Fish Oil Reduces Cardiovascular Risk in Hemodialysis Patients: NEJM
Canada: A large randomized trial presented at the American Society of Nephrology’s Kidney Week has found that fish oil supplementation markedly lowered the risk of serious cardiovascular events in patients on maintenance hemodialysis. The benefit was observed in patients both with and without prior cardiovascular events.
Published in The New England Journal of Medicine, the study, led by Dr. Charmaine E. Lok from the Division of Nephrology, Department of Medicine, University Health Network, Toronto, and colleagues, provides compelling evidence supporting the cardiovascular benefits of omega-3 fatty acid supplementation in a population highly vulnerable to heart-related complications.
Cardiovascular disease remains the leading cause of death among patients undergoing hemodialysis, yet effective preventive strategies are limited. Previous studies have suggested potential heart-protective effects of omega-3 polyunsaturated fatty acids (PUFAs)—notably eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—in the general population. However, their role in patients with end-stage kidney disease on dialysis has been unclear until now.
In this double-blind, randomized, placebo-controlled trial conducted across 26 sites in Canada and Australia, adult hemodialysis patients were randomly assigned to receive either 4 grams of fish oil daily (containing 1.6 g EPA and 0.8 g DHA) or a corn oil placebo. The study aimed to determine whether daily supplementation could reduce the risk of major cardiovascular events, including sudden and non-sudden cardiac death, myocardial infarction, stroke, and peripheral vascular disease leading to amputation.
Between November 2013 and July 2019, a total of 1,228 participants were enrolled, with 610 assigned to the fish-oil group and 618 to the placebo group.
Key Findings:
- During an average follow-up of 3.5 years, patients receiving fish oil had a significantly lower rate of serious cardiovascular events compared with those on placebo (0.31 vs. 0.61 per 1000 patient-days; hazard ratio 0.57).
- Fish oil supplementation was associated with a reduced risk of cardiac death (HR 0.55).
- The risk of myocardial infarction was also lower among patients receiving fish oil (HR 0.56).
- A substantial reduction in stroke risk was observed with fish oil use (HR 0.37).
- The likelihood of developing peripheral vascular disease leading to amputation was decreased with fish oil supplementation (HR 0.57).
- When non-cardiac causes of death were included, the overall risk remained lower in the fish oil group (HR 0.77).
- The probability of experiencing a first cardiovascular event or death from any cause was reduced by 27% with fish oil use (HR 0.73).
- Adherence to therapy and the incidence of adverse events were comparable between the fish oil and placebo groups.
- Fish oil supplementation was well-tolerated and safe for long-term use in patients undergoing hemodialysis.
The authors concluded that daily n−3 fatty acid supplementation significantly reduced the incidence of serious cardiovascular events among individuals on maintenance hemodialysis. These findings offer a promising avenue for improving cardiovascular outcomes in this high-risk population and may influence future clinical recommendations for the use of omega-3 supplements in dialysis care.
Reference:
Lok CE, et al "Fish-oil supplementation and cardiovascular events in patients receiving hemodialysis" N Engl J Med 2025; DOI: 10.1056/NEJMoa2513032.
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