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Clin J Am Soc Nephrol. 2009 Apr;4(4):745-54. doi: 10.2215/CJN.04590908. Epub 2009 Apr 1.

Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis.

Author information

1
Department of Nephrology, Queen Elizabeth Hospital, Birmingham, United Kingdom. c.a.hutchison@bham.ac.uk

Abstract

BACKGROUND AND OBJECTIVES:

Extended hemodialysis using a high cut-off dialyzer (HCO-HD) removes large quantities of free light chains in patients with multiple myeloma. However, the clinical utility of this method is uncertain. This study assessed the combination of chemotherapy and HCO-HD on serum free light chain concentrations and renal recovery in patients with myeloma kidney (cast nephropathy) and dialysis-dependent acute renal failure.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

An open-label study of the relationship between free light chain levels and clinical outcomes in 19 patients treated with standard chemotherapy regimens and HCO-HD.

RESULTS:

There were sustained early reductions in serum free light chain concentrations (median 85% [range 50 to 97]) in 13 patients. These 13 patients became dialysis independent at a median of 27 d (range 13 to 120). Six patients had chemotherapy interrupted because of early infections and did not achieve sustained early free light chain reductions; one of these patients recovered renal function (at 105 d) the remaining 5 patients did not recover renal function. Patients who recovered renal function had a significantly improved survival (P < 0.012).

CONCLUSION:

In dialysis-dependent acute renal failure secondary to myeloma kidney, patients who received uninterrupted chemotherapy and extended HCO-HD had sustained reductions in serum free light chain concentrations and recovered independent renal function.

PMID:
19339414
PMCID:
PMC2666427
DOI:
10.2215/CJN.04590908
[Indexed for MEDLINE]
Free PMC Article

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