Triglyceride lowering in nephrotic syndrome patients consuming a fish oil concentrate

Lipid-lowering therapy in patients with renal disease

A growing number of clinical trials have examined the effects of different lipid lowering strategies in patients with renal disease. We carried out a meta-analysis to compare and contrast the relative efficacy of various antilipemic therapies in different renal disease settings. Studies that investigated one or more therapies designed to lower serum lipids were combined using weighted multiple linear regression. The analysis adjusted treatment effects for differences in baseline lipid levels and possible placebo effects. The results showed that antilipemic therapies generally had similar effects on lipids in different renal disease settings. In nephrotic syndrome the greatest and most consistent reductions in low density lipoprotein cholesterol (LDL) were seen with 3-hydroxy-3-methylglutaryl co-enzyme A (HMG-CoA) reductase inhibitors (regression coefficient with 95% confidence interval in mg/dl = -63, -79 to -46). Similar results were seen for LDL in renal transplant (-51, -57 to -45), renal insufficiency (-62, -82 to -42), hemodialysis (-65, -80 to -50) and continuous ambulatory peritoneal dialysis (CAPD) patients (-84, -104 to -64). Fibric acid analogues had less effect on LDL, but caused greater reductions in triglycerides: -132, -178 to -87, in nephrotic syndrome; -69, -93 to -45 in transplant: -107, -169 to -45 in renal insufficiency; -72, -120 to -24 in hemodialysis; and -96, -162 to -30 in CAPD. In general, the effects of diet and other therapies were less consistent. Despite possible limitations of this meta-analysis, the results provide a useful framework for choosing antilipemic therapy, and point to areas for future long-term studies examining the safety and efficacy of lipid lowering strategies in patients with renal disease.

n-3 fatty acids and renal diseases

There are numerous biologic rationales for the use of n-3 fatty acids in renal diseases, including a possible increase in the renal vasodilatory capacity by a rearrangement of renal prostanoid production, a reduction in the production of proinflammatory leukotrienes, a reduction in the transcapillary escape rate of albumin, and actions limiting cyclosporine-related nephrotoxicity. Studies of animal models of renal disease, mostly of immune-renal disease, support the idea of the possible usefulness of these compounds. The most promising areas of clinical investigation include the reduction of proteinuria in some chronic glomerular diseases, the treatment of immunoglobulin A nephropathy, and the prevention of cyclosporine-induced nephrotoxicity. However, the results of larger clinical studies, some of which are ongoing, are necessary to support the use of n-3 fatty acids in human renal diseases.

[The effect of highly unsaturated fatty acids on the parameters of lipoprotein metabolism and rheology during their administration to patients undergoing chronic hemodialysis treatment]

Fifteen hemodialysis patients were treated with capsules of highly unsaturated fatty acids given in addition to their normal diet over a period of 6 months. At study start they received 12 capsules daily, each containing 105 mg eicosapentaenoic acid and 75 mg docosahexaenoic acid. There was a significant fall of triglycerides from an initial 521 mg/dl on average to 334 mg/dl. Total cholesterol was reduced from 266 mg/dl to 233 mg/dl with a continuous fall throughout the study period, ldl cholesterol being the main part, falling from 227 mg/dl to 192 mg/dl. These changes were accompanied by a reduction of apolipoprotein A1 from 118 mg/dl to 109 mg/dl and of B from 212 mg/dl to 204 mg/dl. Parameters of whole blood viscosity decreased significantly (viscous component eta' from 6.81 to 6.44 mPas--elastic component eta" from 1.85 to 1.53 mPas), while the plasma viscosity remained unchanged with 1.44 mPas. The improvement of flow properties results from adherence of omega-3 fatty acids to the phospholipids of the red cell membrane. The conclusion is that supplementation with fish oil in addition to normal food intake of dialysis patients contributes to an improvement of lipoprotein metabolism and flow properties. Thus, two risk factors concerning thrombosis and cardiovascular diseases can be positively influenced.

Dietary alpha-linolenic acid alters tissue fatty acid composition, but not blood lipids, lipoproteins or coagulation status in humans

We examined the effect of dietary alpha-linolenic acid (ALA) on the indices of lipid and coagulation status and on the fatty acid composition of serum and peripheral blood mononuclear cell (PBMNC) lipids in ten healthy men (age 21-37 yr) who consumed all their meals at the Western Human Nutrition Research Center for 126 d. There was a stabilization period of 14 d at the start when all 10 subjects consumed the basal diet (BD) containing 23.4 energy percent (en%) fat and two intervention periods of 56 d each. During the first intervention period, 5 subjects consumed the BD containing 23.4 en% fat, and 5 subjects consumed a diet providing 6.3% calories from alpha-linolenic acid [flaxseed oil (FSO) diet containing 28.8 en% fat]. Diets were crossed over between the two groups during the second intervention period. Feeding the FSO diet did not significantly alter serum triglycerides, cholesterol, high-density lipoproteins, low-density lipoproteins, apoprotein A-I and apoprotein B when compared to the corresponding values in the subjects fed the BD, nor was there any effect of the FSO diet on the bleeding time, prothrombin time and partial prothrombin time for these subjects. Feeding the ALA-containing diet did cause a significant increase in ALA concentration in serum (P < 0.001) and PBMNC lipids (P < 0.05). It also caused a significant increase (P < 0.05) in the eicosapentaenoic and docosapentaenoic acid contents of PBMNC lipids, and a decrease (P < 0.01) in linoleic and eicosatrienoic acid contents of serum lipids.(ABSTRACT TRUNCATED AT 250 WORDS)