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. 2022 Jun 5;14(6):391.
doi: 10.3390/toxins14060391.

Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney

Gabriele Donati  1 , Fulvia Zappulo  2 , Elisa Maietti  3 , Anna Scrivo  2 , Lorenzo Gasperoni  2 , Elena Zamagni  4 , Paola Tacchetti  4 , Lucia Pantani  4 , Olga Baraldi  2 , Giorgia Comai  2 , Maria Cappuccilli  2 , Michele Cavo  4 , Gaetano La Manna  2
Affiliations

Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney

Gabriele Donati et al. Toxins (Basel). .

Abstract

Renal impairment in Multiple Myeloma (MM) represents one of the most important factors that influences patient survival. In fact, before the introduction of modern chemotherapy, less than 25% of patients with acute kidney injury (AKI) and MM who required dialysis recovered sufficient renal function to become independent from dialysis, with a median overall survival of less than 1 year. There are many other factors involved in determining patient survival. In this study we aimed to investigate the role of double filter-based extracorporeal treatment for removal of serum free light chains (sFLC) in acute myeloma kidney (AKI for MM) and to evaluate patient overall survival. All patients received Bortezomib-based chemotherapy and extracorporeal treatment for sFLC removal. For each session 2 dialyzers of the same kind were used. The dialytic dose was not related to the degree of renal function but to the removal of sFLC. The factors that have been found to be significantly associated with lower mortality were reduction of sFLC at day 12 and day 30, >50% reduction of sFLC at day 30, number of sessions and independence from dialysis. Among baseline characteristics, albumin level was statistically associated with the patients’ outcome. Our analysis highlights the importance of the early treatment for removal of sFLC in AKI for MM. These results indicate that the early removal of sFLC can improve patient’s outcome.

Keywords: PEPA; PMMA; acute kidney injury; double dialysis filter; free light chains; multiple myeloma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival estimates according to serum albumin at baseline, p = 0.007.
Figure 2
Figure 2
Kaplan–Meier survival estimates according to sFLC removal at Day 30 from the beginning of combined treatment, p = 0.002.
Figure 3
Figure 3
Kaplan–Meier survival estimates according to renal recovery, p < 0.001.
Figure 4
Figure 4
Scheme with all the steps of the study.
See this image and copyright information in PMC

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