Chronic kidney disease (CKD) is common in patients with cancer, with reported prevalence ranging from 12% to 53% at cancer diagnosis. 1 Cancer patients with concomitant CKD have worse cancer outcomes than those with normal kidney function. 2 Despite the prevalence of kidney dysfunction and its prognostic implications, there is limited evidence to guide cancer treatment in patients with CKD. One reason may be the exclusion of CKD patients from clinical trials (as has been documented in cardiovascular studies). 3 We sought to quantify and characterize the exclusion of patients with CKD in randomized clinical trials of anticancer drugs. Methods | We performed a systematic search of MEDLINE for randomized trials of drugs for the 5 most common solid cancers (bladder, breast, colorectal, lung, and prostate) in 6 highprofile general medicine and oncology journals (selected based on impact factor, and listed in Table 1) from January 2012 through December 2017. We excluded trials of surgery, radiation, and supportive care. Nonrandomized studies and pooled analyses were also excluded.

Original Clinical Science-General Background. Pretransplant diabetes and new-onset diabetes after transplant (NODAT) are known risk factors for vascular events after kidney transplantation, but the incidence and magnitude of the risk of major adverse cardiovascular events (MACE) and cardiac deaths remain uncertain in recent era. Methods. A population cohort study of kidney transplant recipients identified using data from linked administrative healthcare databases from Ontario, Canada. The incidence rates of MACE (expressed as events with 95% confidence interval [95% CI] per 1000 person-years were reported according to diabetes status of pretransplant diabetes, NODAT, or no diabetes. Extended Cox regression model was used to examine the association between diabetes status, MACE, and cardiac death. Results. Of 5248 recipients, 1973 (38%) had pretransplant diabetes, and 799 (15%) developed NODAT with a median follow-up of 5.5 y. The incidence rates (95% CI) of MACE for recipients with pretransplant diabetes, NODAT, and no diabetes between 1 and 3 y posttransplant were 38.1 (32.1-45.3), 12.6 (6.3-25.2), and 11.8 (9.2-15.0) per 1000 person-years, respectively. Compared with recipients with pretransplant diabetes, recipients with NODAT experienced a lower risk of MACE (adjusted hazard ratio, 0.59; 95% CI, 0.47-0.74) but not cardiac death (adjusted hazard ratio, 0.97; 95% CI, 0.61-1.55). The rate of MACE and cardiac death was lowest in patients without diabetes. Conclusions. Patients with pretransplant diabetes incur the greatest rate of MACE and cardiac deaths after transplantation. Having NODAT also bears high burden of vascular events compared with those without diabetes, but the magnitude of the increased rate remains lower than recipients with pretransplant diabetes.

Background: Patients with acute kidney injury (AKI) may require inter-hospital transfer in order to receive renal replacement therapy (RRT). Inter-hospital transfer may lead to delays in therapy resulting in poor patient outcomes. There is minimal data comparing outcomes among patients undergoing transfer for RRT versus those who receive RRT at the hospital to which they first present. Methods: We conducted a population-based cohort study of all adult patients (19 years and older) who received acute dialysis within 14 days of admission to an acute care hospital between April 1, 2004 and March 31, 2015. The transferred group included all patients who presented to a hospital without a dialysis program and underwent interhospital transfer (with the start of dialysis ≤3 days of transfer and within 14 days of initial admission). All other patients were considered non-transferred. The primary outcome was time to 90-day all-cause mortality adjusting for demographics, comorbidities and measures of acute illness severity. We also assessed chronic dialysis dependence as a secondary outcome using Fine and Gray proportional hazards model to account for the competing risks of death. In a secondary post-hoc analysis, we assessed these outcomes in a propensity-score matched cohort, matching on age, sex and prior chronic kidney disease status. Results: We identified 27,270 individuals initiating acute RRT within 14 days of a hospital admission, of whom 2,113 underwent inter-hospital transfer. Inter-hospital transfer was associated with lower rate of mortality [adjusted hazard ratio (aHR) 0.90 (95%CI: 0.84-0.97)]. Chronic dialysis dependence was not significantly different between groups [aHR 0.98 (0.91-1.06)]. In the propensity score matched analysis, interhospital transfer remained associated with a lower risk of death [HR 0.88 (0.80-0.96)]. Conclusions: Inter-hospital transfer for receipt of RRT does not confer higher mortality or worse kidney outcomes.