This Week in General Medicine — Oct 26, 2026
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The week's practice-changing General Medicine research, summarized for clinicians.
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Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
A video decision aid plus patient-recorded preferences raised advance care planning documentation from 40 to about 57 percent among older adults with advanced kidney disease and reduced indecision.
JAMA Internal Medicine · 2026 · PubMed
This week’s papers
- 01
Sibeprenlimab in IgA Nephropathy - Final Phase 3 Trial Analysis.
In 510 adults with IgA nephropathy, monthly sibeprenlimab held kidney function essentially stable over two years and sharply reduced kidney decline or failure versus placebo.
Rizk DV et al. · New England Journal of Medicine · 2026
From the briefingRizk and colleagues report the final analysis of the VISIONARY trial of sibeprenlimab, a monoclonal antibody against the cytokine known as APRIL, given as 400 milligrams under the skin every four weeks to 510 adults [1]. Earlier reports showed reduced proteinuria; the question here was whether kidney function itself was protected. Over two years, patients on placebo lost a little over four units of estimated filtration rate per year, while patients on sibeprenlimab essentially held steady, a difference of about four and a half units per year. The hard composite of kidney function decline or kidney failure occurred in just one patient on the drug versus 28 on placebo, and serious adverse events and serious infections were, if anything, less common with treatment [1].
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Atacicept in IgA Nephropathy - Phase 3 Trial Final Efficacy Analysis.
Weekly atacicept stabilized kidney function in IgA nephropathy and cut composite disease progression by roughly three quarters versus placebo, with fewer serious adverse events over two years.
Barratt J et al. · New England Journal of Medicine · 2026
From the briefingBarratt and colleagues report a strikingly parallel result from ORIGIN 3, testing weekly atacicept, which blocks both APRIL and a related cytokine, in 428 treated adults [2]. Placebo patients lost roughly five and a half units of filtration in the first year while atacicept patients barely changed, and composite progression was cut by roughly three quarters, with no atacicept patient reaching dialysis, transplant, or death compared with seven on placebo [2]. Taken together, two independent trials with different molecules now converge on the same signal: blocking this pathway appears to stabilize kidney function rather than merely lower proteinuria. Both trials were industry funded and follow-up is two years, so durability over the decades these patients live with the disease remains unknown, but the consistency strengthens the case for this drug class.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
Across 85 randomized trials, SGLT2 inhibitors raised hemoglobin by about 0.6 g/dL and hematocrit by about two points, with increased erythropoietin, though clinical significance remains unclear.
Yang Y et al. · JAMA · 2026
From the briefingStaying with the kidney but shifting to a drug class generalists prescribe daily, Yang and colleagues in JAMA pooled 85 randomized trials with over seventy thousand participants to quantify what SGLT2 inhibitors do to red cell indices [3]. Compared with control, these drugs raised hemoglobin by about 0.6 grams per deciliter and hematocrit by a little over two points, alongside a rise in erythropoietin and a small fall in transferrin saturation [3]. The practical relevance is interpretive: a modest hemoglobin rise in a patient on one of these agents is an expected drug effect. The authors are explicit, though, that the clinical significance remains unclear, and most included trials ran only about six months.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.
A video decision aid plus patient-recorded preferences raised advance care planning documentation from 40 to about 57 percent among older adults with advanced kidney disease and reduced indecision.
Volandes AE et al. · JAMA Internal Medicine · 2026
From the briefingThe kidney theme closes on decisions rather than drugs. In JAMA Internal Medicine, Volandes and colleagues ran the VIDEO-KD trial across 12 ambulatory clinics, enrolling 453 adults aged 65 or older with advanced chronic kidney disease [4]. Patients in the intervention arm watched a certified video describing hemodialysis, peritoneal dialysis, and conservative kidney management, then recorded their own statement of goals and preferences that was sent to their clinician. Advance care planning documentation at one year rose from 40 percent to just under 57 percent, and documented discussion of kidney failure options rose by a similar margin [4]. After the video, the share of patients who remained undecided dropped from about four in ten to about one in eight, and about half of intervention patients preferred conservative management. The cohort was over 80 percent White, so generalizability to more diverse populations is an open question, and documentation is a process outcome rather than proof that care matched patient goals, but the trial provides randomized evidence that a low-intensity tool changes what gets discussed and recorded.
If you only have time for one paper this week, make it the VIDEO-KD trial in JAMA Internal Medicine [4]. It addresses a decision generalists encounter constantly in older patients with failing kidneys, and it offers rare randomized evidence that a scalable, low-cost tool changes whether goals of care are discussed and recorded at all.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Projected Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections in the United States.
