HMN 2025: How Fish oil supplement halves serious cardiovascular events in patients on dialysis

A daily fish oil supplement has been shown to significantly reduce serious cardiovascular events in people receiving dialysis for kidney failure. The findings come from a major international clinical trial co-led in Australia by Monash Health and the School of Clinical Sciences at Monash University.

The PISCES trial involved 1,228 participants across 26 dialysis sites in Australia and Canada. Results were presented at the American Society of Nephrology Kidney Week 2025 and published simultaneously in the New England Journal of Medicine.

Participants who received four grams per day of fish oil, containing the natural active ingredients EPA and DHA, experienced a 43% lower rate of serious cardiovascular events compared with the placebo group. These events included heart attack, stroke, cardiac death and vascular related amputations.

Adjunct Professor Kevan Polkinghorne, nephrologist at Monash Health and adjunct in the School of Clinical Sciences, served as the lead investigator for the Australian arm.

“Patients on dialysis have extremely high cardiovascular risk, and very few therapies have been shown to reduce that risk,” Professor Polkinghorne said. “In a field where many trials have been negative, this is a significant finding.

“Dialysis patients typically have much lower levels of EPA and DHA than the general population. This may help explain the magnitude of benefit observed in this group.”

Professor Polkinghorne noted that the findings are specific to people receiving hemodialysis for kidney failure and should not be applied to healthy individuals or other patient groups.

Central trial coordination was provided by the Australasian Kidney Trials Network (AKTN). About 200 Australian participants contributed to the study, including 44 treated at Monash Health.

International leadership for PISCES was provided by Professor Charmaine Lok and colleagues at the University Health Network in Toronto and the University of Calgary.

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