Friedman Allon, Moe Sharon
Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Clin J Am Soc Nephrol. 2006 Mar;1(2):182-92. doi: 10.2215/CJN.00740805. Epub 2005 Nov 30.
Chronic dialysis patients experience a host of conditions that limit quality and length of life, and recent therapeutic strategies have had only modest success in ameliorating many of these problems. By mediating cell membrane function and structure and the synthesis of lipid mediators such as eicosanoids, omega-3 fatty acids may offer dialysis patients a host of therapeutic benefits. Omega-3 fatty acids are derived primarily from dietary sources, and cold-water fish is the main source of eicosapentanoic and docosahexanoic acids, the two major bioactive omega-3 fatty acids. Studies of omega-3 supplementation in dialysis patients describe salutary effects on triglyceride levels, dialysis access patency, and perhaps uremic pruritus and oxidative stress. In contrast, the putative hematologic, antihypertensive, anti-inflammatory, and antiarrhythmic effects are not as well documented. Adverse effects generally have been limited to gastrointestinal complaints. Unfortunately, the preponderance of published studies are characterized by suboptimal study design, small sample sizes, supraphysiologic omega-3 doses that may be difficult to consume for extended periods, little long-term follow-up, and a lack of confirmation of compliance. Not surprising, the 2005 National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients recommend further research in this field. In summary, although preliminary data suggest that omega-3 fatty acids may have clinical benefits, formal recommendations encouraging omega-3 supplementation of dialysis patients are premature until long-term and adverse effects are better defined.
慢性透析患者会经历一系列限制生活质量和寿命的状况，而近期的治疗策略在改善其中许多问题方面仅取得了有限的成功。通过调节细胞膜功能与结构以及类花生酸等脂质介质的合成，ω-3脂肪酸可能为透析患者带来诸多治疗益处。ω-3脂肪酸主要来源于饮食，冷水鱼是二十碳五烯酸和二十二碳六烯酸这两种主要的生物活性ω-3脂肪酸的主要来源。对透析患者补充ω-3脂肪酸的研究表明，其对甘油三酯水平、透析通路通畅性或许还有尿毒症瘙痒和氧化应激有有益影响。相比之下，其假定的血液学、抗高血压、抗炎和抗心律失常作用的文献记载则没那么充分。不良反应通常仅限于胃肠道不适。不幸地是，已发表研究大多存在研究设计欠佳、样本量小、超生理剂量的ω-3可能难以长期服用、长期随访少以及缺乏依从性确认等问题。不出所料，2005年美国国家肾脏基金会《肾脏病预后质量倡议：透析患者心血管疾病临床实践指南》建议在该领域开展进一步研究。总之，尽管初步数据表明ω-3脂肪酸可能具有临床益处，但在更好地明确其长期影响和不良反应之前，鼓励对透析患者补充ω-3脂肪酸的正式建议还为时过早。
