Five PubMed papers to open first: dialysis for acute kidney injury, a chemotherapy-free leukemia regimen, glucose monitors off insulin, vasopressin timing, and a hepatitis B vaccine projection
A ranked ten-minute triage of five papers entered in PubMed between October 13 and 20, 2026: a dialysis trial stopped early for harm, a chemotherapy-free regimen in Ph-positive leukemia, continuous glucose monitoring for people with type 2 diabetes not on insulin, a 3,959-patient test of vasopressin timing in septic shock, and a model of the proposed hepatitis B vaccination change.
This issue covers the papers that entered PubMed between October 13 and October 20, 2026, dated by each record's PubMed entry date. Four come from The New England Journal of Medicine and JAMA. The fifth is the week's strongest NIH-funded paper, a model of what a live change to the US childhood vaccination schedule would do to hepatitis B infections.
The two intensive-care trials point in opposite directions. Continuous renal-replacement therapy held up better than the intermittent alternative in acute kidney injury, and moving vasopressin earlier in septic shock changed nothing measurable across 3,959 patients.
Every paper here is days old, so the citation signal is still empty. Crossref and OpenAlex return 0 or 1 cited-by works for each of the five, and Europe PMC returns 0 for all five. The table carries the individual counts so you can re-rank the list yourself. The order runs on journal tier first, then on randomized design, sample size, endpoint strength, and how directly a result changes a decision.
The Lancet and BMJ indexed no original research in this window, so this issue carries neither.
At a glance
| Rank | Paper | Journal and tier | Design and sample | Primary result | Early cited-by signal |
|---|---|---|---|---|---|
| 1 | Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury (ICRAKI) 1 | The New England Journal of Medicine; very high impact tier | Multicenter, open-label noninferiority RCT, stopped early; 554 randomized, 535 analyzed | Major adverse kidney event by day 90 in 78.1% with intermittent hemodialysis against 71.6% with continuous therapy; 90-day death 63.1% against 53.5% | 1 2 |
| 2 | Ponatinib-Blinatumomab or Imatinib-Chemotherapy for Adult Ph-Positive ALL (GIMEMA ALL2820) 3 | The New England Journal of Medicine; very high impact tier | Phase 3, open-label, 2:1 randomization; 236 randomized, median follow-up 23.7 months | 24-month event-free survival 86% against 67% (P<0.001); survival without measurable residual disease 68% against 42% | 1 4 |
| 3 | Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes (CONNECT) 5 | The New England Journal of Medicine; very high impact tier | 26-week RCT at 22 US primary care practices; 283 randomized | HbA1c fell 1.6 percentage points with CGM and 0.7 with routine care; adjusted difference −0.9 (95% CI −1.1 to −0.6) | 0 6 |
| 4 | Effect of Vasopressin Initiation Threshold on Septic Shock Mortality (VASSPR) 7 | JAMA; very high impact tier | Pragmatic cluster-randomized crossover strategy trial at 13 hospitals; 3,959 patients | 28-day mortality 31.8% against 33.0%; adjusted odds ratio 0.98 (95% CI 0.87 to 1.06) | 0 8 |
| 5 | Projected Effect of 2026 Federal Changes to the Childhood Immunization Schedule on Chronic Hepatitis B Virus Infections 9 | Annals of Internal Medicine; high impact tier in general medicine; NIH-funded | Markov cohort model of a 3.6-million-infant US birth cohort over 20 years | Vaccination through shared decision making projected to raise childhood infections 83%, from 255 to 467 | 0 10 |
1. Intermittent dialysis was not shown to be noninferior, and deaths were higher
Journal and impact tier: The New England Journal of Medicine, very high impact tier; published online October 14, 2026. PubMed entered the paper the same day, under PMID 42873070. 1
Author and affiliation: First author Stéphane Gaudry is in the Département de Réanimation Médico-Chirurgicale at Assistance Publique–Hôpitaux de Paris (AP-HP) Hôpital Avicenne in Bobigny, and at Sorbonne Université in Paris. The trial ran under the ICRAKI Trial Group. 1
Design, setting, and sample: ICRAKI is a multicenter, open-label, noninferiority trial. Adults with acute kidney injury and an indication to start renal-replacement therapy were assigned to intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. 554 patients were randomized, 272 to intermittent hemodialysis and 282 to continuous therapy, and 535 entered the intention-to-treat analysis. The trial was stopped early, after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis. The primary outcome was a major adverse kidney event at day 90: death, dependence on renal-replacement therapy, or creatinine more than 25% above baseline. The registry lists AP-HP as sponsor and marks the study terminated with 554 enrolled. 111
