Efficacy of omega-3 fatty acids supplementation in treatment of uremic pruritus in hemodialysis patients: a double-blind randomized controlled trial

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Abstract

Background

Uremic pruritus is a common and bothersome complaint among end-stage renal disease which affect between 25% and 60% of this population .But there is no decisive cure for treatment of it. In this study, the effects of omega-3 for treatment of pruritus were investigated in hemodialysis patients.

Methods

A double-blind randomized study was carried out in the form of placebo-controlled crossover study in four dialysis centers in Tehran, Iran during 2008. At first, 22 hemodialysis patients suffering from pruritus with previous drug resistance were selected. Next, these patients were randomly allocated into two groups of omega-3-placebo (group A) and placebo-omega-3 (group B) .Patients in group A were treated with a 1-gram Fish oil capsule for 20 days, and subsequently, they were treated with placebo for 20 days after a 14-day wash-out period .But the reverse act was done in group B.The pruritus assessment was made quantitatively through Detailed Pruritus Score.

Results

Pruritus was decreased up to 65% from score mean of 20.3 (95% CI: 16.7-23.8) to 6.4 (95% CI: 2.9-9.8) in omega-3 group and the decrease in the placebo group was 15% from score mean of 17.0 (95% CI: 12.4-21.6) to 14.4 (95% CI: 10.5-18.2).So the level of statistical difference was significant (P=0.0001).

Discussion

Omega-3 fatty acids found to be more effective than placebo in decreasing of uremic pruritus. So it seems that Omega-3 fatty acids could be used as an efficient drug for treatment of pruritus in uremic patients.

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Most cited references 42

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Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials.

Johanna M. Geleijnse, Erik J. Giltay, Diederick Grobbee … (2002)

The antihypertensive effect of fish oil was estimated from randomized trials using metaregression analysis. Modification of the blood pressure (BP) effect by age, gender, blood pressure, and body mass index was examined. A total of 90 randomized trials of fish oil and BP were identified through MEDLINE (1966-March 2001). Trials with co-interventions, patient populations, non-placebo controls, or duration of 45 years) and in hypertensive populations (BP >or= 140/90 mmHg). High intake of fish oil may lower BP, especially in older and hypertensive subjects. The antihypertensive effect of lower doses of fish oil (< 0.5 g/day) however, remains to be established.

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n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review.

Ethan Balk, Joseph Lau, Mei Chung … (2006)

Studies on the relation between dietary n-3 fatty acids (FAs) and cardiovascular disease vary in quality, and the results are inconsistent. A systematic review of the literature on the effects of n-3 FAs (consumed as fish or fish oils rich in eicosapentaenoic acid and docosahexaenoic acid or as alpha-linolenic acid) on cardiovascular disease outcomes and adverse events was conducted. Studies from MEDLINE and other sources that were of > or =1 y in duration and that reported estimates of fish or n-3 FA intakes and cardiovascular disease outcomes were included. Secondary prevention was addressed in 14 randomized controlled trials (RCTs) of fish-oil supplements or of diets high in n-3 FAs and in 1 prospective cohort study. Most trials reported that fish oil significantly reduced all-cause mortality, myocardial infarction, cardiac and sudden death, or stroke. Primary prevention of cardiovascular disease was reported in 1 RCT, in 25 prospective cohort studies, and in 7 case-control studies. No significant effect on overall deaths was reported in 3 RCTs that evaluated the effects of fish oil in patients with implantable cardioverter defibrillators. Most cohort studies reported that fish consumption was associated with lower rates of all-cause mortality and adverse cardiac outcomes. The effects on stroke were inconsistent. Evidence suggests that increased consumption of n-3 FAs from fish or fish-oil supplements, but not of alpha-linolenic acid, reduces the rates of all-cause mortality, cardiac and sudden death, and possibly stroke. The evidence for the benefits of fish oil is stronger in secondary- than in primary-prevention settings. Adverse effects appear to be minor.

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Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients.

S. Maruyama, K Akazawa, Junichiro J. Kazama … (2006)

Although uremia is well known as the most common cause of pruritus, the mechanisms of pruritus in chronic hemodialysis patients remain unclear. The purpose was to characterize uremic pruritus in more detail and to investigate whether severe pruritus is a marker for poor prognosis. A total of 1773 adult hemodialysis patients were studied. A questionnaire was given to each patient to assess the intensity and frequency, as well as pruritus-related sleep disturbance. We analyzed the relationship between clinical and laboratory data and the severity of pruritus in hemodialysis patients and followed them for 24 months prospectively. In total, 453 patients had severe pruritus with a visual analogue scale (VAS) score more than or equal to 7.0. Among them, more than 70% complained of sleep disturbance, whereas the majority of patients with a VAS score of less than 7.0 had no sleep disturbance. Male gender, high levels of blood urea nitrogen, beta2-microglobulin (beta2MG), hypercalcemia, and hyperphosphatemia were identified as independent risk factors for the development of severe pruritus, whereas a low level of calcium and intact-parathyroid hormone were associated with reduced risk. During the follow-up, 171 (9.64%) patients died. The prognosis of patients with severe pruritus was significantly worse than the others. Moreover, severe pruritus was independently associated with death even after adjusting for other clinical factors including diabetes mellitus, age, beta2MG, and albumin. Severe uremic pruritus caused by multiple factors, not only affects the quality of life but may also be associated with poor outcome in chronic hemodialysis patients.

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Author and article information

Journal

Journal ID (nlm-ta): Iran Red Crescent Med J

Journal ID (iso-abbrev): Iran Red Crescent Med J

Journal ID (publisher-id): Kowsar

Title: Iranian Red Crescent Medical Journal

Publisher: Kowsar

ISSN (Print): 2074-1804

ISSN (Electronic): 2074-1812

Publication date (Electronic): 30 September 2012

Publication date (Print): September 2012

Volume: 14

Issue: 9

Pages: 515-522

Affiliations

[1 ]Assistant Professor of Nephrology, Urology and Nephrology Research Center(UNRC), Shohada Medical Center, Nephrology Dept., Shahid Beheshti University, M.C.(SBMU), Tehran, I.R. Iran

[2 ]Resident of Internal Medicine, Shohada Medical Center, Internal Medicine Dept., SBMU, Tehran, I.R. Iran

[3 ]General Practitioner, UNRC, Tehran, I.R. Iran

[4 ]Assistant professor of Internal medicine, Department of Internal medicine, Shohada Hospital,Shahid Beheshti university of medical sciences, Tehran, I.R. Iran

Author notes

[* ]Correspondence: Esmat Ghanei, MD UNRC, No.103, Boostan 9th St., Pasdaran Ave, Tehran, I.R. Iran. Tel.: +98 21 22567222, Fax: +98 21 22567282, E-mail: dr_e_ghanei@ 123456yahoo.com

Article

PMC ID: 3482323

PubMed ID: 23115713

SO-VID: ba3856a5-422e-4f4f-85ab-26311ffa95e1

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Efficacy of omega-3 fatty acids supplementation in treatment of uremic pruritus in hemodialysis patients: a double-blind randomized controlled trial

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Abstract

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Discussion

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Herbal Medicines Journal (Herb Med J)

Most cited references 42

Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials.

n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review.

Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients.

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