Restricted accessResearch articleFirst published online 2011-1
Effect of Intravenous ω-3 Fatty Acid Infusion and Hemodialysis on Fatty Acid Composition of Free Fatty Acids and Phospholipids in Patients With End-Stage Renal Disease
Background: Patients treated with hemodialysis (HD) have been reported to have decreased levels of ω-3 polyunsaturated fatty acids (PUFAs) in plasma and cells. The aim of this study was to investigate the effect of ω-3 PUFAs administered intravenously during HD, as well as the effect of HD treatment, on the fatty acid composition of plasma free fatty acids (FFAs), plasma phospholipids, and platelet phospholipids. Methods: Forty-four HD patients were randomized to groups receiving either a single dose of a lipid emulsion containing 4.1 g of ω-3 PUFAs or placebo (saline) administered intravenously during HD. Blood was drawn immediately before (baseline) and after (4 hours) HD and before the next HD session (48 hours). Fatty acid composition was measured using gas chromatography. Results: The increase in ω-3 FFAs was greater in the ω-3 PUFA group compared with the placebo group, whereas the increase in total FFAs was similar between the 2 groups. In the ω-3 PUFA group, ω-3 PUFAs in plasma phospholipids were higher after 48 hours than at baseline, and in platelet phospholipids, ω-3 PUFAs increased after 4 hours. In the placebo group, no changes were observed in ω-3 PUFAs in plasma and platelet phospholipids. Conclusions: Intravenous ω-3 PUFAs administered during HD caused a transient selective increase in ω-3 FFA concentration. Furthermore, ω-3 PUFAs were rapidly incorporated into platelets, and the content of ω-3 PUFAs in plasma phospholipids increased after 48 hours.
SarnakMJLeveyASSchoolwerthAC. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154-2169.
2.
Morbitidy & mortality. Atlas of end-stage renal disease in the United States. Am J Kidney Dis. 2009;53(suppl 1):S211-S226.
3.
PrioriSGAliotEBlømstrom-LundqvistC. Task Force on Sudden Cardiac Death, European Society of Cardiology. Europace. 2002;4:3-18.
4.
HerzogCAMangrumJMPassmanR. Sudden cardiac death and dialysis patients. Semin Dial. 2008;21:300-307.
5.
SiscovickDSRaghunathanTEKingI. Dietary intake and cell membrane levels of long-chain ω-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA. 1995;274:1363-1367.
6.
AlbertCMCamposHStampferMJ. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med. 2002;346:1113-1118.
7.
MarchioliRBarziFBombaE. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105:1897-1903.
8.
BurrMLFehilyAMGilbertJF. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: diet and reinfarction trial (DART). Lancet. 1989;2:757-761.
9.
WeylandtKHKangJXLeafA. Polyunsaturated fatty acids exert antiarrhythmic actions as free acids rather than in phospholipids. Lipids. 1996;31:977-982.
10.
FriedmanANMoeSMPerkinsSMLiYWatkinsBA. Fish consumption and omega-3 fatty acid status and determinants in long-term hemodialysis. Am J Kidney Dis. 2006;47:1064-1071.
11.
SaifullahAWatkinsBASahaCLiYMoeSMFriedmanAN. Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients—a pilot study. Nephrol Dial Transplant. 2007;22:3561-3567.
12.
FolchJLeesMSloane StanleyGH. A simple method for the isolation and purification of total lipids from animal tissues. J Biol Chem. 1957;226:497-509.
13.
BurdgeGCWrightPJonesAEWoottonSA. A method for separation of phosphatidylcholine, triacylglycerol, non-esterified fatty acids and cholesterol esters from plasma by solid-phase extraction. Br J Nutr. 2000;84:781-787.
14.
PaquotCHautfenneA, eds. IUPAC Standard Methods for Analysis of Oils, Fats, and Derivatives (IUPAC Method 2.301). 7th ed.London, UK: Blackwell Scientific; 1987.
15.
van KuijkFJThomasDWStephensRJDratzEA. Gas chromatography-mass spectrometry method for determination of phospholipid peroxides; I. Transesterification to form methyl esters. J Free Radic Biol Med. 1985;1:215-225.
16.
FouqueDVennegoorMterWP. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007;22(suppl 2):ii45-ii87.
17.
K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(suppl 3):S16-S153.
