ORIGINAL RESEARCH Adherence to Fish Oil Intervention in Patients With Chronic Kidney Disease Rachel Zabel, PhD,* Susan Ash, PhD,* Neil King, PhD,* and Judith Bauer, PhD† Objective: With growing recognition of the role of inflammation in the development of chronic and acute disease, fish oil is increasingly used as a therapeutic agent, but the nature of the intervention may pose barriers to adherence in clinical populations. Our objective was to investigate the feasibility of using a fish oil supplement in hemodialysis patients. Design: This was a nonrandomized intervention study. Setting: Eligible patients were recruited at the Hemodialysis Unit of Wesley Hospital, Brisbane, Queensland, Australia. Patients: The sample included 28 maintenance hemodialysis patients out of 43 eligible patients in the unit. Exclusion criteria included patients regularly taking a fish oil supplement at baseline, receiving hemodialysis for less than 3 months, or being unable to give informed consent. Intervention: Eicosapentaenoic acid (EPA) was administered at 2000 mg/day (4 capsules) for 12 weeks. Adherence was measured at baseline and weekly throughout the study according to changes in plasma EPA, and was further measured subjectively by self-report. Results: Twenty patients (74%) adhered to the prescription based on changes in plasma EPA, whereas an additional two patients self-reported good adherence. There was a positive relationship between fish oil intake and change in plasma EPA. Most patients did not report problems with taking the fish oil. Using the baseline data, it was not possible to characterize adherent patients. Conclusions: Despite potential barriers, including the need to take a large number of prescribed medications already, 74% of hemodialysis patients adhered to the intervention. This study demonstrated the feasibility of using fish oil in a clinical population. Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. P ATIENTS with chronic kidney disease show signs of chronic inflammation that can lead to protein-energy wasting and is associated with an increased risk of mortality. 1 Fish oil has anti-inflammatory properties, and may be a useful treatment for conditions in which inflammation is an underlying mechanism. There may be barriers to compliance with this type of intervention in a clinical population, e.g., hemodialysis patients. Previous fish oil intervention studies used a high number of capsules, and reported issues with ad- herence, such as gastrointestinal disturbances and unpalatable taste and odor. 2 Nonadherence is asso- ciated with misleading results, significant cost implications, and a reduction in the effectiveness of treatment. 3 A review of studies examining adherence to pre- scribed medications highlighted the limitations of most studies that used subjective methods such as *Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia. †Wesley Research Institute, Wesley Hospital, Auchenflower, Queensland, Australia. This work was conducted at the Wesley Research Institute, Wesley Hospital, Auchenflower, Queensland, Australia. Fish oil was supplied ‘‘in kind’’ by Nordic Naturals, Inc. (Watso- nville, CA). Nordic Naturals, Inc., had no role in the study design, collection, analysis, or interpretation of data, writing of the manu- script, or in the decision to submit the manuscript for publication. There are no conflicts of interest to declare. R.Z. designed the study, collected the data, analyzed and interpreted the results, and wrote the manuscript. S.A., J.B., and N.K also designed the study, and assis- ted in the interpretation of results and writing of the manuscript. All authors read and approved the final manuscript. Address reprint requests to Rachel Zabel, PhD, School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia. E-mail: r.zabel@ qut.edu.au Ó 2010 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/10/-0--0000$36.00/0 doi:10.1053/j.jrn.2010.01.003 Journal of Renal Nutrition, Vol -, No - (-), 2010: pp 1–5 1 ARTICLE IN PRESS