Iranian Red Crescent Medical Journal

Published by: Kowsar

Efficacy of omega-3 fatty acids supplementation in treatment of uremic pruritus in hemodialysis patients: a double-blind randomized controlled trial

Esmat Ghanei 1 , * , J Zeinali 2 , M Borghei 3 and M Homayouni 4
Authors Information
1 Assistant Professor of Nephrology, Urology and Nephrology Research Center(UNRC), Shohada Medical Center, Nephrology Dept., Shahid Beheshti University, M.C.(SBMU), Tehran, I.R. Iran
2 Resident of Internal Medicine, Shohada Medical Center, Internal Medicine Dept., SBMU, Tehran, I.R. Iran
3 General Practitioner, UNRC, Tehran, I.R. Iran
4 Assistant professor of Internal medicine, Department of Internal medicine, Shohada Hospital,Shahid Beheshti university of medical sciences.
Article information
  • Iranian Red Crescent Medical Journal: September 01, 2012, 14 (9); 515-522
  • Published Online: September 30, 2012
  • Article Type: Research Article
  • Received: July 12, 2012
  • Accepted: April 1, 2012

To Cite: Ghanei E, Zeinali J, Borghei M, Homayouni M. Efficacy of omega-3 fatty acids supplementation in treatment of uremic pruritus in hemodialysis patients: a double-blind randomized controlled trial, Iran Red Crescent Med J. 2012 ; 14(9):515-522.

