title: Effects of fish oil on serum lipid profile in dialysis patients: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The effects of fish oil supplements on lipid profile in dialysis patients are controversial. With increasing interest in the potential health benefits of fish oil, it is important to explore its real effects.
  
  
  OBJECTIVE
  We aimed to identify and quantify the effects of fish oil on triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in dialysis patients.
  
  
  METHODS
  PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for relevant trials of fish oil and lipid profile in dialysis patients. We identified 209 potential studies and included 13 randomized controlled trials. Eligible studies, determined by consensus using predefined criteria, were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed.
  
  
  RESULTS
  Compared with the control group, serum TG and TC levels in the fish oil group were reduced by 0.23 mmol/L (95% CI, -0.31, -0.14, P <0.01) and 0.12 mmol/L (95% CI, -0.23, -0.01, P =0.03), respectively. HDL-C levels were increased by 0.20 mmol/L (95% CI, 0.01, 0.40, P <0.01) attributable to fish oil. In contrast, fish oil did not influence serum LDL-C levels. Subgroup analysis showed the effects of fish oil were stronger in subjects with higher baseline TG levels, and the long-term intervention (>12 w) demonstrated a tendency towards greater improvement of serum HDL-C and LDL-C levels compared with short-term intervention (≤12 w). However, both of the changes were not statistically significant in meta-regression analysis. There were no obvious difference in effects of different doses and components of fish oil on lipid levels.
  
  
  CONCLUSIONS
  Fish oil supplements reduced serum TG and TC levels, and increased HDL-C levels, without affecting LDL-C levels among dialysis patients. It should benefit patients at risk of cardiovascular diseases. Based on randomized controlled trials, we suggested a daily supplement dose of fish oil for dialysis patients of >1 g, but a high dose might not be necessary.
authors.affiliation: Department of Nephrology, The 150th Hospital of PLA, Luoyang, China. zhukov2012@hotmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Chongya
authors.initials: C
authors.lastname: Dong
authors.forename: Han
authors.initials: H
authors.lastname: Du
authors.forename: He
authors.initials: H
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Hu
authors.forename: Feng
authors.initials: F
authors.lastname: Hu
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood*; D005395:Fish Oils / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
chemical_list: D000924:Anticholesteremic Agents; D005395:Fish Oils; D014280:Triglycerides; D002784:Cholesterol
references.citation: J Ren Nutr. 2012 Nov;22(6):525-32
references.pmid: 22698988
references.citation: Am J Kidney Dis. 1998 Nov;32(5):853-906
references.pmid: 9820460
references.citation: Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
references.pmid: 19622511
references.citation: Prostaglandins Leukot Essent Fatty Acids. 2012 Jan-Feb;86(1-2):29-34
references.pmid: 22071008
references.citation: Prostaglandins Leukot Essent Fatty Acids. 2002 Jul;67(1):13-8
references.pmid: 12213430
references.citation: Nephrol Dial Transplant. 1999 Apr;14(4):898-902
references.pmid: 10328467
references.citation: J Nutr Biochem. 2010 Sep;21(9):781-92
references.pmid: 20382009
references.citation: J Ren Nutr. 2011 Nov;21(6):479-84
references.pmid: 21439849
references.citation: Spine (Phila Pa 1976). 2009 Aug 15;34(18):1929-41
references.pmid: 19680101
references.citation: Proc Natl Acad Sci U S A. 1997 Apr 29;94(9):4318-23
references.pmid: 9113987
references.citation: Curr Opin Clin Nutr Metab Care. 2004 Mar;7(2):151-6
references.pmid: 15075705
references.citation: J R Soc Med. 2000 Apr;93(4):178-82
references.pmid: 10844882
references.citation: J Gen Intern Med. 2004 Apr;19(4):380-9
references.pmid: 15061748
references.citation: Lancet. 2003 Feb 8;361(9356):477-85
references.pmid: 12583947
references.citation: J Ren Nutr. 2009 Jul;19(4):259-66
references.pmid: 19539180
references.citation: J Ren Nutr. 2010 Sep;20(5):321-8
references.pmid: 20303788
references.citation: Am J Kidney Dis. 2000 Dec;36(6 Suppl 3):S24-30
references.pmid: 11118155
references.citation: Clin J Am Soc Nephrol. 2006 Mar;1(2):182-92
references.pmid: 17699207
references.citation: Saudi J Kidney Dis Transpl. 2008 Mar;19(2):254-5; author reply 255
references.pmid: 18310879
references.citation: J Am Soc Nephrol. 2007 Apr;18(4):1246-61
references.pmid: 17360943
references.citation: Semin Dial. 2003 Mar-Apr;16(2):118-27
references.pmid: 12641876
references.citation: Nephron. 1990;55(4):445-7
references.pmid: 2202923
references.citation: Control Clin Trials. 1996 Feb;17(1):1-12
references.pmid: 8721797
references.citation: Saudi J Kidney Dis Transpl. 2007 Nov;18(4):571-6
references.pmid: 17951945
references.citation: BMJ. 2001 Jul 7;323(7303):42-6
references.pmid: 11440947
references.citation: Kidney Int. 1991 Jan;39(1):169-83
references.pmid: 2002630
references.citation: JAMA. 2012 May 2;307(17):1809-16
references.pmid: 22550196
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: J Am Soc Nephrol. 1992 May;2(11):1634-9
references.pmid: 1610984
references.citation: Nutr Metab Cardiovasc Dis. 2004 Dec;14(6):344-50
references.pmid: 15853118
references.citation: N Engl J Med. 2011 Jun 23;364(25):2439-50
references.pmid: 21696310
references.citation: JAMA. 2000 Apr 19;283(15):2008-12
references.pmid: 10789670
references.citation: Circulation. 2002 Nov 19;106(21):2747-57
references.pmid: 12438303
references.citation: J Am Soc Nephrol. 2002 Jan;13(1):184-190
references.pmid: 11752036
references.citation: Nutr Clin Pract. 2009 Aug-Sep;24(4):508-12
references.pmid: 19461006
references.citation: Am J Clin Nutr. 2006 Jun;83(6 Suppl):1526S-1535S
references.pmid: 16841863
references.citation: Kidney Int. 2013 Jun;83(6):1130-5
references.pmid: 23389417
references.citation: J Biol Chem. 1999 Aug 13;274(33):23577-83
references.pmid: 10438539
references.citation: Am J Kidney Dis. 2004 Jul;44(1):77-83
references.pmid: 15211441
references.citation: Vasc Health Risk Manag. 2012;8:187-95
references.pmid: 22536073
references.citation: Am J Kidney Dis. 1992 Jun;19(6):505-13
references.pmid: 1534442
references.citation: J Am Soc Nephrol. 1999 Oct;10(10):2177-84
references.pmid: 10505695
references.citation: J Clin Epidemiol. 1992 Jul;45(7):769-73
references.pmid: 1619456
references.citation: J Ren Nutr. 2000 Oct;10(4):191-5
references.pmid: 11070146
references.citation: Nephrol Dial Transplant. 2008 Sep;23(9):2918-24
references.pmid: 18436564
references.citation: Ren Fail. 2011;33(9):892-8
references.pmid: 21859401
references.citation: Nephrol Dial Transplant. 2007 Dec;22(12):3561-7
references.pmid: 17623719