Dietary Lipids and Dyslipidemia in Chronic Kidney Disease.

Zdzislaw Kochan,Sylwia Malgorzewicz,Joanna Karbowska,Natalia Szupryczynska

doi:10.3390/nu13093138

Zdzislaw Kochan, Sylwia Malgorzewicz + Show 2 more

Open Access

https://doi.org/10.3390/nu13093138

Copy DOI

Journal: Nutrients	Publication Date: Sep 9, 2021
Citations: 21	License type: CC BY 4.0

Affiliation: Gdańsk Medical University

Abstract

The progression of chronic kidney disease (CKD) leads to altered lipid metabolism. CKD patients exhibit high blood triglyceride (TG) levels, reduced concentrations and functionality of high-density lipoproteins (HDL), and elevated levels of atherogenic small, dense, low-density lipoproteins (sdLDL). Disorders of lipid metabolism and other metabolic disturbances place CKD patients at high risk for cardiovascular disease (CVD). Extensive evidence supports the cardioprotective effects of unsaturated fatty acids, including their beneficial effect on serum cholesterol and TG levels. Dietary lipids might therefore be especially important in the nutritional management of CKD. We review current dietary recommendations for fat intake by CKD patients and suggest potential nutritional interventions by emphasizing dietary lipids that might improve the blood lipid profile and reduce cardiovascular risk in CKD.

Highlights

These findings suggest that a nutritional intervention should be designed to change the dietary intake of fatty acids
Fish oil monounsaturated fatty acids [g/100 g]; PUFA, polyunsaturated fatty acids [g/100 g]; EPA, eicosapentaenoic acid [mg/100 g]; DHA, docosahexaenoic acid [mg/100 g]; CH, cholesterol [mg/100 g]; K, potassium [mg/100 g]; P, phosphorus [mg/100 g]; Protein [g/100 g]; PPR, phosphorus-to-protein ratio [mg/g]; Servings, the number of 150 g servings of fish, mollusks, or crustaceans per week to provide an average of 1 g/day of the marine ω-3 PUFAs (EPA + DHA); * the number of tablespoons (13.5 g) of oil to provide 2 g of marine ω-3 PUFAs (EPA + DHA); # Cod liver oil is not recommended for chronic kidney disease (CKD) patients because of its high content of retinol
Clinical trials have demonstrated that a daily intake of at least 1 g of EPA + DHA might improve dyslipidemia in patients on dialysis, emphasizing the importance of eating foods rich in long-chain ω-3 PUFAs

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The proportion of CKD patients who die from cardiovascular disease (CVD) increases as their glomerular filtration rate (GFR) declines and kidney disease progresses from GFR category G1 to G5 [6]. Supplementation with ω-3 PUFAs for five years, did not slow the decline of eGFR in diabetic patients in a longitudinal placebo-controlled study [14]. In another clinical trial, ω-3 PUFAs supplemented for three months did not modify urine albumin excretion in patients with CKD, but significantly lowered serum TG levels, improved arterial stiffness, and reduced systolic blood pressure [13]. Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) advise PUFA supplementation in patients with CKD, but no main authority has yet issued dietary guidelines aimed at increasing PUFA intake [15]

Dyslipidemia in Chronic Kidney Disease

Food Sources of Fatty Acids for Patients with CKD

Omega-3 PUFA in CKD

Inclusion of Fish in the Diet of Patients with Advanced CKD

Findings

Summary and Conclusions