Patients on hemodialysis who consumed pomegranate juice for 1 year developed significantly fewer infections compared with those who did not, results from a single-center placebo-controlled study showed. They also had significant reductions in markers of inflammation and protein oxidation, Dr. Batya Kristal reported during a press briefing at the annual meeting of the American Society of Nephrology. "Antioxidant-rich pomegranate juice has been shown to improve the lipid profile in patients with diabetes, reduce blood pressure in patients with hypertension, and improve heart function in those with heart disease," said Dr. Kristal, a nephrologist with Western Galilee Hospital, Nahariya, Israel.
She and her associates set out to study the use of pomegranate juice in hemodialysis patients "because they also suffer from oxidative stress, which is caused by excess production of free oxygen radicals in the face of low antioxidants," she said. "Free radicals are involved in the development of chronic diseases such as aging, coronary heart disease, and cancer. The damage of free radicals can be reduced by dietary intake of antioxidants." During dialysis, she continued, the blood flow through the dialyzer enhances free radical release, which adds to the high levels of oxidative stress and inflammation. For the study, 101 dialysis patients were randomized to receive 3.38 ounces of pomegranate juice or placebo three times per week for 1 year. "The pomegranate juice and placebo bottles looked the same," Dr. Kristal said. "Even the taste was similar. Both patients and staff were blinded to its content."
The researchers chose a commercial pomegranate juice manufactured in Turkey and marketed in Israel. She said the product was chosen because it had the highest concentration of polyphenols among 14 pomegranate juices tested. The study’s primary end point was the change from baseline in markers of inflammation and protein oxidation, including neutrophil priming, interleukin-6, albumin, and oxygenized fibrinogen. The main secondary end point was the rate of hospitalization due to infections. After 1 year, patients in the pomegranate group had significant reductions in neutrophil priming (P = .003), oxidized fibrinogen (P = .001), Il-6 (P less than .001), and albumin (P = .005), while those in the placebo group had no significant change in any of the markers.
Dr. Kristal also reported that patients in the pomegranate group had a lower rate of infection-related hospitalization compared with patients in the placebo group (33 vs. 55 per 1,000 patient-months, respectively), a difference that was not statistically significant (P = .11). However, significantly fewer patients in the pomegranate group developed a second infection-related hospitalization compared with their counterparts in the placebo group (3 vs. 18 per 1,000 patient-months, for a P value of .01). Since pomegranate juice contains a high amount of potassium, Dr. Kristal emphasized that its intake by dialysis patients should be monitored by a dietician and a nephrologist, to prevent potassium overload. She also noted that pomegranate juice may interfere with the metabolism of certain drugs. The study was funded by the Chief Scientist Office of the Ministry of Health, Israel; the Jess and Mildred Fisher Family Cardiology Research Fund; and the Office of the Executive Vice President for Research, Technion, Israel.