Fish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis
Lok CE, Farkouh M, Hemmelgarn BR, Moist LM, Polkinghorne KR, Tomlinson G, Tam P, Tonelli M, Udell JA, PISCES Investigators
The New England journal of medicine · 26 citas
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Organización sin fines de lucro
- Heart and Stroke Foundation of Canada
- Universidad u hospital
- Lawson Health Research Institute
- Gobierno
- National Health and Medical Research Council
- Organización sin fines de lucro
- Peter Munk Cardiac Care Innovation Fund
- Organización sin fines de lucro
- Kidney CARE Network International
- Subvenciones
- Heart and Stroke Foundation of Canada (G-15-0009388); National Health and Medical Research Council (1123392); Heart and Stroke Foundation of Canada (Ontario Chapter, personnel award #7511-A)
Según 5 financiadores declarados.
Publicación
- Publicado
- 2025-11-07 · N Engl J Med · vol. 394 · número 2 · págs. 128–137
- Editorial
- Massachusetts Medical Society
- Citado
- 53 citas · más que el 100% de estudios similares · 30.6× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 38 trabajos
- Acceso
- De pago
- Áreas de investigación
- Dialysis and Renal Disease Management · Fatty Acid Research and Health · Acute Kidney Injury Research
- Palabras clave
- Hemodialysis, Stroke (engine), Heart failure, Heart rate, Blood pressure, Disease
- MeSH
- humans, kidney failure, chronic, cardiovascular diseases, fatty acids, omega-3, docosahexaenoic acids, eicosapentaenoic acid, treatment outcome, renal dialysis, cause of death, follow-up studies, double-blind method, dietary supplements, aged, middle aged, canada, australia, female, male
9 autores
- Charmaine E. Lok🇨🇦University Health Network; University of Toronto; Toronto General Hospital; Toronto General Hospital Research Institute
- Michael E. Farkouh🇨🇦🇺🇸University Health Network; Cedars-Sinai Smidt Heart Institute
- Brenda R. Hemmelgarn🇨🇦University of Alberta
- Louise M. MOIST🇨🇦Western University
- Kevan R. Polkinghorne🇦🇺Monash Health; Monash University
- GEORGE A. TOMLINSON🇨🇦Toronto General Hospital; Toronto General Hospital Research Institute
- Paul YW Tam🇨🇦University Health Network; Scarborough Health Network
- Marcello A. Tonelli🇨🇦University of Calgary
- Jacob Allen Udell🇨🇦University Health Network; University of Toronto; Women's College Hospital
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
Cardiovascular disease is the leading cause of death in patients receiving hemodialysis, yet effective preventive therapies remain limited. Supplementation with n-3 polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may have cardiovascular benefits in the general population, but efficacy among patients receiving hemodialysis is uncertain.
Methods
In a double-blind, randomized, placebo-controlled trial conducted at 26 sites in Canada and Australia, we assigned adult patients receiving maintenance hemodialysis to daily supplementation with fish oil (4 g of n-3 polyunsaturated fatty acids [1.6 g of EPA and 0.8 g of DHA]) or corn-oil placebo. The primary end point was a composite of all serious cardiovascular events including sudden and nonsudden cardiac death, fatal and nonfatal myocardial infarction, peripheral vascular disease leading to amputation, and fatal and nonfatal stroke. Secondary end points included extension of the primary end point to include noncardiac causes of death, the individual components of the primary end point, and a first cardiovascular event or death from any cause.
Results
Between November 28, 2013, and July 22, 2019, a total of 1228 participants underwent randomization; 610 were assigned to the fish-oil group and 618 to the placebo group. During 3.5 years of follow-up, the rate of serious cardiovascular events was significantly lower in the fish-oil group than in the placebo group (0.31 vs. 0.61 per 1000 patient-days; hazard ratio, 0.57; 95% confidence interval [CI], 0.47 to 0.70; P<0.001). The rate of the extended primary end point that included noncardiac causes of death appeared to be lower in the fish-oil group than in the placebo group, with a hazard ratio of 0.77 (95% CI, 0.65 to 0.90). The hazard ratio for cardiac death was 0.55 (95% CI, 0.40 to 0.75); for fatal and nonfatal myocardial infarction, 0.56 (95% CI, 0.40 to 0.80); for peripheral vascular disease leading to amputation, 0.57 (95% CI, 0.38 to 0.86); for fatal and nonfatal stroke, 0.37 (95% CI, 0.18 to 0.76); and for a first cardiovascular event or death from any cause, 0.73 (95% CI, 0.61 to 0.87). Adherence to the trial regimen and the incidence of adverse events did not differ meaningfully between the groups.
Conclusions
The rate of serious cardiovascular events among participants receiving maintenance hemodialysis was lower with daily supplementation with n-3 fatty acids than with placebo. (Supported by the Heart and Stroke Foundation of Canada and others; PISCES ClinicalTrials.gov number, ISRCTN00691795.).
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
Confianza de la comunidad
Cargando…
¿Cuánto confías en los hallazgos de este estudio?
Comentarios
¿Algo está mal aquí?
Señala este estudio si su información, etiquetas o financiación parecen incorrectas. Un editor revisa cada señalamiento.
Información educativa sobre investigación publicada. No es consejo médico ni una recomendación para empezar o dejar nada.