Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis

Carolyn Blair; Adrian Slee; Clare McKeaveney; Alexander P. Maxwell; Faizan Awan; Malcolm Brown; Andrew Davenport; Damian Fogarty; Denis Fouque; William Johnston; Kamyar Kalantar-Zadeh; Robert Mullan; Helen Noble; Sam Porter; David S. Seres; Joanne Shields; Ian Swaine; Miles Witham; Joanne Reid

doi:10.1016/j.clnesp.2026.102957

Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis

Carolyn Blair
, Adrian Slee
, Clare McKeaveney
, Alexander P. Maxwell
, Faizan Awan
, Malcolm Brown
, Andrew Davenport
, Damian Fogarty
, Denis Fouque
, William Johnston
, Kamyar Kalantar-Zadeh
, Robert Mullan
, Helen Noble
, Sam Porter
, David S. Seres
, Joanne Shields
, Ian Swaine
, Miles Witham
, Joanne Reid^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction
Evidence on the anti-inflammatory effects and safety of omega-3 fatty acid supplementation in haemodialysis (HD) patients remains limited, particularly regarding the influence of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dose, composition, and source.

Methods
We searched PubMed (n = 345), CENTRAL (n = 148) and EMBASE (n = 706) to July 2025. Studies were screened using Covidence, risk of bias was assessed using the Cochrane ROB 1 tool, and analyses were conducted in Review Manager 9.5.1. Only trials reporting C-reactive protein (CRP) were included. Pre-planned subgroup analyses examined formulation type, total daily dose, active ingredient dose, and DHA:EPA composition. Random-effects models were used to generate pooled standardised mean differences (SMDs), with heterogeneity assessed using I2. A sensitivity analysis excluded studies at high risk of bias. The protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/JCBHN).

Results
Thirteen studies (n = 678) were included (12 in meta-analyses). Two studies were judged high risk of bias, one unclear, and the remainder low risk. Adverse events were poorly reported: eight trials did not report any events, while five described only mild, transient effects (e.g., diarrhoea). Omega-3 fatty acids reduced CRP more than comparators across triglyceride formulations (SMD –0.62, 95 % CI –1.22 to −0.03; P = 0.04, I2 = 74 %); in the <2000 mg/day total dose subgroup (SMD –0.32, 95 % CI –0.61 to −0.04; P = 0.02, I2 = 29 %); and in the <2000 mg/day active ingredient subgroup (SMD –0.36, 95 % CI –0.59 to −0.13; P = 0.003, I2 = 31 %). No statistically significant differences were observed between subgroups. Sensitivity analyses did not materially change the results.

Conclusion
A daily dose <2000 mg of omega-3 fatty acids in natural triglyceride form appears more effective than synthetic ethyl ester formulations for lowering CRP in HD patients. Larger, high-quality trials are required to confirm therapeutic benefit, determine optimal dosing, and clarify the ideal EPA:DHA composition for this population.

Original language	English
Article number	102957
Journal	Clinical Nutrition ESPEN
Volume	72
Early online date	13 Feb 2026
DOIs	https://doi.org/10.1016/j.clnesp.2026.102957
Publication status	Published - Apr 2026

Publications and Copyright Policy

This work is licensed under Queen’s Research Publications and Copyright Policy.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Chronic kidney disease
CRP
Fish oil
Haemodialysis
Inflammation
Omega-3 fatty acids

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Nutrition and Dietetics

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Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis
Copyright 2026 the authors. This is an accepted manuscript distributed under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
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Cite this

Blair, C., Slee, A., McKeaveney, C., Maxwell, A. P., Awan, F., Brown, M., Davenport, A., Fogarty, D., Fouque, D., Johnston, W., Kalantar-Zadeh, K., Mullan, R., Noble, H., Porter, S., Seres, D. S., Shields, J., Swaine, I., Witham, M., & Reid, J. (2026). Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis. Clinical Nutrition ESPEN, 72, Article 102957. https://doi.org/10.1016/j.clnesp.2026.102957

