V SAGLIMBENE1,2, G WONG1,3,4, M RUOSPO2,5, S PALMER6, K CAMPBELL7, V GARCIA LARSEN8, P NATALE2, A TEIXEIRA-PINTO1,J CARRERO9, P STENVINKEL9, L GARGANO2, A MURGO2, D JOHNSON7,10,
M TONELLI11, R GELFMAN2, E CELIA2, T ECDER2, A BERNAT2, D DELCASTILLO2, D TIMOFTE2, M TÖRÖK2, A BEDNAREK-SKUBLEWSKA2,12,JDUŁAWA2,13, P STROUMZA2, M HANSIS2, E FABRICIUS2,12, C WOLLHEIM2, J HEGBRANT2, J CRAIG1,3, G STRIPPOLI1,2,14
1University of Sydney, Sydney, New South Wales; 2Diaverum Medical-ScientiﬁcOfﬁce, Lund, Sweden; 3Children’s Hospital at Westmead, Sydney, New South Wales; 4Westmead Hospital, Sydney, New South Wales; 5Amedeo Avogadro University of Eastern Piedmont, Novara, Italy; 6University of Otago Christchurch, Christchurch, New Zealand; 7University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland; 8Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; 9Karolinska Institute, Stockholm, Sweden; 10University of Queensland, Woolloongabba, Queensland; 11University of Calgary, Calgary, Canada; 12Medical University of Lublin, Lublin, Poland; 13Medical University of Silesia, Katowice, Poland; 14University of Bari, Bari, Italy
Aim: To evaluate the association between dietary intake of n-3 and n-6 polyunsaturated fatty acids (PUFA) and cardiovascular and all-cause mortality in adults receiving haemodialysis.
Background: Essential PUFA are protective factors for cardiovascular risk in the general population, but their role in haemodialysis is uncertain. Methods: The DIET-HD study is a cohort study (n=9757) conducted between January 2014 and January 2016 in eleven countries. Adjusted Cox regression analyses clustered by country were undertaken to estimate hazard ratios (HRs) and 95% conﬁdence intervals (CIs) for cardiovascular and all-cause mortality associated with PUFA dietary intake.
Results: During 1.5 years (8108 person-years) median follow up, compared to patients with the lowest dietary n-3 PUFA intake (<0.37 g/week), the HRs (CI) for cardiovascular mortality among patients in the middle (0.37 to <1.8 g/week) and highest (≥1.8 g/week) tertiles of n-3 PUFA were 0.80 (0.64 to 1.00) and 1.13 (0.88 to 1.45), respectively; the HRs for all-cause mortality were 0.95 (0.82 to 1.09) and 1.08 (0.92 to 1.28), respectively. Compared to patients with the lowest n-6 PUFA intake (<31 g/week), the HRs for cardiovascular mortality among patients in the middle (31 to <62 g/week) and highest (≥62 g/week) tertiles of n-6 PUFA were 1.01 (0.80 to 1.28) and 0.95 (0.73 to 1.25), respectively; the HRs for all-cause mortality were 1.01 (0.86 to 1.18) and 1.14 (0.96 to 1.36), respectively. Dietary PUFA intake was substantially lower than the recommended intake for cardiovascular prevention in the general population.
Conclusions: Dietary PUFA intakes were not associated with cardiovascular or all-cause mortality in haemodialysis patients. The possibility that higher dose n-3 PUFA, reached by supplementation, might mitigate cardiovascular risk has not been excluded.