Copyright © 2012, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
  • 1. Ponticelli C, Bencini PL. Pruritus in dialysis patients: a neglected problem. Nephrol Dial Transplant. 1995; 10(12): 2174-2176[PubMed]
  • 2. Stahle-Backdahl M. Uremic pruritus. Clinical and experimental studies. Acta Derm Venereol Suppl (Stockh). 1989; 145: 1-38
  • 3. Mettang T, Fritz P, Weber J, Machleidl C, Hubel E, Kuhlmann U. Uremic pruritus in patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD). The role of plasma histamine and skin mast cells. Clin Nephrol. 1990; 34(3): 136-141[PubMed]
  • 4. Zucker I, Yosipovitch G, David M, Gafter U, Boner G. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol. 2003; 49(5): 842-846[DOI]
  • 5. Pisoni RL, Wikstrom B, Elder SJ, Akizawa T, Asano Y, Keen Ml, Saran R, Mendelssohn Dc, Youg Ew, Port Fk. Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2006; 21(12): 495-3505[DOI][PubMed]
  • 6. Rosenthal S. Uremic dermatitis. Arch Derm Syphilol. 1931; 23(5): 934-945[DOI]
  • 7. Cawley EP, Hoch-Ligheti C, Bond GM. The eccrine sweat glands of patients in uremia. Arch Dermatol. 1961; 84: 889-897[DOI][PubMed]
  • 8. Narita I, Alchi B, Omori K, Sato F, Ajiro J, Saga D, Kando D, Skatisume M, Maruyama S, Kazoma Akazawa K, Gejyo F. Etiology and prognostic significance of severe uremic pruritus in chronic hemodialysis patients. Kidney Int. 2006; 69(9): 1626-1632[DOI]
  • 9. Hiroshige K, Kabashima N, Takasugi M, Hirushige K, Kuroiwa A. Optimal dialysis improves uremic pruritus. Am J Kidney Dis. 1995; 25(3): 413-419[DOI][PubMed]
  • 10. De Marchi S, Cecchin E, Villalta D, Sepiacci G, Santini G, Bortoli E. Relief of pruritus and decreases in plasma histamine concentrations during erythropoietin therapy in patients with uremia. N Engl J Med. 1992; 326(15): 969-974[DOI][PubMed]
  • 11. Friga V, Linos A, Linos DA. Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients? Nephron. 1997; 75(1): 48-53[DOI][PubMed]
  • 12. Mettang T, Pauli-Magnus C, Kuhlmann U. "Sick-bag" syndrome. Perit Dial Int. 2000; 20(2): 243[PubMed]
  • 13. Rosner MH. Cromolyn sodium: a potential therapy for uremic pruritus? Hemodial Int. 2006; 10(2): 189-192[DOI][PubMed]
  • 14. Cho YL, Liu HN, Huang TP, Tarng Dc. Uremic pruritus: roles of parathyroid hormone and substance P. J Am Acad Dermatol. 1997; 36(4): 538-543[DOI][PubMed]
  • 15. Cohen EP, Russell TJ, Garancis JC. Mast cells and calcium in severe uremic itching. Am J Med Sci. 1992; 303(6): 360-365[DOI][PubMed]
  • 16. Wikstrom B, Gellert R, Ladefoged SD, Danda Y, Akai M, Ide K, Oqasawara M, Kawashimay ., Ueno K, Mori A, Ueno Y. Kappa-opioid system in uremic pruritus: multicenter, randomized, double-blind, placebo-controlled clinical studies. J Am Soc Nephrol. 2005; 16(12): 3742-3747[DOI][PubMed]
  • 17. Vila T, Gommer J, Scates AC. Role of gabapentin in the treatment of uremic pruritus. Ann Pharmacother. 2008; 42(7): 1080-1084[DOI][PubMed]
  • 18. Gunal AI, Ozalp G, Yoldas TK, Gunal Sy, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant. 2004; 19(12): 3137-3139[DOI][PubMed]
  • 19. Narita I, Iguchi S, Omori K, Gejyo F. Uremic pruritus in chronic hemodialysis patients. J Nephrol. 2008; 21(2): 161-165[PubMed]
  • 20. Yoshimoto-Furuie K, Yoshimoto K, Tanaka T, Saimas ., Kikuchi Y, Shay J, Horrobin DF, Echizen H. Effects of oral supplementation with evening primrose oil for six weeks on plasma essential fatty acids and uremic skin symptoms in hemodialysis patients. Nephron. 1999; 81(2): 151-159[DOI][PubMed]
  • 21. Legroux-Crespel E, Cledes J, Misery L. A comparative study on the effects of naltrexone and loratadine on uremic pruritus. Dermatology. 2004; 208(4): 326-330[DOI][PubMed]
  • 22. Silverberg DS, Iaina A, Reisin E, Rotzak R, Eliahou HE. Cholestyramine in uraemic pruritus. Br Med J. 1977; 1(6063): 752-753[DOI][PubMed]
  • 23. Mettang T, Pauli-Magnus C, Alscher DM. Uraemic pruritus--new perspectives and insights from recent trials. Nephrol Dial Transplant. 2002; 17(9): 1558-1563[DOI][PubMed]
  • 24. Lugon JR. Uremic pruritus: a review. Hemodial Int. 2005; 9(2): 180-188[DOI][PubMed]
  • 25. Chen YC, Chiu WT, Wu MS. Therapeutic effect of topical gamma-linolenic acid on refractory uremic pruritus. Am J Kidney Dis. 2006; 48(1): 69-76[DOI][PubMed]
  • 26. Begum R, Belury MA, Burgess JR, Peck Lw. Supplementation with n-3 and n-6 polyunsaturated fatty acids: effects on lipoxygenase activity and clinical symptoms of pruritus in hemodialysis patients. J Ren Nutr. 2004; 14(4): 233-241[DOI][PubMed]
  • 27. Friedman A, Moe S. Review of the effects of omega-3 supplementation in dialysis patients. Clin J Am Soc Nephrol. 2006; 1(2): 182-192[DOI][PubMed]
  • 28. Duo LJ. Electrical needle therapy of uremic pruritus. Nephron. 1987; 47(3): 179-183[DOI][PubMed]
  • 29. Peck LW. Essential fatty acid deficiency in renal failure: can supplements really help? J Am Diet Assoc. 1997; 97(10 Suppl 2)-153[DOI]
  • 30. Peck LW, Monsen ER, Ahmad S. Effect of three sources of long-chain fatty acids on the plasma fatty acid profile, plasma prostaglandin E2 concentrations, and pruritus symptoms in hemodialysis patients. Am J Clin Nutr. 1996; 64(2): 210-214[PubMed]
  • 31. Calabrese JR, Rapport DJ, Shelton MD. Fish oils and bipolar disorder: a promising but untested treatment. Arch Gen Psychiatry. 1999; 56(5): 413-414[DOI]
  • 32. Carlson SE, Rhodes PG, Rao VS, Goldgar DE. Effect of fish oil supplementation on the n-3 fatty acid content of red blood cell membranes in preterm infants. Pediatr Res. 1987; 21(5): 507-510[DOI][PubMed]
  • 33. Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA, France M. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart. 85(5): 544-548[DOI][PubMed]
  • 34. Khalatbary ., GhR Zarrinjoei. Anti-inflammatory effect of oleuropein in Experimental Rat Spinal cord Trauma. IRCMJ. 2012; 14(4): 229-234
  • 35. Bjorneboe A, Soyland E, Bjorneboe GE, Rojka G, Drevon CA. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl. 1989; 731: 233-236[PubMed]
  • 36. Bittiner SB, Tucker WF, Cartwright I, Bleehen SS. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet. 1988; 1(8582): 378-80[DOI]
  • 37. Wang C, Harris WS, Chung M, Lichtenstein Ah, Balk Kupelnick B, Jordan HS, lau J. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr. 2006; 84(1): 5-17[PubMed]
  • 38. Balk EM, Lichtenstein AH, Chung M, Kupelnick B, Chew P, Lau J. Effects of omega-3 fatty acids on serum markers of cardiovascular disease risk: a systematic review. Atherosclerosis. 2006; 189(1): 19-30[DOI][PubMed]
  • 39. Wang C, Chung M, Lichtenstein A, Balk E, Kupelnick B, Devine D, Lawrence A, Lau J. Effects of omega-3 fatty acids on cardiovascular disease. Evid Rep Technol Assess (Summ). 94: 1-8
  • 40. Geleijnse JM, Giltay EJ, Grobbee DE, et al. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J Hypertens. 2002; 20(8): 1493-1499[DOI][PubMed]
  • 41. Robinson JG, Stone NJ. Antiatherosclerotic and antithrombotic effects of omega-3 fatty acids. Am J Cardiol. 2006; 98(4A): 39i-49i[DOI]
  • 42. James MJ, Gibson RA, Cleland LG. Dietary polyunsaturated fatty acids and inflammatory mediator production. Am J Clin Nutr. 2000; 71(1 Suppl): 343S-348S[PubMed]
  • 43. Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002; 106(21): 2747-2757[DOI][PubMed]
  • 44. Mohammad Kazem Fallahzadeh, Jamshid Roozbeh, Bita Geramizadeh, Mohammad Reza Namaz. Interleukin-2 serum levels are elevated in patients with uremic pruritus: a novel finding with practical implications Nephrol. Dial. Transplant. 2011; [DOI]
  • 45. Zhang P, Kim W, Zhou L, Wang N, Ly LH, McMurray DN, Chapkin RS. Dietary fish oil inhibits murine antigen-specific Th1 cell development by suppression of clonal expansion. J Nutr. 2006; 136: 2391-8[PubMed]
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