ASN: Pomegranate Juice May Help Dialysis Patients

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ASN: Pomegranate Juice May Help Dialysis Patients

By Charles Bankhead, Staff Writer, MedPage Today

Published: November 20, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.    Earn CME/CE credit
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Action Points 

    * Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


    * Explain that dialysis patients who regularly consumed pomegranate juice for a year had significantly fewer infection-related hospitalizations.


    * Note that the reduced risk of hospitalization was associated with substantial reductions in markers of inflammation and oxidative stress

DENVER -- Dialysis patients had significantly fewer infection-related hospitalizations during a year of regular consumption of pomegranate juice, data from a placebo-controlled clinical trial showed.

The rate of first hospitalization declined by 40% and second hospitalization by 80% in patients who consumed 100 cc of pomegranate juice three times a week, Israeli investigators reported here at the American Society of Nephrology meeting.

Hospitalization related to cardiovascular disease also declined by about 40% in patients who received the juice.

The reduced risk of hospitalization was associated with substantial reductions in markers of inflammation and oxidative stress.

"Twelve months of consumption of pomegranate juice had a continuous, accumulative beneficial effect," Batya Kristal, MD, of Western Galilee Hospital in Nahariya, said during a news briefing.

Pomegranate consumption for health benefits dates back to ancient times. Some biblical scholars believe a pomegranate, not an apple, led to Adam and Eve's undoing in the Garden of Eden, said Kristal.

The rationale for evaluating pomegranate's potential benefits in dialysis patients came from the recognition that oxidative stress and inflammation play a key role in the pathogenesis of kidney disease.

Moreover, patients with end-stage renal disease (ESRD) have an increased incidence of cardiovascular risk factors, including diabetes, dyslipidemia, and hypertension, which also have links to oxidative stress and inflammation.

Pomegranates are rich in dietary antioxidants, suggesting potential benefits for dialysis patients, Kristal continued.

Kristal and colleagues randomized 101 dialysis patients to pomegranate juice or matching placebo. Patients in both groups received their assigned drinks three times a week during regularly scheduled dialysis sessions.

The primary endpoint was the change from baseline in markers of inflammation and protein oxidation (neutrophil priming, interleukin-6, albumin, and oxidized fibrinogen). The principal secondary endpoint was the rate of hospitalization related to infection.

Kristal reported that patients who consumed pomegranate juice had significant reductions in:

    * Neutrophil priming by CD11b, P=0.003
    * Oxidized fibrinogen, P=0.001
    * IL-6, P<0.001
    * Albumin, P=0.005

The placebo group had no significant change in levels of any of the markers, said Kristal.

Patients who consumed pomegranate juice had a rate of first infection-related hospitalization of 32.5/1,000 patient-months compared with 54.9 in the placebo group (P=0.11). The difference in the rate of second infection-related hospitalization achieved statistical significance (3.1 versus 17.9/1,000 patient-months, P=0.01).

First and second hospitalizations for cardiovascular causes were reduced by 36% and 44%, respectively, in patients randomized to pomegranate juice, but did not change in the placebo group.

No adverse effects attributable to the pomegranate juice were observed during the study, said Kristal. However, she pointed out that pomegranates contain high concentrations of potassium, creating a potential for potassium overload in dialysis patients.

"Habitual pomegranate juice intake by patients with chronic kidney disease or on dialysis should be monitored by a dietitian and a nephrologist," said Kristal.

Kristal and her coauthors had no disclosures.

Primary source: American Society of Nephrology
Source reference:
Kristal B et al "One year of pomegranate juice consumption decreases oxidative stress, inflammation, and infections in hemodialysis patients" ASN 10. Abstract TH-FC059.

http://www.medpagetoday.com/MeetingCoverage/ASN/23549