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Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters
Ana Berni Wennekers1, María Pilar Martín Azara1, Victoria Dourdil Sahun2
1Servicio Nefrología, H.C.U. Lozano Blesa, Zaragoza, España.
Introduction:
Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis.
Methods:
We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m(2) HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days.
Results:
A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session.
Conclusions:
Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed.
Insights
High cut-off (HCO) filter dialysis effectively removed serum free light chains (sFLCs) in multiple myeloma patients, aiding renal recovery. This treatment offers significant cost savings and improved outcomes for patients with cast nephropathy.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Multiple myeloma (MM) is a plasma cell malignancy associated with elevated serum free light chains (sFLCs).
- sFLCs can precipitate in renal tubules, causing cast nephropathy and acute kidney injury (AKI), requiring dialysis in up to 50% of MM patients.
- AKI in MM is a serious complication, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of high cut-off (HCO) filter dialysis in reducing sFLCs and improving renal function in multiple myeloma patients with cast nephropathy.
- To assess the impact of HCO filter dialysis on patient recovery and independence from dialysis.
- To determine the cost-effectiveness of HCO filter dialysis.
Main Methods:
- A retrospective analysis of 13 multiple myeloma patients treated with HCO filter dialysis (Theralite®, 2.1 m²) between July 2011 and February 2015.
- Patients underwent consecutive 6-hour dialysis sessions, followed by alternate-day sessions.
- Albumin levels were monitored, with a standard infusion protocol administered post-dialysis.
Main Results:
- A total of 151 sessions were performed, with an average of 11.6 sessions per patient.
- HCO filter dialysis significantly reduced both kappa and lambda sFLCs by 93.7% by the end of treatment, with an average reduction of 57.7% per session.
- Ten out of 13 patients (77%) recovered sufficient renal function to become dialysis-independent. No significant changes in albumin levels were observed.
Conclusions:
- Combination therapy with chemotherapy and prolonged HCO filter dialysis is effective in reducing sFLC levels and achieving renal recovery in multiple myeloma patients.
- HCO filter dialysis facilitates significant renal function recovery, enabling dialysis independence in a majority of treated patients.
- Contrary to prior beliefs, HCO filter dialysis offers substantial cost savings, making it a viable and economical treatment option.
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