31
    
32.
Tayyebi-Khosroshahi H, Houshyar J, Dehghan-Hesari R, Alikhah H, Vatankhah A, Safaeian AR, et al. Effect of treatment with Omega-3 Fatty Acid on C reactive protein and tumor necrosis factor-alfa in hemodialysis patients. Saudi J Kidney Dis Transpl 2012;23:500-6.  Back to cited text no. 32
[PUBMED]  Medknow Journal  
33.
Şahinarslan A, Güz G, Mutluay R, Okyay K, Demirtaş C, Paşaoğlu H, et al. The impact of dialysis type on biomarkers for cardiovascular diseases. Arch Turk Soc Cardiol 2011;39:456-62.  Back to cited text no. 33