Sunday, April 5, 2009

Progression of CKD

I found a useful explanation of the mechanics of chronic kidney disease and why it tends to worsen over time:

1 comment:

  1. Interesting use of Omega-3 to slow progression of Immunoglobulin A Nephropathy (IgA):

    Immunoglobulin A (IgA) nephropathy is a kidney disorder that results from the deposition of IgA in the glomeruli of the kidney. The cause of IgA nephropathy is not clear, but progressive renal failure may eventually develop in 15-40% of patients (163). Since glomerular IgA deposition results in increased production of inflammatory mediators, omega-3 fatty acid supplementation could potentially modulate the inflammatory response and preserve renal function. In a multicenter, randomized controlled trial, supplementing IgA nephropathy patients with fish oil (1.8 g/day of EPA + 1.2 g/day of DHA) for two years significantly slowed declines in renal function (164). Over the 2-year treatment period, 33% of the placebo group experienced a 50% increase in serum creatinine (i.e., evidence of declining renal function) compared to only 6% in the fish oil supplemented group. These results were sustained over an average of six years of follow-up (165), but improvements were not observed with higher doses of fish oil (166). A much smaller 2-year trial found that a low dose of omega-3 fatty acids (0.85 g/day of EPA + 0.57 g/day of DHA) slowed the progression of renal disease in high-risk IgA nephropathy patients (167). In contrast, several studies have failed to find a significant benefit of omega-3 PUFA supplementation in IgA nephropathy patients (168-171). Interestingly, fish oil treatment (3 g/day of EPA + DHA) for six months did not decrease the urinary excretion of inflammatory mediators in IgA nephropathy patients (172). Two meta-analyses of randomized controlled trials of fish oil supplementation did not find evidence of a statistically significant benefit in IgA nephropathy patients overall (173, 174). Due to the inconsistent results of available randomized controlled trials, it is not clear whether fish oil supplementation will prevent the progression of IgA nephropathy in children or adults (139).