Yes that's correct

LOL! Im not a dialysis patient and I take it!

#NephJC

Actually, we actually found the opposite - many patients were wanting a "natural" treatment and didnt mind! Some actually left the study to buy commercial fish oil as they didnt know if they had placebo. But to be fair, some also left the study due to pill burden #NephJC

One of the differences between omega-3 studies in general population vs HD is the baseline levels of EPA and DHA. There was a meta-analysis of 53 studies (2018) showing HD pts consistently have lower levels. Also studies varied in "carrier compound", doses and ratios, which may all impact #NephJC

Indeed! We did not know what to expect, but hopeful. Having worked on this for over a decade, I was initially "stunned" by the result but then not really surprised given the multitude of potential effects of EPA and DHA on the cardiovasculature, and our HD patients deficiencies in it #NephJC

We did a lot of sensitivity analyses (see Supplement) using various methods of recurrent event analysis that showed consistent results. Didn't matter how you sliced the fish!

There were prior concerns of increased bleeding risk with fish oil but we did not see it in PISCES. In another study called the OPERA study, high doses of fish oil had lower bleeding events compared with control. #NephJC

EPA and DHA has an effect on arrhythmias and SCD, especially formation of reentry arrhythmias. e.g. EPA and DHA modulates sodium, calcium and potassium ion channels affecting the cardiac action potential. #NephJC

The authors are working with manufacturers to produce the study formulation just for hemodialysis patients #NephJC

Fistula First initiative killed AV grafts... but we use fish oil in our graft patients

Yes, key CV effects 1) Delay progression traditional risk factors: 2) Has an acute effect: a. Increases plaque stabilization and reduces plaque rupture (changes plaque characteristics, b.    Reduces thrombosis. e.g. reduces thromboxane A2 (proaggregatory), etc c. Reduces arrhythmias, esp. reentry

I think thats fine as not all fish oils are the same#NephJC

Hi Swap! I'm here but not sure how to post anything - LOL!

Hi Everyone - its Charmaine, PI for PISCES. I have never posted anything so let me know if you see my hello

Hi! I'm Charmaine, PI for PISCES :). I have no fishy conflicts