[Development and treatment of renal insufficiency in multiple myeloma]

Renal insufficiency occurs in 55% of patients with multiple myeloma and is second only to infection as the most common cause of death in these patients. In acute renal failure, improvement can be achieved by correcting fluid balance or hypercalcaemia. Since 1968 chronic dialysis has been recommended as a worthwhile treatment. Haemodialysis and CAPD appear to be equally effective. One year survival in myeloma patients maintained on chronic haemodialysis was 53% while it is reported as 66-76% for myeloma patients not on dialysis. Transplantation may be a treatment option, but only in carefully selected patients. It has been suggested that chronic dialysis should be offered only if there has been a good response to chemotherapy. However, response to chemotherapy and duration of remission are unrelated to renal function and many patients require dialysis before any response to chemotherapy is known. Therefore almost all uraemic myeloma patients should start dialysis initially.