So the belle of the ball at last year’s Kidney Week was the PISCES trial, which reported a striking ~50% reduction in cardiovascular outcomes with fish oil in hemodialysis patients. That is an extraordinary signal. If you’re unaware, or skeptical, I suggest ’d strongly encourage you to check out NephJC’s coverage or listen to the Freely Filtered episode. The data look clean, internally consistent, and genuinely impressive.
One of the practical sticking points, however, has been how to translate PISCES into practice. Specifically: what fish oil actually matches the intervention used in the trial? The investigators are working with their supplier to bring the study formulation to market, but in the meantime clinicians are left asking what, if anything, can reasonably substitute.
Earlier this year, I was invited to the Medical University of South Carolina to give grand rounds, and during the discussion Ruth Campbell mentioned that she has been using the FDA-regulated, prescription omega-3 product Lovaza for her patients. As it turns out, that choice is quite defensible: Lovaza is fairly similar to the fish oil used in PISCES, both in formulation (omega-3 ethyl esters) and dose, differing mainly in the EPA:DHA ratio:
Because Lovaza is an FDA-approved prescription drug, it fits cleanly into most EHR workflows, and patients are far more likely to receive what the label says they’re getting than with unregulated over-the-counter fish oil supplements. That reliability matters when you’re trying to reproduce a trial signal as strong as PISCES.
I like it. I’ve started prescribing it.
What are you using for your patients?