Modeling projects that replacing universal hepatitis B birth-dose vaccination with shared decision making would raise chronic childhood infections by about 83 percent and greatly expand susceptibility.
Mohareb AM et al. · Annals of Internal Medicine · 2026
From the briefingOur second theme is preventing and finding chronic infection, where two modeling studies and a major review frame current policy debates. In the Annals of Internal Medicine, Mohareb and colleagues used a simulation of a single birth cohort of about 3.6 million infants born in the United States to project the effect of proposed changes to the childhood hepatitis B schedule [5]. Compared with universal birth-dose vaccination, deferring the first dose to two months was projected to increase chronic childhood infections by about a fifth, while shifting to shared decision making was projected to increase them by over 80 percent. By age 20, the number of people susceptible to hepatitis B would rise from about a quarter of a million to nearly two million under the shared decision-making approach [5]. These are model projections dependent on assumptions about coverage and horizontal transmission, and the authors acknowledge uncertainty there, but they conclude the analysis supports reinstating universal birth-dose vaccination.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Cost-Effectiveness of HCV Screening in Emergency Departments Using DETECT Hep C Trial Results.
Simulation using DETECT Hep C data found nontargeted emergency department hepatitis C screening cost-effective at about 12,820 dollars per quality-adjusted life year versus targeted or no screening.
Czoty LMW et al. · JAMA Internal Medicine · 2026
From the briefingA parallel question for hepatitis C comes from Czoty and colleagues in JAMA Internal Medicine, who fed data from the DETECT Hep C trial in three emergency departments into a lifetime cost-effectiveness model [6]. Nontargeted screening of all emergency department patients outperformed both targeted screening and no screening, costing about thirteen thousand dollars per quality-adjusted life year gained, well under the conventional threshold. The population-level gains look tiny because more than nine in ten people screened do not have the infection, but the benefit for those who do is clear [6]. This adds economic support to universal emergency department screening as a pillar of elimination efforts, though it remains a model rather than observed outcomes.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Helicobacter pylori Infection - Advances, Challenges, and the Road Ahead.
A review of four decades of Helicobacter pylori research highlights rising antibiotic resistance and lack of a vaccine as key barriers, framing eradication and screening as gastric cancer prevention.
Li H et al. · New England Journal of Medicine · 2026
From the briefingRounding out this theme, Li, Megraud, and Marshall offer a review of Helicobacter pylori in the New England Journal of Medicine, tracing four decades since its discovery [7]. They emphasize that rising antibiotic resistance worldwide and the absence of a vaccine are now the central obstacles, and they review screening strategies aimed at primary prevention of gastric cancer. It is a useful synthesis rather than new data, but it situates eradication squarely as cancer prevention.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Retatrutide Once Weekly for Treatment of Obstructive Sleep Apnea.
In adults with moderate-to-severe sleep apnea and excess weight, investigational retatrutide reduced apnea events significantly more than placebo over 80 weeks, alongside substantial weight loss.
Grunstein RR et al. · New England Journal of Medicine · 2026
From the briefingOur final theme brings together therapeutic results that range from remarkable to null. In the New England Journal of Medicine, Grunstein and colleagues report two phase 3 trials of retatrutide, a triple agonist of the GIP, GLP-1, and glucagon receptors, in adults with moderate-to-severe obstructive sleep apnea and a body mass index of at least 27, with or without type 2 diabetes [8]. Baseline apnea severity was high, at well over 50 events per hour. At 80 weeks, the higher doses cut the apnea-hypopnea index by roughly 25 to 34 events per hour, substantially more than placebo, with weight loss of up to about a fifth of body weight in patients without diabetes [8]. Effects were smaller in patients with diabetes, gastrointestinal side effects were most common, and retatrutide remains investigational, but the data add to evidence that incretin-based therapy can treat sleep apnea itself.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Disease-free survival and overall survival after neoadjuvant immunotherapy in mismatch repair-deficient colon cancer in the Netherlands: results of the single-arm, multicentre, phase 2, NICHE-2 trial.
Brief neoadjuvant ipilimumab plus nivolumab in resectable mismatch repair-deficient colon cancer yielded 100 percent three-year disease-free and five-year overall survival in a single-arm trial.
Chalabi M et al. · The Lancet · 2026
From the briefingThe most eye-catching numbers of the week come from The Lancet, where Chalabi and colleagues report long-term results of NICHE-2, a single-arm phase 2 trial in the Netherlands [9]. Patients with resectable stage 2 or 3 mismatch repair-deficient colon cancer received one dose of ipilimumab and two doses of nivolumab before surgery. Among 111 per-protocol patients followed for about five years, three-year disease-free survival and five-year overall survival were both 100 percent, and every patient was circulating tumor DNA negative after surgery [9]. Without a control arm this cannot be a definitive comparison, but the authors argue it supports neoadjuvant immunotherapy as a potential standard of care for this molecular subgroup, which makes mismatch repair testing at diagnosis increasingly consequential.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Individualized Cardiac Index-Guided Hemodynamic Therapy in High-Risk Patients Undergoing Elective Major Abdominal Surgery: The PELICAN Randomized Clinical Trial.
