In a randomized, placebo-controlled trial of 1228 hemodialysis patients, daily fish oil supplementation (4 g n-3 PUFA: 1.6 g EPA, 0.8 g DHA) significantly reduced serious cardiovascular events compared with placebo over 3.5 years (HR 0.57; 95% CI, 0.47–0.70). Benefits extended to cardiac death, myocardial infarction, stroke, amputation, and all-cause mortality, with adherence and adverse events similar between groups. Supplementation with n-3 fatty acids thus lowered cardiovascular risk in this population.