Can you take fish oil with kidney disease

Supplements of vitamin D and omega-3 fatty acids (often sold as fish oil) do not help people with type 2 diabetes stave off chronic kidney disease, according to findings from the largest clinical study to date of the supplements in this patient population.

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The paper was published Friday, Nov. 8, 2019, in JAMA and presented concurrently at an American Society of Nephrology conference in Washington, D.C.

"We were hopeful for both of these interventions, vitamin D and fish oil, but they don't appear to be particularly effective for this purpose," said Dr. Ian de Boer, the paper's lead author. He is a professor of medicine at the University of Washington School of Medicine and associate director of the Kidney Research Institute, a collaboration of UW Medicine and Northwest Kidney Centers.

Of the 28 million Americans who live with type 2 diabetes, de Boer said, about 40 percent develop chronic kidney disease, a condition in which the kidneys cannot adequately remove waste and fluid from the body. This disrupts a person's health in myriad ways and can progress to kidney failure. It also greatly increases the risk of cardiovascular events and death.

Previous animal-model and cell-culture studies have suggested that vitamin D and fish oil supplements have anti-inflammatory and other properties that might prevent or slow type 2 diabetes' progression to chronic kidney disease. Research also has found associations between humans' kidney decline and lower levels of vitamin D and lower dietary intake of fish.

"A lot of people use the supplements hoping there are beneficial kidney and cardiovascular effects," de Boer said. "We wanted this study to clarify whether these supplements have any real kidney benefit in adults with diabetes. Even if it's not the result we hoped for, closing a chapter is useful for patients and clinicians and researchers alike."

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The study was conducted as part of the nationwide VITamin D and OmegA-3 TriaL (VITAL). The investigators designed a five-year study of kidney function in 1,312 adults with type 2 diabetes in the trial. The adults (men aged ?50, women aged ?55) had no clinically apparent cardiovascular disease or cancer, and most did not start with signs of kidney disease.

Participants submitted blood and urine samples to establish a baseline estimated glomerular filtration rate - eGFR, a measure of the kidneys' waste-filtering performance - and the presence of protein in the urine. They were then randomly assigned to one of four treatment groups:

370 people received supplements of vitamin D and omega-3 fatty acids (fish oil)
333 received vitamin D and a fish oil placebo
289 received a vitamin D placebo and a capsule of fish oil
320 received two placebos

Blood and urine samples were collected at two years and again at four or five years after randomization. On average, kidney function declined by about 15% over the course of the study. The amount of decline did not vary significantly whether participants were assigned to vitamin D or placebo, or to omega-3 fatty acids or placebo. There were also no significant differences in urine protein excretion.

The VITAL trial is evaluating the overall benefits and risks of these supplements, and the effects on kidney function are an important piece of the puzzle. The present study answers a key question that helps to advance public health."
Dr. JoAnn Manson, the study's senior author and director of the main VITAL trial

She is chief of preventive medicine at Brigham and Women's Hospital and a professor of medicine at Harvard Medical School.

Source:

Journal reference:

de Boer, I.H., et al. (2019) Effect of Vitamin D and Omega-3 Fatty Acid Supplementation on Kidney Function in Patients With Type 2 Diabetes. JAMA. doi.org/10.1001/jama.2019.17380.

Posted in: Medical Research News | Medical Condition News

Tags: Animal Model, Anti-Inflammatory, B Cell, Blood, Cancer, Cardiology, Cardiovascular Disease, Cell, Cell Culture, Chronic, Chronic Kidney Disease, Diabetes, Endocrinology, Fatty Acids, Fish, Fish Oil, Hospital, Kidney, Kidney Disease, Kidney Failure, Medical School, Medicine, Nephrology, Placebo, Protein, Public Health, Research, Supplements, T-Cell, Type 2 Diabetes, Vitamin D

Source/Disclosures

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Disclosures: The authors report no relevant financial disclosures.

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For patients with kidney disease not yet on dialysis, omega-3 fatty acid supplementation led to improvements in pulse wave velocity and serum triglyceride levels, suggesting that daily use could reduce risk for cardiovascular events.

Supplementation did not, however, impact albuminuria.

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“There is interest in the possible beneficial effects that omega-3 polyunsaturated fatty acids ... could have for CKD,” Daniel Bunout, MD, of the Institute of Nutrition and Food Technology at the University of Chile, and colleagues wrote. “These fatty acids have pharmacological properties that could improve kidney function, such as anti-inflammatory actions and a reduction in blood pressure and triglyceride levels.”

Adding that previous research also suggests a benefit of omega-3 polyunsaturated fatty acids (PUFA) on albuminuria, the researchers highlighted that various studies have reached different conclusions.

“The causes of these contradictory results are numerous,” they explained. “One explanation might be limited compliance to supplementation schedules related to bad odor and secondary gastrointestinal effects of fish oil.”

Bunout and colleagues sought to add to the existing literature by assessing the impact of fatty acid supplementation on albuminuria and cardiovascular risk factors, such as pulse wave velocity (“a marker of arterial stiffness”) and triglycerides.

To limit the potential effect of “bad odor,” a highly deodorized oil containing omega-3 PUFA was used in the study.

For 3 months, 100 patients with CKD and a urine albumin excretion of at least 30 mg/g creatinine took either 3,666 mg/day of docosahexaenoic and eicosapentaenoic acids or a corn oil supplement, with the researchers noting the omega-3 PUFA supplements were “virtually indistinguishable from corn oil in terms of taste and odor.”

Results showed that at 3 months patients receiving the active supplement had significant increases in their omega-3 index (3.1% to 5.5%).

Although supplementation did not appear to improve albuminuria (defined as a 20% reduction in urine albumin), the researchers found that participants receiving omega-3 PUFA maintained their pulse wave velocity, while controls experienced an increase during follow-up. Triacylglycerol levels also decreased significantly in the omega-3 PUFA group.

Regarding adverse effects, 12 participants in the control group and 14 in omega-3 PUFA group reported mild gastrointestinal symptoms.

Elaborating on these findings, Bunout and colleagues emphasized that omega-3 fatty acid supplementation did not impact albuminuria.

“Considering that the ultimate goal of any therapeutic intervention in CKD is to delay its progression, this new study adds to the evidence that [omega-3 PUFA] do not have a role for this purpose,” they contended.

Still, they suggested the positive effects seen for the other measures are important for patients with CKD, as lessening arterial stiffness can help maintain kidney function and prevent heart failure, while reducing serum triglycerides can slow disease progression and decrease mortality rates.

“[Omega-3 PUFA] may reduce pulse wave velocity, blood pressure, and triglyceride levels in patients with CKD and thus reduce cardiovascular risk,” the researchers concluded.

Does omega

Results from observational studies suggest that Omega-3 (n-3) fatty acids may prevent or slow down the decline of kidney function (9,10).

Is omega

Vitamin D and Omega-3 Fatty Acid has no Effect on Kidney Function.

Are fish oils good for kidneys?

Dietary fish oil supplementation has been shown to reduce progression of renal disease among patients with IgA nephropathy [56] and to suppress mesangial cell activation and proliferation in animal models [60].

Does fish oil affect creatinine levels?

“Our results showed a significant decrease in serum creatinine level after fish-oil supplement in Type 2 diabetes mellitus patients,” stated the researcher.