|Year : 2019 | Volume
| Issue : 1 | Page : 335-339
The effect of high-dose omega-3 supplementation on lipid profile in children on chronic hemodialysis
Ali M Elshafie1, Zein A Omar1, Belal A Montser2, Mohamed A. M. E. Farahat3
1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Healthcare Quality Manshea, Sultan University Hospital, Menoufia, Egypt
|Date of Submission||14-Sep-2017|
|Date of Acceptance||19-Nov-2017|
|Date of Web Publication||17-Apr-2019|
Mohamed A. M. E. Farahat
17 Ahmed Maher Street, Shebin Elkom, Elmounfia, 32511
Source of Support: None, Conflict of Interest: None
The aim was to assess the changes in the lipid profile of children with end-stage renal disease (ESRD) on chronic hemodialysis after administration of high-dose omega-3.
Children with ESRD on chronic hemodialysis have many factors that increase their risk of cardiovascular disease (CVD) such as dyslipidemia, hypertension, and physical inactivity. CVD is considered to be one of the major causes of morbidity and mortality in these children. Some studies were done on the omega-3 effects on lipid profile, the results of which were promising that omega-3 can improve the lipid profile which has a good impact on saving the ESRD patients from dyslipidemia and CVD.
Patients and methods
This interventional prospective study had included 26 children with ESRD on chronic hemodialysis in the Pediatric Hemodialysis Unit at the Menoufia University Hospital, who were treated daily with a high dose of omega-3 (2000 mg) for 3 months (from January to April 2016) and lipid profile was done and compared before and after omega-3 supplementation.
After supplementation of high-dose omega-3, there were statistically highly significant decrease (P < 0.001) in total cholesterol by 30%, triglyceride by 32%, and low-density lipoprotein by 23%, together with a statistically highly significant increase (P < 0.001) in high-density lipoprotein by 26%.
The use of high-dose omega-3 had caused significant improvement in the lipid profile of ESRD children on chronic hemodialysis, so supplementary omega-3 may be a suitable treatment for these patients.
Keywords: chronic kidney disease, hemodialysis, lipid profile, omega-3
|How to cite this article:|
Elshafie AM, Omar ZA, Montser BA, E. Farahat MA. The effect of high-dose omega-3 supplementation on lipid profile in children on chronic hemodialysis. Menoufia Med J 2019;32:335-9
|How to cite this URL:|
Elshafie AM, Omar ZA, Montser BA, E. Farahat MA. The effect of high-dose omega-3 supplementation on lipid profile in children on chronic hemodialysis. Menoufia Med J [serial online] 2019 [cited 2020 Jun 6];32:335-9. Available from: http://www.mmj.eg.net/text.asp?2019/32/1/335/256134
| Introduction|| |
It is established that patients with end-stage renal disease (ESRD) have changes in lipid metabolism leading to dyslipidemia, which is a risk factor for cardiovascular diseases (CVDs) . CVD is a major source of morbidity and is a leading cause of death in ESRD patients on chronic hemodialysis . Omega-3 has a lipid-altering effect by lipid derangement ,. Omega-3 regulates lipid homeostasis by decreasing the synthesis of very low-density lipoprotein (LDL) and triglyceride (TG) levels . Hypertriglyceridemia and high-free fatty acids are the risk factors for atherosclerosis and CVDs , so omega-3 has cardioprotective effects . Omega-3 fatty acids may help patients with CVD, lupus nephritis, idiopathic immunoglobulin A nephropathy, and renal failure by modulating the cell membrane structure and function and also by the synthesis of lipid mediators such as eicosanoids, so that omega-3 supplementation may offer some health benefits to patients on dialysis . Omega-3 fatty acids play an important role in improving the immune and inflammatory responses, slowing the progression of arteriosclerosis and blood pressure control . The aim of this work was to assess the changes in the lipid profile of children with ESRD on chronic hemodialysis after administration of high-dose omega-3.
| Patients and Methods|| |
This interventional prospective study was done on 26 children with ESRD on chronic hemodialysis in the Hemodialysis Unit in the Pediatric Nephrology Unit at the Menoufia University Hospital during the period from January 2016 to April 2016. The study protocol was approved by the Ethics Committee of Faculty of Medicine, Menoufia University and written informed consent was obtained from the guardian of each patient. All patients were daily treated with 2000 mg (Omega-3 Plus; SEDICO, Giza, Egypt) containing 360 mg eicosapentaenoic acid and 240 mg docosahexaenoic acid for 3 months in the form of capsules (containing 1 g omega-3 for each day, one capsule every 12 h). All patients were dialyzed on Fresenius 4008B dialysis machine (Fresenius Medical Care Company, Hamburg, Germany) using a polysulfone hollow fiber dialyzer suitable for the surface area of the patients and bicarbonate dialysis solutions were used.
