Fish oil for kidney transplant recipients
Lim AK, Manley KJ, Roberts MA, Fraenkel MB
The Cochrane database of systematic reviews · 13 citas
Etiquetas de revisión
Financiación no declaradaDatos neutrales que nuestra revisión registró sobre cómo se hizo este estudio. Describen el método, nunca si nos gusta el resultado.
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2016-08-17 · Cochrane Database Syst Rev · vol. 2016 · número 8 · pág. CD005282
- Editorial
- Elsevier BV
- Citado
- 40 citas · más que el 91% de estudios similares · 3.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 122 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Fatty Acid Research and Health · Transplantation: Methods and Outcomes · Sodium Intake and Health
- Palabras clave
- Medicine, Calcineurin, Relative risk, Adverse effect, Internal medicine, Randomized controlled trial, Meta-analysis, Renal function, Kidney transplantation, Nephrotoxicity, Transplantation, Immunosuppression, Confidence interval, Kidney
- MeSH
- kidney, humans, lipids, fish oils, kidney transplantation, graft rejection, graft survival, blood pressure, randomized controlled trials as topic, calcineurin inhibitors
4 autores
- Andy K. H. Lim🇦🇺Monash Medical Centre
- Karen Joy Manley🇦🇺Austin Health
- Matthew A. Roberts🇦🇺Eastern Health; Monash University
- Margaret B. Fraenkel🇦🇺Eastern Health; Monash University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Calcineurin inhibitors used in kidney transplantation for immunosuppression have adverse effects that may contribute to nephrotoxicity and increased cardiovascular risk profile. Fish oils are rich in very long chain omega-3 fatty acids, which may reduce nephrotoxicity by improving endothelial function and reduce rejection rates through their immuno-modulatory effects. They may also modify the cardiovascular risk profile. Hence, fish oils may potentially prolong graft survival and reduce cardiovascular mortality.
Objectives
This review aimed to look at the benefits and harms of fish oil treatment in ameliorating the kidney and cardiovascular adverse effects of CNI-based immunosuppressive therapy in kidney transplant recipients.
Search methods
We searched the Cochrane Kidney and Transplant Specialised Register (up to 17 March 2016) through contact with the Information Specialist using search terms relevant to this review.
Selection criteria
All randomised controlled trials (RCTs) and quasi-RCTs of fish oils in kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen. RCTs of fish oil versus statins were included.
Data collection and analysis
Data was extracted and the quality of studies assessed by two authors, with differences resolved by discussion with a third independent author. Dichotomous outcomes were reported as risk ratio (RR) and continuous outcome measures were reported as the mean difference (MD) with 95% confidence intervals using the random effects model. Heterogeneity was assessed using a Chi(2) test on n-1 degrees of freedom and the I(2) statistic. Data not suitable for pooling were tabulated and described.
Main results
Fifteen studies (733 patients) were suitable for analysis. All studies were small and had variable methodology. Fish oil did not significantly affect patient or graft survival, acute rejection rates, or calcineurin inhibitor toxicity when compared to placebo. Overall SCr was significantly lower in the fish oil group compared to placebo (5 studies, 237 participants: MD -30.63 µmol/L, 95% CI -59.74 to -1.53; I(2) = 88%). In the subgroup analysis, this was only significant in the long-course (six months or more) group (4 studies, 157 participants: MD -37.41 µmol/L, 95% CI -69.89 to -4.94; I(2) = 82%). Fish oil treatment was associated with a lower diastolic blood pressure (4 studies, 200 participants: MD -4.53 mm Hg, 95% CI -7.60 to -1.45) compared to placebo. Patients receiving fish oil for more than six months had a modest increase in HDL (5 studies, 178 participants: MD 0.12 mmol/L, 95% CI 0.03 to 0.21; I(2) = 47%) compared to placebo. Fish oil effects on lipids were not significantly different from low-dose statins. There was insufficient data to analyse cardiovascular outcomes. Fishy aftertaste and gastrointestinal upset were common but did not result in significant patient drop-out.
Authors' conclusions
There is insufficient evidence from currently available RCTs to recommend fish oil therapy to improve kidney function, rejection rates, patient survival or graft survival. The improvements in HDL cholesterol and diastolic blood pressure were too modest to recommend routine use. To determine a benefit in clinical outcomes, future RCTs will need to be adequately powered with these outcomes in mind.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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