@article{9558dadc00f944bbbb634c50ac8e9e7c,

title = "Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis",

abstract = "Introduction Evidence on the anti-inflammatory effects and safety of omega-3 fatty acid supplementation in haemodialysis (HD) patients remains limited, particularly regarding the influence of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dose, composition, and source. Methods We searched PubMed (n = 345), CENTRAL (n = 148) and EMBASE (n = 706) to July 2025. Studies were screened using Covidence, risk of bias was assessed using the Cochrane ROB 1 tool, and analyses were conducted in Review Manager 9.5.1. Only trials reporting C-reactive protein (CRP) were included. Pre-planned subgroup analyses examined formulation type, total daily dose, active ingredient dose, and DHA:EPA composition. Random-effects models were used to generate pooled standardised mean differences (SMDs), with heterogeneity assessed using I2. A sensitivity analysis excluded studies at high risk of bias. The protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/JCBHN). Results Thirteen studies (n = 678) were included (12 in meta-analyses). Two studies were judged high risk of bias, one unclear, and the remainder low risk. Adverse events were poorly reported: eight trials did not report any events, while five described only mild, transient effects (e.g., diarrhoea). Omega-3 fatty acids reduced CRP more than comparators across triglyceride formulations (SMD –0.62, 95 \% CI –1.22 to −0.03; P = 0.04, I2 = 74 \%); in the <2000 mg/day total dose subgroup (SMD –0.32, 95 \% CI –0.61 to −0.04; P = 0.02, I2 = 29 \%); and in the <2000 mg/day active ingredient subgroup (SMD –0.36, 95 \% CI –0.59 to −0.13; P = 0.003, I2 = 31 \%). No statistically significant differences were observed between subgroups. Sensitivity analyses did not materially change the results. Conclusion A daily dose <2000 mg of omega-3 fatty acids in natural triglyceride form appears more effective than synthetic ethyl ester formulations for lowering CRP in HD patients. Larger, high-quality trials are required to confirm therapeutic benefit, determine optimal dosing, and clarify the ideal EPA:DHA composition for this population.",

keywords = "Chronic kidney disease, CRP, Fish oil, Haemodialysis, Inflammation, Omega-3 fatty acids",

author = "Carolyn Blair and Adrian Slee and Clare McKeaveney and Maxwell, \{Alexander P.\} and Faizan Awan and Malcolm Brown and Andrew Davenport and Damian Fogarty and Denis Fouque and William Johnston and Kamyar Kalantar-Zadeh and Robert Mullan and Helen Noble and Sam Porter and Seres, \{David S.\} and Joanne Shields and Ian Swaine and Miles Witham and Joanne Reid",

year = "2026",

month = apr,

doi = "10.1016/j.clnesp.2026.102957",

language = "English",

volume = "72",

journal = "Clinical Nutrition ESPEN",

issn = "2405-4577",

publisher = "Elsevier Ltd",

}

Blair, C, Slee, A, McKeaveney, C , Maxwell, AP, Awan, F, Brown, M, Davenport, A, Fogarty, D, Fouque, D, Johnston, W, Kalantar-Zadeh, K, Mullan, R, Noble, H , Porter, S, Seres, DS, Shields, J, Swaine, I, Witham, M & Reid, J 2026, 'Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis', Clinical Nutrition ESPEN, vol. 72, 102957. https://doi.org/10.1016/j.clnesp.2026.102957

TY - JOUR

T1 - Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis

AU - Blair, Carolyn

AU - Slee, Adrian

AU - McKeaveney, Clare

AU - Maxwell, Alexander P.

AU - Awan, Faizan

AU - Brown, Malcolm

AU - Davenport, Andrew

AU - Fogarty, Damian

AU - Fouque, Denis

AU - Johnston, William

AU - Kalantar-Zadeh, Kamyar

AU - Mullan, Robert

AU - Noble, Helen

AU - Porter, Sam

AU - Seres, David S.