The inclusion criteria were ESRD with a glomerular filtration rate of less than 10 ml/min/1.73 m 2, age less than 18 years, and regular hemodialysis at least three sessions per week for at least 3 months before the study. The exclusion criteria were predialysis stages of chronic kidney disease (stage 1 or 2 or 3), regular hemodialysis for less than 3 months before the study, chronic peritoneal dialysis and primarily CVD.
All children performed these investigations before and after omega-3 supplementation: predialysis and postdialysis blood urea nitrogen, predialysis and postdialysis serum creatinine, hemoglobin, platelets count, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone, albumin, phosphorus, calcium, potassium, sodium, and lipid profile [serum TG, cholesterol level, high-density lipoprotein (HDL), and LDL] results were compared and analyzed before and after omega-3 supplementation.
Statistical presentation and analysis of the present study were conducted with SPSS v. 23 IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, New York, USA); data were expressed by mean, range, SD, frequency, percentage, paired t-test, and the Wilcoxon signed-rank test. A P value greater than 0.05 was considered statistically nonsignificant and a P value of less than 0.001 was considered statistically highly significant.
| Results|| |
Out of the 26 patients in this study: their age ranged from 8 to 17 years, their mean age was 13.4 ± 2.5 years, number of men was 13 (50%), number of women was 13 (50%), mean height was 129 ± 24.5 cm, 17 (65.5%) patients had a height of less than −3 SD on Z score (severely stunted), three (11.5%) patients had a height of between −2 and −3 SD on Z score (stunted), six (23%) patients had a height of between −2 and 2 SD on Z score (normal), no patients had a height of more than 2 SD on Z score, the mean BMI was 17.1 ± 3.2 kg/m 2, four (15.5%) patients had a BMI of less than −3 SD on Z score (severely wasted), six (23%) patients had a BMI of between −2 and −3 SD on Z score (wasted), 16 (61.5%) patients had a BMI of between −2 and 2 SD on Z score (normal), and no patients had a BMI of more than 2 SD on Z score [Table 1].
|Table 1: Personal characteristics and anthropometric measurements of the studied patients|
Click here to view
Etiologies of renal failure in the studied 26 patients were obstructive uropathy in 10 (38.4%) patients, glomerulonephritis in five (19.2%) patients, cystic kidney diseases in two (7.7%) patients, cystinosis in one (3.8%) patient, and of unknown etiology in eight (30.7%) patients [Table 2].
Using of high-dose omega-3 (2000 mg/day) for 3 months in this study showed no statistically significant differences between blood pressure, hemoglobin, platelets, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone level, albumin, efficiency of dialysis (Kt/V and urinary reduction ratio), phosphorus (PO4), calcium (Ca), potassium (K), and sodium (Na) levels in the studied ESRD patients on chronic hemodialysis before and after supplementation of omega-3 [Table 3]. However, it showed highly statistically significant decrease (P < 0.001) in the total cholesterol (TC) level from 287.3 ± 9.5 to 200.1 ± 7.3 mg/dl after supplementation of high-dose omega-3 (30%), serum TG level from 190.1 ± 13.8 to 127.8 ± 13.9 mg/dl after supplementation of high-dose omega-3 (32%), and LDL level from 206.8 ± 7.8 to 158 ± 7.4 mg/dl after supplementation of high-dose omega-3 (23%), together with highly statistically significant increase (P < 0.001) in the HDL level from 42.5 ± 4.8 to 53.7 ± 4.9 mg/dl after supplementation of high-dose omega-3 (26%) [Table 4] and [Figure 1].
|Table 3: Blood pressure, mean hemoglobin, platelets, iron profile, parathyroid hormone, albumin, efficiency of dialysis, PO4, Ca, K, Na before and after omega-3 supplementation of the studied patients|
Click here to view
|Table 4: Lipid profile before and after omega-3 supplementation of the studied patients|
Click here to view
|Figure 1: Lipid profile before and after omega-3 supplementation of the studied patients. HDL, high-density lipoprotein; LDL, low-density lipoprotein; TC, total cholesterol; TG, triglyceride.|
Click here to view
| Discussion|| |
In our study on 26 ESRD children on chronic hemodialysis the age ranged from 8 to 17 years, mean age was 13.4 ± 2.5 years, 17 (65.5%) patients had a height of less than −3 SD on Z score (severely stunted), three (11.5%) patients had a height of between −2 and −3 SD on Z score (stunted), four (15.5%) patients had a BMI of less than −3 SD on Z score (severely wasted), and six (23%) patients had a BMI of between −2 and −3 SD on Z score (wasted). This agreed with Smith et al.  in their study on more than 5000 children which showed that more than 35% of children with chronic kidney disease had a height of less than −1.88 SD on Z score. Rigden  reported that most chronic kidney disease patients were suffering from growth retardation as it is considered one of the most dangerous complications of chronic kidney disease.
