FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 331:1194-1199 November 3, 1994 Number 18 Next

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The n-3 fatty acids in fish oil affect eicosanoid and cytokine production and therefore have the potential to alter renal hemodynamics and inflammation. The effects of fish oil could prevent immunologic renal injury in patients with IgA nephropathy.

Methods In a multicenter, placebo-controlled, randomized trial we tested the efficacy of fish oil in patients with IgA nephropathy who had persistent proteinuria. The daily dose of fish oil was 12 g; the placebo was a similar dose of olive oil. Serum creatinine concentrations, elevated in 68 percent of the patients at base line, and creatinine clearance were measured for two years. The primary end point was an increase of 50 percent or more in the serum creatinine concentration at the end of the study.

Results Fifty-five patients were assigned to receive fish oil, and 51 to receive placebo. According to Kaplan-Meier estimation, 3 patients (6 percent) in the fish-oil group and 14 (33 percent) in the placebo group had increases of 50 percent or more in their serum creatinine concentrations during treatment (P = 0.002). The annual median changes in the serum creatinine concentrations were 0.03 mg per deciliter (2.7 µmol per liter) in the fish-oil group and 0.14 mg per deciliter (12.4 µmol per liter) in the placebo group. Proteinuria was slightly reduced and hypertension was controlled to a comparable degree in both groups. The cumulative percentage of patients who died or had end-stage renal disease was 40 percent in the placebo group after four years and 10 percent in the fish-oil group (P = 0.006). No patient discontinued fish-oil treatment because of adverse effects.

Conclusions In patients with IgA nephropathy, treatment with fish oil for two years retards the rate at which renal function is lost.

Source Information

From the Division of Nephrology, Department of Medicine (J.V.D., D.C.S.), the Section of Biostatistics (E.J.B., K.P.O.), and the Department of Laboratory Medicine and Pathology (K.E.H.), Mayo Clinic and Mayo Foundation, Rochester, Minn. The investigators of the Mayo Nephrology Collaborative Group are listed in the Appendix.

Address reprint requests to Dr. Donadio at the Division of Nephrology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905.

Full Text of this Article

This article has been cited by other articles:

