Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis
Abstract
Background Cardiovascular disease is the leading cause of death in patients receiving hemodialysis, yet effective preventive therapies remain limited. Supplementation with n-3 polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may have cardiovascular benefits in the general population, but efficacy among patients receiving hemodialysis is uncertain. Methods In a double-blind, randomized, placebo-controlled trial conducted at 26 sites in Canada and Australia, we assigned adult patients receiving maintenance hemodialysis to daily supplementation with fish oil (4 g of n-3 polyunsaturated fatty acids [1.6 g of EPA and 0.8 g of DHA]) or corn-oil placebo. The primary end point was a composite of all serious cardiovascular events including sudden and nonsudden cardiac death, fatal and nonfatal myocardial infarction, peripheral vascular disease leading to amputation, and fatal and nonfatal stroke. Secondary end points included extension of the primary end point to include noncardiac causes of death, the individual components of the primary end point, and a first cardiovascular event or death from any cause. Results Between November 28, 2013, and July 22, 2019, a total of 1228 participants underwent randomization; 610 were assigned to the fish-oil group and 618 to the placebo group. During 3.5 years of follow-up, the rate of serious cardiovascular events was significantly lower in the fish-oil group than in the placebo group (0.31 vs. 0…
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In the hemodialysis trial, no significant difference in all-cause mortality was observed with fish-oil supplementation.
“The intervention was well-tolerated, though no significant difference in all-cause mortality was observed.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [93]
In a recent multicenter, double-blind randomized trial in patients on maintenance hemodialysis, daily fish-oil supplementation (4 g of n-3 polyunsaturated fatty acids [1.6 g EPA and 0.8 g DHA]) over a median follow-up of 3.5 years significantly reduced the risk of major cardiovascular events, including myocardial infarction, stroke, and cardiovascular death, compared with placebo.
“Over a median follow-up of 3.5 years, fish-oil significantly reduced the risk of major cardiovascular events, including myocardial infarction, stroke, and cardiovascular death, compared with placebo.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [93]
The fish-oil intervention in the hemodialysis trial was well-tolerated.
“The intervention was well-tolerated, though no significant difference in all-cause mortality was observed.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [93]
These findings suggest that omega-3 supplementation may provide cardiovascular protection in a high-risk population with chronic kidney disease.
“These findings suggest that omega-3 supplementation may provide cardiovascular protection in a high-risk population with chronic kidney disease.”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [93]
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InfluentialTen tips for the first hemodialysis sessions
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Role of Omega-3 Fatty Acids in IgA Nephropathy: An Updated Review of Mechanisms and Evidence
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Omega-3 Fatty Acids in the Management of Cardiovascular Disease Prevention
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- Authors
- Lok, C. E., Farkouh, M., Hemmelgarn, B. R., Moist, L. M., Polkinghorne, K. R., Tomlinson, G., Tam, P., Tonelli, M., & Udell, J. A.
- Affiliations
- University Health Network (CA)
- University of Alberta (CA)
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
- Monash Health (AU)
- Toronto General Hospital Research Institute
- Scarborough Health Network (CA)
- University of Calgary (CA)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2026-01-08
- Volume
- 394
- Issue
- 2
- Pages
- 128-137
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W4416008526
- Cited by
- 60
- References
- 38
- Citations by year
- 2026: 59 · 2025: 1
- FWCI
- 33.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Heart and Stroke Foundation of Canada (G-15- 0009388, Ontario Chapter, personnel award #7511-A)
- Lawson Health Research Institute
- Kidney CARE Network International
- National Health and Medical Research Council (APP1123392)
- Peter Munk Cardiac Care Innovation Fund (CMT-1516-237)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- fish oil supplementation, omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, hemodialysis, cardiovascular events, cardiovascular disease prevention, mortality, myocardial infarction, stroke, peripheral vascular disease, amputation, cardiovascular mortality, end-stage renal disease, end-of-life care
- MeSH terms
- Adult, Aged, Australia, Canada, Cardiovascular Diseases, Cause of Death, Docosahexaenoic Acids, Double-Blind Method, Female, Fish Oils, Follow-Up Studies, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Middle Aged, Eicosapentaenoic Acid, Fatty Acids, Omega-3, Treatment Outcome, Dietary Supplements
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