18.
SvenssonMSchmidtEBJorgensenKAChristensenJH. N-3 fatty acids as secondary prevention against cardiovascular events in patients who undergo chronic hemodialysis: a randomized, placebo-controlled intervention trial. Clin J Am Soc Nephrol. 2006;1:780-786.
19.
Kris-EthertonPMHarrisWSAppelLJ. Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol. 2003;23:151-152.
20.
SvenssonMChristensenJHSollingJSchmidtEB. The effect of n-3 fatty acids on plasma lipids and lipoproteins and blood pressure in patients with CRF. Am J Kidney Dis. 2004;44:77-83.
21.
KutnerNGClowPWZhangRAvilesX. Association of fish intake and survival in a cohort of incident dialysis patients. Am J Kidney Dis. 2002;39:1018-1024.
22.
FriedmanANSahaCWatkinsBA. Feasibility study of erythrocyte long-chain omega-3 polyunsaturated fatty acid content and mortality risk in hemodialysis patients. J Ren Nutr. 2008;18:509-512.
23.
FellstromBCJardineAGSchmiederRE. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med. 2009;360:1395-1407.
24.
KraneVWinklerKDrechslerCLilienthalJMarzWWannerC. Effect of atorvastatin on inflammation and outcome in patients with type 2 diabetes mellitus on hemodialysis. Kidney Int. 2008;74:1461-1467.
25.
Szklarek-KubickaMFijalkowska-MorawskaJZaremba-DrobnikDUcinskiACzekalskiSNowickiM. Effect of intradialytic intravenous administration of omega-3 fatty acids on nutritional status and inflammatory response in hemodialysis patients: a pilot study. J Ren Nutr. 2009;19:487-493.
OliverMFKurienVAGreenwoodTW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet. 1968;1:710-714.
29.
TanseyMJOpieLH. Relation between plasma free fatty acids and arrhythmias within the first twelve hours of acute myocardial infarction. Lancet. 1983;2:419-422.
30.
JouvenXCharlesMADesnosMDucimetièreP. Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population. Circulation. 2001;104:756-761.
31.
PilzSScharnaglHTiranB. Elevated plasma free fatty acids predict sudden cardiac death: a 6.85-year follow-up of 3315 patients after coronary angiography. Eur Heart J. 2007;28:2763-2769.
32.
GillettMPObinecheENKhanSTAbdulleAM. Plasma concentrations of non-esterified fatty acids in chronic renal failure in the United Arab Emirates. Saudi Med J. 2004;25:1611-1616.
33.
MarangoniRCivardiFSavinoR. Plasma lipids and fatty acid levels in chronically uremic patients undergoing blood purification with different methods. Artif Organs. 1992;16:625-629.
34.
NasstromBStegmayrBGuptaJOlivecronaGOlivecronaT. A single bolus of a low molecular weight heparin to patients on haemodialysis depletes lipoprotein lipase stores and retards triglyceride clearing. Nephrol Dial Transplant. 2005;20:1172-1179.
ElmadfaIStrohSBrandtKSchlotzerE. Influence of a single parenteral application of a 10% fish oil emulsion on plasma fatty acid pattern and the function of thrombocytes in young adult men. Ann Nutr Metab. 1993;37:8-13.
40.
PortoisLDeckelbaumRJMalaisseWJCarpentierYA. Accumulation rapide d’eicosapentaénoate dans les phospholipids cellularies après injection intraveineuse d’une émulsion d’huile de poisson et de triglycérides à chaîne moyenne à des sujets normaux. Nutr Clin Metabol. 2004;18:S53.
41.
MayerKFegbeutelCHattarK. Omega-3 vs omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients: impact on plasma fatty acids and lipid mediator generation. Intensive Care Med. 2003;29:1472-1481.
MorlionBJTorwestenELessireH. The effect of parenteral fish oil on leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma. Metabolism. 1996;45:1208-1213.
44.
PluessTTHayozDBergerMM. Intravenous fish oil blunts the physiological response to endotoxin in healthy subjects. Intensive Care Med. 2007;33:789-797.
45.
HarrisWSSandsSAWindsorSL. Omega-3 fatty acids in cardiac biopsies from heart transplantation patients: correlation with erythrocytes and response to supplementation. Circulation. 2004;110:1645-1649.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