• Ferraro, P. M., Ferraccioli, G. F., Gambaro, G., Fulignati, P., Costanzi, S. (2009). Combined treatment with renin-angiotensin system blockers and polyunsaturated fatty acids in proteinuric IgA nephropathy: a randomized controlled trial. Nephrol Dial Transplant 24: 156-160 [Abstract] [Full Text]  
• Higashihara, E., Nutahara, K., Horie, S., Muto, S., Hosoya, T., Hanaoka, K., Tuchiya, K., Kamura, K., Takaichi, K., Ubara, Y., Itomura, M., Hamazaki, T. (2008). The effect of eicosapentaenoic acid on renal function and volume in patients with ADPKD. Nephrol Dial Transplant 23: 2847-2852 [Abstract] [Full Text]  
• Diaz Encarnacion, M. M., Warner, G. M., Gray, C. E., Cheng, J., Keryakos, H. K. H., Nath, K. A., Grande, J. P. (2008). Signaling pathways modulated by fish oil in salt-sensitive hypertension. Am. J. Physiol. Renal Physiol. 294: F1323-F1335 [Abstract] [Full Text]  
• Lauretani, F., Semba, R. D., Bandinelli, S., Miller, E. R. III, Ruggiero, C., Cherubini, A., Guralnik, J. M., Ferrucci, L. (2008). Plasma Polyunsaturated Fatty Acids and the Decline of Renal Function. Clin. Chem. 54: 475-481 [Abstract] [Full Text]  
• Saifullah, A., Watkins, B. A., Saha, C., Li, Y., Moe, S. M., Friedman, A. N. (2007). Oral fish oil supplementation raises blood omega-3 levels and lowers C-reactive protein in haemodialysis patients a pilot study. Nephrol Dial Transplant 22: 3561-3567 [Abstract] [Full Text]  
• Tumlin, J. A., Madaio, M. P., Hennigar, R. (2007). Idiopathic IgA Nephropathy: Pathogenesis, Histopathology, and Therapeutic Options. CJASN 2: 1054-1061 [Abstract] [Full Text]  
• Cybulsky, A. V. (2007). Cyclooxygenases, Prostanoids, and Glomerular Injury: Complex Relationships. J. Am. Soc. Nephrol. 18: 367-368 [Full Text]  
• Hogg, R. J., Fitzgibbons, L., Atkins, C., Nardelli, N., Bay, R. C., for the North American IgA Nephropathy Study Group, (2006). Efficacy of Omega-3 Fatty Acids in Children and Adults with IgA Nephropathy Is Dosage- and Size-Dependent. CJASN 1: 1167-1172 [Abstract] [Full Text]  
• Donadio, J. V., Bergstralh, E. J., Bibus, D. M., Grande, J. P. (2006). Is Body Size a Biomarker for Optimizing Dosing of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with IgA Nephropathy?. CJASN 1: 933-939 [Abstract] [Full Text]  
• Hogg, R. J., Lee, J., Nardelli, N., Julian, B. A., Cattran, D., Waldo, B., Wyatt, R., Jennette, J. C., Sibley, R., Hyland, K., Fitzgibbons, L., Hirschman, G., Donadio, J. V. Jr., Holub, B. J. (2006). Clinical Trial to Evaluate Omega-3 Fatty Acids and Alternate Day Prednisone in Patients with IgA Nephropathy: Report from the Southwest Pediatric Nephrology Study Group. CJASN 1: 467-474 [Abstract] [Full Text]  
• Hagiwara, S., Makita, Y., Gu, L., Tanimoto, M., Zhang, M., Nakamura, S., Kaneko, S., Itoh, T., Gohda, T., Horikoshi, S., Tomino, Y. (2006). Eicosapentaenoic acid ameliorates diabetic nephropathy of type 2 diabetic KKAy/Ta mice: Involvement of MCP-1 suppression and decreased ERK1/2 and p38 phosphorylation. Nephrol Dial Transplant 21: 605-615 [Abstract] [Full Text]  
• Friedman, A., Moe, S. (2006). Review of the Effects of Omega-3 Supplementation in Dialysis Patients. CJASN 1: 182-192 [Abstract] [Full Text]  