Targeting each patient's preoperative cardiac index during major abdominal surgery did not reduce a seven-day composite of organ injury, infection, cardiac arrest, or death versus routine care.
Saugel B et al. · JAMA · 2026
From the briefingThe counterpoint is the PELICAN trial in JAMA, from Saugel and colleagues, which randomized about 1,100 high-risk patients undergoing elective major abdominal surgery at 12 European university centers [10]. Hemodynamic therapy individualized to each patient's preoperative resting cardiac index did not reduce a composite of kidney injury, myocardial injury, severe infection, cardiac arrest, or death within seven days, which occurred in roughly 44 versus 47 percent of patients, a non-significant difference, and no individual component differed either [10]. This is a clean negative result that weakens the case for cardiac index targeting as a routine perioperative strategy.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in General Medicine. This week we're covering 10 notable papers spanning new evidence in kidney disease, the value of screening and vaccination against chronic infection, and a mix of striking and sobering results in obesity, cancer, and perioperative care. Let's dive in.
Kidney disease dominates the week, starting with two phase 3 trials in IgA nephropathy, both in the New England Journal of Medicine, that target the same immune pathway with different drugs. Rizk and colleagues report the final analysis of the VISIONARY trial of sibeprenlimab, a monoclonal antibody against the cytokine known as APRIL, given as 400 milligrams under the skin every four weeks to 510 adults [1]. Earlier reports showed reduced proteinuria; the question here was whether kidney function itself was protected. Over two years, patients on placebo lost a little over four units of estimated filtration rate per year, while patients on sibeprenlimab essentially held steady, a difference of about four and a half units per year. The hard composite of kidney function decline or kidney failure occurred in just one patient on the drug versus 28 on placebo, and serious adverse events and serious infections were, if anything, less common with treatment [1]. Barratt and colleagues report a strikingly parallel result from ORIGIN 3, testing weekly atacicept, which blocks both APRIL and a related cytokine, in 428 treated adults [2]. Placebo patients lost roughly five and a half units of filtration in the first year while atacicept patients barely changed, and composite progression was cut by roughly three quarters, with no atacicept patient reaching dialysis, transplant, or death compared with seven on placebo [2]. Taken together, two independent trials with different molecules now converge on the same signal: blocking this pathway appears to stabilize kidney function rather than merely lower proteinuria. Both trials were industry funded and follow-up is two years, so durability over the decades these patients live with the disease remains unknown, but the consistency strengthens the case for this drug class.
Staying with the kidney but shifting to a drug class generalists prescribe daily, Yang and colleagues in JAMA pooled 85 randomized trials with over seventy thousand participants to quantify what SGLT2 inhibitors do to red cell indices [3]. Compared with control, these drugs raised hemoglobin by about 0.6 grams per deciliter and hematocrit by a little over two points, alongside a rise in erythropoietin and a small fall in transferrin saturation [3]. The practical relevance is interpretive: a modest hemoglobin rise in a patient on one of these agents is an expected drug effect. The authors are explicit, though, that the clinical significance remains unclear, and most included trials ran only about six months.
The kidney theme closes on decisions rather than drugs. In JAMA Internal Medicine, Volandes and colleagues ran the VIDEO-KD trial across 12 ambulatory clinics, enrolling 453 adults aged 65 or older with advanced chronic kidney disease [4]. Patients in the intervention arm watched a certified video describing hemodialysis, peritoneal dialysis, and conservative kidney management, then recorded their own statement of goals and preferences that was sent to their clinician. Advance care planning documentation at one year rose from 40 percent to just under 57 percent, and documented discussion of kidney failure options rose by a similar margin [4]. After the video, the share of patients who remained undecided dropped from about four in ten to about one in eight, and about half of intervention patients preferred conservative management. The cohort was over 80 percent White, so generalizability to more diverse populations is an open question, and documentation is a process outcome rather than proof that care matched patient goals, but the trial provides randomized evidence that a low-intensity tool changes what gets discussed and recorded.
