BACKGROUND AND AIMS Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19. The incidence of AKI is estimated to be around 5%–80%, according to the series, but data on renal function evolution is limited. Our main objective was to describe the incidence of AKI in patients with SARS-CoV-2 infection; secondarily, we analysed the severity of AKI and medium-term renal function evolution in these patients. METHOD A retrospective observational study that included patients hospitalized a single hospital, diagnosed with SARS-CoV-2 infection, who developed AKI (March-May 2020). We register clinical and demographic characteristics, creatinine upon admission and prior to discharge, as well as creatinine and CKD-EPI glomerular filtration rate (eGFR) after at least 3 months after discharge. CKD was defined according to KDIGO stages based on the eGFR (G3-G5). The KDIGO classification was used to define and classify AKI. Recovery of kidney function was defined as difference in at discharge or post-hospitalization creatinine < 0.3 mg/dL with respect basal creatinine. The clinical follow-up ranged from admission to death or end of study. RESULTS Of 258 patients hospitalized with SARS-CoV-2 infection, AKI occurred in 73 (28.3%). 63% (n = 46) were men; the mean of age was 69 years (57–76). DRA severity: 35 (48%) KDIGO-1, 15 (21%) KDIGO-2 and 23 (31%) KDIGO-3. The mean stay was associated with the severity of AKI: 7 days (3–11) for KDIGO-1, 11 days for KDIGO-2 (5–22) and 12 days (8–35) for KDIGO-3 (P = .02). The stage of CKD established differences in the severity of AKI: 66.6% (n = 6) of the patients with CKD G4–G5 presented AKI-KDIGO 3 versus only 25.0% (n = 4) in the CKD-G3 patients (P = .02). Admission to the ICU was more frequent in KDIGO 2–3 versus KDIGO-1 [39% (n = 15) versus 9% (n = 3); P < .01]. Of the 48 patients discharged, 30 (62.5%) had recovered their baseline renal function upon discharge. Only 2 are still on RRT after 8 months (2.7% of all patients). Of the 25 patients died (34% of patients with AKI) with a median time of 3 days from DRA diagnosis (1–8). Renal function of 35 patients was monitored, which correspond to 19 (54%) KDIGO-1, 8 (23%) KDIGO-2, 8 (23%) KDIGO-3 stages. In these patients, analytical control starting 3 months after hospitalization revealed FG 66 (SD 30; 56–76) mL/min/1.73 m2. We have not found differences in renal function between pre- and post-hospitalization in related test. A total of 77% (n = 37) of discharged patients recovered their baseline renal function in the post-hospitalization control. CONCLUSION The incidence of AKI in the context of COVID-19 in our series was 28.3%, with an associated mortality of 34.2%. Most of the patients presented with AKI KDIGO 1 (47.9%). The severity of AKI is associated with a longer hospital stay, admission to the ICU and the requirement for RRT. The advanced stages of CKD pre-admission showed more severity of AKI. The maintenance in TRS in our series has been 2.7%. Patients who were discharged for recovery/improvement of COVID-19 had normalized kidney function during subsequent follow-up, regardless of the severity of the AKI developed on admission for COVID-19.

