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

Abstract

Lay Summary This is a retrospective multicenter study that evaluated the effectiveness of intensive haemodialysis (IHD) vs standards dialysis on renal recovery in patients with acute kidney injury (AKI) associated with myeloma multiple (MM). In this paper, we demonstrated that IHD for early light chain reduction was associated with a better renal prognosis. Another finding is the importance of maintenance diuresis as a marker of good prognosis of renal function. To our knowledge few studies have been focused in the comparison between IHD vs standard dialysis in MM patients with AKI. We consider that if we manage to recover the renal function, we achieve a great clinical impact since the patient with chronic kidney disease and especially in hemodialysis, an increased risk of mortality as well as poorer quality of life. 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.