Abstract
BackgroundCardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease. Research indicates that the Mediterranean diet is protective of cardiovascular disease in the general population. Components of this diet have been trialled in haemodialysis patients with the aim of reducing the risk of cardiovascular disease and improving associated risk factors. Components include fish, fruit and vegetables in the form of fish oil supplements and vitamin and antioxidant supplements. This narrative review provides an overview of observational studies, and interventional and randomised controlled trials examining the association of these supplements with cardiovascular outcomes in haemodialysis patients.MethodsWe reviewed the relevant literature by searching English-language publications in Web of Science and references from relevant articles published since 1992. Eight-seven abstracts were reviewed and 38 relevant articles were included.ResultsThe extant literature suggests that risk of mortality is reduced in patients with a higher fish intake and those with higher serum omega-3 fatty acid levels. However, the pathways by which risk of mortality is reduced have not been fully extrapolated. While only a few studies have examined the effect of vitamin B supplementation in haemodialysis patients, these studies suggest that supplementation alone does not reduce the risk of mortality. Finally, studies examining vitamin E supplementation have drawn inconsistent conclusions regarding its pro-oxidant or antioxidant effects. Differences between studies are likely due to methodological variations in regards to dose, route of administration and treatment duration.ConclusionsNutritional and dietary supplementation in haemodialysis patients is an area which requires larger, more methodologically robust randomised controlled trials to determine if risk of cardiovascular outcomes can be improved.
Highlights
Cardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease
Research indicates that healthy adults can reduce their risk of Cardiovascular disease (CVD) by adopting a diet that is either i) low in fat, cholesterol, saturated fatty acids or sodium or ii) high in fruit and vegetables, fibre, fish, polyunsaturated or monounsaturated fatty acids, or potassium [1]
Previous research generally indicates a positive effect of the Mediterranean diet on traditional cardiovascular risk factors, including blood pressure, and total and Low-density lipoprotein (LDL) cholesterol levels, as well as outcomes including CVD morbidity and mortality [2]
Summary
Cardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease. Components include fish, fruit and vegetables in the form of fish oil supplements and vitamin and antioxidant supplements This narrative review provides an overview of observational studies, and interventional and randomised controlled trials examining the association of these supplements with cardiovascular outcomes in haemodialysis patients. Cardiovascular complications are the most common cause of mortality in people with end-stage kidney disease (ESKD) Dietary approaches in this population have focused predominantly on reducing the risk of incident cardiovascular disease (CVD) and cardiovascular events. The Mediterranean style diet incorporates many of these recommendations and is widely regarded as a beneficial approach to maintaining cardiovascular health throughout life This dietary approach originated from the traditional diets of Greece, Italy and Spain, and promotes increased intake of high fibre foods such as fruit, vegetables and legumes; increased intake of fish; moderate intake of dairy products and wine ( red wine); and low intake of red meats. Improvements have been reported in serum markers of inflammation including C-reactive protein (CRP) and interleukin-6 (IL-6) [4]
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