BACKGROUND AND AIMS There is evidence that cancer risk is increased in people with chronic kidney disease (CKD), specially when glomerular filtration rate decreases [1,2]. This association do appear to be site-specific [3,4]. Cancer incidence increases by time since first dialysis in addition [5]. The aim of our study is to describe characteristics of dialysis incident patients with diagnosis of malignancy in a multicentre spanish cohort. METHOD We performed a multicentre collaborative retrospective study over the period 2015–20 of clinical and demographical data from incident dialysis patients with diagnosis of cancer. Data from Seville, Cadiz, Marbella and Huelva was collected from the Registry of Renal Patients of the Andalusian Health Service (SICATA). Data from Canary Islands was collected from Registry of Renal Patients of the Canary Islands Health Service. Data from Cantabria was collected from the Registry of Renal Patients of Cantabrian Health Service. Rest of centres provided their own collected data (Gregorio Maranon General University Hospital and University Hospital October 12). Statistics: Quantitative variables are expressed as mean/-SD (normal distribution) or median (IQ 25–75) (non-normal distribution). Qualitative variables are expressed as percentage. RESULTS 727 incident dialysis patients were diagnosed with cancer before (79.9%) or after (20%) starting dialysis over the study period. Prevalence was 15.9% among all incident patients. 73.2% of patients were men with a mean age 70.1 (SD 10.3) years old. At the time of starting dialysis, 30.6% were smokers, 45.5% patients presented diabetes, 88% high blood pressure, 18.5% received immunosupresive therapy in the past, 4.1% had history of hepatitis B, C or HIV infection and mean proteinuria was measured in 2990 mg/g (SD 3832). Diabetic kidney disease and chronic tubulointerstitial nephritis were the most common causes of CKD (22.1% and 22.9%, respectively). 14.4% of patients had history of glomerular nephropathy. Mean time from CKD diagnosis to dialysis start was 6 years and from CKD diagnosis to cancer diagnosis was 5.4 years (SD 6.4). Solid cancer was found in 88% of patients and 12% had hematological malignancy. Most common malignancies were urinary tract cancers (bladder, 17%, kidney 17.3% and prostate 13.2%) followed by colon cancer, 11.27% of cases. 32% of patients had active neoplasia at the time of starting dialysis and 15.1% had metastatic disease. 33.8% of patients died over follow-up. Neoplastic disease was the most common cause of death (29.6%) followed by cardiovascular (19.5%) and infectious disease (16.2%). A total of 7.1% of patients underwent kidney transplant (previous malignancies were prostate, kidney cancer and multiple myeloma in majority of these cases). CONCLUSION Among our spanish multicentre cohort of incident dialysis patients, the average duration between the diagnosis of CKD and cancer was 5.4 years. The most commonly observed cancer sites were urinary tract and kidney malignancies, as previously reported in other cohorts. Study findings may be a useful reference for cancer screening guidelines in our population.

Background and Aims Kidney injury is a common complication in multiple myeloma (MM) and it has a negative prognostic implication. Most common cause of Acute Kidney Injury (AKI) in these patients is Light chain Cast Nephropathy, where free light chains precipitate in the tubules and bind with uromodulin, turning into intratubular casts that obstruct the tubules and also promote local giant cell reaction and interstitial inflammation and fibrosis. Free light chains (FLCs) can also damage the kidneys due to direct tubular toxicity when excessive amounts are reabsorbed by the proximal tubules. Targeted therapy to reduce FLC load can help recover renal function. Both total reduction and reduction speed are relevant for prognosis. FLC removal through extracorporeal techniques can be used as an adjuvant therapy, having an important part on the evolution of the disease. We gathered data from our experience treating MM patients with AKI with HFR-supra hemodialysis (HD) and analized the evolution and possible influence of this technique on renal recovery. Method This is an observational retrospective study. We included all patients with a diagnosis of multiple myeloma and acute kidney injury who received HFR-Supra hemodialysis in between years 2016-2022 in Hospital Virgen Macarena (Seville). We initially performed 6-10 daily HFR-Supra HD sessions and then modulated the frequency based on renal response (if renal replacement therapy had to be continued they underwent a usual hemodialysis regime 3 days a week). We continued these sessions until renal recovery was achieved or free light chain levels were reduced in agreement with the Hematology team. Measurement of pre and post dialysis FLCs was made always at first and last session and at least once in between, depending on the total number of sessions. Results 12 patients, with mean age at diagnosis 63.6 (43-86) years, presented with AKI stage KDIGO 3. 