Introduction: High risk of early death, especially contributed to cardiovascular disease, exists in patients who have chronic kidney disease (CKD). And the burden of cardiovascular disease is able to be lightened by an increase in omega-3 polyunsaturated fatty acid (omega-3 PUFA). A diet high in omega-3 PUFA in the general population is protective, although it is inconclusive about its beneficial role in the CKD population. Methods: From the 1999 to 2014 National Health and Nutrition Examination Surveys (NHANES), we can collect 2,990 participants who suffered from CKD, who were classified into 4 groups: <0.86, 0.87–1.30, 1.31–1.92, and 1.93–9.65 g/day based on NHANES 24-h dietary recall questionnaire dietary omega-3 PUFA. Moreover, their mortality details were available to be obtained by linking NHANES to the National Death Index. The associations between dietary omega-3 PUFA and mortality were evaluated by constructing multivariable Cox proportional hazards models. Results: Over 8 years of a median follow-up, 864 deaths were recorded. The adjusted hazard ratios (95% confidence interval) for all-cause mortality of the diseased people with CKD in the 2nd (0.87–1.30 g/day), 3rd (0.87–1.30 g/day), and 4th (1.93–9.65 g/day) quartiles of dietary omega-3 PUFA were 0.94 (0.72, 1.23), 0.74 (0.54, 1.02), and 0.67 (0.48, 0.93), respectively, versus those with the lowest quartile of dietary omega-3 PUFA intake (<0.86 g/day) (p for trend = 0.011). Conclusion: There may be a inverse relation of dietary omega-3 PUFA intake and all-cause mortality in patients with CKD. Therefore, an increase of dietary omega-3 PUFA may be encouraged to be used clinically in patients with CKD.

1.
Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
.
Lancet
.
2020
;
395
(
10225
):
709
33
. .
2.
Menon
V
,
Gul
A
,
Sarnak
MJ
.
Cardiovascular risk factors in chronic kidney disease
.
Kidney Int
.
2005
;
68
(
4
):
1413
8
. .
3.
Levin
A
,
Foley
RN
.
Cardiovascular disease in chronic renal insufficiency
.
Am J Kidney Dis
.
2000
;
36
(
6 Suppl 3
):
S24
30
. .
4.
Fried
LF
,
Shlipak
MG
,
Crump
C
,
Bleyer
AJ
,
Gottdiener
JS
,
Kronmal
RA
,
Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals
.
J Am Coll Cardiol
.
2003
;
41
(
8
):
1364
72
. .
5.
Weiner
DE
,
Tighiouart
H
,
Elsayed
EF
,
Griffith
JL
,
Salem
DN
,
Levey
AS
,
The Framingham predictive instrument in chronic kidney disease
.
J Am Coll Cardiol
.
2007
;
50
(
3
):
217
24
. .
6.
Fung
F
,
Sherrard
DJ
,
Gillen
DL
,
Wong
C
,
Kestenbaum
B
,
Seliger
S
,
Increased risk for cardiovascular mortality among malnourished end-stage renal disease patients
.
Am J Kidney Dis
.
2002
;
40
(
2
):
307
14
. .
7.
Stenvinkel
P
,
Herzog
CA
.
Chapter 78 – cardiovascular disease in chronic kidney disease
. In:
Floege
J
,
Johnson
RJ
,
Feehally
J
, editors.
Comprehensive clinical nephrology
. 4th ed.
Philadelphia
:
Mosby
;
2010
. p.
935
50
.
8.
Stenvinkel
P
,
Carrero
JJ
,
Axelsson
J
,
Lindholm
B
,
Heimbürger
O
,
Massy
Z
.
Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle?
Clin J Am Soc Nephrol
.
2008
;
3
(
2
):
505
21
. .
9.
Li
ZH
,
Zhong
WF
,
Liu
S
,
Kraus
VB
,
Zhang
YJ
,
Gao
X
,
Associations of habitual fish oil supplementation with cardiovascular outcomes and all cause mortality: evidence from a large population based cohort study
.
BMJ
.
