1. In this retrospective cohort study, which examined patients receiving maintenance dialysis for end-stage renal disease, 21.9% of patients who received cardiopulmonary resuscitation (CPR) survived to discharge.
2. There was a median post-discharge survival interval was 5.0 months, which is much lower than the previously reported median post-discharge survival of 3 years for other hospitalized patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Cardiopulmonary resuscitation (CPR) can be a useful life-prolonging technique if used in an appropriately chosen patient population. For instance, studies have shown that older patients with more comorbidities have higher mortality after CPR. There is, however, limited data on CPR outcomes in patients on maintenance dialysis. This study aimed to characterize patterns and outcomes of in-hospital CPR in adults receiving maintenance dialysis. Overall, about 22% of patients receiving maintenance dialysis that received CPR survived to discharge. There was a median post discharge survival interval of about 5 months. Both rates of CPR and survival increased significantly over the study period.
While the rate of survival to discharge in this population was comparable to previously reported survival rates for other hospitalized patients, the median post-discharge survival was significantly lower. Strengths of this study include using a population-based cohort, hence increasing generalizability. However some limitations include use of Medicare claims data that may not have been validated. There was also a lack of analysis of patient data on factors that may impact survival post-CPR, such as cardiac arrest rhythm, treatments during resuscitation, or hospital-level characteristics.
In-Depth [retrospective cohort]: This study used data from the US Renal Data System (USRDS) registry, which details demographic and clinical patient information about end-stage renal disease (ESRD) throughout the USA. A total of 663,734 patients aged 18 years or older, who were on maintenance dialysis from January 2000 to December 2010, were included in the cohort. Using linked Medicare claims, all in-hospital CPR events that occurred beyond 90 days after initiation of dialysis were ascertained. Outcomes analyzed included CPR incidence, proportion of CPR recipients surviving to discharge, post-discharge survival and receipt of CPR before in-hospital death. Analyses were adjusted for sex, race, ESRD etiology, comorbidities, dialysis modality and year of dialysis initiation.
Of patients who received CPR, 21.9% survived to discharge (95% CI 21.4%-22.3%) with a median survival of 5 months (IQR 0.7-16.8 months). However, 14.9% (95% CI 14.8%-15.1%) of patients who died in-hospital received CPR. Over the study period, the incidence of CPR increased (1.0 events per 1000 hospital days to 1.6 events per 1000 hospital days; P <0.001) and the percentage of CPR recipients surviving to discharge increased (15.2% to 28.0%; P<0.001). There was an upward trend in post-discharge survival [2000: median 6.5 months (IQR 2.7-26.7 months), 2011: 5.9 months (IQR 1.7-17.9 months)]. These intervals of post-discharge survival are substantially worse than that which is reported for other patient populations.
Alternate Sunitinib Schedules May Benefit Some with Metastatic Renal Cell ... - Cancer Therapy Advisor
Most oral agents for renal cell carcinoma (RCC) are currently given in a continuous schedule. However, some studies have suggested that an alternate dosing and scheduling for sunitinib may provide advantages.
Now, researchers report that understanding just what the optimal dosing regimens may be for RCC could lead to improvements in the ability to refine dosing and scheduling for all oral anticancer therapies.1
“There are alternative ways of giving sunitinib that may allow for maintenance of dose, which in other studies has been shown to be associated with better clinical outcomes. It may allow the drug to be better tolerated. Given that sunitinib is noncurative, any alternatives to allow better tolerance for patients are an advance,” said study investigator Brian Rini, MD, who is an associate professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, OH.
Sunitinib malate, an oral multitargeted tyrosine kinase inhibitor, has been shown to improve outcomes in comparison to interferon alpha (IFN-?) and studies have confirmed that patients with RCC have better outcomes with higher exposure to sunitinib.
However, maintenance of sunitinib dose intensity can be challenging due to well documented treatment-related adverse events (AEs) such as fatigue, hypertension, hand–foot syndrome, and diarrhea.
