Gamma-tocopherol and docosahexaenoic acid decrease inflammation in dialysis patients.
OBJECTIVE
Increased cardiovascular risk in hemodialysis patients may be related to augmented oxidative stress and inflammation, for which no proven beneficial therapies are available.


METHODS
We examined the effects of gamma tocopherol and docosahexaenoic acid (DHA) administration on inflammation and oxidative stress markers in hemodialysis patients in a randomized, double-blinded, placebo-controlled, clinical trial. Active treatment consisted of capsules containing gamma tocopherol (308 mg) and DHA (800 mg).


METHODS
Outpatient dialysis center.


METHODS
Seventy maintenance hemodialysis patients.


METHODS
Plasma concentrations of interleukin-6 (IL-6) and protein carbonyl content were determined by enzyme-linked immunosorbant assay. C-reactive protein was measured by nephelometry. The F(2) isoprostanes were measured by gas chromatography-mass spectrometry. Erythrocyte DHA content was measured by gas chromatography.


RESULTS
Sixty-three patients were enrolled, and 57 completed the study. No serious adverse events were attributed to either active treatment or placebo. In the treatment group, but not in the placebo group, there were significant decreases in IL-6 (21.4 +/- 3.5 to 16.8 +/- 3.7 pg/mL), white blood cell (WBC) count (7.4 +/- 0.3 to 6.9 +/- 0.4 10(3)/microL), and neutrophil fraction of WBCs (4.8 +/- 0.3 to 4.4 +/- 0.3 10(3)/microL), at P < .05 for all. There were no significant changes in plasma concentrations of CRP, F(2) isoprostanes, or carbonyls in either group.


CONCLUSIONS
Thus, gamma tocopherol and DHA are well-tolerated and reduce selected biomarkers of inflammation in hemodialysis patients. Larger randomized, clinical trials will be required to determine if gamma tocopherol and DHA can reduce cardiovascular complications in hemodialysis patients.
Himmelfarb
Jonathan
J
Division of Nephrology and Renal Transplantation, Maine Medical Center, Portland, Maine 04102, USA. himmej@mmc.org
Phinney
Stephen
S
Ikizler
T Alp
TA
Kane
Jane
J
McMonagle
Ellen
E
Miller
Guy
G
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002849:Chromatography, Gas; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D004912:Erythrocytes / Q000737:chemistry; D028441:F2-Isoprostanes; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D018384:Oxidative Stress / Q000187:drug effects; D050050:Protein Carbonylation / Q000187:drug effects; D006435:Renal Dialysis; D016896:Treatment Outcome; D024504:gamma-Tocopherol / Q000009:adverse effects / Q000627:therapeutic use*
D015415:Biomarkers; D028441:F2-Isoprostanes; D015850:Interleukin-6; D004281:Docosahexaenoic Acids; D024504:gamma-Tocopherol; D002097:C-Reactive Protein