Renal Failure-Related Mortality in Multiple Myeloma: United States Trends From 1999 to 2020

Multiple myeloma (MM) causes the deposition of monoclonal light chains in kidney tubules and glomeruli. This nephrotoxicity is exacerbated by nephrotoxic medicines, sepsis, dehydration and hypercalcemia. This study assesses the temporal, racial, sex-based, and regional disparities in mortality due to renal failure associated with MM in the US from 1999 to 2020.

Data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 persons were determined. The change in AAMRs was examined through annual percent Change (APC) and the average annual percent change (AAPC) using Joinpoint regression. Patients aged 45-85+ years were identified using ICD-10 codes for Multiple Myeloma (C90.0) as the UCD and renal failure (N17-N19) as MCD.

Between 1999 and 2020, 42,093 total deaths were found. Overall AAMR declined from 1.94 in 1999 to 1.18 in 2020 (AAPC: -2.10). Men had higher overall AAMR (2.16) than women (1.26). NH Blacks had the highest overall AAMR (3.61), followed by NH Whites (1.47), Hispanics (1.38), and NH Asians (0.82). AAMR also varied substantially by region (Midwest: 1.66; South: 1.65; West: 1.58; Northeast: 1.54). Nonmetropolitan areas had higher AAMR (1.69) than metropolitan areas (1.61). States in the top percentiles were District of Columbia, Maryland and South Carolina.

The overall AAMR for renal failure-associated MM mortality decreased from 1999 to 2020. We observed the highest AAMR in males, NH Blacks, Midwest, and nonmetropolitan areas of the US. However, NH Blacks also exhibited the greatest decrease in mortality over the study period.