The Curbsiders Internal Medicine Podcast · The Curbsiders Internal Medicine Podcast

#514 Hotcakes: Oral Semaglutide, Fish Oil in ESRD, IV Iron During Infection, New US Dietary Guidelines, & Anticoagulation after Ablation in AFib

·1 hr 10 min·4 clips

IV iron during infection looked like it cut mortality by about 50%, but Rahul says immortal time bias may explain it.

1. The Curbsiders Internal Medicine Podcast #514 covers oral semaglutide, fish oil in hemodialysis, IV iron during acute infection, new U.S. dietary guidelines, and anticoagulation after ablation in atrial fibrillation. 2. Dr. Matthew Frank Watto hosts with Dr. Paul Nelson-Williams, Dr. Rahul Ganatra, and Dr. Josh Gilman, and Rahul and Josh help frame the critical-appraisal segments. 3. The episode exists to test whether several recent articles should change practice, using the hosts as the reviewers rather than outside experts. 4. The oral semaglutide discussion centers on the Wharton et al. NEJM 2025 trial in adults with overweight or obesity. 5. Paul says the trial showed 13.6% weight loss with oral semaglutide versus 2.2% with placebo, a difference of minus 11.4 percentage points. 6. Rahul says the result is not surprising because prior injected and oral GLP-1 receptor agonist trials already established weight loss benefit. 7. The hosts note GI side effects as the main limitation, including nausea in almost half of participants and vomiting in about a third. 8. Paul also brings up dysesthesia, citing a New England Journal clinician piece and saying the symptom appeared in about 5% of patients at the studied dose. 9. The fish-oil segment focuses on the Pisces trial in chronic hemodialysis patients at 26 sites in Canada and Australia. 10. Paul says the trial used four grams daily of steam-deodorized citrus-flavored omega-3 polyunsaturated fatty acids and compared them with citrus-flavored corn oil placebo. 11. Josh contrasts this with prior mixed omega-3 evidence, including REDUCE-IT and older low-dose studies, and notes that REDUCE-IT was in non-dialysis patients with high triglycerides. 12. Rahul highlights the trial's adherence check using plasma phospholipid omega-3 incorporation and a follow-up period of up to three and a half years. 13. The IV-iron segment comes from a Blood paper by Sohail and colleagues on hospitalized patients with iron deficiency anemia and acute infection. 14. Rahul names the infection cohorts as MRSA bacteremia, pneumonia, UTI, colitis, and cellulitis, all identified through ICD-10 codes in TrinetX. 15. The study reported improved 14-day and 90-day survival with IV iron, with absolute risk reductions of about 1% to 4% at 14 days and 3% to 6% at 90 days. 16. Rahul argues that immortal time bias could fully explain the survival advantage because patients had to live long enough to receive IV iron within seven days of the index date. 17. The conversation keeps a journal-club tone, with the hosts interrupting each other, checking assumptions, and asking how the results might fail. 18. The pacing is fast and practical, with named trials, exact doses, and side-effect rates used as the basis for critique. 19. Clinicians who want trial appraisal on diabetes, dialysis, and inpatient anemia will get the most from this episode. 20. People looking for long-form narrative or light entertainment may skip this one.

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