PLASMA MARINE N-3 POLYUNSATURATED FATTY ACIDS AND CORONARY ATHEROSCLEROSIS IN PATIENTS WITH END STAGE KIDNEY DISEASE

A high intake of marine n-3 polyunsaturated fatty acids (PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with a lower risk of atherosclerotic cardiovascular disease (CVD) in the general population. However, the possible anti-atherosclerotic effects of marine n-3 PUFAs in individuals with end stage kidney disease (ESKD) is less known.

We aimed to investigate the association between the content of EPA and DHA in plasma, an objective biomarker of fish intake, and measures of atherosclerosis including presence of luminal stenosis and calcium deposition in the coronary arteries in patients with ESKD.

Adult kidney transplantation candidates were recruited during pre-transplant work-up between February 2011 to February 2014.

Fasting, morning blood samples were drawn. Plasma phospholipid fatty acid composition were analyzed by gas chromatography. Individual fatty acids were quantified as weight percentage of total fatty acids (wt%). Patients were categorized into tertiles of EPA and DHA in plasma. All patients underwent cardiac computed tomography angiography (CTA), and a significant stenosis was defined as a ≥50% reduction in luminal diameter. Levels of coronary artery calcium score (CACS) was determined by Agatstons method.

Statistical analyses were conducted using logistic regression adjusted for major CVD risk factors including age, sex, smoking, body mass index (BMI), diabetes mellitus (DM) and low-density lipoprotein (LDL) cholesterol.

We excluded 22 patients without complete information on exposures and/or covariates leaving 135 patients for analysis. The median age was 54.4 (25th; 75th percentiles: 44.9; 63.6) years, 95 (70.4%) were men and 42 (31.1%) were current smokers and the median BMI was 25.3 (25th; 75th percentiles: 22.6; 28.7) kg/m2. The median LDL was 2.5 (25th; 75th percentiles: 1.9; 3.4) mmol/l, 45 (33.3%) had DM and 126 (93.3%) were treated for hypertension. A total of 68 patients (50.4%) had a significant coronary stenosis, 33 (24.4%) had no calcification in their coronary arteries (CACS = 0), whereas 46 (34.1%) had severe coronary calcification (CACS ≥400).

The median level of EPA + DHA was 5.15% (25th; 75th percentiles: 3.76; 6.71). Patients with higher plasma levels of n-3 PUFA were older, less likely to have DM, to be men and current smokers. The presence of coronary stenosis, coronary calcification (CACS>0) and CACS ≥400 were more prevalent in patients that had higher levels of n-3 PUFA in plasma (Table).

Conclusions