<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.

Introduction: Hematologic malignancies, including lymphomas and leukemias, may be treated with autologous or allogeneic bone marrow transplantation. However, these approaches can increase the risk of infection, sepsis, graft-versus-host disease, and nephrotoxicity, possibly resulting in acute kidney injury (AKI). Objective: To evaluate AKI in patients with lymphomas or leukemia submitted to bone marrow transplantation (BMT). Method: Retrospective, observational cohort study of cases from a database of 256 patients (53.9% males) hospitalized for BMT between 2012 and 2014 at a cancer hospital in Sao Paulo, Brazil. Of these, 79 were selected randomly for analysis. Demographic data, length of hospitalization, and associated morbidities were recorded. AKI was identified according to Kidney Diseases Improving Global Outcomes (KDIGO) criteria. Results: The most frequent diagnoses for the 79 cases were non-Hodgkin’s lymphoma (30.4%), acute myeloid leukemia (26.6%), and Hodgkin’s lymphoma (24.1%). The probability of 100 days-survival after BMT was 81%, and three years after BMT was 61%. In-hospital mortality was significantly higher among patients who presented AKI during hospitalization (p<0.001). However, there was no difference in overall life expectancy (p=0.770). Conclusion: A significant prevalence of AKI was found in patients with leukemia or lymphoma while they were hospitalized for BMT, resulting in significantly increased rates of in-hospital mortality. The presence of AKI during hospitalization was not associated with a subsequent reduction in life expectancy.

Background: Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) and how these factors influence the efficiency of dialysis and the outcomes of these patients are scarce. We aim to describe the predictive clinical characteristics of hemodialysis catheter-related complications in critically ill cancer patients with acute kidney injury. Methods: This is a retrospective cohort study of 62 cancer patients subjected to short-term hemodialysis catheter implants. We evaluated the clinical characteristics of patients and the complications related to catheter implantation: mild malfunction, characterized by reversal of access lines; infections; and catheter replacement due to severe malfunction or infections. The outcomes analyzed were recovery of renal function, discharge from the ICU, and death. Results: The most frequent complications were related to mild malfunction, which justified dialysis line reversal in 21.3% of the patients. The complication rate was higher in patients undergoing conventional hemodialysis, in those with coronary disease, and in those who had more than three dialysis sessions. The presence of metastasis was more frequently related to catheter reversals. Patients with mild or severe malfunction were more likely to be hospitalized for more than 18 days in the ICU. All patients with mild malfunction had hospitalization times greater than 28 days. Conclusions: Hemodialysis catheter-related complications were associated with longer ICU and hospital stays in cancer patients with AKI. Mild malfunction of the hemodialysis catheter was the most frequent complication. Patients with metastasis and sepsis, who used diuretics, and who used intermittent dialysis methods had milder catheter malfunctions.

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