Objective To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD). Design Pooled analysis. Data sources A consortium of 19 studies from 12 countries identified up to May 2020. Study selection Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate. Data extraction and synthesis Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were pooled across cohorts using inverse variance weighted meta-analysis. Main outcome measures Primary outcome of incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m2. In a sensitivity analysis, incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m2 and <75% of baseline rate. Results 25 570 participants were included in the primary outcome analysis and 4944 (19.3%) developed incident CKD during follow-up (weighted median 11.3 years). In multivariable adjusted models, higher levels of total seafood n-3 PUFAs were associated with a lower incident CKD risk (relative risk per interquintile range 0.92, 95% confidence interval 0.86 to 0.98; P=0.009, I2=9.9%). In categorical analyses, participants with total seafood n-3 PUFA level in the highest fifth had 13% lower risk of incident CKD compared with those in the lowest fifth (0.87, 0.80 to 0.96; P=0.005, I2=0.0%). Plant derived α linolenic acid levels were not associated with incident CKD (1.00, 0.94 to 1.06; P=0.94, I2=5.8%). Similar results were obtained in the sensitivity analysis. The association appeared consistent across subgroups by age (≥60 v <60 years), estimated glomerular filtration rate (60-89 v ≥90 mL/min/1.73 m2), hypertension, diabetes, and coronary heart disease at baseline. Conclusions Higher seafood derived n-3 PUFA levels were associated with lower risk of incident CKD, although this association was not found for plant derived n-3 PUFAs. These results support a favourable role for seafood derived n-3 PUFAs in preventing CKD. Individual participant data are owned by individual participating cohorts and are available to researchers on consent from participating cohorts. For further queries or requests, please contact force@tufts.edu. Further details are available at the FORCE website: .

中文翻译：

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omega 3 多不饱和脂肪酸与慢性肾病的关联：19 个队列的汇总分析


目的 评估 omega 3 多不饱和脂肪酸 (n-3 PUFA) 生物标志物（包括植物来源的 α 亚麻酸和海鲜来源的二十碳五烯酸、二十二碳五烯酸和二十二碳六烯酸）循环水平与慢性肾病 (CKD) 发生的前瞻性关联。设计汇总分析。数据来源 截至 2020 年 5 月，由来自 12 个国家的 19 项研究组成的联盟确定了研究选择。前瞻性研究采用测量的 n-3 PUFA 生物标志物数据和基于估计肾小球滤过率的 CKD 事件。数据提取和合成 每个参与队列都使用预先指定且一致的暴露、结果、协变量和模型进行从头分析。使用逆方差加权荟萃分析对各队列的结果进行汇总。主要结果指标 CKD 事件的主要结果定义为新发估计肾小球滤过率 <60 mL/min/1.73 m2。在敏感性分析中，CKD 事件定义为新发估计肾小球滤过率 <60 mL/min/1.73 m2 且 < 基线率的 75%。结果 25570 名参与者被纳入主要结局分析，4944 名参与者 (19.3%) 在随访期间发生 CKD（加权中位数 11.3 年）。在多变量调整模型中，较高水平的海鲜 n-3 PUFA 总量与较低的 CKD 风险相关（每五分位数范围的相对风险为 0.92，95% 置信区间为 0.86 至 0.98；P=0.009，I2=9.9%）。在分类分析中，与最低五分之一的海鲜 n-3 PUFA 水平最高的参与者相比，其发生 CKD 的风险降低了 13%（0.87、0.80 至 0.96；P=0.005，I2=0.0%）。植物来源的 α 亚麻酸水平与 CKD 发病率无关（1.00、0.94 至 1.06；P=0.94，I2=5.8%）。 敏感性分析也得到了类似的结果。基线时年龄（≥60 v <60 岁）、估计肾小球滤过率（60-89 v ≥90 mL/min/1.73 m2）、高血压、糖尿病和冠心病的亚组之间的相关性似乎一致。结论 较高的海鲜来源的 n-3 PUFA 水平与较低的 CKD 风险相关，但植物来源的 n-3 PUFA 并未发现这种关联。这些结果支持海鲜衍生的 n-3 PUFA 在预防 CKD 方面发挥有利作用。个体参与者数据归个体参与队列所有，并且在获得参与队列同意后可供研究人员使用。如有进一步疑问或要求，请联系force@tufts.edu。更多详情请访问 FORCE 网站：.