Bone biopsy is still the gold standard to assess bone turnover (T), mineralization (M), and volume (V) in CKD patients, and serum biomarkers are not able to replace histomorphometry. Recently, metabolomics has emerged as a new technique that could allow for the identification of new biomarkers useful for disease diagnosis or for the understanding of pathophysiologic mechanisms, but it has never been assessed in the chronic kidney disease-mineral and bone disorder (CKD-MBD) scenario. In this study, we investigated the association between serum metabolites and the bone TMV classification in patients with end-stage renal disease by using serum NMR spectroscopy and bone biopsy of 49 hemodialysis patients from a single center in Brazil. High T was identified in 21 patients and was associated with higher levels of dimethylsulfone, glycine, citrate, and N-acetylornithine. The receiver-operating characteristic curve for the combination of PTH and these metabolites provided an area under the receiver-operating characteristic curve (AUC) of 0.86 (0.76 to 0.97). Abnormal M was identified in 30 patients and was associated with lower ethanol. The AUC for age, diabetes mellitus, and ethanol was 0.83 (0.71 to 0.96). Low V was identified in 17 patients and was associated with lower carnitine. The association of age, phosphate, and carnitine provided an AUC of 0.83 (0.70 to 0.96). Although differences among the curves by adding selected metabolites to traditional models were not statistically significant, the accuracy of the diagnosis according to the TMV classification seemed to be improved. This is the first study to evaluate the TMV classification system in relation to the serum metabolome assessed by NMR spectroscopy, showing that selected metabolites may help in the evaluation of bone phenotypes in CKD-MBD.

Background and Aims Cisplatin (CDDP) is used as the first line of treatment for some tumors, but its use may be restricted due to its nephrotoxicity. Carboplatin (CARBO) and oxaliplatin (OXA) are less nephrotoxic alternatives to CDDP. This study has the objective to determine the incidence of acute kidney disease after chemotherapy with CDDP, CARBO, or OXA. Methods A clinical study of a retrospective cohort of patients who underwent treatment with CDDP, CARBO, or OXA from January‐December 2016. Acute kidney Disease (AKD) was defined as elevated serum creatinine (sCR) levels before and up to 3 months after chemotherapy. Morbidities, type of tumor, and treatment data were recorded. Results A total of 212 patients aged 55.5 ± 14.0 years were evaluated. Among the comorbidities, 30% had arterial hypertension (AH) and 11% had diabetes, and 18% were treated with CDDP, 41% with CARBO, and 41% with OXA. There was no difference in sCR levels before and after chemotherapy regardless of the chemotherapy used. The prevalence of eGFRs <60 mL/min after chemotherapy was higher in patients with AH and cardiovascular disease (CVD). The incidence of post‐chemotherapy AKD was 7.0% (n = 13) and the mortality rate was 38.2%. Survival was lower in patients with AKD (P = .012). Conclusions There was a low incidence of AKD among the patients regardless of the chemotherapy used, but the patients with AKD had shorter survival. In addition, the reduction in eGFR after chemotherapy was greater in patients with AH and CVD.

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<b><i>Introduction:</i></b> Patients with cancer admitted to critical care units are at increased risk of being affected with acute kidney injury (AKI) and mortality. Sustained low-efficiency dialysis (SLED) combines the cardiovascular stability of continuous therapy with the operational facility of conventional hemodialysis (HD). Citrate has become an alternative to heparin in anticoagulation because it favors the maintenance of filter patency and reduces bleeding. We analyzed the efficacy and safety of citrate versus heparin use in extended HD for patients with cancer and AKI. <b><i>Methods:</i></b> This retrospective cohort study evaluated patients with cancer and dialytic AKI who received SLED with anticoagulation using citrate versus heparin from January 2014 to June 2017. After stratifying patients by the type of anticoagulation received, we evaluated demographic and clinical data, plus SLED session characteristics. We also analyzed dialysis outcomes, including insufficient session time, hypotension, poor catheter flow, line inversion, and dialysis system coagulation. <b><i>Results:</i></b> We identified 423 SLED sessions among 124 patients (41 patients in the heparin group and 83 patients in the citrate group). More sessions with citrate (26.6 vs. 40.9%, <i>p</i> &#x3c; 0.001) had serum platelet concentrations &#x3c;50,000/mm³ or &#x3c;100,000/m³ and ionic calcium (Ca⁺⁺) values &#x3c;1.16 mmol/L (33.2 vs. 18.5%, <i>p</i> &#x3c; 0.001). Dialysis intercurrence occurred in 27% of sessions. The highest odds were associated with heparin sessions (OR 2.88). Compared with the citrate group, the heparin group was subject to more dialysis system coagulation (12.3%), the need for line reversal (9.8%), and insufficient session time (23.9%). <b><i>Conclusion:</i></b> Citrate represents a safe and effective anticoagulant for SLED for cancer patients with AKI undergoing treatment in the intensive care unit.

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