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


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.

SUBMITTER: Hutchison CA 

PROVIDER: S-EPMC2666427 | biostudies-literature | 2009 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Hutchison Colin A CA   Bradwell Arthur R AR   Cook Mark M   Basnayake Kolitha K   Basu Supratik S   Harding Stephen S   Hattersley John J   Evans Neil D ND   Chappel Mike J MJ   Sampson Paul P   Foggensteiner Lukas L   Adu Dwomoa D   Cockwell Paul P  

Clinical journal of the American Society of Nephrology : CJASN 20090401 4


<h4>Background and objectives</h4>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.<h4>Design, setting, participants, & measurement  ...[more]

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