Marine n-3 polyunsaturated fatty acids in renal transplantation
Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Background. Cardiovascular disease is the leading cause of death following renal transplantation. Marine n-3 polyunsaturated fatty acids (PUFAs) exert cardio-protective metabolic effects that may lower mortality risk after renal transplantation. Anti-inflammatory effects of marine n-3 PUFAs and potential beneficial effects on fibrosis may preserve renal graft function and prevent graft loss.\nMaterials and methods. This retrospective observational cohort study included 1990 Norwegian renal transplant recipients transplanted between 1999 and 2011. Associations between plasma marine n-3 PUFA levels and patient and renal graft survival were assessed by multivariable Cox proportional hazard regression analysis. Associations between plasma marine n-3 PUFA levels and cardiovascular risk markers at ten weeks post-transplant as well as change in renal graft function during the first five years after transplantation were evaluated by linear regression analysis. Plasma phospholipids fatty acids were determined by gas chromatography. Plasma marine n-3 PUFA levels were defined as the sum of the three marine n-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA) levels in weight percentage (wt%) of total plasma phospholipid fatty acids.\nResults. During a median follow-up time of 6.8 years, 569 (28.6%) renal grafts were lost, either due to death of the renal transplant recipient (n=340) or graft failure in surviving patients (death censored graft loss, n=229). There were 406 deaths (20.4%) during follow-up, including 164 deaths due to cardiovascular disease (40.4% of deaths), 95 deaths due to cancer (23.4%) and 101 deaths due to infectious disease (24.9%).\nPlasma marine n-3 PUFA levels ranged from 1.35 to 23.87 wt%, with a median level of 7.95 wt% (interquartile range 6.20 to 10.03 wt%). Mortality rates were lower in patients with high plasma marine n-3 PUFA levels (= 7.95 wt%) compared with low levels (< 7.95 wt%) across age groups, with a pooled mortality rate ratio estimate of 0.69 (confidence interval [CI] 0.57 to 0.85). When grouped according to plasma marine n-3 PUFA levels, patients belonging to the upper quartile (= 10.03 wt%) compared with the lower (= 6.20 wt%) had a 56% lower mortality risk (multivariable adjusted hazard ratio [HR] 0.44; 95% CI 0.26 to 0.75). Similar results were found for plasma EPA and DHA levels, when analyzed separately. In contrast, no association was found between plasma DPA levels and mortality. Patients belonging to the upper marine n-3 PUFA quartile compared with the lower had a significantly lower cardiovascular mortality risk (multivariable adjusted HR 0.18; 95% CI 0.08 to 0.42), primarily due to strong negative associations between plasma marine n-3 PUFA levels and the risk of lethal stroke or sudden cardiac death. We found no significant association between plasma marine n-3 PUFA levels and deaths due to infectious disease. However, patients belonging to the upper plasma EPA quartile compared with the lower had a significant lower risk of death due to infectious disease. Plasma marine n-3 PUFA levels were not associated with death due to cancer.\nFor every 1.0 wt% increase in plasma marine n-3 PUFA level, there was an 11% reduced risk of overall graft loss (multivariable adjusted HR 0.89; 95% CI 0.84 to 0.93) and a 10% reduced risk of death censored graft loss (multivariable adjusted HR 0.90; 95% CI 0.84 to 0.97). Higher plasma marine n-3 PUFA levels were associated with lower decline in renal graft function during the first five years after transplantation. Acute rejection episodes within the first three months after renal transplantation did not differ across marine n-3 PUFA quartiles. However, beyond three months, patients belonging to the lower marine n-3 PUFA quartile suffered more acute rejection episodes than patients in the three upper quartiles.\nPlasma marine n-3 PUFA levels were associated with lower resting heart rate, lower fasting plasma glucose levels, lower plasma triglyceride levels and higher plasma high-density lipoprotein cholesterol levels, while no significant association were found with blood pressure, pulse wave velocity or plasma low-density lipoprotein cholesterol levels.\nConclusion. Higher plasma marine n-3 PUFA levels were independently associated with better patient and graft survival after renal transplantation. We also found significant beneficial associations between plasma marine n-3 PUFA levels and plasma triglyceride levels, resting heart rate, fasting plasma glucose levels, plasma high-density lipoprotein cholesterol levels, acute rejection rate and renal graft function, which might explain a lower mortality and graft loss risk in patients with high plasma marine n-3 PUFA levels.
Author: Ivar Eide
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2401778179