1 of them was oliguric. Median serum creatinine at diagnosis was 4.4 mg/dL [2,2-17], mean proteinuria was 4,1g/24 h [0,7-8,7] and 66,7% had positive Bence Jones proteinuria (mean 2,3g/24 h). 2 of the patients had previous chronic kidney disease stage 3a. All of them were diagnosed with Light Chain Multiple Myeloma (75% kappa, mean 10346 mg/L; 25% lambda, mean 5990 mg/L). Mean clonal bone marrow plasma cell was 20,7% [2-55]. According to the Revised International Staging System (R-ISS), 25% were stage 2 and 75% were stage 3. Renal biopsy was performed in 4 patients, all showed evidence of Cast Nephropathy. The indication for starting HFR-Supra HD was FLC removal in 9 patients, need of renal replacement therapy in 1 and both in 2 patients. We have experience in our center with using this therapy as an adyuvant treatment and often we start the technique in patients who present with AKI but would not necessarily have immediate need for renal replacement therapy. The goal is to remove FLCs and avoid further damage to the kidney tissue. Out of the 12 patients, 9 were able so stop dialysis (75%). They received a mean number of 12,4 [3-41] sessions in 3,7 [0,2-25] months). Free light chain removal per session was 24% on average [5-43%]. All of them were started on bortezomib-dexamethasone regime as initial chemotherapy for MM. As per renal recovery, at 3 months 33,3% achieved complete response, 11,1% partial response and 55,6% minimal response. At 1 year, 42,9% achieved complete response, 14,3% partial response and 42,9% minimal response. One-year survival rate was 91,7% (1 patient died from respiratory sepsis less than 1 month after diagnosis). Conclusion HFR-Supra hemodialyisis achieved a 24% free light chain removal per session on average. After presenting severe AKI (KDIGO 3), almost 43% of patients who received this adyuvant therapy obtained full renal recovery at 1 year and in 75% of patients withdrawal from hemodialysis was possible. 1 year survival was 91,7%.

No abstract

Background and Aims Accuracy in the estimation of the glomerular filtration rate (GFR) in oncological patients is essential in order to adjust chemotherapy doses accordingly. Finding an appropriate formula for this subgroup of patients is a subject of ongoing debate. The present study introduces a cohort of the aforementioned patients followed in the Onconephrology outpatients clinic, in which different formulas were applied for the calculation of the GFR. Method A retrospective study with a cohort of 17 onconephrological patients was conducted. The following variables were evaluated: age, sex, height, weight, body mass index, body surface area and type of tumor. Renal function was estimated with the Cockcroft Gault, the Janowitz-Williams, the CKD-EPI, the adjusted by body surface-CKD-EPI, the MDRD, the adjusted by body surface-MDRD, the CKD-EPI Cystatin C, the adjusted by body surface-CKD-EPI Cystatin C formulas and 24-hour urine creatinine clearance. Every equation was compared with the Cr EDTA clearance which is considered the gold standard. The statistical analysis was carried out by means of the IBM SPSS Statistics software. Concordance between chromatography and the remaining formulas was assessed with the Wilcoxon (null hypothesis of no difference between medians) and Bland-Altman tests. Results 6 women and 11 men were included in the study, with a mean age of 64.24 years (SD 9.9), a mean BMI of 28.25kg/m2 (SD 7.98), and a mean Cr EDTA clearance was 37.07ml/min (SD 15.45). 15 patients suffered from solid malignancies, whereas the remaining 2 patients suffered from hematological tumors. The most common solid tumor was lung cancer (n=5), followed by rectal carcinoma (n=2). The null hypothesis was accepted for the adjusted for body surface-CKD-EPI Cystatin C equation (p-0,089) and 24-hour urine creatinine clearance (p 0.955), when compared to 51Cr EDTA clearance. The Bland-Altman test revealed the smallest differences between the 24-hour urine creatinine clearance and 51Cr EDTA clearance (-0.09867), with 95% concordance limits of -36.14 and 34.17, and a non-significant linear regression coefficient (p 0.915). Conclusion This study revealed that the 24-hour urine creatinine clearance is the closest formula to the gold standard for the assessment of the GFR in patients with malignancies. However, the small sample size hinders the generalization of these results. Larger sample size studies are mandatory to confirm these findings.