Omega-3 polyunsaturated fatty acid exposure and cardiovascular outcomes in dialysis: a systematic review and meta-analysis.

BACKGROUND

Patients with dialysis-dependent chronic kidney disease (CKD) have a high cardiovascular burden, prompting interest in fish oils or long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) as potential risk-reducing therapies in this population.

METHODS

We conducted a systematic review and meta-analysis of studies in adults receiving dialysis that assessed associations between n-3 PUFA supplementation, baseline levels, or dietary intake and CV outcomes, or all-cause mortality. Hazard ratios (HRs) were pooled using random-effects models.

RESULTS

Twelve studies met inclusion criteria. In hemodialysis-dependent CKD, fish oil supplementation lowered cardiovascular events by 44% (HR 0.56; 95% CI 0.46-0.68) and myocardial infarction by 48% (HR 0.52; 95% CI 0.34-0.78). Higher baseline n-3 PUFA levels were associated with a 31% reduction in all-cause mortality (HR 0.69; 95% CI 0.54-0.88). Higher dietary n-3 PUFA intake showed a non-significant trend toward lower all-cause mortality (HR 0.92; 95% CI 0.79-1.08).

CONCLUSION

In dialysis-dependent CKD, higher n-3 PUFA exposure through fish oil supplementation or higher baseline levels was associated with fewer cardiovascular events and all-cause mortality. Appropriately dosed n-3 PUFA supplementation represents a promising cardiovascular risk reduction strategy in dialysis-dependent CKD, although confirmatory randomized trials are warranted.