Impact of OMEGA-3 fatty acid in patients undergoing hemodialysis: a systematic review and meta-analysis

BACKGROUND: Cardiovascular disease is the leading cause of death among patients undergoing hemodialysis, while effective preventive strategies remain limited. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have demonstrated cardiovascular benefits in the general population. We evaluated the effects of n-3 PUFA supplementation in adults receiving hemodialysis. METHODS: PubMed, Embase, and CENTRAL were searched through November 2025 for randomized controlled trials (RCTs) comparing n-3 PUFAs versus placebo in adult hemodialysis patients. Data were pooled using a random-effects model and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses were performed based on Diabetes, Hypertension, Age and Follow-up. RESULTS: n-3 PUFA supplementation did not significantly reduce all-cause mortality (RR = 0.93; 95% CI 0.80-1.08; p = 0.33). In contrast, cardiovascular mortality was significantly reduced (RR = 0.55; 95% CI 0.42-0.71; p < 0.001) along with fewer vascular access related events (RR = 0.83; 95% CI 0.73-0.95; p = 0.005). significant effects were observed for fatal or non-fatal MI (RR = 0.50; 95% CI 0.36-0.68; p < 0.001). CONCLUSIONS: n-3 PUFA supplementation significantly reduces cardiovascular mortality, myocardial infarction, and vascular access events in hemodialysis patients without affecting all-cause mortality. While these findings support n-3 PUFAs as adjunctive cardioprotective therapy in this population, the concentration of evidence in a single large trial warrants cautious interpretation, and confirmation from further large RCTs remains necessary.