Valeria M Saglimbene1, Germaine Wong2, Marinella Ruospo3, Suetonia C Palmer4, Katrina Campbell5, Vanessa Garcia Larsen6, Patrizia Natale7, Armando Teixeira-Pinto8, Juan-Jesus Carrero9, Peter Stenvinkel10, Letizia Gargano11, Angelo M Murgo12, David W Johnson13, Marcello Tonelli14, Rubén Gelfman15, Eduardo Celia16, Tevfik Ecder17, Amparo G Bernat18, Domingo Del Castillo19, Delia Timofte20, Marietta Török21, Anna Bednarek-Skublewska22, Jan Duława23, Paul Stroumza24, Susanne Hoischen25, Martin Hansis26, Elisabeth Fabricius27, Charlotta Wollheim28, Jörgen Hegbrant29, Jonathan C Craig30, Giovanni F M Strippoli31. 1. Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: vsag1982@gmail.com. 2. Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Road, Westmead, NSW 2145, Australia; Department of Renal Medicine, Westmead Hospital, Hawkesbury Rd & Darcy Road, Westmead, NSW 2145, Australia. Electronic address: germaine.wong@health.nsw.gov.au. 3. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy. Electronic address: marinella.ruospo@diaverum.com. 4. Department of Medicine, University of Otago Christchurch, PO Box 4345, 8140, New Zealand. Electronic address: suetonia.palmer@otago.ac.nz. 5. Department of Nutrition and Dietetics, University of Queensland at Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia. Electronic address: kcampbel@bond.edu.au. 6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: vgla@jhu.edu. 7. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy. Electronic address: patrizia.natale@diaverum.com. 8. Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia. Electronic address: armando.teixeira-pinto@sydney.edu.au. 9. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. Electronic address: Juan.Jesus.Carrero@ki.se. 10. Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. Electronic address: Peter.Stenvinkel@ki.se. 11. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: letiza.gargano@diaverum.com. 12. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Angelo.Murgo@diaverum.com. 13. Department of Nephrology, Division of Medicine, University of Queensland at the Princess Alexandra Hospital, ARTS Building, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia; Translational Research Institute, University of Queensland, 37 Kent Street, Woolloongabba, QLD 4102, Australia. Electronic address: David.Johnson2@health.qld.gov.au. 14. Cumming School of Medicine, Health Sciences Centre, University of Calgary, 2500 University Dr NW, Calgary AB T2N 1N4, Canada. Electronic address: cello@ucalgary.ca. 15. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Ruben.Gelfman@diaverum.com. 16. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Eduardo.Celia@diaverum.com. 17. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: tevfik.ecder@dmed.com.tr. 18. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Amparo.Bernat@diaverum.com. 19. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Domingo.DelCastillo@diaverum.com. 20. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Delia.Timofte@diaverum.com. 21. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Marietta.Torok@diaverum.com. 22. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Medical University of Lublin, Aleje Racławickie 1, Lublin, Poland. Electronic address: Anna.Bednarek@diaverum.com. 23. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Medical University of Silesia, Medyków 18, Katowice, Poland. Electronic address: Jan.Dulawa@diaverum.com. 24. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Paul.Stroumza@diaverum.com. 25. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Susanne.Hoischen@diaverum.com. 26. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Martin.Hansis@diaverum.com. 27. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Elisabeth.Fabricius@diaverum.com. 28. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Charlotta.Wollheim@diaverum.com. 29. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: Jorgen.Hegbrant@diaverum.com. 30. Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Road, Westmead, NSW 2145, Australia. Electronic address: jonathan.craig@sydney.edu.au. 31. Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 70124 Bari, Italy; Diaverum Academy, Via Solarino 1, Bari 70124, Italy. Electronic address: gfmstrippoli@gmail.com.
Abstract
BACKGROUND & AIMS: Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. METHODS: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. RESULTS: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. CONCLUSIONS: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.
BACKGROUND & AIMS:Patients on hemodialysis suffer from high risk of premature death, which is largely attributed to cardiovascular disease, but interventions targeting traditional cardiovascular risk factors have made little or no difference. Long chain n-3 polyunsaturated fatty acids (n-3 PUFA) are putative candidates to reduce cardiovascular disease. Diets rich in n-3 PUFA are recommended in the general population, although their role in the hemodialysis setting is uncertain. We evaluated the association between the dietary intake of n-3 PUFA and mortality for hemodialysis patients. METHODS: The DIET-HD study is a prospective cohort study (January 2014-June 2017) in 9757 adults treated with hemodialysis in Europe and South America. Dietary n-3 PUFA intake was measured at baseline using the GA2LEN Food Frequency Questionnaire. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association of dietary n-3 PUFA intake with cardiovascular and all-cause mortality. RESULTS: During a median follow up of 2.7 years (18,666 person-years), 2087 deaths were recorded, including 829 attributable to cardiovascular causes. One third of the study participants consumed sufficient (at least 1.75 g/week) n-3 PUFA recommended for primary cardiovascular prevention, and less than 10% recommended for secondary prevention (7-14 g/week). Compared to patients with the lowest tertile of dietary n-3 PUFA intake (<0.37 g/week), the adjusted hazard ratios (95% confidence interval) for cardiovascular mortality for patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.82 (0.69-0.98) and 1.03 (0.84-1.26), respectively. Corresponding adjusted hazard ratios for all-cause mortality were 0.96 (0.86-1.08) and 1.00 (0.88-1.13), respectively. CONCLUSIONS: Dietary n-3 PUFA intake was not associated with cardiovascular or all-cause mortality in patients on hemodialysis. As dietary n-3 PUFA intake was low, the possibility that n-3 PUFA supplementation might mitigate cardiovascular risk has not been excluded.
Authors: Amelie Bernier-Jean; Germaine Wong; Valeria Saglimbene; Marinella Ruospo; Suetonia C Palmer; Patrizia Natale; Vanessa Garcia-Larsen; David W Johnson; Marcello Tonelli; Jörgen Hegbrant; Jonathan C Craig; Armando Teixeira-Pinto; Giovanni F M Strippoli Journal: Kidney Int Rep Date: 2021-09-15