Gerry George MATHEW
Turkish Journal of Nephrology - 2026;35(2):158-162
Cardiovascular disease causes 40%-50% of deaths in chronic kidney disease. Omega-3 polyunsaturated fatty acids have pleiotropic cardiovascular effects including anti-inflammatory, antiarrhythmic, and lipid-modulating properties. The landmark Prevention of Cardiovascular Events in End-Stage Renal Disease (PISCES) trial demonstrated a striking 43% reduction in serious cardiovascular events with high-dose fish oil (4 g/day eicosapentaenoic acid + docosahexaenoic acid) in 1228 hemodialysis patients, contrasting sharply with neutral findings from contemporary general population trials (VITamin D and OmegA-3 TriaL (VITAL), the Long-Term Outcomes Study to Assess Statin Residual Risk with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia (STRENGTH) and Omega-3 Fatty acids in Elderly with Myocardial Infarction (OMEMI). This paradigm shift suggests hemodialysis patients represent a unique population benefiting from omega-3 supplementation, potentially due to heightened inflammation, atherogenic dyslipidemia, and uraemia-specific cardiovascular pathophysiology. This opinion article examines PISCES findings, explores mechanisms underlying population-specific responses, discusses implications for clinical practice, and identifies knowledge gaps requiring confirmatory trials.
