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Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis
Charmaine E Lok1,2,3, Michael Farkouh4,5, Brenda R Hemmelgarn6
1Division of Nephrology, Department of Medicine, University of Health Network, Toronto.
The New England Journal of Medicine
|November 7, 2025
Summary
Daily n-3 fatty acid supplementation significantly reduced cardiovascular events in hemodialysis patients. This finding offers a promising preventive therapy for this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Nutritional Science
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in hemodialysis patients.
- Existing preventive therapies for CVD in this population are limited.
- The cardiovascular benefits of n-3 polyunsaturated fatty acids (PUFAs) are known in the general population but uncertain in hemodialysis patients.
Purpose of the Study:
- To evaluate the efficacy of n-3 PUFA supplementation in reducing cardiovascular events in patients undergoing maintenance hemodialysis.
- To assess the impact of fish oil, rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on serious cardiovascular outcomes.
Main Methods:
- A double-blind, randomized, placebo-controlled trial involving 1228 adult hemodialysis patients across 26 sites in Canada and Australia.
- Participants received daily supplementation of fish oil (4 g n-3 PUFAs, including 1.6 g EPA and 0.8 g DHA) or a corn-oil placebo.
- The primary endpoint was a composite of serious cardiovascular events, with secondary endpoints including noncardiac death and individual event components.
Main Results:
- A significant reduction in serious cardiovascular events was observed in the fish-oil group compared to placebo (0.31 vs. 0.61 per 1000 patient-days; hazard ratio, 0.57; P<0.001).
- The fish-oil group also showed a trend towards lower rates for the extended primary endpoint including noncardiac causes of death (hazard ratio, 0.77).
- Significant reductions were noted for cardiac death, myocardial infarction, peripheral vascular disease leading to amputation, and stroke.
Conclusions:
- Daily n-3 fatty acid supplementation effectively lowers the rate of serious cardiovascular events in patients receiving maintenance hemodialysis.
- This intervention presents a potential therapeutic strategy to mitigate cardiovascular risk in this vulnerable patient group.
- Adherence and adverse event profiles were similar between the fish-oil and placebo groups.
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