LACK OF RENAL EFFECTS OF FISH-OIL ADMINISTRATION IN PATIENTS WITH ADVANCED CIRRHOSIS AND IMPAIRED GLOMERULAR-FILTRATION

The treatment of renal failure in cirrhotic patients with ascites rema ins unsatisfactory, Recent studies have shown that the dietary supplem entation with fish oil improves the renal function of normal subjects, as well as that of patients with renal failure of different etiologie s, We have investigated the renal effects of a daily supplementation f or 1 month of 12 g fish oil (27% C20:5 n-3 eicosapentanoic acid [EPA], and 23% C22:6 n-3 docosahexanoic acid [DHA]) in a prospective study o f cirrhotic patients with ascites, nine with normal renal function (gr oup 1) and eight with renal failure (glomerular filtration rate [GFR] < 60 mL/min, group 2), Compliance with the dietary regimen was confirm ed by fatty acid chromatography that showed increased plasma concentra tion of EPA (from 1.5 +/- 0.7% to 3.7 +/- 0.8%, P = .024, in group 1; and from 0.53 +/- 0.3% to 2.9 +/- 0.8%, P = .03, in group 2) and of DH A (from 2.1 +/- 0.4% to 3.4 +/- 0.3%, P = .008, in group 1; and from 1 .45 +/- 0.5% to 3.8 +/- 0.4%, P = .05, in group 2), At the end of the study, in patients from group 1, the glomerular filtration rate increa sed by 19% (from 94 +/- 8 to 113 +/- 13 mL/min, P = .039), and the uri ne flow increased by 39% (from 0.85 +/- 0.14 to 1.12 +/- 0.2 mL/min, P = .039), while no changes occurred in the renal function of patients from group 2, No changes were observed in the urinary excretion of pro staglandin (PG) E(2) or of 6-keto prostaglandin-1-alpha (6-K-PGF(1)-al pha) nor in plasma renin activity (PRA) or the plasma concentration of aldosterone (PA) or antidiuretic hormone (ADH) in both groups. As far as undesirable effects of fish oils were considered, the mean arteria l pressure (MAP) decreased in both groups (group 1: from 88.6 +/- 2 to 85.3 +/- 2 mm Hg, P = .015; group 2: from 88.2 +/- 3 to 82.8 +/- 3 mm Hg, P = .05), and bleeding time displayed a significant increase when patients were considered collectively (from 744 +/- 89 to 872 +/-: 10 6 seconds, P = .0068), In conclusion, the administration of fish oil f or 1 month was unable to improve renal function in cirrhotic patients with ascites and renal failure, The occurrence of undesirable effects, such as the reduction of arterial pressure and the prolongation of bl eeding time, argues against the use of fish oils in these patients.