Primary endpoint and quantitative result: A major adverse kidney event by day 90 occurred in 203 of 260 patients (78.1%) on intermittent hemodialysis and 197 of 275 (71.6%) on continuous therapy, an adjusted absolute risk difference of 6.28 percentage points (95% CI −1.22 to 13.79). Death by day 90 occurred in 63.1% against 53.5%, and the Kaplan–Meier estimates were 63.3% and 53.6% (hazard ratio 1.30; 95% CI 1.04 to 1.63). Hypotension was the most common complication, in 68.8% and 66.5% of the two groups. 1
Why it matters: Intensivists and nephrologists choose between these two methods at the bedside, and the choice is rarely reversible: continuous therapy ties up a machine and a nurse for days, while intermittent sessions clear the same solute in hours. A randomized comparison stopped for harm is the kind of result that resets a default. An editorial in the same issue, "Continuous or Intermittent Renal-Replacement Therapy — What Is the Question?", takes up what the trial can and cannot answer. 12
Limitation and evidence boundary: A trial stopped early inflates an apparent harm signal and leaves the effect estimate unstable. The analysis rests on 535 of 554 randomized patients, the design is open-label, and the abstract reports no noninferiority margin. French intensive care units over one enrollment period set the boundary of what can be generalized. 1
Funding or disclosure: Funded by the French Ministry of Health; registered as ICRAKI, NCT06032884. 11
2. A chemotherapy-free frontline regimen beat imatinib plus chemotherapy in Ph-positive ALL
Journal and impact tier: The New England Journal of Medicine, very high impact tier; volume 395, issue 15, pages 1483–1494. PubMed entered the paper on October 14, 2026, under PMID 42874102. 3
Author and affiliation: First author Sabina Chiaretti is in Hematology, Department of Translational and Precision Medicine, at Sapienza University in Rome. The closing author, Robin Foà, is in the same department. The trial ran under the GIMEMA Investigators. 3
Design, setting, and sample: This phase 3 trial randomly assigned adults with newly diagnosed Philadelphia-chromosome-positive acute lymphoblastic leukemia in a 2:1 ratio to ponatinib plus blinatumomab, or to imatinib plus chemotherapy, as front-line treatment. 236 patients were randomized — 158 to the chemotherapy-free arm and 78 to control — with a median age of 55 years (range 24 to 82). Patients in the control arm whose measurable residual disease persisted or returned could cross over to the intervention. The primary endpoint was event-free survival. The registry lists 236 actual enrollees, GIMEMA as sponsor, and the study as active and not recruiting. 313
Primary endpoint and quantitative result: At a median follow-up of 23.7 months, 24-month event-free survival was 86% in the chemotherapy-free arm against 67% in the control arm (P<0.001). Survival without measurable residual disease was 68% against 42%. A complete hematologic response at the end of induction occurred in 94% against 79%, and a molecular response after blinatumomab consolidation in 71% against 49%. Of 31 control patients who crossed over, 20 (64%) reached a molecular response. Overall survival was 90% against 85%, and the cumulative incidence of relapse 5% against 13%. Only 19% of the intervention arm went on to a stem-cell transplant after a first complete hematologic response. 3
Why it matters: Standard front-line therapy for this leukemia has meant a tyrosine kinase inhibitor layered onto chemotherapy, with transplant for most patients. This trial removes the chemotherapy and most of the transplants, and still gains 19 percentage points of event-free survival at two years. Hematologists will weigh that against a regimen whose long-term safety data are still filling in. An editorial in the same issue, "Chemotherapy-free Treatment of Ph-Positive ALL," by Adele K. Fielding, works through the trade-off. 14
Limitation and evidence boundary: The trial is open-label and enrolled 236 patients, with median follow-up still short of two years. Overall survival, 90% against 85%, is reported without a confidence interval in the abstract, so the event-free advantage has not yet become a demonstrated survival difference. All patients were treated at GIMEMA centers in Italy. 3
Funding or disclosure: Funded by the Associazione Italiana per la Ricerca sul Cancro and others; registered as GIMEMA ALL2820, NCT04722848. 13
3. Glucose monitors lowered HbA1c in type 2 diabetes treated without insulin
Journal and impact tier: The New England Journal of Medicine, very high impact tier; published online October 14, 2026. PubMed entered the paper on October 15, 2026, under PMID 42878622. 5
Author and affiliation: First author Tamara K. Oser is in the Department of Family Medicine at the University of Colorado Anschutz School of Medicine in Aurora. The trial ran under the CONNECT Study Group, with co-authors at the Jaeb Center for Health Research in Tampa, Florida, and at primary care practices across the country. 5
