Effect of omega-3 fatty acids on kidney function after myocardial infarction: the Alpha Omega Trial

Clin J Am Soc Nephrol. 2014 Oct 7;9(10):1676-83. doi: 10.2215/CJN.10441013. Epub 2014 Aug 7.

Abstract

Background and objectives: Kidney function gradually decreases with age, and myocardial infarction accelerates this deterioration. Omega-3 (n-3) fatty acids may slow down the decline of kidney function. The effect of marine and plant-derived n-3 fatty acids on kidney function in patients after myocardial infarction was examined.

Design, setting, participants, & measurements: In the Alpha Omega Trial, 2344 patients with history of myocardial infarction ages 60-80 years old (81% men) were randomized to one of four trial margarines. The patients received an additional targeted amount of 400 mg/d eicosapentaenoic acid and docosahexaenoic acid, 2 g/d α-linolenic acid, eicosapentaenoic acid-docosahexaenoic acid plus α-linolenic acid, or placebo for 40 months. Serum cystatin C and serum creatinine were assessed at baseline and after 40 months. Creatinine-cystatin C-based GFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration equation.

Results: Patients consumed 19.9 g margarine/d, providing an additional 239 mg/d eicosapentaenoic acid with 159 mg/d docosahexaenoic acid, 1.99 g/d α-linolenic acid, or both in the active treatment groups. After 40 months, compared with baseline, mean (±SD) creatinine-cystatin C-based GFR was -6.9 (±12.6), -4.8 (±13.4), -6.2 (±12.8), and -6.0 (±13.0) ml/min per 1.73 m(2) in the placebo, eicosapentaenoic acid-docosahexaenoic acid, α-linolenic acid, and eicosapentaenoic acid-docosahexaenoic acid plus α-linolenic acid groups, respectively. After 40 months, in patients receiving eicosapentaenoic acid-docosahexaenoic acid compared with placebo, the decline in creatinine-cystatin C-based GFR was 2.1 less (95% confidence interval, 0.6 to 3.6; P<0.01) ml/min per 1.73 m(2); other comparisons were not statistical significant. Odds ratios (95% confidence intervals) of incident CKD (<60 ml/min per 1.73 m(2)) and rapid decline of kidney function (≥3 ml/min per year) for eicosapentaenoic acid-docosahexaenoic acid compared with placebo were 0.83 (0.58 to 1.18) and 0.85 (0.67 to 1.08), respectively.

Conclusions: Long-term supplementation with 400 mg/d eicosapentaenoic acid-docosahexaenoic acid provides a small beneficial effect on kidney function in patients with a history of myocardial infarction.

Trial registration: ClinicalTrials.gov NCT00127452.

Keywords: CKD; cardiovascular disease; clinical trial; nutrition; omega-3 fatty acids.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Chi-Square Distribution
  • Creatinine / blood
  • Cystatin C / blood
  • Disease Progression
  • Docosahexaenoic Acids / administration & dosage*
  • Double-Blind Method
  • Eicosapentaenoic Acid / administration & dosage*
  • Female
  • Food, Fortified*
  • Glomerular Filtration Rate*
  • Humans
  • Kidney / physiopathology*
  • Logistic Models
  • Male
  • Margarine*
  • Middle Aged
  • Models, Biological
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / diet therapy*
  • Myocardial Infarction / physiopathology
  • Netherlands
  • Odds Ratio
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • alpha-Linolenic Acid / administration & dosage*

Substances

  • Biomarkers
  • CST3 protein, human
  • Cystatin C
  • alpha-Linolenic Acid
  • Docosahexaenoic Acids
  • Margarine
  • Eicosapentaenoic Acid
  • Creatinine

Associated data

  • ClinicalTrials.gov/NCT00127452