Heart disease is the leading cause of death for people with kidney failure who require dialysis. When the kidneys stop working properly, waste products and extra fluid build up in the body. Dialysis is a life‑saving treatment that helps filter the blood when the kidneys can no longer do this job on their own.
However, even with dialysis treatment, patients often face many serious health challenges. One of the biggest dangers is cardiovascular disease, which includes heart attacks, strokes, and other problems affecting the heart and blood vessels.
Researchers have long known that people receiving dialysis have an extremely high risk of cardiovascular complications. In fact, heart‑related problems are responsible for a large proportion of deaths among dialysis patients.
Unfortunately, many treatments that are effective in the general population do not work as well for people with kidney failure. Because of this, scientists have been searching for new ways to reduce heart risks in this vulnerable group.
A new international study now suggests that a simple nutritional supplement may help. The research focused on fish oil, which contains omega‑3 fatty acids that are known to support heart health. These fatty acids, called EPA and DHA, are naturally found in oily fish such as salmon, sardines, and mackerel.
Previous research has suggested that omega‑3 fats may reduce inflammation, improve blood vessel function, and lower the risk of certain heart problems. However, evidence for their benefits in dialysis patients has been limited until now.
The new research was part of a large clinical trial called the PISCES trial. This study was jointly led by researchers from Monash Health and the School of Clinical Sciences at Monash University in Australia, along with international collaborators.
The results were presented at the American Society of Nephrology Kidney Week 2025 meeting and were later published in the prestigious medical journal The New England Journal of Medicine.
The trial included 1,228 participants who were receiving dialysis treatment for kidney failure. These patients were recruited from 26 medical centers across Australia and Canada. Clinical trials of this size are important because they allow researchers to carefully compare treatments and determine whether they truly improve health outcomes.
Participants in the study were randomly divided into two groups. One group received a daily dose of four grams of fish oil containing the omega‑3 fatty acids EPA and DHA.
The other group received a placebo, which is a treatment that looks the same but does not contain the active ingredients. By comparing these two groups over time, researchers could determine whether fish oil made a meaningful difference.
The results were striking. Patients who took fish oil experienced significantly fewer major cardiovascular events than those who took the placebo.
Overall, the rate of serious heart‑related events was reduced by about 43 percent in the fish oil group. These events included heart attacks, strokes, death caused by heart disease, and amputations related to poor blood circulation.
Adjunct Professor Kevan Polkinghorne, a kidney specialist at Monash Health and a researcher at the School of Clinical Sciences, led the Australian part of the trial.
According to Professor Polkinghorne, the findings are especially important because few treatments have been shown to lower cardiovascular risk in dialysis patients. Many previous studies in this area have produced disappointing results, so the clear benefit seen in this trial stands out.
Researchers believe one reason fish oil may work particularly well for dialysis patients is that these individuals often have lower levels of omega‑3 fatty acids in their bodies compared with the general population.
Because EPA and DHA play important roles in heart and blood vessel health, restoring these levels through supplementation may provide significant benefits.
However, the researchers also emphasized that the results apply specifically to people receiving hemodialysis for kidney failure.
Hemodialysis is the most common form of dialysis, in which a machine filters waste products from the blood. The study does not suggest that fish oil supplements would provide the same level of benefit for healthy individuals or for people without kidney disease.
The research was supported by the Australian National Health and Medical Research Council, and the trial was coordinated by the Australasian Kidney Trials Network. Approximately 200 participants from Australia took part in the study, including 44 patients treated at Monash Health.
The international leadership of the trial included Professor Charmaine Lok and colleagues from the University Health Network in Toronto and the University of Calgary.
From a scientific perspective, the study provides strong evidence that omega‑3 fatty acids may play a protective role for the cardiovascular system in dialysis patients. The large sample size, randomized design, and international collaboration all strengthen the reliability of the findings.
A reduction of 43 percent in major cardiovascular events is considered a substantial improvement, especially in a patient group with very high baseline risk.
However, there are still important questions that future research should explore. For example, scientists will want to understand exactly how omega‑3 fatty acids produce these protective effects in dialysis patients.
It will also be important to confirm the findings in additional studies and determine whether different doses or treatment durations might produce similar benefits.
Overall, the results suggest that fish oil supplementation could become a valuable additional therapy for people undergoing dialysis. If confirmed in further studies, this relatively simple and inexpensive intervention may help reduce the burden of heart disease in one of the most vulnerable patient populations.
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