title: Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients.
abstract: BACKGROUND
  Anemia is a common complication among hemodialysis (HD) patients. Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment, about 10% of HD patients show suboptimal response to these agents. Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness. Considering the anti-inflammatory properties of omega-3 fatty acids, this study aimed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients.
  
  
  METHODS
  In this randomized, placebo-controlled trial, 54 adult patients with HD duration of at least 3 months were randomized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months. Anemia parameters including blood hemoglobin, serum iron, transferrin saturation (TSAT), erythropoietin resistance index, and required dose of intravenous iron and erythropoietin, and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, C-reactive protein (CRP), hepcidin, ferritin, intact parathyroid hormone (iPTH), and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention.
  
  
  RESULTS
  45 subjects (25 in the omega-3 and 20 in the placebo group) completed the study. No significant changes were observed in blood hemoglobin, serum iron, TSAT, and required dose of intravenous iron in either within or between group comparisons. Additionally, erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group. Although a relative alleviation in inflammatory state appeared in the omega-3 group, the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment (P <0.001 and P = 0.003, respectively).
  
  
  CONCLUSIONS
  Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia. However, future well-designed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia.
authors.forename: Afshin
authors.initials: A
authors.lastname: Gharekhani
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Khatami
authors.affiliation: Nephrology Research Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran. dashtis@sina.tums.ac.ir.
authors.forename: Simin
authors.initials: S
authors.lastname: Dashti-Khavidaki
authors.forename: Effat
authors.initials: E
authors.lastname: Razeghi
authors.forename: Alireza
authors.initials: A
authors.lastname: Abdollahi
authors.forename: Seyed-Saeed
authors.initials: SS
authors.lastname: Hashemi-Nazari
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Mansournia