Effect factors related to a high probability of hemodialysis independence in newly diagnosed multiple myeloma patients requiring hemodialysis

Abstract

Background Renal failure is a severe complication of symptomatic myeloma, related to higher mortality. Recovery from dialysis dependence can lead to enormous survival benefits. We investigated the effect factors for probability of dialysis independence. Methods Retrospective data on 45 newly diagnosed MM (NDMM) patients with serious renal impairment and requiring hemodialysis were analyzed. The statistical methods including logistic regression analysis, Kaplan‐Meier survival curves, the log‐rank test and the Cox proportional hazards model for survival analysis were used in our study. Results Twenty‐two of the 45 patients, who were on hemodialysis at diagnosis, became dialysis independence. In the logistic regression analysis, serum level of β2‐microglobulin, kidney disease history, involved free light chain, and achieving at least VGPR were significantly associated with reversibility from dialysis dependence. In addition, achieving hemodialysis discontinuation was related to better survival. The multivariate analyses demonstrated that reversibility from dialysis dependence, proteinuria < 3.5 g/24 h, and achieving at least VGPR were significantly associated with OS among NDMM patients requiring hemodialysis. Conclusion Lower serum level of β2‐microglobulin and lower level of free light chain at diagnosis, achieving at least VGPR, and shorter kidney disease history are related to a high probability of dialysis independence in NDMM patients with serious renal failure requiring dialysis.

Circulating miRNAs as diagnostic biomarkers for multiple myeloma and monoclonal gammopathy of undetermined significance

“…In addition, miRNAs were negatively correlated with LDH (P < .05) in MM. These serum parameters reflecting the tumor load of MM, not only relate to the clinical stage, but also affect the renal function and prognosis of MM patients [27][28][29]. In our previous study, we demonstrated that these serum indicators were related to MM prognosis 30.…”

The role of cystatin C as a proteasome inhibitor in multiple myeloma

“…Substantial FLCs (nephrotoxic proteins) accumulated in the proximal tubular epithelium are responsible for most tubulointerstitial injuries. Monoclonal light chains in renal tubules stimulate the production of some proinflammatory cytokines, including macrophage chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), which subsequently, rapidly leads to renal tubulointerstitial fibrosis [11,12]. Light chain proteins can also cause glomerular function impairment when deposited on the glomerular basement membrane (GBM) and mesangial area [13].…”