2020
;
368
:
m456
. .
10.
Fats and fatty acids in human nutrition. Proceedings of the joint FAO/WHO expert consultation. November 10–14, 2008. Geneva, Switzerland
.
Ann Nutr Metab
,
2009
;
55
(
1–3
):
5
300
. .
11.
Eckel
RH
,
Jakicic
JM
,
Ard
JD
,
de Jesus
JM
,
Houston Miller
N
,
Hubbard
VS
,
2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines
.
Circulation
.
2014
;
129
(
25 Suppl 2
):
S76
99
. .
12.
Lichtenstein
AH
,
Lichtenstein
AH
,
Appel
LJ
,
Brands
M
,
Carnethon
M
,
Daniels
S
,
Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee
.
Circulation
.
2006
;
114
(
1
):
82
96
. .
13.
Baggio
B
,
Musacchio
E
,
Priante
G
.
Polyunsaturated fatty acids and renal fibrosis: pathophysiologic link and potential clinical implications
.
J Nephrol
.
2005
;
18
(
4
):
362
7
.
14.
Calder
PC
,
Yaqoob
P
.
Omega-3 polyunsaturated fatty acids and human health outcomes
.
Biofactors
.
2009
;
35
(
3
):
266
72
. .
15.
He
K
.
Fish, long-chain omega-3 polyunsaturated fatty acids and prevention of cardiovascular disease--eat fish or take fish oil supplement?
Prog Cardiovasc Dis
.
2009
;
52
(
2
):
95
114
. .
16.
Xun
P
,
Hou
N
,
Daviglus
M
,
Liu
K
,
Morris
JS
,
Shikany
JM
,
Fish oil, selenium and mercury in relation to incidence of hypertension: a 20-year follow-up study
.
J Intern Med
.
2011
;
270
(
2
):
175
86
. .
17.
de Roos
B
,
Mavrommatis
Y
,
Brouwer
IA
.
Long-chain n-3 polyunsaturated fatty acids: new insights into mechanisms relating to inflammation and coronary heart disease
.
Br J Pharmacol
.
2009
;
158
(
2
):
413
28
. .
18.
Lee
CC
,
Adler
AI
.
Recent findings on the effects of marine-derived n-3 polyunsaturated fatty acids on urinary albumin excretion and renal function
.
Curr Atheroscler Rep
.
2012
;
14
(
6
):
535
41
. .
19.
Centers for Disease Control and Prevention, National Center for Health Statistics. Available from: https://www.cdc.gov/nchs/nhanes/index.htm.
20.
Centers for Disease Control and Prevention, National Center for Health Statistics
.
National health and nutrition examination survey, 1999–2000 data documentation, codebook, and frequencies: standard biochemistry profile & hormones (LAB18)
.
2006
. Available from: https://wwwn.cdc.gov/Nchs/Nhanes/1999–2000/LAB18.htm.
21.
Centers for Disease Control and Prevention, National Center for Health Statistics
.
National health and nutrition examination survey 2005–2006 data documentation, codebook, and frequencies: standard biochemistry profile (BIOPRO_D)
.
2008
. Available from: https://wwwn.cdc.gov/Nchs/Nhanes/20052-006/BIOPRO_D.htm.
22.
Levey
AS
,
Stevens
LA
,
Schmid
CH
,
Zhang
YL
,
Castro
AF
,
Feldman
HI
,
A new equation to estimate glomerular filtration rate
.
Ann Intern Med
.
2009
;
150
(
9
):
604
12
. .
23.
24.
Zhang
YB
,
Chen
JX
,
Jiang
YW
,
Xia
PF
,
Pan
A
.
Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey
.
Eur J Nutr
.
2021
;
60
(
4
):
1945
55
. .
25.
Zhuang
P
,
Wang
W
,
Wang
J
,
Zhang
Y
,
Jiao
J
.
Polyunsaturated fatty acids intake, omega-6/omega-3 ratio and mortality: findings from two independent nationwide cohorts
.
Clin Nutr
.
