Valeria M Saglimbene1, Germaine Wong2, Anita van Zwieten3, Suetonia C Palmer4, Marinella Ruospo5, Patrizia Natale6, Katrina Campbell7, Armando Teixeira-Pinto8, Jonathan C Craig9, Giovanni F M Strippoli10. 1. Sydney School of Public Health, Faculty of Medicine and Health, 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, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Rd, 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. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Rd, Westmead, NSW 2145, Australia. Electronic address: anita.vanzwieten@sydney.edu.au. 4. Department of Medicine, University of Otago Christchurch, PO Box 4345, 8140, New Zealand. Electronic address: suetonia.palmer@otago.ac.nz. 5. Diaverum Medical-Scientific Office, Trollebergsvagen 2-4, 222 29 Lund, Sweden. Electronic address: marinella.ruospo@diaverum.com. 6. 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. 7. Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4102, Australia. Electronic address: kcampbel@bond.edu.au. 8. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, NSW 2006, Australia; Centre for Kidney Research, Children's Hospital at Westmead, 170 Hawkesbury Rd, Westmead, NSW 2145, Australia. Electronic address: armando.teixeira-pinto@sydney.edu.au. 9. College of Medicine and Public Health, Flinders University, Bedford Park SA, 5042 Adelaide, Australia. Electronic address: jonathan.craig@flinders.edu.au. 10. Sydney School of Public Health, Faculty of Medicine and Health, 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 5, Bari 70124, Italy. Electronic address: gfmstrippoli@gmail.com.
Abstract
BACKGROUND & AIMS: Dietary and supplemental long chain omega-3 polyunsaturated fatty acids (n-3 PUFA) have shown vascular benefits for the general population, but effects among people with chronic kidney disease (CKD) are largely uncertain. We aimed to evaluate the effects of n-3 PUFA intake among patients with CKD. METHODS: We searched MEDLINE, Embase, and CENTRAL through January 12, 2018. Eligible studies were randomized controlled trials evaluating n-3 PUFA intake (supplementation or dietary) compared with placebo, standard care, or other treatment, on cardiovascular and all-cause mortality, end stage kidney disease (ESKD), acute transplant rejection, and allograft loss. Risks of bias and evidence certainty were assessed using Cochrane and Grading of Recommendations Assessment, Development and Evaluation processes. RESULTS: Sixty trials (4129 participants) were eligible, all of supplementation, with a median follow-up of 6 months. Low to very low certainty evidence suggested that n-3 PUFA supplementation reduced cardiovascular death for participants on hemodialysis (39 events; relative risk (RR) 0.45, 95% confidence interval (CI) 0.23-0.89), prevented ESKD (29 events; RR 0.30, CI 0.09-0.98) in participants with CKD not receiving renal replacement therapy, and made little or no difference in all-cause mortality (215 events; RR 1.05, CI 0.84-1.33), acute transplant rejection (188 events; RR 0.98, CI 0.80-1.21) or allograft loss (39 events; RR 0.98, CI 0.54-1.81]). Risk of bleeding (44 events; RR 1.40, CI 0.78-2.49) and gastrointestinal side-effects (103 events; RR 1.14, CI 0.79-1.67) were uncertain. CONCLUSIONS: n-3 PUFA supplementation may reduce cardiovascular mortality in patients on hemodialysis but it is uncertain whether supplementation prevents mortality or ESKD in patients with CKD.
BACKGROUND & AIMS: Dietary and supplemental long chain omega-3 polyunsaturated fatty acids (n-3 PUFA) have shown vascular benefits for the general population, but effects among people with chronic kidney disease (CKD) are largely uncertain. We aimed to evaluate the effects of n-3 PUFA intake among patients with CKD. METHODS: We searched MEDLINE, Embase, and CENTRAL through January 12, 2018. Eligible studies were randomized controlled trials evaluating n-3 PUFA intake (supplementation or dietary) compared with placebo, standard care, or other treatment, on cardiovascular and all-cause mortality, end stage kidney disease (ESKD), acute transplant rejection, and allograft loss. Risks of bias and evidence certainty were assessed using Cochrane and Grading of Recommendations Assessment, Development and Evaluation processes. RESULTS: Sixty trials (4129 participants) were eligible, all of supplementation, with a median follow-up of 6 months. Low to very low certainty evidence suggested that n-3 PUFA supplementation reduced cardiovascular death for participants on hemodialysis (39 events; relative risk (RR) 0.45, 95% confidence interval (CI) 0.23-0.89), prevented ESKD (29 events; RR 0.30, CI 0.09-0.98) in participants with CKD not receiving renal replacement therapy, and made little or no difference in all-cause mortality (215 events; RR 1.05, CI 0.84-1.33), acute transplant rejection (188 events; RR 0.98, CI 0.80-1.21) or allograft loss (39 events; RR 0.98, CI 0.54-1.81]). Risk of bleeding (44 events; RR 1.40, CI 0.78-2.49) and gastrointestinal side-effects (103 events; RR 1.14, CI 0.79-1.67) were uncertain. CONCLUSIONS: n-3 PUFA supplementation may reduce cardiovascular mortality in patients on hemodialysis but it is uncertain whether supplementation prevents mortality or ESKD in patients with CKD.