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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 Nannizziopsis is a genus of fungi with several known cases in reptiles of pyogranulomatous infections at cutaneous and musculoskeletal level, of rapid and fatal evolution. There are few cases of this genus described in humans, mainly skin affection but also with visceral abcesses, typically in immunosuppressed patients, with a recent visit to Africa. Case presentation A 45-year-old woman immunosuppressed after renal transplantation and with a recent visit to Nigeria presented with a painless breast abcess, ulceration to the skin and bleeding, and non hematic telorrhea. The mammogram, also completed with an ultrasound scan, showed a polylobulated nodule, BI-RADS 4C. Due to the suspicion of breast cancer, a core needle biopsy was performed and the pathology study showed abundant presence of fungal spores and hyphae. It was identified by genomic amplification of the internal transcription spacer region-2 and a percentage of similarity with sequences of Nannizziopsis obscura from GenBank of 98% was obtained. An empiric treatment with anidulafungin was initiated, and after the surgical resection, it was replaced by isavuconazole, with a total time of treatment of one month. Conclusions This is the first case report of a successful treatment of Nannizziopsis obscura with isavuconazole, with the shortest time of treatment published for this fungi. We highlighted the importance of referring difficult to diagnose species to reference centers, as well as achieving the most complete resection in order to shorten the antibiotic therapy.

BACKGROUND AND AIMS Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV), partly due to the vascular inflammation itself, the associated organic damage and the treatment [1]. AAV has been associated with traditional risk factors, such as hypertension (HTN), diabetes mellitus (DM) or impared renal function [2], which also contribute to accelerated atherosclerosis. However, there are not specific recommendations about CVD treatment in AAV patients [3], and the vascular risk scores used for general population have not been extrapolated yet. Our objective is to assess the frequency of cardiovascular events (CVE) and mortality in AAV patients and to explore the possible vascular risk factors (VRF) and the therapeutic intervention on them. METHOD A descriptive and retrospective study of a multidisciplinary cohort of AAV patients followed prospectively was performed in 12 hospitals of the 8 provinces of Autonomous Community of Andalusia. Factors that presumably may influence in CVD and mortality were collected. Two CV risk scores were measured [4, 5]. The presence of a strategy carried out by clinicians on CV risk was analysed according guides ESC/ESH and KDIGO guides. Data was analysed using Chi-square, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval. RESULTS A multicentre cohort of 220 AAV patients followed up from 1979 until June 2020 was studied, during a mean ± standard deviation follow-up of 96.79 ± 75.83 months. The mean age at diagnosis was 59.92 ± 16.25 years, 45% were female and all but one caucasians. Sociodemographic and clinical characteristics are shown in Table 1. After AAV diagnosis, 30/224 (13%) patients presented at least one CVE (Figure 1A and B), 37% IHD, 43% CVA and 50% PVD. Independent prognostic factors of CVE were age (HR 1.042, P = .005) and the presence of hypertension (HTN) 6 months after diagnosis (HR 4.641, P = .01). Regarding classic VRFs, 81% had HTN [33% already presented it before diagnosis and 48% after (35% in the first 6 months)]. Thirty-four patients presented DM at the end of following [12% already presented it before diagnosis and 22% presented it after (16% in the first 6 months)]. The independent predictor for HTN at 6 months was renal involvement at BVAS baseline, and DM in the first 6 months for HTN at the end of following. Attending to the ESC Vascular Risk scale, 8.4% presented low risk, 16.9% moderate, 29.8 high and 44.4% very high risk. According to the REGICOR scale, the mean value of suffering a CV event in the next 10 years was 4.6%±3.32%, with 59%, 34% and 7% of patients presenting low, moderate and high risk, respectively. Regarding VRF management strategies, just 14% of hypertensive patients, 16.2% of those that needed dyslipidemia treatment, and 8.6% of diabetic patients were not within the target guidelines recommendations. Fifty-one patients (23%) died (Figure 1C and D), 23.5% due to infectuous disease, 19.6% to cancer, 17.6% to CVD,13.7% to AAV relapse and 13 due to organic deficit, other or an unknown cause. In our final model of multivariate analysis, just age and renal function at baseline were independent predictors of mortality. Independent prognostic factors of mortality were age (HR 1.083, P = .00) and baseline creatinine (HR 4.41, P = .01). CONCLUSION Age and early HTN are risk factors for having a CVE, and age and renal function are predictors of mortality. HTN are more frecuent in AAV patients than in general population. CVD screening in AAV patients is demanded. The REGICOR and ESC scores could be extrapolated as a predictor of cardiovascular risk in AAV patients.