2019
;
38
(
2
):
848
55
. .
26.
U.S. Department of Health and Human Services and U.S. Department of Agriculture
.
2015–2020 Dietary guidelines for Americans
. 8th ed.
2015
. Available from: https://health.gov/dietaryguidelines/2015/guidelines/.
27.
U.S. Department of Agriculture, Agricultural Research Service
.
FNDDS documentation and databases
.
2019
. Available from: https://www.ars.usda.gov/north east-area/beltsville-md-bhnrc/beltsville -human -nutrition-research-center/food-surveys-research-group/docs/fndds-download-databases/.
28.
U.S. Department of Agriculture, Agricultural Research Service
.
Food patterns equivalents database: databases and SAS data sets
.
2019
. Available from: https://www.ars.usda.gov/north east-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/fped-datab ases/.
29.
National Cancer Institute
.
Developing the healthy eating index
.
2019
. Available from: https://epi.grants.cancer.gov/hei/developing.html#f1b.
30.
Chobanian
AV
,
Bakris
GL
,
Black
HR
,
Cushman
WC
,
Green
LA
,
Izzo
JL
,
The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report
.
JAMA
.
2003
;
289
(
6
):
2560
72
. .
31.
Kilpatrick
ES
,
Bloomgarden
ZT
,
Zimmet
PZ
.
International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes: response to the International Expert Committee
.
Diabetes Care
.
2009
;
32
(
12
):
e159
; author reply e160. .
32.
US Department of Health and Human Services
.
2008
Physical activity guidelines for Americanss
,
Washington, DC
,
Department of Health of Human Services
,
2008
.
Available from:
http://www.health.gov/PAGuidelines.
33.
Haskell
WL
,
Lee
IM
,
Pate
RR
,
Powell
KE
,
Blair
SN
,
Franklin
BA
,
Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association
.
Med Sci Sports Exerc
.
2007
;
39
(
8
):
1423
34
. .
34.
Centers for Disease Control and Prevention
,
National Center for Health Statistics: 2015 Public-Use Linked Mortality Files
.
2015
.
Available from:
https://www.cdc.gov/nchs/data-linkage/mortalitymethods.htm.
35.
Durrleman
S
,
Simon
R
.
Flexible regression models with cubic splines
.
Stat Med
.
1989
;
8
(
5
):
551
61
. .
36.
Nakamura
Y
,
Ueshima
H
,
Okamura
T
,
Kadowaki
T
,
Hayakawa
T
,
Kita
Y
,
Association between fish consumption and all-cause and cause-specific mortality in Japan: NIPPON DATA80, 1980–99
.
Am J Med
.
2005
;
118
(
3
):
239
45
. .
37.
Manson
JE
,
Cook
NR
,
Lee
IM
,
Christen
W
,
Bassuk
SS
,
Mora
S
,
Marine n-3 fatty acids and prevention of cardiovascular disease and cancer
.
N Engl J Med
.
2019
;
380
(
1
):
23
32
. .
38.
Rizos
EC
,
Ntzani
EE
,
Bika
E
,
Kostapanos
MS
,
Elisaf
MS
.
Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis
.
JAMA
.
2012
;
308
(
10
):
1024
33
. .
39.
Aung
T
,
Halsey
J
,
Kromhout
D
,
Gerstein
HC
,
Marchioli
R
,
Tavazzi
L
,
Associations of omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77 917 individuals
.
JAMA Cardiol
.
2018
;
3
(
3
):
225
34
. .
40.
Bowman
L
,
Bowman
L
,
Mafham
M
,
Wallendszus
K
,
Stevens
W
,
Buck
G
,
Effects of n-3 fatty acid supplements in diabetes mellitus
.
N Engl J Med
.
2018
;
379
(
16
):
1540
50
. .
41.
Rauch
B
,
Schiele
R
,
Schneider
S
,
Diller
F
,
Victor
N
,
Gohlke
H
,
OMEGA, a randomized, placebo-controlled trial to test the effect of highly purified omega-3 fatty acids on top of modern guideline-adjusted therapy after myocardial infarction
.
