N-3 polyunsaturated fatty acid supplementation in chronic progressive renal disease

Abstract

Chronic renal failure (CRF) may be accelerated by secondary lipid and immune abnormalities which could be antagonized by polyunsaturated fatty acid (PUFA). We examined 20 CRF patients on conservative treatment, randomized in two groups: G1 consisted of 10 control patients and G2 10 patients supplemented for 12 months with a 3.4 g daily dose of PUFA. In basal conditions and after 12 months the following parameters were checked: creatinine clearance (CCr), daily urinary protein excretion per unit of residual renal function (UProt/CCr), rate of progression of renal insufficiency (delta CCr); triglycerides (TG), total (TC), HDL (HDALC) and LDL (LDLC) cholesterol, apolipoproteins Apo Al, Apo B, lipoprotein(a) Lp(a); lymphocyte subpopulations; spontaneous (c) and stimulated (s) cytokines IL-1 beta, IL-2, tumor necrosis factors TNF-alpha secretion by peripheral mononuclear cells. The groups did not differ in their basal parameters, which did not change in G1 during follow-up. In G2 the following parameters, initially higher than normal significantly decreased after 12 months: TG (2.9 +/- 0.45 to 2.6 +/- 0.3 mmol/l p < 0.005), Apo B (1.40 +/- 0.37 to 1.22 +/- 0.36 g/l, p < 0.05), c TNF-alpha (1008.1 +/- 534.9 to 726.8 +/- 458.7 pg/ml, p < 0.05). Spontaneous (c) IL-1 beta (216.7 +/- 116.2 to 150.5 +/- 107.8 pg/ml, p < 0.05), c IL-2 (124.5 +/- 43.8 to 101.6 +/- 25.8 pg/ml, p < 0.05), and s TNF-alpha (2456.4 +/- 908.3 to 1632.2 +/- 497.1 pg/ml, p < 0.005) also decreased, although already within the normal range at baseline. G2 patients experienced a steady monthly reduction of CCr whereas it rose progressively in G1 (p < 0.05), with a simultaneous increase in UProt/CCr (p < 0.05). PUFA are beneficial on the lipid and immune abnormalities secondary to CRF and may also have a useful effect on the progression of chronic renal damage.