PUFA status and omega-3 fatty acid supplementation in hemodialysis patients: Pathophysiological aspects and clinical outcomes

Abstract

In general, patients with end-stage renal disease treated with chronic hemodialysis have plasma and cell membrane fatty acid profiles that indicate essential fatty acid deficiency, with low omega (n)-3 and n-6 polyunsaturated fatty acid products, including dihomo-γ-linolenic, arachidonic, and eicosapentaenoic and docosahexaenoic acids. Abnormal fatty acid metabolism in hemodialysis patients may contribute to clinical problems such as itching, abnormal perspiration, susceptibility to infection, delayed wound healing, anemia, and increased incidence of cardiovascular events. By modulating cell membrane structure and function as well as synthesis of lipid mediators such as eicosanoids, n-3 polyunsaturated fatty acid supplementation may offer multiple health benefits to dialysis patients based on antiinflammatory and cardioprotective effects. The present review summarizes what is known about the concentration of polyunsaturated fatty acids in hemodialysis patients and evaluates the effects of n-3 polyunsaturated fatty acid supplementation from randomized controlled studies designed with the purpose of identifying the link between polyunsaturated fatty acid levels and clinical outcomes in end-stage renal disease. There are many limitations in the published studies which deal with changes in fatty acid metabolism and polyunsaturated fatty acid content in chronic renal failure. However, in general, it can be concluded that patients on hemodialysis need nutritional care programs with an adequate n-6/n-3 polyunsaturated fatty acid ratio in their diet. In fact, further well-designed and controlled studies are needed to confirm that n-3 polyunsaturated fatty acid supplementation might reduce the progression of chronic kidney disease and eliminate some clinical problems in hemodialysis patients.