Intervention Review

Fish oil for kidney transplant recipients

  1. Andy KH Lim1,*,
  2. Karen J Manley2,
  3. Matthew A Roberts3,
  4. Margaret B Fraenkel3

Editorial Group: Cochrane Renal Group

Published Online: 18 APR 2007

Assessed as up-to-date: 16 JAN 2007

DOI: 10.1002/14651858.CD005282.pub2


How to Cite

Lim AKH, Manley KJ, Roberts MA, Fraenkel MB. Fish oil for kidney transplant recipients. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005282. DOI: 10.1002/14651858.CD005282.pub2.

Author Information

  1. 1

    Monash Medical Centre, Department of Nephrology, Clayton, VIC, Australia

  2. 2

    Austin Health, Department of Nutrition and Dietetics, Heidelberg, VIC, Australia

  3. 3

    Austin Health, Department of Nephrology, Heidelberg, VIC, Australia

*Andy KH Lim, Department of Nephrology, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia. Andy.lim@med.monash.edu.au. Andykhlim@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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

To assess the benefits and harms of fish oil supplementation on kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library, issue 2 2005), MEDLINE (1966-April 2005) and EMBASE (1980-April 2005).

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 Chi² test on n-1 degrees of freedom and the I² statistic. Data not suitable for pooling were tabulated and described.

Main results

Sixteen studies (733 patients) were suitable for analysis. Fish oil did not significantly affect patient or graft survival, acute rejection rates, calcineurin inhibitor toxicity or renal function, when compared to placebo. Fish oil treatment was associated with a lower diastolic blood pressure (MD 4.5 mmHg; P = 0.004) compared to placebo. Patients receiving fish oil for more than six months had a modest increase in HDL (MD 0.12 mmol/L; P = 0.01) 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 renal 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Fish oil for kidney transplant recipients

This review set out to assess any benefit or harm in using fish oil to reduce the risk of kidney damage and heart disease in people who have had a kidney transplant and are receiving standard drugs to prevent rejection. Information from 16 studies was used and showed that fish oils provide a slight improvement in HDL cholesterol and diastolic blood pressure. These studies did not provide enough information on the differences in the risk of death, heart disease, kidney transplant rejection or kidney function between patients receiving fish oils and those receiving placebo. There appeared to be no harmful effects of taking fish oil. The benefits of taking fish oil after a kidney transplant are a mild improvement in some heart disease risk factors. There was not enough information to show any benefit in preventing heart disease or reduction in kidney function. Larger, better studies are needed before regular use of fish oil can be recommended.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

魚油用於接受腎臟移植患者的效用

抗排斥藥Calcineurin (鈣蛋白) 抑制劑使用於腎臟移植以抑制免疫反應,但產生的不良反應可能有腎毒性及增加心血管的風險。魚油富含長鏈omega3脂肪酸,可改善血管內皮狀況,進而減少腎毒性和透過其免疫調節作用,降低排斥率,它亦可調節心血管疾病的危險因子。因此,魚油基本上可以延長移植腎的存活期,並且降低心血管的死亡率。

目標

對於接受「以calcineurin抑制劑為基礎的免疫抑制處方」的腎移植接受者,評估其服用魚油補充劑的利與弊。

搜尋策略

我們搜尋了Cochrane對照試驗註冊資料庫 (CENTRAL:於Cochrane Library資料庫中,2005年2月發佈) 、MEDLINE (自1966年至2005年4月) 和EMBASE (自1980年至2005年4月) 。

選擇標準

所有「有服用魚油」並接受「以calcineurin抑制劑為基礎的免疫抑制療程」的腎移植接受者,之所有的隨機對照試驗 (RCTs) 和準隨機對照試驗 (quasiRCTs) 皆納入研究分析;比較服用魚油和史達汀 (statins) 類藥物的隨機對照試驗亦納入分析。 Data collection and analysis

資料收集與分析

資料由兩位作者篩選並評估試驗的品質,若有意見不同則與獨立的第三位作者討論議決。分岐的結果以相對風險 (RR) 來表示,而連續尺標結果的評估則利用隨機作用模式,並以均值差 (MD) 和95% 的信賴區間來表示。異質性則利用卡方試驗 (Chi2 test) 來測n1的自由度 (degrees of freedom) ,並以I2統計。不適合聚合 (pooling) 一起的資料會列表描述。

主要結論

16個試驗共733位受試者符合標準而納入分析。與安慰劑比較時,魚油並未顯著地影響病人或移植腎存活率、急性排斥發生率、calcineurin抑制劑的毒性或腎功能;但與安慰組比較,服用魚油組能降低舒張壓 (MD平均:4.5 mmHg;P = 0.004) 。服用魚油超過6個月的病人,其HDL與安慰劑組相比,也有稍微的增加 (MD:0.12 mmol/L;P = 0.01) 。魚油對脂質的作用效果與低劑量的史達汀 (statins) 相比,沒有顯著的差異性。因資料不足而無法分析魚油對心血管的影響。雖然服用魚油常會嘔出魚油味和腸胃道不適,但病人並不會因此而停止服用魚油。

作者結論

從最近的隨機對照試驗中,並沒有足夠的證據可建議使用魚油治療以改善腎功能、排斥率、病人或移植腎存活率。對於改善HDL膽固醇和舒張壓的能力,則因為效果太輕微所以不足以建議常規服用。為了進一步確認臨床使用結果的利益,未來需要做更多的隨機對照試驗以強化這些結果的證據力。

翻譯人

本摘要由馬偕醫院黃永新翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

此文獻分析評估,在腎臟移植後使用標準免疫抑制劑來預防排斥反應的患者,使用魚油以降低腎臟受損及心臟疾病的利與弊。共16個試驗結果顯示,服用魚油有稍微增加HDL膽固醇以及降低舒張壓的好處。但在服用魚油組和安慰劑組之比較,有關死亡,心臟病,腎移植排斥反應或腎功能的風險差異,這些試驗並無法提供足夠的證據。不過服用魚油對身體似乎沒有不良的影響。腎臟移植後服用魚油的好處是心臟疾病的危險因子稍微降低。但對心臟疾病或腎功能損害的預防而言,目前並沒有足夠的證據。仍需更大型、更好的試驗證明後,才能做為常規使用魚油的建議。