Mahdi Amirdosara
1 
, Zahra Sahraei
2 , Farzaneh Futuhi
3* 1 Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Adult Nephrology, School of Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Chronic kidney disease (CKD) is a progressive disorder associated with high morbidity and mortality, primarily driven by cardiovascular complications and progression to end-stage renal disease (ESRD). Proteinuria and persistent low-grade inflammation are key mechanisms underlying disease progression. Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been investigated as adjunctive therapeutic agents due to their anti-inflammatory, antioxidant, and antifibrotic properties. This narrative review synthesizes evidence from the literature to evaluate the effectiveness of omega-3 PUFA supplementation on proteinuria, inflammatory markers, and renal function in patients with CKD. A structured literature search was conducted using relevant Medical Subject Headings (MeSH) and free-text terms, including observational studies, randomized controlled trials (RCTs), systematic reviews, and meta-analyses published in English. The findings indicated that omega-3 PUFA supplementation is associated with a modest but statistically significant reduction in proteinuria, particularly in patients with IgA nephropathy, along with a decreased risk of ESRD. However, its effects on estimated glomerular filtration rate (eGFR) and serum creatinine clearance are generally not significant. The anti-inflammatory effects remain inconclusive, as most pooled analyses do not show significant reductions in markers such as C-reactive protein (CRP), interleukin-6 (IL-6), or tumor necrosis factor-alpha (TNF-α), although some benefit has been observed in hemodialysis patients with elevated baseline inflammation. Experimental studies more consistently demonstrate antioxidant and antifibrotic effects. Overall, omega-3 PUFAs may serve as a supportive therapy in CKD management, particularly for reducing proteinuria and delaying disease progression, although further large-scale, well-designed clinical trials are necessary to confirm definitive clinical recommendations.
Implication for health policy/practice/research/medical education:
Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may provide modest clinical benefits in chronic kidney disease (CKD) by reducing proteinuria, especially in IgA nephropathy, and lowering the risk of progression to end-stage renal disease (ESRD), although they show no significant improvement in estimated glomerular filtration rate (eGFR) or creatinine clearance. Their anti-inflammatory effects remain inconsistent, with most studies reporting no significant reductions in markers such as C-reactive protein (CRP), interleukin-6 (IL-6), or tumor necrosis factor-alpha (TNF-α), except for some benefit in hemodialysis patients with elevated baseline inflammation. Evidence from experimental models more consistently supports antioxidant and antifibrotic effects. Overall, omega-3 supplementation appears to be a potentially useful adjunct to standard CKD management, but its clinical efficacy requires confirmation through larger, well-designed trials.
Please cite this paper as: Amirdosara M, Sahraei Z, Futuhi F. Omega-3 polyunsaturated fatty acid supplementation in chronic kidney disease; effects on inflammation, proteinuria, and renal function - a narrative review study. J Nephropathol. 2026;x(x):e28734. DOI: 10.34172/jnp.28734.