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Kidney Week

Abstract: SA-PO1059

Long Chain Omega-3 Polyunsaturated Fatty Acids and Patient Important Outcomes in CKD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

  • Saglimbene, Valeria Maria, University of Sydney, Sydney, Australia
  • Wong, Germaine, University of Sydney, Sydney, New South Wales, Australia
  • van Zwieten, Anita, University of Sydney, Sydney, New South Wales, Australia
  • Palmer, Suetonia, University of Otago, Christchurch, New Zealand
  • Ruospo, Marinella, Diaverum, Bari, Italy
  • Natale, Patrizia, Diaverum, Bari, Italy
  • Craig, Jonathan C., University of Sydney, Sydney, New South Wales, Australia
  • Strippoli, Giovanni F.M., University of Bari, Bari, Italy
Background

Long-chain omega-3 polyunsaturated fatty acid (n-3 PUFA) has recognised vascular benefits in the general population, but knowledge of supplementation among patients with CKD is largely restricted to vascular access outcomes.We aimed to assess the benefits and harms of n-3 PUFA therapy in patients with chronic kidney disease (CKD).

Methods

MEDLINE, Embase, CENTRAL and reference lists were searched up to January date, 2018. We included randomised 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 Grading of Recommendations Assessment, Development and Evaluation processes, respectively.

Results

Sixty studies (n=4129), median sample size of 41 participants (interquartile range 30 to74) and median follow-up duration of 6 months (3 to 12), were included. N-3 PUFA reduced cardiovascular death (n=1,045; relative risk [95% confidence interval], 0.45 [0.23, 0.89]; moderate evidence certainty) in dialysis patients, and progression to ESKD (n=170; 0.30 [0.09, 0.98]; very low evidence certainty) in patients with moderate to advanced stage CKD. Effects on all-cause mortality (n=1876; 1.05 [0.83, 1.33]; low evidence certainty); acute transplant rejection (n=543; 0.98 [0.80, 1.21]; low evidence certainty) and graft loss (n=434; 0.98 [0.54, 1.81]; very low evidence certainty) were uncertain. Risks of bleeding (n=770; 1.40 [0.78, 2.49]) and gastrointestinal side-effects (n=1455; 1.14 [0.79, 1.67]) were uncertain.

Conclusion

N-3 PUFA supplementation may protect patients on dialysis against cardiovascular mortality. It appeared to prevent ESKD in patients with moderate to advanced stage CKD but the evidence certainty was very limited.