Design, setting, and sample: This 26-week randomized trial ran at 22 primary care practices in the United States. Adults with type 2 diabetes who were not using insulin were assigned to continuous glucose monitoring or to routine care. 283 people were randomized, 145 to CGM and 138 to routine care, and participants ranged from 21 to 84 years old. The primary outcome was the glycated hemoglobin level at 26 weeks, with CGM-measured secondary outcomes tested hierarchically to control the type I error rate. The registry lists DexCom as sponsor with 283 actual enrollees. 515
Primary endpoint and quantitative result: Mean glycated hemoglobin fell from 8.8±1.3% to 7.2±1.1% with CGM and from 8.7±1.2% to 8.0±1.4% with routine care, an adjusted mean difference of −0.9 percentage points (95% CI −1.1 to −0.6; P<0.001). Mean time in the 70–180 mg/dL range was 21 percentage points higher with CGM (95% CI 16 to 26). Time below 54 mg/dL was 0.17 percentage points lower and time below 70 mg/dL was 0.20 points lower, both meeting the trial's noninferiority criteria. No severe hypoglycemia events were reported. 5
Why it matters: Continuous glucose monitoring has been established in type 1 diabetes and in insulin-treated type 2 diabetes, where a sensor informs a dose the patient is about to take. The group not on insulin is much larger, is managed mostly in primary care, and until now had no randomized evidence of this size. The 1.6-point fall inside the CGM arm is the number a family physician will set against the cost of a sensor. 5
Limitation and evidence boundary: The trial enrolled 283 people for 26 weeks, in practices that agreed to take part, with no masking. The endpoints are glycated hemoglobin and sensor-measured glucose, so the result says nothing about clinical events or cost. The maker of the sensor funded the trial. 5
Funding or disclosure: Funded by Dexcom; registered as CONNECT, NCT06601166. 15
4. Starting vasopressin earlier in septic shock changed neither mortality nor kidney outcomes
Journal and impact tier: JAMA, very high impact tier; published online October 14, 2026. PubMed entered the paper the same day, under PMID 42872917. 7
Author and affiliation: First author Ithan D. Peltan is in the Department of Pulmonary and Critical Care Medicine at Intermountain Medical Center in Murray, Utah. Co-authors come from Intermountain Health, the University of Utah School of Medicine, and Intermountain's pharmacy and digital technology services. 7
Design, setting, and sample: VASSPR is a pragmatic, cluster-randomized, cluster-crossover strategy trial at 13 hospitals in Idaho and Utah, enrolling from February 1, 2024, to July 31, 2025. Hospitals were assigned one of two strategies: start fixed-dose vasopressin when total vasopressor dose reached 0.1 µg/kg/min of norepinephrine equivalent, or wait until it reached 0.4. They crossed over to the other strategy monthly. 3,959 patients with septic shock were included; the median age was 68 years (IQR 57 to 77) and 48% were female. The primary outcome was 28-day mortality, and the key secondary outcome was kidney-replacement-therapy-free days through day 28. The registry lists a phase 4 crossover design with the outcomes assessor masked and Intermountain Health Care as sponsor. 716
Primary endpoint and quantitative result: The strategies did change practice. Among patients likely to be managed differently, 68.0% received vasopressin under the lower-threshold strategy against 42.7% under the higher-threshold strategy, and the median maximum vasopressor dose before vasopressin was 0.14 against 0.34 µg/kg/min. 28-day mortality was 31.8% against 33.0%, an adjusted marginal odds ratio of 0.98 (95% CI 0.87 to 1.06; P=.62) and an adjusted risk difference of −0.4 percentage points (95% CI −2.7 to 1.3). Both arms had a median of 29 kidney-replacement-therapy-free days (adjusted marginal odds ratio 1.01; 95% CI 0.91 to 1.14). 7
Why it matters: Guidance and much of the literature have leaned toward adding vasopressin early, and the timing question comes up on rounds every day. A hospital-level trial that produced a 25-point gap in vasopressin exposure is a sharper test of that guidance than another dose comparison. A JAMA editorial, "Vasopressin in Septic Shock—Is Early the Right Question?", argues the timing debate has been framed around the wrong variable. 17
Limitation and evidence boundary: Cluster strategies bleed into each other: clinicians in the same hospital treat under alternating strategies month by month, and the achieved separation was 68% against 43% exposure rather than a clean contrast. Randomization at the hospital level means the analysis rests on 13 clusters. One health system in two states supplies the entire evidence base. 7
Funding or disclosure: The registry lists Intermountain Health Care as sponsor and the University of Utah as a collaborating institution; the abstract names no separate funding source. 16
