Dialysis-dependent AKI due to multiple myeloma - Influence of high cut-off dialysis and novel chemotherapy on renal recovery Dialysis-dependent AKI due to multiple myeloma - influence of high cut-off dialysis and novel chemotherapy on renal recovery

Gerth U., Görlich D., Thölking G., Berdel W., Pavenstädt H., Brand M., Kümpers P., Pohlen M.

Abstract

High cut-off hemodialysis (HCO-HD) can effectively reduce serum free light chains (sFLC) due to multiple myeloma (MM). In this retrospective case-control study we analyzed renal recovery in a single-center cohort of 59 dialysis-dependent acute kidney injury (AKI) patients treated with either conventional HD (conv. HD, n = 17) or HCO-HD (n = 42). Sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3%) compared to 29.4% of conv. HD patients (p=0.007). The median duration of sFLC to reach values <1000 mg/l was 14.5 days in the HCO-HD group, compared to 36 days in the conv. HD group. The corresponding rate of renal recovery was 64.3% and 29.4%, respectively (p=0.014). Concerning chemotherapy, patients treated with novel agents revealed a renal recovery rate of 50.0% (non HCO-HD) which could be increased to 65.6% by HCOHD (p=0.540). If treated with protocols excluding any novel chemotherapeutic agent the corresponding rates of renal recovery were 23.1% compared to 60.0% (HCO-HD; p=0.072), respectively. In addition, multivariate regression as well as decision tree analysis (recursive partitioning) revealed HCOHD (OR 6.1 [95%CI 1.5-24.5], p=0.011) and low initial uric acid values (OR 1.3 [95%CI 1.0-1.7], p=0.045) as independent and paramount variables for favorable renal outcome. These results suggest an additional benefit of HCO-HD on sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This accounted especially to patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%.