Early use of PEPA dialyzer for light chains removal and for the recovery from myeloma cast nephropathy: A case report

Donati, Gabriele; Zappulo, Fulvia; Chiocchini, Anna Laura Croci; Comai, Giorgia; Zamagni, Elena; Manna, Gaetano La

doi:10.1111/hdi.12733

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…In consideration of our previous positive experience in a single case report and in a cohort of 16 patients, in our patient 2 PEPA dialyzers were used in series during each HDF session with positive outcome and without albumin loss [ 37 , 38 ].…”

Section: Conclusion and Discussionmentioning

confidence: 99%

Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report

et al. 2023

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Background Older individuals with multiple comorbidities and especially patients with multiple myeloma are at higher risk of contracting SARS-CoV-2. When patients with multiple myeloma (MM) are also affected by SARS-CoV-2 the time to start immunosuppressants is still a clinical dilemma especially when urgent hemodialysis is required for acute kidney injury (AKI). Case presentation We present a case of an 80-year-old woman who was diagnosed with AKI in MM. The patient began hemodiafiltration (HDF) with free light chain removal combined with bortezomib and dexamethasone. The reduction of free light chains concurrently was obtained by means of HDF using poly ester polymer alloy (PEPA) high-flux filter: 2 PEPA filters were used in series during each 4-h length HDF session. A total of 11 sessions was carried out. The hospitalization was complicated with acute respiratory failure caused by SARS-CoV-2 pneumonia successfully treated with both pharmacotherapy and respiratory support. Once the respiratory status stabilized MM treatment was resumed. The patient was discharged in stable condition after 3 months of hospitalization. The follow up showed significant improvement of the residual renal function which allowed interruption of hemodialysis (HD). Conclusions The complexity of patients affected by MM, AKI, and SARS-CoV-2 should not discourage the attending physicians to offer the adequate treatment. The cooperation of different specialists can lead to a positive outcome in those complicated cases.

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Section: Conclusion and Discussionmentioning

confidence: 99%

Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report

et al. 2023

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“…14 In 2023, a study of eight patients 17 with a 269min session length and Qb between 313 and 330 mL/ min, showed that removal of β 2 -microglobulin, κFLC, and λFLC RRs were similar between FDY 210 in HD, Theranova 500 in HD, Vie 21X in HD, all three MCO dialyzers, versus Elisio 21H in post-dilution HDF, and all of them were superior to Elisio 21H in HD. In 2019, Donati et al 18 published a case report of recovery from acute kidney injury secondary to λFLC myeloma cast nephropathy with the FDY 210 dialyzer combined with bortezomib chemotherapy in seven HD treatments, with λFLC RRs ranging between 40% and 70%. In this study, all HD and HDF treatments showed good safety, with a global blood albumin RR.…”

Section: Discussionmentioning

confidence: 99%

Most recently developed polyester polymer alloy dialyzer: A new medium cut‐off membrane?

Maduell,

Rodríguez‐Espinosa,

Rodas

et al. 2024

Artificial Organs

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BackgroundNew versions of the polyester polymer alloy (PEPA) membrane have appeared over the years, with increases in both the pore size and the amount of polyvinylpyrrolidone (PVP) to optimize hydrophilicity performance. This study aimed to assess the efficacy of the most recently developed PEPA dialyzer, the FDY series, in hemodialysis (HD) modality in terms of uremic toxin removal and albumin loss and to compare it with that of several high‐flux dialyzers currently used in HD and post‐dilution hemodiafiltration (HDF) treatments.MethodsA prospective study was carried out in 21 patients. All patients underwent six dialysis sessions with the same routine dialysis parameters; only the dialyzer and/or the dialysis modality varied: FX80 in HD, FDY 180 in HD, Clearum HS17 in HDF, Elisio 19H in HDF, Vitapes 180 in HDF, and FX80 in post‐dilution HDF. The reduction ratios (RR) of urea, creatinine, ß2‐microglobulin, myoglobin, κFLC, prolactin, α1‐microglobulin, α1‐acid glycoprotein, λFLC, and albumin were compared intraindividually. Dialysate albumin loss was also measured.ResultsBoth membranes FDY and FX80 are high‐flux dialyzers and are applied here in high‐flux HD. The average RR of β2‐microglobulin was slightly lower in the two HD treatments than in the HDF treatments. Comparison of dialysis treatments revealed that the PEPA FDY dialyzer in the HD modality was more effective than the FX80 dialyzer in high‐flux HD and was as effective as post‐dilution HDF, especially in terms of myoglobin, κFLC, prolactin, α1‐microglobulin, and λFLC RRs. The FDY treatments obtained similar albumin RR in blood and slightly higher dialysate albumin loss, although the values were clinically acceptable.ConclusionsThe most recently developed PEPA dialyzers in the HD modality were as effective as all treatments in the HDF modality and were clearly superior to high‐flux helixone HD treatment. These results confirm that this dialyzer should be categorized within the medium cut‐off (MCO) membrane classification.

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“…As to PEPA dialyzer, our group published the first successful case report of a patient affected by AKI due to MCN who experienced the recovery of renal function by means of chemotherapy combined to extracorporeal removal of sFLC. Two PEPA dialyzers were used in series during the 7 dialysis sessions carried out for sFLC removal [17]. There are no other in vivo experiences of removal of sFLC with PEPA dialyzer.…”

Section: Discussionmentioning

confidence: 99%

Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney

Donati

Zappulo

Maietti

et al. 2022

Toxins

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Renal impairment in Multiple Myeloma (MM) represents one of the most important factors that influences patient survival. In fact, before the introduction of modern chemotherapy, less than 25% of patients with acute kidney injury (AKI) and MM who required dialysis recovered sufficient renal function to become independent from dialysis, with a median overall survival of less than 1 year. There are many other factors involved in determining patient survival. In this study we aimed to investigate the role of double filter-based extracorporeal treatment for removal of serum free light chains (sFLC) in acute myeloma kidney (AKI for MM) and to evaluate patient overall survival. All patients received Bortezomib-based chemotherapy and extracorporeal treatment for sFLC removal. For each session 2 dialyzers of the same kind were used. The dialytic dose was not related to the degree of renal function but to the removal of sFLC. The factors that have been found to be significantly associated with lower mortality were reduction of sFLC at day 12 and day 30, >50% reduction of sFLC at day 30, number of sessions and independence from dialysis. Among baseline characteristics, albumin level was statistically associated with the patients’ outcome. Our analysis highlights the importance of the early treatment for removal of sFLC in AKI for MM. These results indicate that the early removal of sFLC can improve patient’s outcome.

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Early use of PEPA dialyzer for light chains removal and for the recovery from myeloma cast nephropathy: A case report

Cited by 5 publications

References 11 publications

Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report

Acute myeloma kidney and SARS-COV2 infection with dialysis need: never say never - a case report

Most recently developed polyester polymer alloy dialyzer: A new medium cut‐off membrane?

Early Light Chains Removal and Albumin Levels with a Double Filter-Based Extracorporeal Treatment for Acute Myeloma Kidney

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