5. Deferring the hepatitis B birth dose would raise childhood infections, a policy model projects
Journal and impact tier: Annals of Internal Medicine, high impact tier in general medicine; published online October 20, 2026. PubMed entered the paper on October 19, 2026, under PMID 42896183. 9
Author and affiliation: First author A. M. Mohareb is at the Center for Global Health and the Division of Infectious Diseases at Massachusetts General Hospital, and at Harvard Medical School in Boston. Co-authors sit in the same division and in its Medical Practice Evaluation Center, with two pediatric infectious disease authors at Massachusetts General Hospital and Northwestern University Feinberg School of Medicine. 9
Design, setting, and sample: This is a Markov cohort state-transition model of perinatal and childhood hepatitis B infection, run over 20 years on one US birth cohort of 3.6 million infants. It compares three schedules: universal vaccination at birth, vaccination deferred to 2 months, and vaccination through shared decision making. Inputs include maternal hepatitis B prevalence of 0.4%, surface-antigen testing with 99.5% sensitivity, and vaccine completion of 91.1% under the universal strategy, 87.1% under the deferred strategy, and 50.0% under shared decision making. Uncertainty intervals come from probabilistic sensitivity analysis. 9
Primary endpoint and quantitative result: Universal birth-dose vaccination yields an estimated 255 childhood chronic infections (95% uncertainty interval 130 to 530) in the 2026 birth cohort. Deferred vaccination raises that figure 19%, to 303 (155 to 610), and vaccination through shared decision making raises it 83%, to 467 (209 to 1032). By year 20 the three strategies leave 232,000, 474,000, and 1,806,000 people susceptible to hepatitis B. In a scenario with lower coverage and higher prevalence, the deferred and shared-decision strategies produce 1,700 and 2,192 childhood infections. 9
Why it matters: Proposed federal changes to childhood hepatitis B vaccination are in front of clinicians now, and no trial will answer the question the changes raise: what happens to infections a decade from now. The model compares three specific schedules a family can be offered and reports the answer in infections and susceptible people rather than relative risk, which is the form a pediatrician or a parent can use in a conversation. 9
Limitation and evidence boundary: A model returns the assumptions it is given, and the authors name uncertainty about horizontal, non-perinatal transmission as the main one. Costs, vaccine adverse events, and catch-up programs sit outside the model. Every number here is a projection of policy, not an observed outcome. 9
Funding or disclosure: Primary funding source is the National Institute of Allergy and Infectious Diseases. 9
What to open first
- Deciding how to start dialysis in the ICU: Open ICRAKI if your question is whether intermittent hemodialysis is safe as the first modality, and how early the trial stopped. 1
- A newly diagnosed Ph-positive ALL patient: Open GIMEMA ALL2820 if your question is what a chemotherapy-free ponatinib-blinatumomab front line did to event-free survival, and how many patients still needed a transplant. 3
- A patient with type 2 diabetes not on insulin: Open CONNECT if your question is what a sensor did to HbA1c over 26 weeks in primary care, and whether the trial was built to detect hypoglycemia. 5
- Titrating pressors in septic shock: Open VASSPR if your question is whether moving vasopressin earlier changes mortality, and how much the hospital-level strategies actually differed in practice. 7
- Answering a parent about the hepatitis B birth dose: Open the Annals model if your question is how many more childhood infections the deferred and shared-decision schedules would produce. 9
References
- 1Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury
pubmed.ncbi.nlm.nih.gov
- 2OpenAlex record for the ICRAKI report
openalex.org
- 3Ponatinib-Blinatumomab or Imatinib-Chemotherapy for Adult Ph-Positive ALL
pubmed.ncbi.nlm.nih.gov
- 4OpenAlex record for the GIMEMA ALL2820 report
openalex.org
- 5Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes
pubmed.ncbi.nlm.nih.gov
- 6OpenAlex record for the CONNECT report
openalex.org
- 7Effect of Vasopressin Initiation Threshold on Septic Shock Mortality
pubmed.ncbi.nlm.nih.gov
- 8OpenAlex record for the VASSPR report
openalex.org
- 9
- 10OpenAlex record for the hepatitis B policy model
openalex.org
- 11
- 12Continuous or Intermittent Renal-Replacement Therapy - What Is the Question?
pubmed.ncbi.nlm.nih.gov
- 13
- 14Chemotherapy-free Treatment of Ph-Positive ALL
pubmed.ncbi.nlm.nih.gov
- 15
- 16Vasopressin for Septic Shock Pragmatic Trial
clinicaltrials.gov
- 17Vasopressin in Septic Shock-Is Early the Right Question?
pubmed.ncbi.nlm.nih.gov
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