Abstract

Background: Cardiovascular disease contributes significantly to high rates of premature mortality in renal transplant recipients (RTR). Plasma marine derived omega-3 poly-unsaturated fatty acids (N-3 PUFA) have been shown to have a positive effect on cardiovascular risk in the general population. The benefit of marine derived N-3 PUFA in RTR is unclear as most studies relied on intake derived from food frequency questionnaires rather than on plasma concentrations. Methods: We included 680 stable RTR with a functioning graft >1 year. Plasma EPA and DPA were measured by Agilent gas chromatography with flame ionization detector. We used linear regression analyses to investigate the association of plasma EPA+DHA with log-transformed plasma concentrations of N-terminal Pro Brain Natriuretic Peptide (NT-proBNP). Cox regression analyses were used to analyze the prospective association of EPA+DHA on mortality. Results: RTR were 53 ± 13 year old, 386 (57%) were male and mean eGFR was 52 ± 20 ml/min/1.73m 2. Mean plasma concentrations of EPA+DHA were 0.28 ± 0.12 µmol/L. Median NT-proBNP concentrations were 249 [IQR 105-625] ng/L. EPA+DHA was inversely associated with NT-proBNP, independent of potential confounders, including age, sex and eGFR (st.β-0.080, P=0.02). During 5.4 years of follow-up, 146 (22%) RTR died. In prospective analyses, we observed EPA+DHA was inversely associated with risk of premature mortality, independent of potential confounders (HR 0.24; 95%CI 0.06-0.98, P=0.047). Conclusions: High circulating concentrations of marine derived N-3 PUFA (EPA+DHA) are associated with low circulating concentrations of NT-proBNP, consistent with beneficial effects on cardiovascular health and low risk of premature mortality in RTR. These results support advices for increased intake of N-3 PUFAs in RTR.