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Updated: Aug 7, 2026
09:02
A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Plasma Exchange in Myeloma-Associated Acute Kidney Injury: A Multicenter Propensity-Matched Cohort Study
Joseph O'Brien1, Monica S Nair2, Niraj B Desai3
1Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
Journal of Clinical Apheresis
|August 6, 2026
Summary
Plasma exchange (PLEX) did not improve outcomes for multiple myeloma patients with acute kidney failure. This study found no significant difference in dialysis dependence or survival rates between patients who received PLEX and those who did not.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Light chain cast nephropathy is a severe complication of multiple myeloma, often leading to acute kidney failure.
- Plasma exchange (PLEX) is a potential treatment to remove harmful free light chains (FLCs), but its efficacy in the current treatment landscape is unclear.
Purpose of the Study:
- To evaluate the effectiveness of plasma exchange (PLEX) in multiple myeloma patients experiencing acute kidney failure due to light chain cast nephropathy.
- To determine if PLEX impacts key outcomes such as dialysis dependence and mortality in this patient population.
Main Methods:
- A retrospective multicenter cohort study was conducted using the TriNetX Research Network.
- Newly diagnosed multiple myeloma patients with acute kidney failure and elevated FLC levels (>1500 mg/L) between 2014-2024 were identified.
- Patients receiving PLEX within 7 days were compared to those who did not, using propensity score matching to control for confounding factors.
Main Results:
- Out of 5454 eligible patients, 251 received PLEX. After matching, 248 patients were in each group.
- PLEX was not associated with a significant reduction in dialysis dependence at 90 days (16.1% vs. 18.1%) or 180 days (18.5% vs. 20.2%).
- No significant differences were observed in mortality, ICU admission, or dialysis-free survival between the PLEX and non-PLEX groups.
Conclusions:
- Plasma exchange (PLEX) does not appear to improve renal outcomes or survival for multiple myeloma patients with acute kidney failure in the modern treatment era.
- The findings suggest that prompt initiation of effective anti-myeloma therapy is crucial for managing this condition.
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