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Title: | Fish oil for kidney transplant recipients. | Authors: | Manley K.J.;Lim A.K.H.;Fraenkel M.B.;Roberts M.A. | Monash Health Department(s): | Nephrology | Institution: | (Lim) Monash Medical Centre, Department of Nephrology, 246 Clayton Rd, Clayton, VIC 3168, Australia (Manley) Austin Health, Department of Nutrition and Dietetics, PO Box 5555, Heidelberg, VIC 3084, Australia (Roberts, Fraenkel) Monash University, Eastern Health Clinical School, Box Hill, VIC 3128, Australia | Issue Date: | 5-Sep-2016 | Copyright year: | 2016 | Publisher: | John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ, United Kingdom) | Place of publication: | United Kingdom | Publication information: | Cochrane Database of Systematic Reviews. 2016 (8) (no pagination), 2016. Article Number: CD005282. Date of Publication: 18 Aug 2016. | Journal: | Cochrane Database of Systematic Reviews | Abstract: | Background: Calcineurin inhibitors used in kidney transplantation for immunosuppression have adverse effects that may contribute to nephrotoxicity and increased cardiovascular risk profile. Fish oils are rich in very long chain omega-3 fatty acids, which may reduce nephrotoxicity by improving endothelial function and reduce rejection rates through their immuno-modulatory effects. They may also modify the cardiovascular risk profile. Hence, fish oils may potentially prolong graft survival and reduce cardiovascular mortality. Objective(s): This review aimed to look at the benefits and harms of fish oil treatment in ameliorating the kidney and cardiovascular adverse effects of CNI-based immunosuppressive therapy in kidney transplant recipients. Search Method(s): We searched the Cochrane Kidney and Transplant Specialised Register (up to 17 March 2016) through contact with the Information Specialist using search terms relevant to this review. Selection Criteria: All randomised controlled trials (RCTs) and quasi-RCTs of fish oils in kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen. RCTs of fish oil versus statins were included. Data Collection and Analysis: Data was extracted and the quality of studies assessed by two authors, with differences resolved by discussion with a third independent author. Dichotomous outcomes were reported as risk ratio (RR) and continuous outcome measures were reported as the mean difference (MD) with 95% confidence intervals using the random effects model. Heterogeneity was assessed using a Chi2 test on n-1 degrees of freedom and the I2 statistic. Data not suitable for pooling were tabulated and described. Main Result(s): Fifteen studies (733 patients) were suitable for analysis. All studies were small and had variable methodology. Fish oil did not significantly affect patient or graft survival, acute rejection rates, or calcineurin inhibitor toxicity when compared to placebo. Overall SCr was significantly lower in the fish oil group compared to placebo (5 studies, 237 participants: MD -30.63 mumol/L, 95% CI -59.74 to -1.53; I2 = 88%). In the subgroup analysis, this was only significant in the long-course (six months or more) group (4 studies, 157 participants: MD -37.41 mumol/L, 95% CI -69.89 to -4.94; I2 = 82%). Fish oil treatment was associated with a lower diastolic blood pressure (4 studies, 200 participants: MD -4.53 mm Hg, 95% CI -7.60 to -1.45) compared to placebo. Patients receiving fish oil for more than six months had a modest increase in HDL (5 studies, 178 participants: MD 0.12 mmol/L, 95% CI 0.03 to 0.21; I2 = 47%) compared to placebo. Fish oil effects on lipids were not significantly different from low-dose statins. There was insufficient data to analyse cardiovascular outcomes. Fishy aftertaste and gastrointestinal upset were common but did not result in significant patient drop-out. Authors' conclusions: There is insufficient evidence from currently available RCTs to recommend fish oil therapy to improve kidney function, rejection rates, patient survival or graft survival. The improvements in HDL cholesterol and diastolic blood pressure were too modest to recommend routine use. To determine a benefit in clinical outcomes, future RCTs will need to be adequately powered with these outcomes in mind.Copyright © 2016 The Cochrane Collaboration. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1002/14651858.CD005282.pub3 | PubMed URL: | 27535773 [http://www.ncbi.nlm.nih.gov/pubmed/?term=27535773] | ISSN: | 1469-493X | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/40463 | Type: | Review | Subjects: | bloating/si [Side Effect] cardiovascular disease/dt [Drug Therapy] cardiovascular disease/si [Side Effect] cause of death cholesterol blood level creatinine blood level creatinine clearance diarrhea/si [Side Effect] diastolic blood pressure drug efficacy drug safety gastrointestinal symptom/si [Side Effect] glomerulus filtration rate graft failure/co [Complication] *graft recipient graft survival human immunosuppressive treatment kidney function kidney graft rejection/co [Complication] kidney graft rejection/dt [Drug Therapy] kidney graft rejection/pc [Prevention] *kidney transplantation lipid blood level lipoprotein blood level acute graft rejection/dt [Drug Therapy] medication compliance nausea/si [Side Effect] nephrotoxicity/dt [Drug Therapy] nephrotoxicity/si [Side Effect] patient compliance patient satisfaction priority journal randomized controlled trial (topic) review side effect/si [Side Effect] systematic review systolic blood pressure triacylglycerol blood level vomiting/si [Side Effect] calcineurin inhibitor/ae [Adverse Drug Reaction] calcineurin inhibitor/dt [Drug Therapy] cholesterol/ec [Endogenous Compound] creatinine/ec [Endogenous Compound] *fish oil/ae [Adverse Drug Reaction] *fish oil/cm [Drug Comparison] *fish oil/dt [Drug Therapy] high density lipoprotein/ec [Endogenous Compound] high density lipoprotein cholesterol/ec [Endogenous Compound] hydroxymethylglutaryl coenzyme A reductase inhibitor/ae [Adverse Drug Reaction] hydroxymethylglutaryl coenzyme A reductase inhibitor/cm [Drug Comparison] lipid/ec [Endogenous Compound] low density lipoprotein cholesterol/ec [Endogenous Compound] triacylglycerol/ec [Endogenous Compound] mean arterial pressure acute graft rejection/co [Complication] glomerulus filtration rate graft failure / complication *graft recipient graft survival human immunosuppressive treatment kidney function kidney graft rejection / complication / drug therapy / prevention *kidney transplantation lipid blood level lipoprotein blood level mean arterial pressure medication compliance nausea / side effect nephrotoxicity / drug therapy / side effect patient compliance patient satisfaction priority journal randomized controlled trial (topic) Review side effect / side effect systematic review systolic blood pressure triacylglycerol blood level vomiting / side effect diastolic blood pressure bloating / side effect cause of death cholesterol blood level creatinine blood level creatinine clearance diarrhea / side effect drug efficacy drug safety gastrointestinal symptom / side effect acute graft rejection / complication / drug therapy cardiovascular disease / drug therapy / side effect |
Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
Appears in Collections: | Articles |
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