Our second theme is preventing and finding chronic infection, where two modeling studies and a major review frame current policy debates. In the Annals of Internal Medicine, Mohareb and colleagues used a simulation of a single birth cohort of about 3.6 million infants born in the United States to project the effect of proposed changes to the childhood hepatitis B schedule [5]. Compared with universal birth-dose vaccination, deferring the first dose to two months was projected to increase chronic childhood infections by about a fifth, while shifting to shared decision making was projected to increase them by over 80 percent. By age 20, the number of people susceptible to hepatitis B would rise from about a quarter of a million to nearly two million under the shared decision-making approach [5]. These are model projections dependent on assumptions about coverage and horizontal transmission, and the authors acknowledge uncertainty there, but they conclude the analysis supports reinstating universal birth-dose vaccination.
A parallel question for hepatitis C comes from Czoty and colleagues in JAMA Internal Medicine, who fed data from the DETECT Hep C trial in three emergency departments into a lifetime cost-effectiveness model [6]. Nontargeted screening of all emergency department patients outperformed both targeted screening and no screening, costing about thirteen thousand dollars per quality-adjusted life year gained, well under the conventional threshold. The population-level gains look tiny because more than nine in ten people screened do not have the infection, but the benefit for those who do is clear [6]. This adds economic support to universal emergency department screening as a pillar of elimination efforts, though it remains a model rather than observed outcomes.
Rounding out this theme, Li, Megraud, and Marshall offer a review of Helicobacter pylori in the New England Journal of Medicine, tracing four decades since its discovery [7]. They emphasize that rising antibiotic resistance worldwide and the absence of a vaccine are now the central obstacles, and they review screening strategies aimed at primary prevention of gastric cancer. It is a useful synthesis rather than new data, but it situates eradication squarely as cancer prevention.
Our final theme brings together therapeutic results that range from remarkable to null. In the New England Journal of Medicine, Grunstein and colleagues report two phase 3 trials of retatrutide, a triple agonist of the GIP, GLP-1, and glucagon receptors, in adults with moderate-to-severe obstructive sleep apnea and a body mass index of at least 27, with or without type 2 diabetes [8]. Baseline apnea severity was high, at well over 50 events per hour. At 80 weeks, the higher doses cut the apnea-hypopnea index by roughly 25 to 34 events per hour, substantially more than placebo, with weight loss of up to about a fifth of body weight in patients without diabetes [8]. Effects were smaller in patients with diabetes, gastrointestinal side effects were most common, and retatrutide remains investigational, but the data add to evidence that incretin-based therapy can treat sleep apnea itself.
The most eye-catching numbers of the week come from The Lancet, where Chalabi and colleagues report long-term results of NICHE-2, a single-arm phase 2 trial in the Netherlands [9]. Patients with resectable stage 2 or 3 mismatch repair-deficient colon cancer received one dose of ipilimumab and two doses of nivolumab before surgery. Among 111 per-protocol patients followed for about five years, three-year disease-free survival and five-year overall survival were both 100 percent, and every patient was circulating tumor DNA negative after surgery [9]. Without a control arm this cannot be a definitive comparison, but the authors argue it supports neoadjuvant immunotherapy as a potential standard of care for this molecular subgroup, which makes mismatch repair testing at diagnosis increasingly consequential.
The counterpoint is the PELICAN trial in JAMA, from Saugel and colleagues, which randomized about 1,100 high-risk patients undergoing elective major abdominal surgery at 12 European university centers [10]. Hemodynamic therapy individualized to each patient's preoperative resting cardiac index did not reduce a composite of kidney injury, myocardial injury, severe infection, cardiac arrest, or death within seven days, which occurred in roughly 44 versus 47 percent of patients, a non-significant difference, and no individual component differed either [10]. This is a clean negative result that weakens the case for cardiac index targeting as a routine perioperative strategy.
If you only have time for one paper this week, make it the VIDEO-KD trial in JAMA Internal Medicine [4]. It addresses a decision generalists encounter constantly in older patients with failing kidneys, and it offers rare randomized evidence that a scalable, low-cost tool changes whether goals of care are discussed and recorded at all.
Here is what this week's evidence adds up to in General Medicine. First, two independent phase 3 trials now show that blocking the APRIL pathway stabilizes kidney function in IgA nephropathy over two years, a firm and consistent signal whose long-term durability is still unsettled. Second, the hemoglobin rise with SGLT2 inhibitors is real but small, and its clinical meaning remains unclear. Third, a video decision aid increased advance care planning documentation in older adults with advanced kidney disease, though whether it improves goal-concordant care is not yet known. Fourth, modeling studies support universal birth-dose hepatitis B vaccination and nontargeted emergency department hepatitis C screening, with the caveat that these are projections rather than observed outcomes. And finally, neoadjuvant immunotherapy produced exceptional survival in mismatch repair-deficient colon cancer in a single-arm trial, while cardiac index-guided intraoperative therapy failed to improve outcomes in a well-powered randomized trial.
That's your roundup for This Week in General Medicine. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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