Circulation
.
2010
;
122
(
21
):
2152
9
. .
42.
León
H
,
Shibata
MC
,
Sivakumaran
S
,
Dorgan
M
,
Chatterley
T
,
Tsuyuki
RT
.
Effect of fish oil on arrhythmias and mortality: systematic review
.
BMJ
.
2008
;
337
:
a2931
. .
43.
Noori
N
,
Dukkipati
R
,
Kovesdy
CP
,
Sim
JJ
,
Feroze
U
,
Murali
SB
,
Dietary omega-3 fatty acid, ratio of omega-6 to omega-3 intake, inflammation, and survival in long-term hemodialysis patients
.
Am J Kidney Dis
.
2011
;
58
(
2
):
248
56
. .
44.
Saglimbene
VM
,
Wong
G
,
Ruospo
M
,
Palmer
SC
,
Campbell
K
,
Larsen
VG
,
Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: the DIET-HD multinational cohort study
.
Clin Nutr
.
2019
;
38
(
1
):
429
37
. .
45.
Marik
PE
,
Varon
J
.
Omega-3 dietary supplements and the risk of cardiovascular events: a systematic review
.
Clin Cardiol
.
2009
;
32
(
7
):
365
72
. .
46.
Casula
M
,
Soranna
D
,
Catapano
AL
,
Corrao
G
.
Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: a meta-analysis of randomized, placebo controlled trials [corrected]
.
Atheroscler Suppl
.
2013
;
14
(
2
):
243
51
. Erratum in: Atheroscler Suppl. 2014 Mar;233(1):122. .
47.
Perunicic-Pekovic
GB
,
Rasic
ZR
,
Pljesa
SI
,
Sobajic
SS
,
Djuricic
I
,
Maletic
R
,
Effect of n-3 fatty acids on nutritional status and inflammatory markers in haemodialysis patients
.
Nephrology
.
2007
;
12
(
4
):
331
6
. .
48.
Kalantar-Zadeh
K
,
Braglia
A
,
Chow
J
,
Kwon
O
,
Kuwae
N
,
Colman
S
,
An anti-inflammatory and antioxidant nutritional supplement for hypoalbuminemic hemodialysis patients: a pilot/feasibility study
.
J Ren Nutr
.
2005
;
15
(
3
):
318
31
. .
49.
Harris
WS
,
Ginsberg
HN
,
Arunakul
N
,
Shachter
NS
,
Windsor
SL
,
Adams
M
,
Safety and efficacy of Omacor in severe hypertriglyceridemia
.
J Cardiovasc Risk
.
1997
;
4
(
5–6
):
385
91
.
50.
Svensson
M
,
Christensen
JH
,
Sølling
J
,
Schmidt
EB
.
The effect of n-3 fatty acids on plasma lipids and lipoproteins and blood pressure in patients with CRF
.
Am J Kidney Dis
.
2004
;
44
(
1
):
77
83
. .
51.
Lee
HW
,
Lee
SM
,
Lee
MH
,
Son
YK
,
Kim
SE
,
An
WS
.
Effect of omega-3 fatty acid on STAMP2 expression in the heart and kidney of 5/6 nephrectomy rat model
.
Mar Drugs
.
2018
;
16
(
11
):
398
. .
52.
Xu
J
,
Feng
ZP
,
Peng
HY
,
Fu
P
.
Omega-3 polyunsaturated fatty acids alleviate adenine-induced chronic renal failure via regulating ROS production and TGF-β/SMAD pathway
.
Eur Rev Med Pharmacol Sci
.
2018
;
22
(
15
):
5024
32
. .
53.
Alexopoulos
E
,
Stangou
M
,
Pantzaki
A
,
Kirmizis
D
,
Memmos
D
.
Treatment of severe IgA nephropathy with omega-3 fatty acids: the effect of a “very low dose” regimen
.
Ren Fail
.
2004
;
26
(
4
):
453
9
. .
54.
