ASN: Less CV Risk in Dialysis With Pomegranate

Action Points

  • Explain that hemodialysis patients had significant improvement in their cardiovascular risk profile after consuming 10 ounces of pomegranate juice weekly for a year.
  • Point out that triglyceride levels and systolic blood pressure declined significantly from baseline, and HDL increased significantly following the consumption of pomegranate juice for one year.

PHILADELPHIA -- Hemodialysis patients had significant improvement in their cardiovascular risk profile after consuming 10 ounces of pomegranate juice weekly for a year, Israeli investigators reported here.

Triglyceride levels and systolic blood pressure declined significantly from baseline (P=0.01 and P=0.006, respectively) and high-density lipoprotein (HDL) increased significantly (P=0.005). Additionally, consumption of pomegranate juice on a regular basis was associated with a 22.2% reduction in use of antihypertensive medications (P=0.05).

In contrast, patients randomized to placebo had no significant changes in any of the parameters, as reported at the American Society of Nephrology (ASN) meeting.

"Ongoing consumption of pomegranate may well lead to a reduction in cardiovascular morbidity and mortality," Batya Kristal, MD, of Western Galilee Hospital in Nahariya, Israel, said during an ASN press briefing. "Ongoing regular consumption of pomegranate juice may well lead to improved quality of life by reducing the high illness rate among dialysis patients."

Pomegranate has a history of association with health benefits dating back to ancient times. For example, pomegranate remnants have been found in Egyptian tombs, Kristal noted.

Over the years, health benefits attributed to pomegranate have ranged from improvement in various gastrointestinal conditions to ameliorating headaches associated with a hangover.

A theoretical basis exists for the health benefits attributed to pomegranate, Kristal continued. Pomegranate juice, for example, contains substantial concentrations of ascorbic acid and polyphenolic acids. Pomegranate peel and pulp have large concentrations of antioxidants.

Various studies have produced evidence of antiviral, antibacterial, anti-inflammatory, and anticarcinogenic potential for pomegranate. Other evidence has suggested that pomegranate may improve lipid profile, blood pressure, and heart function in patients with diabetes, hypertension, and heart disease, Kristal said.

The combination of anecdotal and scientific evidence provided a rationale to examine the potential health benefits of pomegranate in patients on hemodialysis.

Possible cardiovascular benefits of pomegranate are particularly relevant to dialysis patients, who have an increased risk of cardiac morbidity and mortality compared with the general population. Moreover, the risk accrues from a combination of traditional (lipids, diabetes, hypertension) and nontraditional (oxidative stress, inflammation, low albumin) risk factors.

The rationale led Kristal and colleagues to conduct a randomized, placebo-controlled clinical trial in patients on hemodialysis. The patients were randomly assigned to receive 100 cc (3.38 oz., 0.7-mM polyphenols) of pomegranate juice three times weekly or a matching placebo. The primary endpoints were change in lipid profile (triglycerides, low-density lipoprotein or LDL, and HDL) and change in blood pressure (systolic, diastolic, and number of medications).

Kristal and colleagues randomized 101 hemodialysis patients 2:1 to pomegranate juice or placebo. Subsequently, 26 patients in the placebo group and 41 in the pomegranate arm completed the 12-month study. No changes were made in medication or other dietary factors.

The patients had median triglyceride levels of about 200 mg/dL at baseline and a range from less than 110 mg/dL to almost 300 mg/dL. At the end of the study the median value in the pomegranate group had declined to about 150 mg/dL (P=0.01), whereas the median value had increased slightly in the placebo group, but the latter result was not statistically significant.

An analysis limited to patients who had baseline triglycerides of at least 200 mg/dL demonstrated a larger reduction in the pomegranate group (P=0.001) and no significant change in the placebo arm.

Patients randomized to pomegranate juice had a median HDL value of about 30 mg/dL at baseline, and that increased to 35 and 40 mg/dL by the end of the study. The median HDL level did not change significantly in the placebo group. The difference between the groups achieved statistical significance after 3 months (P=0.009).

The median systolic blood pressure at baseline exceeded 140 mm Hg and declined to less than 135 mm Hg in the pomegranate arm, whereas the median did not change significantly in the placebo group. Diastolic blood pressure did not change significantly in either group.

Whereas 22.2% of patients in the pomegranate arm had a reduction in the number of blood pressure medications, 7.7% did so in the placebo group. About 34% of placebo-treated patients required more antihypertensive medication versus 12% of the patients assigned to pomegranate juice.

In the pomegranate arm, the parameters that improved did so within the first three months of the study and either remained stable or continued to increase to the end of the trial.

No patient in either group reported treatment-related adverse effects. However, pomegranate has a substantial concentration of potassium, Kristal noted. Patients with chronic kidney disease face increased risks from potassium overload, especially those on potassium-restricted diets. Additionally, pomegranate can alter the metabolism of some drugs.

As a result, patients on hemodialysis require regular monitoring by dietitians and nephrologists for potential adverse effects associated with pomegranate, Kristal said.

Kristal and co-investigators had no relevant disclosures.

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