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Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients.
J Ren Nutr. 2018 01; 28(1):54-63.JR

Abstract

OBJECTIVE

Alterations in the balance between serum n-3 and n-6 polyunsaturated fatty acids (PUFAs) is predictive of cardiovascular events among hemodialysis patients, although little is known about the serum ratio of n-6 arachidonic acid (AA) to n-6 dihomo-γ-linoleic acid (DGLA) in renal failure. We hypothesized that AA/DGLA ratio is altered in hemodialysis patients resulting in poor clinical outcomes.

METHODS

This was a single center cohort study in an urban area in Japan with cross-sectional analyses. Subjects were 517 hemodialysis patients and 122 control subjects. The main exposure was serum AA/DGLA ratio, and the main outcome measures were all-cause mortality and cardiovascular events during 5 years.

RESULTS

The hemodialysis patients showed a higher median (interquartile range) AA/DGLA ratio than the control subjects (6.46 [5.22-7.81] versus 4.56 [3.74-6.34], P < .001). In a Cox proportional hazard model adjusted for age, sex, dialysis duration, diabetic nephropathy, prior cardiovascular disease, and the ratio of serum n-3 polyunsaturated fatty acids (eicosapentaenoic acid plus docosahexaenoic acid) to AA, the higher quartiles of AA/DGLA ratio were associated with higher risk for all-cause mortality with hazard ratios (95% confidence interval) of 1.50 (0.84-2.76) for quartile 2, 2.10 (1.18-3.86) for quartile 3, and 2.02 (1.10-3.78) for quartile 4 compared with quartile 1. AA/DGLA ratio showed a similar association with the risk of cardiovascular events.

CONCLUSIONS

AA/DGLA ratio was elevated in patients with end-stage renal disease requiring hemodialysis, and a high AA/DGLA ratio was an independent predictor of poor clinical outcomes in this population.

Authors+Show Affiliations

Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Vascular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; Vascular Science Center for Translational Research, Graduate School of Medicine, Osaka City University, Osaka, Japan. Electronic address: t-shoji@med.osaka-cu.ac.jp.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Nephrology, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Division of Internal Medicine, Dialysis Center, Inoue Hospital, Suita, Osaka, Japan.Department of Vascular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; Vascular Science Center for Translational Research, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.Department of Metabolism, Endocrinology and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; Vascular Science Center for Translational Research, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29089279

Citation

Kuwamura, Yukinobu, et al. "Altered Serum N-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 28, no. 1, 2018, pp. 54-63.
Kuwamura Y, Shoji T, Okute Y, et al. Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients. J Ren Nutr. 2018;28(1):54-63.
Kuwamura, Y., Shoji, T., Okute, Y., Yamazaki, Y., Motoyama, K., Morioka, T., Mori, K., Fukumoto, S., Tsujimoto, Y., Shioi, A., Emoto, M., & Inaba, M. (2018). Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 28(1), 54-63. https://doi.org/10.1053/j.jrn.2017.07.001
Kuwamura Y, et al. Altered Serum N-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients. J Ren Nutr. 2018;28(1):54-63. PubMed PMID: 29089279.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Altered Serum n-6 Polyunsaturated Fatty Acid Profile and Risks of Mortality and Cardiovascular Events in a Cohort of Hemodialysis Patients. AU - Kuwamura,Yukinobu, AU - Shoji,Tetsuo, AU - Okute,Yujiro, AU - Yamazaki,Yuko, AU - Motoyama,Koka, AU - Morioka,Tomoaki, AU - Mori,Katsuhito, AU - Fukumoto,Shinya, AU - Tsujimoto,Yoshihiro, AU - Shioi,Atsushi, AU - Emoto,Masanori, AU - Inaba,Masaaki, Y1 - 2017/10/28/ PY - 2017/05/07/received PY - 2017/07/12/revised PY - 2017/07/12/accepted PY - 2017/11/2/pubmed PY - 2018/8/7/medline PY - 2017/11/2/entrez SP - 54 EP - 63 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 28 IS - 1 N2 - OBJECTIVE: Alterations in the balance between serum n-3 and n-6 polyunsaturated fatty acids (PUFAs) is predictive of cardiovascular events among hemodialysis patients, although little is known about the serum ratio of n-6 arachidonic acid (AA) to n-6 dihomo-γ-linoleic acid (DGLA) in renal failure. We hypothesized that AA/DGLA ratio is altered in hemodialysis patients resulting in poor clinical outcomes. METHODS: This was a single center cohort study in an urban area in Japan with cross-sectional analyses. Subjects were 517 hemodialysis patients and 122 control subjects. The main exposure was serum AA/DGLA ratio, and the main outcome measures were all-cause mortality and cardiovascular events during 5 years. RESULTS: The hemodialysis patients showed a higher median (interquartile range) AA/DGLA ratio than the control subjects (6.46 [5.22-7.81] versus 4.56 [3.74-6.34], P < .001). In a Cox proportional hazard model adjusted for age, sex, dialysis duration, diabetic nephropathy, prior cardiovascular disease, and the ratio of serum n-3 polyunsaturated fatty acids (eicosapentaenoic acid plus docosahexaenoic acid) to AA, the higher quartiles of AA/DGLA ratio were associated with higher risk for all-cause mortality with hazard ratios (95% confidence interval) of 1.50 (0.84-2.76) for quartile 2, 2.10 (1.18-3.86) for quartile 3, and 2.02 (1.10-3.78) for quartile 4 compared with quartile 1. AA/DGLA ratio showed a similar association with the risk of cardiovascular events. CONCLUSIONS: AA/DGLA ratio was elevated in patients with end-stage renal disease requiring hemodialysis, and a high AA/DGLA ratio was an independent predictor of poor clinical outcomes in this population. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/29089279/Altered_Serum_n_6_Polyunsaturated_Fatty_Acid_Profile_and_Risks_of_Mortality_and_Cardiovascular_Events_in_a_Cohort_of_Hemodialysis_Patients_ DB - PRIME DP - Unbound Medicine ER -