Lack of renal effects of fish oil administration in patients with advanced cirrhosis and impaired glomerular filtration

Abstract

use of fish oils in these patients. (HEPATOLOGY 1997; The treatment of renal failure in cirrhotic patients 25:313-316.) with ascites remains unsatisfactory. Recent studies have shown that the dietary supplementation with fish oil improves the renal function of normal subjects, as well as that of patients with renal failure of different etioloImpaired glomerular filtration is a life-threatening compligies. We have investigated the renal effects of a daily cation of cirrhosis.1,2 It is characterized by an overwhelming supplementation for 1 month of 12 g fish oil (27% C20:5 activity of vasoconstrictors (both of systemic and intrarenal n-3 eicosapentanoic acid [EPA], and 23% C22:6 n-3 doco-origin) upon vasodilating prostaglandins and kallikrein.1 Resahexanoic acid [DHA]) in a prospective study of cir-cently, it has been shown that the dietary supplementation rhotic patients with ascites, nine with normal renal with fish oil, containing high concentrations of the marine function (group 1) and eight with renal failure (glomeru-polyunsatured fatty acids, eicosapentanoic acid (EPA) (C20:5 lar filtration rate [GFR] õ 60 mL/min, group 2). Compli-n-3) and docosahexanoic acid (DHA) (C22:6 n-3), is able to ance with the dietary regimen was confirmed by fatty improve the renal function of normal subjects, as well as that acid chromatography that showed increased plasma of patients with renal failure of different etiologies.3-7 Such concentration of EPA (from 1.5 { 0.7% to 3.7 { 0.8%, P Å effect is likely mediated by the changed synthesis of prosta-.024, in group 1; and from 0.53 { 0.3% to 2.9 { 0.8%, P Å glandins, 4 antagonism against vasoconstrictor substances, 3.03, in group 2) and of DHA (from 2.1 { 0.4% to 3.4 { 0.3%, or reduced rheological stress to the glomerulus. 8 In the cur-P Å .008, in group 1; and from 1.45 { 0.5% to 3.8 { 0.4%, rent study, we investigated the effects of a 1-month dietary P Å .05, in group 2). At the end of the study, in patients supplementation with fish oil on renal function and vasofrom group 1, the glomerular filtration rate increased active compounds in cirrhotic patients with ascites, with and by 19% (from 94 { 8 to 113 { 13 mL/min, P Å .039), and without impaired glomerular filtration. the urine flow increased by 39% (from 0.85 { 0.14 to 1.12 { 0.2 mL/min, P Å .039), while no changes occurred in PATIENTS AND METHODS the renal function of patients from group 2. No changes were observed in the urinary excretion of prostaglandinThe present study included patients who met the following crite-(PG) E 2 or of 6-keto prostaglandin-1-a (6-K-PGF 1 -a) nor ria: 1) Diagnosis of cirrhosis (based on history, clinical, and laborain plasma renin activity (PRA) or the plasma concentra-tory findings) with portal hypertension, indirectly assessed by the tion of aldosterone (PA) or antidiuretic hormone (ADH) evidence of esophageal varices at endoscopy; 2) absence of arterial in both groups. As far as undesirable effects of fish oils hypertension; respiratory, cardiac, or primary kidney disease; diabewere conside...

Clinical Practice Guidelines of European Association for the Study of the Liver (EASL) on nutrition in chronic liver disease. Part 3

“…Вплив на післяопераційні ускладнення не виявили [132]. Пероральне призначення w3-жирних кислот пацієнтам із цирозом, асцитом та нирковою недостатністю не поліпшувало функцію нирок, але збільшувало тривалість кровотечі та артеріальний тиск, тому автори не рекомендують їх застосовувати у пацієнтів з цирозом [133].…”