Flaxseed in lupus nephritis: A two-year nonplacebo-controlled crossover study

Objective: The objective of this study was to determine the renoprotective effects of ground flaxseed in patients with lupus nephritis. Methods: Forty patients with lupus nephritis were asked to participate in a randomized crossover trial of flaxseed. Twenty-three agreed and were randomized to receive 30 grams of ground flaxseed daily or control (no placebo) for one year, followed by a twelve-week washout period and the reverse treatment for one year. At baseline and sis month intervals, serum phospholipids, flaxseed sachet counts, serum creatinine, 12-hour urine albumin excretion and urine albumin to creatinine ration, serum viscosity and plasma lipids were measured. Results: There were eight drop-outs and of the 15 remaining subjects flaxseed sachet count and serum phospholipid levels indicated only nine were adherent to the flaxseed diet. Plasma lipids and serum viscosity were unaltered by the flaxseed supplementation whereas serum creatinine in the compliant patients during flaxseed administration declined from a mean of 0.97+/-0.31 mg/dL to a mean of 0.94+/-0.30 mg/dL and rose in the control phase to a mean of 1.03+/-0.28 mg/dL [ p value <0.08 ]. Of the fifteen patients mho completed the study, similar changes were noted [ p value <0.1 ]. The nine compliant patients had lower serum creatinines at the end of the two-year study than the 17 patients who refused to participate [ p<0.05 ]. Microalbumin at baseline declined in both control and flaxseed time periods, but there was a trend for a greater decline during flaxseed administration [ p<0.2 ]. Conclusions: Flaxseed appears to be renoprotective in lupus nephritis, but this interpretation is affected by under powering due to poor adherence and potential Hawthorne effects.