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. 2023 Feb 1;16(6):1014-1021.
doi: 10.1093/ckj/sfad022. eCollection 2023 Jun.

Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view

Natàlia Ramos Terrades  1 , Alicia Senin  2 , Maria A Azancot  1 , Mercedes Gironella  3 , Nestor Toapanta  1 , Sheila Bermejo  1 , Lucia Martin  3 , Fernando Caravaca-Fontán  4 , Clara Cuellar  5 , Joaquin Martínez-Lopez  5 , Eva Rodríguez  6 , Oriol Bestard  1 , Maria Jose Soler  1
Affiliations

Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view

Natàlia Ramos Terrades et al. Clin Kidney J. .

Abstract

Background: Acute kidney injury (AKI) in patients with multiple myeloma (MM) requiring renal replacement treatment (RRT) is associated with high morbidity and mortality. Early reduction of serum free light chains (FLC) using both targeted therapy against MM and intensive hemodialysis (IHD) may improve renal outcomes. We evaluated the effectiveness of two different RRT techniques on renal recovery in an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR).

Methods: This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six dialysis sessions per week during the first 14 days (PMMA vs HFR). All patients were diagnosed with de novo MM or first relapsed MM. Primary outcome was renal recovery defined as dialysis-free at 6 months follow-up.

Results: A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .024).

Conclusion: Early reduction of FLC with IHD as an adjuvant treatment along with MM-targeted therapy may exert a positive impact on renal recovery.

Keywords: acute kidney injury; free light chains; hemodialysis; multiple myeloma; renal function recovery.

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Conflict of interest statement

M.J.S. is former Editor-in-Chief of CKJ and reports honorarium for conferences, consulting fees and advisory boards from AstraZeneca, NovoNordsik, Fresenius, Vifor, Bayer, Mundipharma, Ingelheim Lilly, Jansen, ICU Medical, Travere Therapeutics and Boehringer outside the submitted work. S.B. reports honorarium for conferences, consulting fees and advisory boards from AstraZeneca, Boehringer and Mundipharma outside the submitted work. N.R.T., A.S., M.A.A., M.G, N.T., L.M., F.C.-F, C.C., J.M.-L., E.R. and O.B. declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Frequency of patients according to IMWG criteria. CRrenal: complete renal response [best creatine clearance (CrCl): >60 mL/min]; PRrenal: partial renal response (CrCl: 30–59 mL/min); MRrenal: minor renal response (CrCl 15–29 mL/min); NR: no response.
Figure 2:
Figure 2:
Actuarial survival curves of persistent dialysis according to IHD.
See this image and copyright information in PMC

References

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