• Frisch, G., Lin, J., Rosenstock, J., Markowitz, G., D'Agati, V., Radhakrishnan, J., Preddie, D., Crew, J., Valeri, A., Appel, G. (2005). Mycophenolate mofetil (MMF) vs placebo in patients with moderately advanced IgA nephropathy: a double-blind randomized controlled trial. Nephrol Dial Transplant 20: 2139-2145 [Abstract] [Full Text]  
• Barratt, J., Feehally, J. (2005). IgA Nephropathy. J. Am. Soc. Nephrol. 16: 2088-2097 [Full Text]  
• Mishra, A., Chaudhary, A., Sethi, S. (2004). Oxidized Omega-3 Fatty Acids Inhibit NF-{kappa}B Activation Via a PPAR{alpha}-Dependent Pathway. Arterioscler. Thromb. Vasc. Bio. 24: 1621-1627 [Abstract] [Full Text]  
• Laville, M., Alamartine, E. (2004). Treatment options for IgA nephropathy in adults: a proposal for evidence-based strategy. Nephrol Dial Transplant 19: 1947-1951 [Full Text]  
• Jia, Q., Shi, Y., Bennink, M. B., Pestka, J. J. (2004). Docosahexaenoic Acid and Eicosapentaenoic Acid, but Not {alpha}-Linolenic Acid, Suppress Deoxynivalenol-Induced Experimental IgA Nephropathy in Mice. J. Nutr. 134: 1353-1361 [Abstract] [Full Text]  
• Bhattacharya, A., Lawrence, R. A., Krishnan, A., Zaman, K., Sun, D., Fernandes, G. (2003). Effect of Dietary n-3 and n-6 Oils with and without Food Restriction on Activity of Antioxidant Enzymes and Lipid Peroxidation in Livers of Cyclophosphamide Treated Autoimmune-Prone NZB/W Female Mice. J. Am. Coll. Nutr. 22: 388-399 [Abstract] [Full Text]  
• Ng, R. (2003). Fish Oil Therapy in Recurrent IgA Nephropathy. ANN INTERN MED 138: 1011-1011 [Full Text]  
• Praga, M., Gutierrez, E., Gonzalez, E., Morales, E., Hernandez, E. (2003). Treatment of IgA Nephropathy with ACE Inhibitors: A Randomized and Controlled Trial. J. Am. Soc. Nephrol. 14: 1578-1583 [Abstract] [Full Text]  
• Nachman, P. H., Martin, J. (2002). Developments in the Immunotherapy of Glomerular Disease. Journal of Pharmacy Practice 15: 472-489 [Abstract]  
• Simopoulos, A. P. (2002). Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases. J. Am. Coll. Nutr. 21: 495-505 [Abstract] [Full Text]  
• Donadio, J. V., Grande, J. P. (2002). IgA Nephropathy. NEJM 347: 738-748 [Full Text]  
• Sethi, S., Ziouzenkova, O., Ni, H., Wagner, D. D., Plutzky, J., Mayadas, T. N. (2002). Oxidized omega-3 fatty acids in fish oil inhibit leukocyte-endothelial interactions through activation of PPARalpha. Blood 100: 1340-1346 [Abstract] [Full Text]  
• Donadio, J. V., Bergstralh, E. J., Grande, J. P., Rademcher, D. M. (2002). Proteinuria patterns and their association with subsequent end-stage renal disease in IgA nephropathy. Nephrol Dial Transplant 17: 1197-1203 [Abstract] [Full Text]  
• Pestka, J. J., Zhou, H.-R., Jia, Q., Timmer, A. M. (2002). Dietary Fish Oil Suppresses Experimental Immunoglobulin A Nephropathy in Mice. J. Nutr. 132: 261-269 [Abstract] [Full Text]  
• Schmitz, P. G., Antony, K. A. (2002). {omega}-3 fatty acids in ESRD: should patients with ESRD eat more fish?. Nephrol Dial Transplant 17: 11-14 [Full Text]  
• Ballardie, F. W., Roberts, I. S. D. (2002). Controlled Prospective Trial of Prednisolone and Cytotoxics in Progressive IgA Nephropathy. J. Am. Soc. Nephrol. 13: 142-148 [Abstract] [Full Text]  
• Jolly, C. A., Muthukumar, A., Avula, C. P. R., Troyer, D., Fernandes, G. (2001). Life Span Is Prolonged in Food-Restricted Autoimmune-Prone (NZB NZW)F(1) Mice Fed a Diet Enriched with (n-3) Fatty Acids. J. Nutr. 131: 2753-2760 [Abstract] [Full Text]  
