Effect of omega-3 fatty acids on kidney function after myocardial infarction: The Alpha Omega Trial

Background and objectives Kidney function gradually decreases with age, and myocardial infarction accelerates this deterioration. Omega-3 (n-3) fatty acids may slow down the decline of kidney function. The effect of marine and plant-derived n-3 fatty acids on kidney function in patients after myocardial infarction was examined. Design, setting, participants, & measurements In the Alpha Omega Trial, 2344 patients with history of myocardial infarction ages 60–80 years old (81% men) were randomized to one of four trial margarines. The patients received an additional targeted amount of 400 mg/d eicosapentaenoic acid and docosahexaenoic acid, 2 g/d a-linolenic acid, eicosapentaenoic acid–docosahexaenoic acid plus a-linolenic acid, or placebo for 40 months. Serum cystatin C and serum creatinine were assessed at baseline and after 40 months. Creatinine–cystatin C-based GFR was estimated with the Chronic Kidney Disease Epidemiology Collaboration equation. Results Patients consumed 19.9 g margarine/d, providing an additional 239 mg/d eicosapentaenoic acid with 159 mg/d docosahexaenoic acid, 1.99 g/d a-linolenic acid, or both in the active treatment groups. After 40 months, compared with baseline, mean (±SD) creatinine–cystatin C-based GFR was -6.9 (±12.6), -4.8 (±13.4), -6.2 (±12.8), and -6.0 (±13.0) ml/min per 1.73 m2 in the placebo, eicosapentaenoic acid–docosahexaenoic acid, a-linolenic acid, and eicosapentaenoic acid–docosahexaenoic acid plus a-linolenic acid groups, respectively. After 40 months, in patients receiving eicosapentaenoic acid–docosahexaenoic acid compared with placebo, the decline in creatinine–cystatin C-based GFR was 2.1 less (95% confidence interval, 0.6 to 3.6; P