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Introduction. Kidney damage at the onset of multiple myeloma (MM) is observed in 20–40 % of patients, which requires renal replacement therapy in 2–4 % of cases. Deterioration in kidney function is associated with frequent complications and a decline in the quality of life, as well as carries a high risk of early death.Aim. To analyze the treatment of patients first diagnosed with MM, complicated by severe and dialysis-dependent renal failure.Materials and methods. 62 MM patients with a glomerular filtration rate of <30 ml/min /1.73 m2 participated in a retrospective study (11.2014–11.2017) with the following inclusion criteria: the concentration of free light chains in blood serum being >500 mg/l and the selective nature of proteinuria. Diagnosed AL-amyloidosis served as the exclusion criterion. Depending on the need for haemodialysis, patients were divided into two groups: (I) those not requiring it (n = 16) and (II) dialysis-dependent patients (n = 46).Results. The induction therapy included the following bortezomib-containing regimens: VCD — 41 (66.1 %), PAD — 2 (3.2 %), VD — 12 (19.4 %) and VMP — 7 (11.3 %). High-dose consolidation along with autologous hematopoietic stem cell transplantation was performed in 10 patients (16.1 %). The overall rate of anti-myeloma response in the groups came to 64.3 % (I) and 85.3 % (II) (p = 0.047), including complete and strong complete remissions in 14.3 % (I) and 14.7 % (II) of cases. The renal response was achieved by 57.2 % and 23.5 % (p = 0.032) of patients from the first and second groups, respectively. With a median follow-up of 32.1 months, throughout the entire cohort the median of progression-free survival (PFS) amounted to 14.5 months, with a 3-year PFS of 27.4 ± 6.6 %; whereas the median of overall survival (OS) came to 33.6 months, with a 3-year OS of 41.5 ± 7.7 %. There are no differences between the compared groups in terms of the survival rates. In the examined patients (n = 48), the achievement of any renal response was associated with an improvement in the 3-year PFS — 61.1 ± 11.5 % versus 17.7 ± 7.7 % (p = 0.045) — and 3-year OS — 72,2 ± 10.6 % versus 38.1 ± 10.4 % (p= 0.069). The time elapsed between the first haemodialysis procedure and the onset of anti-myeloma chemotherapy served as the predictor value of the renal response. In the group of patients who achieved a renal response, the average time came to 8.6 (95 % confidence interval of 3.5–13.7) days, as compared to 42.5 (12.6–72.5) days for patients without a renal response (p = 0.045).Conclusion. The use of bortezomib-based regimens provides a high frequency of antitumour responses with a probability of stopping dialysis in 23.5 % of dialysis-dependent patients. Possible reasons for the low frequency of renal response include the late diagnosis of MM as a cause of kidney damage, as well as the lack of access to new anti-myeloma drugs if the induction therapy needs to be changed.

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Prophylaxis, diagnostics and correction of nutritional status disturbances is considered as one of the main treatment methods of patients with COVID-19 infection-directed to resolve systemic inflammatory response and correction of metabolic response to a viral infection. Systemic Inflammatory Reaction (SIR) manisfestation as a result of viral infection leads to pronounced metabolic processes disturbances. The main metabolic manifestations of SIR is reflected as hypermetabolic-hypercatabolic syndrome with complex disturbances of protein, lipids and carbohydrates metabolism, increased consumption of carbohydrate-lipid reserves and breakdown of tissue proteins. Thus, adequate correction of metabolic disorders and a wholesome nutritional support, taking into account the clinical picture, severity of the disease, ongoing respiratory and intensive care therapy is an integral component in treating patients with COVID-19 infection which determines the efficiency of its treatment and reduction in mortality. Given the relevance of the problem, the authors decided that it was important to increase the COVID-19 treatment efficacy by producing guidelines based on the most fundamental provisions of the modern approach to nutritional support in critical patients with community acquired pneumonia, acute respiratory failure, ARDS, sepsis, multiple organ failure.

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