• Möllsten, A. V., Dahlquist, G. G., Stattin, E.-L., Rudberg, S. (2001). Higher Intakes of Fish Protein Are Related to a Lower Risk of Microalbuminuria in Young Swedish Type 1 Diabetic Patients. Diabetes Care 24: 805-810 [Abstract] [Full Text]  
• DONADIO, J. V. JR., LARSON, T. S., BERGSTRALH, E. J., GRANDE, J. P. (2001). A Randomized Trial of High-Dose Compared with Low-Dose Omega-3 Fatty Acids in Severe IgA Nephropathy. J. Am. Soc. Nephrol. 12: 791-799 [Abstract] [Full Text]  
• DILLON, J. J. (2001). Treating IgA Nephropathy. J. Am. Soc. Nephrol. 12: 846-847 [Full Text]  
• Holm, T, Andreassen, A.K, Aukrust, P, Andersen, K, Geiran, O.R, Kjekshus, J, Simonsen, S, Gullestad, L (2001). Omega-3 fatty acids improve blood pressure control and preserve renal function in hypertensive heart transplant recipients. Eur Heart J 22: 428-436 [Abstract]  
• Harris, W. S., O'Keefe, J. H. Jr (2001). Invited Review: Cardioprotective Effects of {omega}-3 Fatty Acids. Nutr Clin Pract 16: 6-12 [Abstract]  
• FLOEGE, J., FEEHALLY, J. (2000). IgA Nephropathy: Recent Developments. J. Am. Soc. Nephrol. 11: 2395-2403 [Full Text]  
• Roccatello, D., Ferro, M., Cesano, G., Rossi, D., Berutti, S., Salomone, M., Piccoli, G., Sena, L. M. (2000). Steroid and cyclophosphamide in IgA nephropathy. Nephrol Dial Transplant 15: 833-835 [Abstract] [Full Text]  
• Eritsland, J. (2000). Safety considerations of polyunsaturated fatty acids. Am. J. Clin. Nutr. 71: 197S-201S [Abstract] [Full Text]  
• Kremer, J. M (2000). n-3 Fatty acid supplements in rheumatoid arthritis1. Am. J. Clin. Nutr. 71: 349S-351S [Abstract] [Full Text]  
• Donadio, J. V Jr (2000). Use of fish oil to treat patients with immunoglobulin A nephropathy1. Am. J. Clin. Nutr. 71: 373S-375S [Abstract] [Full Text]  
• Simopoulos, A. P (1999). Essential fatty acids in health and chronic disease. Am. J. Clin. Nutr. 70: 560S-569 [Abstract] [Full Text]  
• DONADIO, J. V. JR., GRANDE, J. P., BERGSTRALH, E. J., DART, R. A., LARSON, T. S., SPENCER, D. C. (1999). The Long-Term Outcome of Patients with IgA Nephropathy Treated with Fish Oil in a Controlled Trial. J. Am. Soc. Nephrol. 10: 1772-1777 [Abstract] [Full Text]  
• YOSHIKAWA, N., ITO, H., SAKAI, T., TAKEKOSHI, Y., HONDA, M., AWAZU, M., ITO, K., IITAKA, K., KOITABASHI, Y., YAMAOKA, K., NAKAGAWA, K., NAKAMURA, H., MATSUYAMA, S., SEINO, Y., TAKEDA, N., HATTORI, S., NINOMIYA, M. (1999). A Controlled Trial of Combined Therapy for Newly Diagnosed Severe Childhood IgA Nephropathy. J. Am. Soc. Nephrol. 10: 101-109 [Abstract] [Full Text]  
• Brown, S. A., Finco, D. R., Brown, C. A. (1998). Is There a Role for Dietary Polyunsaturated Fatty Acid Supplementation in Canine Renal Disease?. J. Nutr. 128: 2765S-2765 [Abstract] [Full Text]  
• Boumpas, D T, Balow, J E (1998). Outcome criteria for lupus nephritis trials: A critical overview. Lupus 7: 622-629 [Abstract]  
• Hricik, D. E., Chung-Park, M., Sedor, J. R. (1998). Glomerulonephritis. NEJM 339: 888-899 [Full Text]  
• De-Souza, D. A., Greene, L. J. (1998). Pharmacological Nutrition After Burn Injury. J. Nutr. 128: 797-803 [Abstract] [Full Text]  
• Piette, W. W. (1997). What Is Schonlein-Henoch Purpura, and Why Should We Care?. Arch Dermatol 133: 515-518 [Abstract]  
• (1996). Increasing fish oil intake - any net benefits?. DTB 34: 60-62 [Abstract] [Full Text]  
• van Ypersele de Strihou, C. (1994). Fish Oil for IgA Nephropathy?. NEJM 331: 1227-1229 [Full Text]