V SAGLIMBENE1, G WONG1, A VAN ZWIETEN1, S PALMER2, K CAMPBELL3, J CRAIG1,4, G STRIPPOLI1,5
1University Of Sydney, Sydney, Australia, 2University of Otago Christchurch, Christchurch, New Zealand, 3Princess Alexandra Hospital, Woolloongabba, Australia, 4Flinders University, Adelaide, Australia, 5University of Bari, Bari, Italy
Aim: To assess the benefits and harms of long-chain omega-3 polyunsaturated fatty acid (n-3 PUFA) therapy in patients with chronic kidney disease (CKD).
Background: N-3 PUFA has recognized vascular benefits in the general population, but knowledge of supplementation among patients with CKD is largely restricted to vascular access outcomes.
Methods: MEDLINE, Embase, CENTRAL and reference lists were searched up to January date, 2018. We included randomized controlled trials evaluating n-3 PUFA supplementation compared with placebo or standard care on cardiovascular and all-cause mortality, progression to end stage kidney disease (ESKD), acute transplant rejection, and graft loss. Risks of bias and evidence certainty were assessed using Cochrane and GRADE processes, respectively.
Results: Sixty RCTs (n=4129), median sample size of 41 participants (interquartile range [IQR]: 30 to 74) and median follow-up duration of 6 months (IQR: 3 to 12), were included. Studies were at unclear risk of bias for most domains.N-3 PUFA reduced cardiovascular death (relative risk [95% confidence interval], 0.43 [0.22 to 0.84], moderate evidence certainty) in dialysis patients, and progression to ESKD (0.30 [0.09 to 0.98], very low evidence certainty) in patients with moderate to advanced stage CKD. Effects on all-cause mortality (1.05 [0.83 to 1.33], low evidence certainty); acute transplant rejection (0.98 [0.80 to 1.21], very low evidence certainty) and graft loss (0.98 [0.54 to 1.81], very low certainty evidence) were uncertain. Bleeding risks (RR [95%CI], 1.40 [0.78, 2.49] and gastrointestinal side-effects (RR [95%CI], 1.14 [0.79 to1.67] were uncertain.
Conclusions: N-3 PUFA therapy may protect patients on dialysis against cardiovascular mortality. It appeared to prevent progression to ESKD in patients with moderate to advanced stage CKD but the evidence certainty was very limited.
Valeria Saglimbene has a Bachelor of Pharmaceutical Chemistry (Honours) from the University of Palermo (Italy) and a Master of Clinical Epidemiology at the University of Sydney. In 2008 she joined the Mario Negri Sud Consorzium (Italy) as Research Assistant at the Department of Pharmacology and Epidemiology, working on RCTs, cohort studies and systematic reviews in CKD. In 2016 she started a PhD at the University of Sydney focused on understanding novel determinants of health outcomes in CKD. As part of her PhD, she conducted a cohort study of 10,000 haemodialysis patients to investigate the association between nutrition and mortality