ESRD due to Multiple Myeloma in the United States, 2001-2010

Abstract

Although management of multiple myeloma has changed substantially in the last decade, it is unknown whether the burden of ESRD due to multiple myeloma has changed, or whether survival of patients with multiple myeloma on RRT has improved. Regarding ESRD due to multiple myeloma necessitating RRT in the United States, we evaluated temporal trends between 2001 and 2010 for demography-adjusted incidence ratios, relative to rates in 2001-2002, and mortality hazards from RRT initiation, relative to hazards in 2001-2002. In this retrospective cohort study, we used the US Renal Data System database (n=1,069,343), 2001-2010, to identify patients with ESRD due to multiple myeloma treated with RRT (n=12,703). Demography-adjusted incidence ratios of ESRD from multiple myeloma decreased between 2001-2002 and 2009-2010 in the overall population (demography-adjusted incidence ratio 0.82; 95% confidence interval, 0.79 to 0.86) and in most demographic subgroups examined. Mortality rates were 86.7, 41.4, and 34.4 per 100 person-years in the first 3 years of RRT, respectively, compared with 32.3, 20.6, and 21.3 in matched controls without multiple myeloma. Unadjusted mortality hazards ratios declined monotonically after 2004 to a value of 0.72; 95% confidence interval, 0.67 to 0.77 in 2009-2010, and declines between 2001-2002 and 2008-2009 were observed (P<0.05) in most demographic subgroups examined. Findings were similar when adjustment was made for demographic characteristics, comorbidity markers, and laboratory test values. These data suggest the incidence of RRT from multiple myeloma in the United States has decreased in the last decade, and clinically meaningful increases in survival have occurred for these patients.

Keywords: PI3K; cystic kidney; polycystins; primary cilium; proliferation; vesicular trafficking.

Figure 1.

Survival curves with 95% confidence limits in patients with ESRD due to multiple myeloma (n=12,702, black curve) versus ESRD due to other causes (gray curve) at initiation of maintenance RRT (P<0.001).

Figure 2.

Mortality rates in the first 3 years of RRT in patients with multiple myeloma (MM+) and a matched control group (MM-). Error bars are 95% confidence intervals. Patients were matched by age, sex, race, ethnicity, and year of RRT inception. Matching occurred for 12,654 of 12,703 patients with multiple myeloma (99.6%). Subgroups are reported by year of RRT initiation (five 2-year periods), age (three levels), sex, and race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other). AA, African American; RE, race/ethnicity.