DOES ADDITIONAL TREATMENT WITH FISH-OIL MITIGATE THE SIDE-EFFECTS OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN DIALYSIS PATIENTS

Since fish oil has been reported to reduce platelet aggregability, to reduce blood viscosity by increasing red blood cell deformability and to lower blood pressure, we studied the effect of dietary supplementat ion with fish oil on the occurrence of adverse effects in patients rec eiving recombinant human erythropoietin (rHuEPO). In a prospective, ra ndomized, double blind cross-over design we studied the effect of dail y ingestion of 3 g fish oil versus 3 g corn oil (placebo) for 5 months , with a wash-out period of 3 months in between. Thirty-two dialysis p atients newly treated with rHuEPO participated. rHuEPO was given using a low and slow dose regimen (25 U/kg twice weekly s.c.). Target Hct w as 35%. Blood pressure, red blood cell deformability, plasma viscosity , fatty acid composition of plasma phospholipids, and fibrinogen level s were measured at 0, 5, 8 and 13 months. In both groups a stable targ et Hct (35%) was reached within 3 months. Blood pressure was not signi ficantly different between the groups at any time point. In 4 patients (2 on fish oil and 2 on placebo) antihypertensives had to be increase d to regulate blood pressure adequately, whereas shunt occlusion occur red in one patient on placebo. Despite a significant increase in the o mega-3 fatty acid content of plasma phospholipids during ingestion of fish oil, no significant changes in red blood cell deformability were observed. Since hypertension and shunt occlusion occurred at rates com parable to those reported in the literature, long-term ingestion of fi sh oil does not appear to mitigate the side effects of low and slow do se rHuEPO.