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

The treatment of renal failure in cirrhotic patients 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 etiologies. We have investigated the renal effects of a daily supplementation for 1 month of 12 g fish oil (27% C20:5 n‐3 eicosapentanoic acid [EPA], and 23% C22:6 n‐3 docosahexanoic acid [DHA]) in a prospective study of cirrhotic patients with ascites, nine with normal renal function (group 1) and eight with renal failure (glomerular filtration rate [GFR] < 60 mL/min, group 2). Compliance with the dietary regimen was confirmed by fatty acid chromatography that showed increased plasma concentration of EPA (from 1.5 ± 0.7% to 3.7 ± 0.8%, P = .024, in group 1; and from 0.53 ± 0.3% to 2.9 ± 0.8%, P = .03, in group 2) and of DHA (from 2.1 ± 0.4% to 3.4 ± 0.3%, P = .008, in group 1; and from 1.45 ± 0.5% to 3.8 ± 0.4%, P = .05, in group 2). At the end of the study, in patients from group 1, the glomerular filtration rate increased by 19% (from 94 ± 8 to 113 ± 13 mL/min, P = .039), and the urine flow increased by 39% (from 0.85 ± 0.14 to 1.12 ± 0.2 mL/min, P = .039), while no changes occurred in the renal function of patients from group 2. No changes were observed in the urinary excretion of prostaglandin (PG) E2 or of 6‐keto prostaglandin‐1‐alpha (6‐K‐PGF1‐alpha) nor in plasma renin activity (PRA) or the plasma concentration of aldosterone (PA) or antidiuretic hormone (ADH) in both groups. As far as undesirable effects of fish oils were considered, the mean arterial pressure (MAP) decreased in both groups (group 1: from 88.6 ± 2 to 85.3 ± 2 mm Hg, P = .015; group 2: from 88.2 ± 3 to 82.8 ± 3 mm Hg, P = .05), and bleeding time displayed a significant increase when patients were considered collectively (from 744 ± 89 to 872 ± 106 seconds, P = .0068). In conclusion, the administration of fish oil for 1 month was unable to improve renal function in cirrhotic patients with ascites and renal failure. The occurrence of undesirable effects, such as the reduction of arterial pressure and the prolongation of bleeding time, argues against the use of fish oils in these patients.

[1]  N. Mcintyre,et al.  Oxford Textbook of Clinical Hepatology , 1999 .

[2]  C. Ponticelli,et al.  Renal effects of dietary supplementation with fish oil in cyclosporine‐treated liver transplant recipients , 1995, Hepatology.

[3]  A. Del Bo,et al.  Vasopressin release and water metabolism in patients with cirrhosis. , 1994, Journal of hepatology.

[4]  R. de Caterina,et al.  n-3 fatty acids reduce proteinuria in patients with chronic glomerular disease. , 1993, Kidney international.

[5]  C. Ponticelli,et al.  Hepatorenal Syndrome: New Perspectives in Pathogenesis and Treatment , 1993 .

[6]  H. Bilo,et al.  Effect of dietary fish oil on renal function and rejection in cyclosporine-treated recipients of renal transplants. , 1993, The New England journal of medicine.

[7]  C. Naylor,et al.  Fish oil in lupus nephritis: clinical findings and methodological implications. , 1993, Kidney international.

[8]  P. Whelton,et al.  Does supplementation of diet with 'fish oil' reduce blood pressure? A meta-analysis of controlled clinical trials. , 1993, Archives of internal medicine.

[9]  W. Jiménez,et al.  Oral misoprostol or intravenous prostaglandin E2 do not improve renal function in patients with cirrhosis and ascites with hyponatremia or renal failure. , 1993, Journal of hepatology.

[10]  M. Epstein.  The hepatorenal syndrome--newer perspectives. , 1992, The New England journal of medicine.

[11]  P. Weber,et al.  Cardiovascular effects of N-3 fatty acids. , 1988, Journal of nutritional science and vitaminology.

[12]  R. Gans,et al.  Omega-3 polyunsaturated fatty acids in chronic renal insufficiency. , 1991, Nephron.

[13]  H. Vetter,et al.  Effects of n-3 fatty acids on renal function and renal prostaglandin E metabolism. , 1990, Kidney international.

[14]  J. Llach,et al.  Effects of intravenous amino acid infusion and dietary proteins on kidney function in cirrhosis , 1990, Hepatology.

[15]  A. Morganti,et al.  Renal and humoral effects of ibopamine, a dopamine agonist, in patients with liver cirrhosis. , 1990, Archives of internal medicine.

[16]  T. Hamazaki,et al.  Favorable effects of fish oil concentrate on risk factors for thrombosis in renal allograft recipients. , 1989, Nephron.

[17]  V. Arroyo,et al.  Prostaglandin precursor fatty acids in cirrhosis with ascites: effect of linoleic acid infusion in functional renal failure. , 1988, Clinical science.

[18]  A. Donker,et al.  Effects of protein intake variation and omega-3 polyunsaturated fatty acids on renal function in chronic renal disease. , 1987, Life sciences.

[19]  G. Bruckner,et al.  Fish oil increases peripheral capillary blood cell velocity in humans. , 1987, Atherosclerosis.

[20]  B. Butland,et al.  Effects of a fish oil supplement on serum lipids, blood pressure, bleeding time, haemostatic and rheological variables. A double blind randomised controlled trial in healthy volunteers. , 1987, Atherosclerosis.

[21]  C. von Schacky,et al.  Long-term effects of dietary marine omega-3 fatty acids upon plasma and cellular lipids, platelet function, and eicosanoid formation in humans. , 1985, The Journal of clinical investigation.

[22]  J. Onrot,et al.  Hemodynamic and humoral effects of caffeine in autonomic failure. Therapeutic implications for postprandial hypotension. , 1985, The New England journal of medicine.

[23]  A. Heyrovský,et al.  A new method for the determination of inulin in plasma and urine. , 1956, Clinica chimica acta; international journal of clinical chemistry.