Effect of Omega 3 Fatty Acids Supplementation on Patency of Arteriovenous Access in Hemodialysis Patients

Abstract

End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or graft for haemodialysis. These access sites should ideally have a long life and a low rate of complications (for example thrombosis, infection, stenosis, aneurysm formation and distal limb ischaemia). Thrombosis of hemodialysis vascular access grafts represents a major medical and economic burden. Dyslipidemia are usually present in chronic renal disease and end stage renal failure is generally associated with hypertriglyceridemia. Omega-3 fatty acids play an important modulatory role in the immune and inflammatory responses, the progression of arteriosclerosis, vascular reactivity and BP control, cell membrane function, and gene expression. Fish oils have been demonstrated to have anti-platelet effects, and reduce intimal hyperplasia in autogenous grafts. In addition, reductions in neointimal hyperplasia formation and enhanced endothelial function have been reported. Such effects may improve AVF and AVG patency by addressing the problem of both thrombosis and stenosis and enhanced endothelial function may also contribute to improved AVF maturation. Our study was designed to evaluate the role of ω-3 fatty acids in preserving the patency of arteriovascular fistulas and grafts in hemodialysis patients. The study was a prospective randomized case control study conducted on 80 chronic hemodialysis patients who currently undergoing hemodialysis three sessions per week for more than 3 months in our hospital (El Maadi Liver & kidney transplantation hospital). The study was conducted through a period of time spanning 6 months. They were divided into two groups; Group 1: (40 hemodialysis patients receiving ω-3 fatty acids for 6 months) Group 2: (40 hemodialysis patients not receiving ω-3 fatty acids). Our study was conducted on 80 chronic hemodialysis patients 40 of them were females (50%), 40 of them were males (50%) (table 1). In our study atrophic kidneys was the most common aetiology of end stage renal disease in group 1 and polycystic kidney disease was the most common aetiology of end stage renal disease in group 2 (table 6). AVF was the vascular access in 82.50 % of patients versus 17.50 %, having AVG (table 4). In our study there was highly significant statistical decrease in triglyceride level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 36). In our study there was highly significant statistical decrease in total cholesterol level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 37). Similarly there was highly significant statistical decrease in LDL level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 38). In our study there was highly significant statistical increase in HDL level in group 1 compared to group 2 over the six months period (p<0.001) (table 10) (figure 39). In our study there was no significant statistical difference between the two groups as regard hemoglobin level,calcium and phosphorus level over the six months period (p<0.05) (table 10) (figure 42, 43, 44). In our study there was significant statistical increase in PTH in group 2 compared to group 1 over the six months (p<0.05) (table 10) (figure 45).