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Omega-3 fatty acid supplementation in primary nephrotic syndrome: effects on plasma lipids and coagulopathy

, : Omega-3 fatty acid supplementation in primary nephrotic syndrome: effects on plasma lipids and coagulopathy. Journal of the American Society of Nephrology 3(6): 1321-1329

The effect of fish oil dietary supplementation on the dyslipidemia and coagulopathy of seven patients with nephrotic syndrome and hypoalbuminemia due to primary kidney disease was studied. Plasma lipids, platelet aggregation studies, simplate bleeding time, and fibrinogen levels were determined before and after 6 wk of treatment with fish oil (15 g/day of MaxEPA; 2.7 g of eicosapentenoic acid (EPA)) and 1.8 g of docosahexenoic acid. Urea kinetics were determined from urine-urea concentration, urinary proteina, and urine volume. A 3-day dietary intake record was obtained from each patient before and after 6 wk of fish oil supplementation. There was no significant dietary change in protein, fat, or carbohydrate intake over the time period of the study. At study end, total triglycerides decreased from 2.98 +- 1.31 to 2.18 +- 1.14 mmol/L (P = 0.002), and very low-density lipoprotein-triglycerides decreased from 2.35 +- 1.34 to 1.28 +- 1.07 mmol/L (P = 0.01). Low-density lipoprotein (LDL) cholesterol increased from 5.18 +- 1.74 to 7.35 +- 2.83 mmol/L (P = 0.005). No significant changes occurred in bleeding time, platelet count, hematocrit, red blood cell flexibility, or whole blood viscosity. Platelet aggregation responses to collagen and arachidonic acid were consistently reduced after treatment, but there was no change in platelet response to ADP. The platelet membrane phospholipids showed a significantly increased incorporation of EPA after the fish oil diet (P = 0.03). Plasma phospholipid EPA (P lt 0.01), docosahexenoic acid (P 7L 0.03), and EPA/arachidonic acid (P lt 0.003) were also significantly increased. Fish oil dietary supplementation improves the hypertriglyceridemia and reduces the platelet hyperaggregation associated with the primary nephrotic syndrome. Elevation in LDL cholesterol with concomittant reduction in high-density lipoprotein/LDL ratio may preclude the use of fish oil as a hypolipidemic agent in patients with primary nephrotic syndrome.


PMID: 1477328

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