It is often noted that treatment-AEs increase throughout each cycle, and tend to be worst in the final 2 weeks of the treatment cycle.
Dr. Rini and his colleagues conducted a literature search in the Medline database using terms renal cell carcinoma, RCC, sunitinib, pharmacokinetics, pharmacodynamics, and endothelial cells between January 2000 and June 2014.
The Medline search also included published abstracts from the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO).
The investigators concluded that there is no conclusive evidence suggesting optimal dosing and scheduling of sunitinib. The researchers found that a sunitinib steady state is reached as well as optimal suppression of vascular perfusion after 2 weeks of therapy.
Various alternative interrupted therapies have been evaluated but only in the retrospective setting. Patients who were either started on or switched to alternate schedules during their course of treatment appeared to maintain clinical efficacy.
Some clinicians have tried giving lower daily doses and some successful strategies have employed the 4-week on followed by 2-week off (4/2) schedule and 2 weeks on, 1 week off (2/1) schedule.
Earnings of $-0.11 Expected in Q1 for NxStage Medical, Inc. (NASDAQ:NXTM) - The Markets Daily
Sell-side Wall Street analysts are anticipating NxStage Medical, Inc. (NASDAQ:NXTM) will post a current quarter earnings per share of $-0.11. This figure is based on the combined estimates of the analysts that cover the company. For the period ending on 2014-12-31 the company reported earnings per share of $-0.08. Based on the latest public information, the firm is slated to next report earnings on or around 2015-05-06.
Analysts that cover the stock have a mean consensus price target of $21 for NxStage Medical, Inc. (NASDAQ:NXTM) .This one year figure is the mean estimate coming from the research analysts that recently released reports on stock. The latest update on price target was seen on 2015-04-15. An arithmetical average of the ratings given by analysts to develop a Consensus Analyst Rating for each company is known as the broker recommendation. These ratings fall on a scale between 1 and 5 where a 1 would be a Strong Buy and a 5 would constitute a Strong Sell. Of the 4 broker recommendations provided, NxStage Medical, Inc. has a 2 rating. Out of these analysts, one contributor sees the stock price hitting $24 within the year while the most bearish target sees the stock at $15. If we look forward at the long term growth estimates for the company, research analysts are expecting current year earnings per share to be $-0.37. The highest broker full year earnings per share estimate is $ $-0.33 while the lowest estimate sits at $-0.37. Company Profile NxStage Medical, Inc. (NxStage) is a medical device company that develops, manufactures and markets products for the treatment of kidney failure, fluid overload and related blood treatments and procedures. The Company’s primary product is the NxStage System One (System One). It also sells needles and blood tubing sets primarily to dialysis clinics for the treatment of end-stage renal disease (ESRD). It operates in two segments: System One and In-Center. It distributes its products in three markets: home, critical care and in-center. In the System One segment it derives its revenues from the sale and rental of the System One and PureFlow SL equipment, and the sale of disposable products in the home and critical care markets. In the In-Center segment, it derives its revenues from the sale of blood tubing sets and needles for hemodialysis primarily for the treatment of ESRD patients at dialysis centers and needles for apheresis, which is referred to as the in-center market.
CRLX101 Fast Tracked for Metastatic Renal Cell Carcinoma - Monthly Prescribing Reference
April 28, 2015
Cerulean Pharma announced that the FDA has granted Fast Track designation to CRLX101 in combination with Avastin (bevacizumab) for the treatment of metastatic renal cell carcinoma (mRCC) following progression through two or three prior lines of therapy.
CRLX101 is a tumor-targeted nanoparticle-drug conjugate (NDC) designed to concentrate in tumors and slowly release camptothecin inside tumor cells. CRLX101 inhibits both topoisomerase 1 and hypoxia-inducible factor-1? (HIF-1?).
CRLX101 has shown activity in four different tumor types, both as monotherapy and in combination with other cancer treatments. Currently CRLX101 is being investigated in combination with Avastin as a treatment of relapsed renal cell carcinoma in a randomized Phase 2 trial.
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Last updated: Tuesday, April 28, 2015
