Daily supplementation with n−3 polyunsaturated fatty acids (fish oil) significantly reduced the risk of serious cardiovascular events in patients receiving maintenance hemodialysis. In a double-blind, randomized, placebo-controlled trial across 26 sites in Canada and Australia, 1,228 adults on hemodialysis were assigned to receive either 4 g of fish oil daily (providing 1.6 g eicosapentaenoic acid and 0.8 g docosahexaenoic acid) or a corn-oil placebo. Over 3.5 years of follow-up, the rate of serious cardiovascular events was markedly lower in the fish-oil group than in the placebo group (0.31 vs. 0.61 per 1,000 patient-days; hazard ratio [HR], 0.57). Extended outcomes including noncardiac deaths also favored fish-oil supplementation (HR, 0.77). Notably, the risk of cardiac death (HR, 0.55), myocardial infarction (HR, 0.56), peripheral vascular disease leading to amputation (HR, 0.57), and stroke (HR, 0.37) were all significantly reduced, as was the composite of first cardiovascular event or death from any cause (HR, 0.73). Adherence and adverse event rates were similar between groups, supporting the safety and efficacy of n−3 fatty acid supplementation as a preventive strategy against cardiovascular complications in the hemodialysis population. Patients on hemodialysis have higher cardiovascular risk. Cardiovascular death in patients on dialysis is 20 times greater than the general population. Source: https://www.nejm.org/
