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Kidney transplant recipients are at high risk for fractures, primarily due to post‐transplant bone disease. This retrospective cohort study analyzed data from the Korean National Health Insurance Service, including 10 083 kidney transplant recipients examined from 2009 to 2017. We assessed fracture incidence, emphasizing vertebral and hip fractures, and the association of physical activity and traditional risk factors with fracture risk. Kidney transplant recipients were categorized into three groups according to physical activity levels: non‐activity, metabolic equivalent of task (MET) 1–499, and MET ≥500. Physical activity was associated with a decreased risk of all types of fractures: any (MET 1–499: adjusted hazard ratio (aHR).75; 95% confidence interval (CI).62–.92, MET ≥500: aHR.84; 95% CI.70–1.00), vertebral (MET 1–499: aHR.69; 95% CI.49–.98, MET ≥500: aHR.67; 95% CI.49–.91), and hip (MET 1–499: aHR.43; 95% CI.23–.81) fractures. Additionally, older age, female sex, and diabetes were associated with an increased fracture risk. The assessment of physical activity and traditional risk factors could improve fracture risk prediction. Our findings emphasize the need for further research to establish optimal physical activity recommendations for fracture prevention in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) has been highlighted as a new treatment option in the end-stage heart failure (HF). Kidney outcome after LVAD in severe cardiorenal syndrome (CRS) patients requiring kidney replacement therapy (KRT) is unclear. We investigated the impact of preoperative KRT on kidney function and survival in LVAD patients with severe CRS. A total of 50 patients followed up for at least 1 year after LVAD implantation was analyzed. The primary outcomes were estimated glomerular filtration rate and survival rate. Patients were divided into two groups depending on in-hospital KRT before LVAD implantation: the control group (n = 33) and the KRT group (n = 17). Postoperative KRT was performed for 76.5% of patients in the KRT group, and all of them discontinued KRT before discharge. There were no statistically significant differences in the degree of eGFR decline in survivors according to preoperative KRT. Although there were no statistically significant differences in the degree of eGFR decline in survivors regardless of preoperative KRT, old age (β −0.94, p < 0.01), preexisting chronic kidney disease (β −21.89, p < 0.01), and high serum creatinine (β −13.95, p < 0.01) were identified as independent predictors of post-LVAD eGFR decline. Mortality rate was higher, and more patients progressed to end-stage kidney disease in KRT group than control group. However, LVAD still can be considered as the treatment option in end-stage HF patients with severe CRS requiring KRT, especially in those with young age and previous normal kidney function. [ABSTRACT FROM AUTHOR]

Background The nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been elucidated, although tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been reported to increase after introduction of the drug. This study compared the incidence and risk factors for acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate drug-related nephrotoxicity. Methods From 2006 to 2017, 276 patients who underwent a first cycle of bortezomib-based chemotherapy for MM were identified in a single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network criteria within 7 days of the first chemotherapy. Results The median (interquartile range) age was 65 (56–72) years, and baseline estimated glomerular filtration rate (eGFR) was 61.3 (34.1–89.1) mL/min/1.73 m2. The incidences of AKI and laboratory TLS were 17% (n  = 47) and 13% (n  = 36), respectively. Ten (3.6%) subjects met both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category [30–59, odds ratio (OR) 3.005 (95% confidence interval 1.163–7.976); 15–29, OR 4.225 (1.183–15.000); <15, OR 16.154 (3.831–70.920) vs ≥60, P  < .001], lower serum albumin level [per 1 increase, OR 0.479 (0.256–0.871), P  = .018], renal amyloidosis [OR 13.039 (4.108–44.041), P  < .001] and use of acyclovir during bortezomib treatment [OR 3.689 (1.133–14.469), P  = .042] were predictors of AKI. MM stages and β-2-microglobulin were not associated with increased risk of AKI. Regarding laboratory TLS, MM stage and β-2-microglobulin were higher in those with TLS than in others. In multivariate analyses, β-2-microglobulin level [OR 1.204 (1.005–1.461), P  = .038] and absence of high-risk chromosome abnormalities [OR 0.143 (0.022–0.588), P  = .016] were associated with higher risk of TLS. Conclusions Development of AKI was often observed in the absence of TLS in patients with MM after treatment with bortezomib. In addition, the risk factors for AKI and TLS varied widely. These findings indicate the potential nephrotoxicity of bortezomib irrespective of TLS in patients with decreased kidney function. [ABSTRACT FROM AUTHOR]