| Haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma. | |
| | |
MedLine Citation:
|
PMID: 22294003 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
INTRODUCTION: Acute renal failure (ARF) occurs in 12%-20% of all multiple myeloma (MM) cases, and the survival of these patients depends on renal function recovery. Renal function is not recovered in 75% of dialysis-dependent patients, and their mean survival with replacement therapy is less than one year. Renal tubular disease is the most frequent cause of renal failure. It is present in more than 55% of renal failure cases and in 75% of those requiring dialysis. Rapid reduction of free light chain levels in the blood is necessary in order to recover renal function. One coadjuvant measure in treating the disease is reducing light chain levels with plasmapheresis, but its efficacy has not yet been clearly proven. Our proposal was therefore to use extended haemodialysis sessions with high cut-off dialysers (HCO-HD), obtaining a recovery rate of more than 60%. We present the progress of 6 patients with myeloma and acute renal failure who were treated with HCO-HD and the complications associated with using this type of haemodialysis. Then, we review the pros and cons of this technique. METHOD: Six patients diagnosed with MM and ARF requiring dialysis and with serum free light chain levels above 500 mg/l were treated with 8-hour haemodialysis sessions with an HCO-HD filter. Before and after each session, serum free light chain levels were measured by nephelometry; other parameters were recorded as well. At the same time, patients underwent chemotherapy according to protocols. RESULTS: The symptom onset times of the 3 men and 3 women diagnosed with MM and ARF were highly variable, from 7 days to more than 1 year. We performed 90 extended sessions with HCO-HD filters, and each patient underwent between 6 and 40 sessions. Free light chain levels decreased by a mean of 65% between treatment onset and completion, except in one patient who experienced a 12.6% reduction. The mean percentage of reduction of light chain levels per session was 54.98% ± 17.27%. A complication occurred during 28% of the sessions. Of these complications, 48% were due to system coagulation. There were no major changes in pre-dialysis albumin, calcium, phosphorous or magnesium levels, although lower values that were not clinically relevant were recorded in one case. Renal function was recovered in 3 patients, they are alive and dialysis-free. In biopsied cases that recovered renal function, the specimen showed tubular nephropathy only. Those patients who took longer to be diagnosed did not recover their renal function, and when biopsied, they were diagnosed with renal tubular disease and light chain deposition disease. CONCLUSION: We found extended haemodialysis with HCO-HD filters to be a reasonable alternative in ARF caused by renal tubular disease, and achieved a recovery rate of 50% in our cases. Function recovery was influenced by the elapsed time between symptom onset and myeloma diagnosis, histological findings, promptness of starting chemotherapy, response to chemotherapy, and effectiveness of light chain extraction. In any case, further studies are needed to examine new chemotherapy agents and new direct free light chain removal techniques. |
| | |
Authors:
|
Guillermo Martín-Reyes; Remedios Toledo-Rojas; Álvaro Torres-de Rueda; Eugenia Sola-Moyano; Lourdes Blanca-Martos; Laura Fuentes-Sánchez; M Dolores Martínez-Esteban; M José Díez-de los Ríos; Alicia Bailén-García; Miguel González-Molina; Isabel García-González |
Related Documents
:
|
13106723 - Unilateral renal disease and hypertension. 1773523 - Effects of canrenone on rrm-sucrose hypertension in wky. 12189653 - Potential pool of non-heart-beating kidney donors in taiwan: chart review in a regional... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Nefrología : publicación oficial de la Sociedad Española Nefrologia Volume: 32 ISSN: 1989-2284 ISO Abbreviation: Nefrologia Publication Date: 2012 |
Date Detail:
|
Created Date: 2012-02-01 Completed Date: 2012-05-29 Revised Date: 2012-06-29 |
Medline Journal Info:
|
Nlm Unique ID: 8301215 Medline TA: Nefrologia Country: Spain |
Other Details:
|
Languages: eng; spa Pagination: 35-43 Citation Subset: IM |
Affiliation:
|
Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga, Spain. gmartínr@senefro.org |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Acute Kidney Injury
/
complications*,
therapy* Aged Aged, 80 and over Female Humans Male Micropore Filters* Middle Aged Multiple Myeloma / complications* Renal Dialysis / adverse effects, instrumentation* |
| Comments/Corrections | |
Comment In:
|
Nefrologia. 2012;32(1):15-9
[PMID:
22294000
]
Nefrologia. 2012 May 14;32(3):396 [PMID: 22592425 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Start-up of a clinical sample processing, storage and management platform: organisation and developm...
Next Document: Early detection of chronic kidney disease: Collaboration of Belgrade nephrologists and primary care ...