AU - Shields, Joanne

AU - Swaine, Ian

AU - Witham, Miles

AU - Reid, Joanne

PY - 2026/4

Y1 - 2026/4

N2 - Introduction Evidence on the anti-inflammatory effects and safety of omega-3 fatty acid supplementation in haemodialysis (HD) patients remains limited, particularly regarding the influence of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dose, composition, and source. Methods We searched PubMed (n = 345), CENTRAL (n = 148) and EMBASE (n = 706) to July 2025. Studies were screened using Covidence, risk of bias was assessed using the Cochrane ROB 1 tool, and analyses were conducted in Review Manager 9.5.1. Only trials reporting C-reactive protein (CRP) were included. Pre-planned subgroup analyses examined formulation type, total daily dose, active ingredient dose, and DHA:EPA composition. Random-effects models were used to generate pooled standardised mean differences (SMDs), with heterogeneity assessed using I2. A sensitivity analysis excluded studies at high risk of bias. The protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/JCBHN). Results Thirteen studies (n = 678) were included (12 in meta-analyses). Two studies were judged high risk of bias, one unclear, and the remainder low risk. Adverse events were poorly reported: eight trials did not report any events, while five described only mild, transient effects (e.g., diarrhoea). Omega-3 fatty acids reduced CRP more than comparators across triglyceride formulations (SMD –0.62, 95 % CI –1.22 to −0.03; P = 0.04, I2 = 74 %); in the <2000 mg/day total dose subgroup (SMD –0.32, 95 % CI –0.61 to −0.04; P = 0.02, I2 = 29 %); and in the <2000 mg/day active ingredient subgroup (SMD –0.36, 95 % CI –0.59 to −0.13; P = 0.003, I2 = 31 %). No statistically significant differences were observed between subgroups. Sensitivity analyses did not materially change the results. Conclusion A daily dose <2000 mg of omega-3 fatty acids in natural triglyceride form appears more effective than synthetic ethyl ester formulations for lowering CRP in HD patients. Larger, high-quality trials are required to confirm therapeutic benefit, determine optimal dosing, and clarify the ideal EPA:DHA composition for this population.

AB - Introduction Evidence on the anti-inflammatory effects and safety of omega-3 fatty acid supplementation in haemodialysis (HD) patients remains limited, particularly regarding the influence of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) dose, composition, and source. Methods We searched PubMed (n = 345), CENTRAL (n = 148) and EMBASE (n = 706) to July 2025. Studies were screened using Covidence, risk of bias was assessed using the Cochrane ROB 1 tool, and analyses were conducted in Review Manager 9.5.1. Only trials reporting C-reactive protein (CRP) were included. Pre-planned subgroup analyses examined formulation type, total daily dose, active ingredient dose, and DHA:EPA composition. Random-effects models were used to generate pooled standardised mean differences (SMDs), with heterogeneity assessed using I2. A sensitivity analysis excluded studies at high risk of bias. The protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/JCBHN). Results Thirteen studies (n = 678) were included (12 in meta-analyses). Two studies were judged high risk of bias, one unclear, and the remainder low risk. Adverse events were poorly reported: eight trials did not report any events, while five described only mild, transient effects (e.g., diarrhoea). Omega-3 fatty acids reduced CRP more than comparators across triglyceride formulations (SMD –0.62, 95 % CI –1.22 to −0.03; P = 0.04, I2 = 74 %); in the <2000 mg/day total dose subgroup (SMD –0.32, 95 % CI –0.61 to −0.04; P = 0.02, I2 = 29 %); and in the <2000 mg/day active ingredient subgroup (SMD –0.36, 95 % CI –0.59 to −0.13; P = 0.003, I2 = 31 %). No statistically significant differences were observed between subgroups. Sensitivity analyses did not materially change the results. Conclusion A daily dose <2000 mg of omega-3 fatty acids in natural triglyceride form appears more effective than synthetic ethyl ester formulations for lowering CRP in HD patients. Larger, high-quality trials are required to confirm therapeutic benefit, determine optimal dosing, and clarify the ideal EPA:DHA composition for this population.

KW - Chronic kidney disease

KW - CRP

KW - Fish oil

KW - Haemodialysis

KW - Inflammation

KW - Omega-3 fatty acids

U2 - 10.1016/j.clnesp.2026.102957

DO - 10.1016/j.clnesp.2026.102957

M3 - Article

C2 - 41692069

AN - SCOPUS:105030953028

SN - 2405-4577

VL - 72

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

M1 - 102957

ER -

Anti-inflammatory effects and safety of omega-3 fatty acids in haemodialysis: A systematic review and meta-analysis

Abstract

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