Regarding the 26 chronic hemodialysis ESRD children in our study, the most common cause of renal failure was obstructive uropathy in 10 (38.4%) patients and the second commonest cause was unknown etiology in eight (30.7%) patients. Similar results have been reported by Hogg et al.  in their study in India and Al-Eisa et al.  in their study in Kuwait which showed that obstructive uropathy is the most common cause of renal failure with a percentage of 31.8 and 29.2%, respectively, although they found that unknown etiology is responsible for 5.7 and 1.7%, respectively, of all causes of renal failure which disagrees with our results. This disagreement may be due to the small sample size in our study or late health care seeking by patients or lack of diagnostic facilities in developing countries which make diagnosis of the etiology of renal failure more difficult and raises the unknown etiology percentage.
Administration of high-dose omega-3 (2000 mg/day) for 3 months by the 26 chronic hemodialysis children participated in our interventional prospective study did not significantly affect the blood pressure, hemoglobin, platelets, total iron-binding capacity, serum iron, transferrin saturation, serum ferritin, parathyroid hormone level, albumin, efficiency of dialysis (Kt/V and urea reduction ratio), phosphorus (PO4), calcium (Ca), potassium (K), and sodium (Na). Similar results have been reported by Khosroshahi et al.  in their randomized controlled trial (RCT) on 100 hemodialysis patients who were assigned into two groups: an experimental group that received omega-3 (oral capsule: 3 g/day) for 2 months and the placebo group; their RCT showed that the differences between the omega-3 and the placebo groups were not significant for hemoglobin, platelet count, serum levels of calcium, sodium, potassium, phosphorus, parathyroid hormone, total iron-binding capacity and iron. Omrani et al.  agreed with our results that omega-3 supplementation did not significantly affect the blood pressure in their randomized clinical trial (case–control) study on 60 hemodialysis adult patients [the experimental group received omega-3 capsules (1000 mg/day) for 10 weeks].
In this interventional prospective study supplementation of the 26 chronic hemodialysis children suffering from ESRD participated in this study with a high-dose of omega-3 (2000 mg/day) containing 360 mg eicosapentaenoic acid and 240 mg docosahexaenoic acid for 3 months which resulted in a highly statistically significant (P < 0.001) increase of HDL level and in a decrease in TC level, serum TG level, and LDL level. The same results have been reported by El-Shinnawy et al.  that omega-3 resulted in a significant decrease in serum TG levels, TC levels, and LDL levels and an increase in HDL levels in their prospective case–control study conducted on 80 chronic hemodialysis adult patients selected from the El-Maadi Liver and Kidney Transplantation Hospital in Egypt (range: 40–60 years). The experimental group received four capsules of omega-3 per day (each capsule contain 1000 mg omega-3) for 6 months. Also Movahedian et al.  agreed with our results as they reported a significant reduction in the levels of TG and very LDL with a marked elevation of HDL levels in their interventional study on 42 hyperlipidemic men with ESRD on regular hemodialysis, with ages from 35 to 70 years who were daily treated with 2000 mg of omega-3 for 3 months. Also, Zhu et al.  agreed with our results in their systematic review and meta-analysis of RCTs on the effects of fish oil on serum lipid profile in dialysis patients as they reported that fish oil supplements reduced serum TG levels and TC levels and increased HDL levels among dialysis patients. Also Chi et al.  agreed with our results in their systematic literature search to identify the relevant RCTs that investigated the effects of omega-3 supplementation on dialysis patients (a total of 678 patients from 14 trials were subjected to meta-analysis) and reported that omega-3 supplementation could significantly decrease the levels of serum TG and LDL.
