Docosahexaenoic Acid Is an Independent Predictor of All-Cause Mortality in Hemodialysis Patients

Hamazaki, Kei; Terashima, Y.; Itomura, Miho; Sawazaki, Shigeki; Inagaki, Hitoshi; Kuroda, Masahiro; Tomita, Shin; Hirata, Hitoshi; Inadera, Hidekuni; Hamazaki, Tomohito

doi:10.1159/000322952

Cited by 28 publications

(28 citation statements)

References 49 publications

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“…In the previous 5‐year cohort study, we found that DHA in RBCs could be an independent predictor of all‐cause mortality in HD patients . In the present study, although the duration was extended to 10 years, we still observed a similar inverse association.…”

Section: Discussionsupporting

confidence: 71%

“…In the present study, although the duration was extended to 10 years, we still observed a similar inverse association. There was no correlation between other n‐3 PUFAs such as EPA and the risk of all‐cause mortality, which was also the case in the previous study . It is of great interest that DHA but not EPA was associated with all‐cause mortality.…”

Section: Discussionsupporting

confidence: 51%

“…Comparison of the results obtained from patients with or without DM highlighted the presence of DM. As speculated in our previous study, this could be due to the stronger effects of DM on arteriosclerosis than the effects of DHA, making it difficult to detect the protective effects of DHA.…”

Section: Discussionmentioning

confidence: 81%

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Inverse association between docosahexaenoic acid and mortality in patients on hemodialysis during over 10 years

Terashima

Hamazaki

Itomura³

et al. 2014

Hemodialysis International

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We have previously conducted a cohort study to investigate n-3 polyunsaturated fatty acids (PUFAs) in red blood cells (RBCs) and risk of all-cause mortality in hemodialysis (HD) patients over 5 years and found that n-3 PUFAs, especially docosahexaenoic acid (DHA), might be an independent predictor of all-cause mortality. In the present study, we extended the study for another 5 years to determine whether DHA levels in RBCs still predict the mortality of HD patients during a 10-year study period. The study cohort consisted of 176 patients (64.1 ± 12.0 [mean ± standard deviation] years of age, 96 men and 80 women) under HD treatment. The fatty acid composition of patients' RBCs was analyzed by gas chromatography. During the study period of 10 years, 97 deaths occurred. After adjustment for 10 confounding factors, the hazard ratio of all-cause mortality of the HD patients in the highest DHA tertile (>8.1%) was 0.52 (95% confidence interval 0.30-0.91) compared with those in the lowest DHA tertile (<7.2%). However, other n-3 PUFAs such as eicosapentaenoic acid and docosapentaenoic acid (n-3) did not reveal any significant correlations. The level of DHA in RBCs could be an independent predictor of all-cause mortality in HD patients even during a long period of follow-up.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionsupporting

confidence: 51%

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Inverse association between docosahexaenoic acid and mortality in patients on hemodialysis during over 10 years

Terashima

Hamazaki

Itomura³

et al. 2014

Hemodialysis International

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“…Hamazaki reported that HD patients with higher levels of DHA in their red blood cells showed a better prognosis than those with lower levels (20). It remains to be determined which of the PUFAs is more effective for reducing mortality in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Eicosapentaenoic Acid (EPA) Decreases the All-Cause Mortality in Hemodialysis Patients

et al. 2015

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Objective Atherosclerosis, which causes cardiovascular disease, is a major cause of death in hemodialysis (HD) patients. Eicosapentaenoic acid (EPA), an anti-hyperlipidemic agent, is known to have antioxidative or anti-inflammatory effects, resulting in improvements in atherosclerosis. In the present study, we examined whether EPA improves the all-cause mortality in patients receiving regular HD therapy. Methods We enrolled 176 patients treated with maintenance HD therapy and performed a longitudinal observational cohort study for three years. We divided the patients into two groups based on whether or not the received EPA treatment [EPA(+) and EPA(-), respectively]. The primary end-point was all-cause death. We also matched the two groups using propensity score matching and examined the effect of EPA. Results Before matching, the all-cause mortality rates were 24.0% in the EPA(+) and 11.8% in the EPA(-) groups, which were significantly different (p=0.044). After propensity score matching, the EPA(+) group still showed a significantly better prognosis than the EPA(-) group (p=0.038). A multivariate analysis showed that EPA treatment significantly reduced the risk of all-cause mortality both before and after propensity score matching. Conclusion EPA treatment is independently associated with lower mortality in HD patients.

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“…A retrospective study found a trend between a erythrocyte omega 3 index levels and survival amongst HD patients; however, the fact that this did not reach statistical significance may be ascribed to an insufficient cohort size to achieve adequate statistical power [180]. Recent longitudinal observational cohort studies have found that the DHA content of erythrocyte plasma membranes is able to independently predict mortality outcomes in HD patients [181,182]. Other studies investigating the fatty acid profile of the serum and mortality in HD patients may be predicted by serum DHA levels [183] or the ratio between n -3 and n -6 [184].…”

Section: Omega-3 Polyunsaturated Fatty Acids (N-3 Pufas)mentioning

confidence: 99%

Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD?

2017

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Diet is one of the largest modifiable risk factors for chronic kidney disease (CKD)-related death and disability. CKD is largely a progressive disease; however, it is increasingly appreciated that hallmarks of chronic kidney disease such as albuminuria can regress over time. The factors driving albuminuria resolution remain elusive. Since albuminuria is a strong risk factor for GFR loss, modifiable lifestyle factors that lead to an improvement in albuminuria would likely reduce the burden of CKD in high-risk individuals, such as patients with diabetes. Dietary therapy such as protein and sodium restriction has historically been used in the management of CKD. Evidence is emerging to indicate that other nutrients may influence kidney health, either through metabolic or haemodynamic pathways or via the modification of gut homeostasis. This review focuses on the role of diet in the pathogenesis and progression of CKD and discusses the latest findings related to the mechanisms of diet-induced kidney disease. It is possible that optimizing diet quality or restricting dietary intake could be harnessed as an adjunct therapy for CKD prevention or progression in susceptible individuals, thereby reducing the burden of CKD.

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Docosahexaenoic Acid Is an Independent Predictor of All-Cause Mortality in Hemodialysis Patients

Cited by 28 publications

References 49 publications

Inverse association between docosahexaenoic acid and mortality in patients on hemodialysis during over 10 years

Inverse association between docosahexaenoic acid and mortality in patients on hemodialysis during over 10 years

Eicosapentaenoic Acid (EPA) Decreases the All-Cause Mortality in Hemodialysis Patients

Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD?

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