Dangardt
F
,
Osika
W
,
Chen
Y
,
Nilsson
U
,
Gan
LM
,
Gronowitz
E
,
Omega-3 fatty acid supplementation improves vascular function and reduces inflammation in obese adolescents
.
Atherosclerosis
.
2010
;
212
(
2
):
580
5
. .
55.
Zanetti
M
,
Gortan Cappellari
G
,
Barbetta
D
,
Semolic
A
,
Barazzoni
R
.
Omega 3 polyunsaturated fatty acids improve endothelial dysfunction in chronic renal failure: role of eNOS activation and of oxidative stress
.
Nutrients
.
2017
;
9
(
8
):
895
. .
56.
Zoccali
C
.
Endothelial dysfunction and the kidney: emerging risk factors for renal insufficiency and cardiovascular outcomes in essential hypertension
.
J Am Soc Nephrol
.
2006
;
17
(
4 Suppl 2
):
S61
3
. .
57.
Fliser
D
,
Wiecek
A
,
Suleymanlar
G
,
Ortiz
A
,
Massy
Z
,
Lindholm
B
,
The dysfunctional endothelium in CKD and in cardiovascular disease: mapping the origin(s) of cardiovascular problems in CKD and of kidney disease in cardiovascular conditions for a research agenda
.
Kidney Int Suppl
.
2011
;
1
(
1
):
6
9
. .
58.
Miyajima
T
,
Tsujino
T
,
Saito
K
,
Yokoyama
M
.
Effects of eicosapentaenoic acid on blood pressure, cell membrane fatty acids, and intracellular sodium concentration in essential hypertension
.
Hypertens Res
.
2001
;
24
(
5
):
537
42
. .
59.
Kamada
T
,
Yamashita
T
,
Baba
Y
,
Kai
M
,
Setoyama
S
,
Chuman
Y
,
Dietary sardine oil increases erythrocyte membrane fluidity in diabetic patients
.
Diabetes
.
1986
;
35
(
5
):
604
11
. .
60.
Terano
T
,
Hirai
A
,
Hamazaki
T
,
Kobayashi
S
,
Fujita
T
,
Tamura
Y
,
Effect of oral administration of highly purified eicosapentaenoic acid on platelet function, blood viscosity and red cell deformability in healthy human subjects
.
Atherosclerosis
.
1983
;
46
(
3
):
321
31
. .
61.
Tsuda
K
,
Nishio
I
.
Membrane fluidity and hypertension
.
Am J Hypertens
.
2003
;
16
(
3
):
259
61
. .
62.
Gojova
A
,
Barakat
AI
.
Vascular endothelial wound closure under shear stress: role of membrane fluidity and flow-sensitive ion channels
.
J Appl Physiol
.
2005
;
98
(
6
):
2355
62
. .
63.
Geiger
MW
,
Turro
NJ
.
Fluidity and oxygen penetration of lipid vesicles studied by fluorescence probes
.
Photochem Photobiol
.
1977
;
26
(
3
):
221
4
. .
64.
Vázquez
CM
,
Rovira
N
,
Ruiz-Gutiérrez
V
,
Planas
JM
.
Developmental changes in glucose transport, lipid composition, and fluidity of jejunal BBM
.
Am J Physiol
.
1997
;
273
(
3 Pt 2
):
R1086
93
. .
65.
Geleijnse
JM
,
Giltay
EJ
,
Grobbee
DE
,
Donders
AR
,
Kok
FJ
.
Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials
.
J Hypertens
.
2002
;
20
(
8
):
1493
9
. .
66.
Schlundt
DG
.
Accuracy and reliability of nutrient intake estimates
.
J Nutr
.
1988
;
118
(
12
):
1432
5
. .
67.
Shamah-Levy
T
,
Rodríguez-Ramírez
S
,
Gaona-Pineda
EB
,
Cuevas-Nasu
L
,
Carriquiry
AL
,
Rivera
JA
.
Three 24-hour recalls in comparison with one improve the estimates of energy and nutrient intakes in an urban Mexican population
.
J Nutr
.
2016
;
146
(
5
):
1043
50
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.