Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients.

Abstract

OBJECTIVE:

Alterations in the balance between serum n-3 and n-6 polyunsaturated fatty acids (PUFAs) is predictive of cardiovascular events among hemodialysis patients, although little is known about the serum ratio of n-6 arachidonic acid (AA) to n-6 dihomo-γ-linoleic acid (DGLA) in renal failure. We hypothesized that AA/DGLA ratio is altered in hemodialysis patients resulting in poor clinical outcomes.

METHODS:

This was a single center cohort study in an urban area in Japan with cross-sectional analyses. Subjects were 517 hemodialysis patients and 122 control subjects. The main exposure was serum AA/DGLA ratio, and the main outcome measures were all-cause mortality and cardiovascular events during 5 years.

RESULTS:

The hemodialysis patients showed a higher median (interquartile range) AA/DGLA ratio than the control subjects (6.46 [5.22-7.81] versus 4.56 [3.74-6.34], P < .001). In a Cox proportional hazard model adjusted for age, sex, dialysis duration, diabetic nephropathy, prior cardiovascular disease, and the ratio of serum n-3 polyunsaturated fatty acids (eicosapentaenoic acid plus docosahexaenoic acid) to AA, the higher quartiles of AA/DGLA ratio were associated with higher risk for all-cause mortality with hazard ratios (95% confidence interval) of 1.50 (0.84-2.76) for quartile 2, 2.10 (1.18-3.86) for quartile 3, and 2.02 (1.10-3.78) for quartile 4 compared with quartile 1. AA/DGLA ratio showed a similar association with the risk of cardiovascular events.

CONCLUSIONS:

AA/DGLA ratio was elevated in patients with end-stage renal disease requiring hemodialysis, and a high AA/DGLA ratio was an independent predictor of poor clinical outcomes in this population.

• Authors: Yukinobu Kuwamura, Tetsuo Shoji, Yujiro Okute, Yuko Yamazaki, Koka Motoyama, Tomoaki Morioka, Katsuhito Mori, Shinya Fukumoto, Yoshihiro Tsujimoto, Atsushi Shioi, Masanori Emoto, Masaaki Inaba
• Journal: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation (J Ren Nutr) Vol. 28 Issue 1 Pg. 54-63 (01 2018) ISSN: 1532-8503 [Electronic] United States
• PMID: 29089279 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Delta-5 Fatty Acid Desaturase
• Fatty Acids, Omega-6
• Serum Albumin
• Docosahexaenoic Acids
• Arachidonic Acid
• Cholesterol
• Eicosapentaenoic Acid
• Fatty Acid Desaturases

Topics

• Aged
• Arachidonic Acid (blood)
• Cardiovascular Diseases (blood, etiology, mortality)
• Cholesterol (blood)
• Cross-Sectional Studies
• Delta-5 Fatty Acid Desaturase
• Docosahexaenoic Acids (blood)
• Eicosapentaenoic Acid (blood)
• Fatty Acid Desaturases (blood)
• Fatty Acids, Omega-6 (blood)
• Female
• Follow-Up Studies
• Humans
• Japan (epidemiology)
• Kidney Failure, Chronic (blood, complications, mortality)
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Renal Dialysis (adverse effects, mortality)
• Risk Factors
• Serum Albumin (metabolism)
• Treatment Outcome