Abstract
The high incidence of cardiovascular disease and vitamin D deficiency in chronic kidney disease patients is well known. Vitamin D activation by omega-3 fatty acid (FA) supplementation may explain the cardioprotective effects exerted by omega-3 FA. We hypothesized that omega-3 FA and 25-hydroxyvitamin D (25(OH)D) supplementation may increase 1,25-dihydroxyvitamin D (1,25(OH)2D) levels compared to 25(OH)D supplementation alone in hemodialysis (HD) patients that have insufficient or deficient 25(OH)D levels. We enrolled patients that were treated for at least six months with 25(OH)D < 30 ng/mL (NCT01596842). Patients were randomized to treatment for 12 weeks with cholecalciferol supplemented with omega-3 FA or a placebo. Levels of 25(OH)D and 1,25(OH)2D were measured after 12 weeks. The erythrocyte membrane FA contents were also measured. Levels of 25(OH)D were increased in both groups at 12 weeks compared to baseline. The 1,25(OH)2D levels at 12 weeks compared to baseline showed a tendency to increase in the omega-3 FA group. The oleic acid and monounsaturated FA content decreased, while the omega-3 index increased in the omega-3 FA group. Omega-3 FA supplementation may be partly associated with vitamin D activation, although increased 25(OH)D levels caused by short-term cholecalciferol supplementation were not associated with vitamin D activation in HD patients.
Highlights
Chronic kidney disease (CKD) is recognized as a public health problem, and the incidence rate is increasing each year
Phosphorous and parathyroid hormone (PTH) levels were not significantly altered, but the levels of high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL) were significantly lower in the cholecalciferol with omega-3 fatty acid (FA) group after 12 weeks compared to baseline (p = 0.024 and p = 0.025, respectively)
1,25(OH)2D to the 25(OH)D and 1,25(OH)2D levels at baseline, but Docosahexaenoic acid (DHA) was significantly correlated with the ratio of 1,25(OH)2D to 25(OH)D (Spearman’s correlation coefficient (r = 0.543, p = 0.037) and partly correlated with 1,25(OH)2D (r = 0.507, p = 0.054) in the 15 patients’ correlation analysis after
Summary
Chronic kidney disease (CKD) is recognized as a public health problem, and the incidence rate is increasing each year. Cardiovascular disease (CVD) is a primary cause of mortality in patients that have decreasing renal function [3]. This probably relates to inflammation, malnutrition, atherosclerosis, dyslipidemia and vascular calcification [4,5,6,7]. Vitamin D deficiency (VDD) is a known risk factor for CVD in CKD patients [8]. Several studies have shown a close association between VDD and increased risk of CVD among CKD patients [10,11]. Because decreased renal function may induce suppression of 1α-hydroxylase activity, active vitamin D levels are lower in patients with CKD than in the general population [15]. We evaluated the effects of omega-3 FA on the change of erythrocyte membrane FA contents in HD patients
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