On the other hand, Omrani et al.  in their randomized clinical trial study on 60 chronic hemodialysis patients (mean age: 55 years) reported that a dose of 1 g/day of omega-3 capsules for 10 weeks received by hemodialysis patients only showed significant decrease in serum TC level, but not other lipids; Elshafie et al.  disagreed with our result in their clinical trial on 23 children with ESRD undergoing hemodialysis, these patients received 1 g omega-3 per day for 3 months, as they reported that there were statistically highly significant differences between the level of TGs before and after supplementation with omega-3 fatty acid although there were nonstatistically significant difference in LDL, HDL, and TC levels. Using a low dose of omega-3 (1 g/day) in Omrani et al.  and Elshafie et al.  studies may be a possible explanation for the difference in the effect of omega-3 on lipid profile between their studies and our study.
| Conclusion|| |
The use of high-dose omega-3 had a beneficial effect on lipid profile of children with ESRD on chronic hemodialysis, and so supplementary omega-3 may be useful in the treatment of lipid abnormalities in end-stage renal disease patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kwan BC, Kronenberg F, Beddhu S, Cheung AK. Lipoprotein metabolism and lipid management in chronic kidney disease. J Am Soc Nephrol 2007; 18
Giray B, Kan E, Bali M, Hineal F, Basaran N. The effect of vitamin E supplementation on antioxidant enzyme activities and lipid peroxidation levels in hemodialysis patients. Clin Chim Acta 2003; 338
Olza J, Mesa MD, Aguilera CM, Moreno-Torres R, Jiménez A, Pérez de la Cruz A, et al.
Influence of an eicosapentaenoic and docosahexaenoic acid-enriched enteral nutrition formula on plasma fatty acid composition and biomarkers of insulin resistance in the elderly. Clin Nutr 2010; 29
Egert S, Stehle P. Impact of n-3fatty acids on endothelial function: results from human intraventions studies. Curr Opin Clin Nutr Metab Care 2011; 14
Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al.
Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371
Wang L, Lim EJ, Toborek M, Hennig B. The role of fatty acids and caveolin-1 in tumer necrosis factor alpha-induced endothelial cell activation. Metabolism 2008; 57
Madsen T, Schmidt EB, Christensen JH. The effect of n-3 fatty acids on C reactive protein levels in patients with chronic renal failure. J Ren Nutr 2007; 17
Friedman A, Moe S. Review of the effects of omega-3 supplementation in dialysis patients. Clin J Am Soc Nephrol 2006; 1
Smith JM, Stablein DM, Munoz R, Hebert D, McDonald A. Contributions of the Transplant Registry: The 2006 Annual Report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Pediatr Transplant 2007; 11
Rigden S. The management of chronic and end stage renal failure in children. In: Webb N, Postlethwaite R, (editors). Clinical paediatric nephrology
ed. Oxford: Oxford University Press; 2003. 427–445.
Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, et al.
National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 2003; 111
Al-Eisa A, Naseef M, Al-Hamad N, Pinto R, Al-Shimeri N, Tahmaz M. Chronic renal failure in Kuwaiti children: an eight-year experience. Pediatr Nephrol 2005; 20
Khosroshahi HT, Dehgan R, Asl BH, Safaian A, Panahi F, Estakhri R, et al.
Effect of omega-3 supplementation on serum level of homocysteine in hemodialysis patients. Iran J Kidney Dis 2013; 7
Omrani H, Pasdar Y, Raisi D, Najafi F, Esfandiari A. The effect of omega-3 on serum lipid profile in hemodialysis patients. J Renal Inj Prev 2015; 4
El-Shinnawy H, Bichari W, Makkeyah Y, Behairy M, Shabaan A. Effect of omega-3 fatty acids on vascular access patency in chronic hemodialysis patients. Life Sci J 2015; 12
Movahedian A, Bordbar-Bonab S, Rahbani-Nobar M, Mortazavi M, Fattahi S, Dolatkhah H. Effect of omega 3 fatty acids on serum lipid profile, malondialdehyde and paraoxonase activity in patients with end stage renal disease under regular hemodialysis. Int J Pharm Chem Res 2013; 2
Zhu W, Dong C, Du H, Zhang H, Chen J, Hu X, et al.
Effects of fish oil on serum lipid profile in dialysis patients: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis 2014; 13
Chi H, Lin X, Huang H, Zheng X, Li T, Zou Y. Omega-3 fatty acid supplementation on lipid profiles in dialysis patients: meta-analysis. Arch Med Res 2014; 45
Elshafie AM, Bahbah MH, Elnemr FM, Elmeshad GM, Elsayed MA. Effect of omega-3 supplementation on lipid profile and inflammatory markers in children on chronic hemodialysis. Menoufia Med J 2016; 29
[Table 1], [Table 2], [Table 3], [Table 4]