Therapeutic Efficacy and Cost Effectiveness of High Cut-Off Dialyzers Compared to Conventional Dialysis in Patients with Cast Nephropathy

Curti, Adriano; Schwarz, Albin; Trachsler, Johannes; Tomonaga, Yuki; Ambühl, Patrice M.

doi:10.1371/journal.pone.0159942

Cited by 18 publications

(34 citation statements)

References 24 publications

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“…11 Urine protein electrophoresis is recommended at least once every 3-6 months, to follow the urine M-protein level as well as to detect other renal complications that may result in albuminuria. 12 Given the data from case series suggesting that an additional high-cut-off haemodialysis might be beneficial for patients with CN, [13][14][15][16][17][18] a correct renal diagnosis is crucial.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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The urine light chain/glomerular filtration rate (GFR) quotient shows a high sensitivity and specificity to detect cast nephropathy in monoclonal light chain disease

Bergner

Hoffmann

Uppenkamp

et al. 2021

European J of Haematology

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Background Cast nephropathy (CN) is associated with a unfavourable outcome in monoclonal light chain (mLC) disease, but also more possible LC‐related renal diseases as well as non‐LC‐related disease can occur. Thus, it is crucial to understand the underlying renal disease. On the other hand, LC can interfere with coagulation preventing kidney biopsy as the gold standard. We sought to develop a non‐invasive algorithm to diagnose CN with a good sensitivity and specificity. Method We analysed data from patients with mLC disease who underwent kidney biopsy. The patients were classified in 4 groups according the renal histology: CN, AL amyloidosis, light chain deposition disease, and other renal disease. Afterwards, different algorithms were calculated for their sensitivity and specificity. Results CN showed a significant higher concentration of serum‐free LC and urine LC (LCu), but there was a wide and overlapping range with the other groups. The best accuracy was achieved for a LCu/GFR ratio >2 in patients with lambda LC and either a LCu/GFR > 1 and proteinuria <8 g/24 h or a LCu/GFR > 5 in patients with proteinuria >8 g/24 h in patients with kappa LC. In lambda LC, the sensitivity and specificity for CN was 94% and 90%, respectively; in kappa LC 87% and 81%, respectively. Discussion In patients with coagulation disturbances due to LC, a non‐invasive algorithm can separate patients with CN from other renal disease in mLC disease.

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Section: Backg Rou N Dmentioning

confidence: 99%

“…Given the data from case series suggesting that an additional high‐cut‐off haemodialysis might be beneficial for patients with CN, 13‐18 a correct renal diagnosis is crucial.…”

Section: Introductionmentioning

confidence: 99%

The urine light chain/glomerular filtration rate (GFR) quotient shows a high sensitivity and specificity to detect cast nephropathy in monoclonal light chain disease

Bergner

Hoffmann

Uppenkamp

et al. 2021

European J of Haematology

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“…There was a higher proportion of male participants, ranging from 50 to 73.7%. All five studies included patients with a diagnosis of cast nephropathy secondary to MM, and histological proof of cast nephropathy reached 100% of patients in four of the five studies [ 19 , 20 , 23 , 24 ]. Three studies only included patients with de novo MM [ 19 , 20 , 23 ], while two of the OBSs also included patients with relapsed MM [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

“…All five studies included patients with a diagnosis of cast nephropathy secondary to MM, and histological proof of cast nephropathy reached 100% of patients in four of the five studies [ 19 , 20 , 23 , 24 ]. Three studies only included patients with de novo MM [ 19 , 20 , 23 ], while two of the OBSs also included patients with relapsed MM [ 24 , 25 ]. The immunoglobulin heavy chain types of immunoglobulin G (IgG) and IgA were the predominant types studied [ 19 , 20 , 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: a systematic review and meta-analysis

Tarragón

Gallagher

et al. 2020

Clinical Kidney Journal

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Background Acute kidney injury (AKI) caused by cast nephropathy is associated with increased morbidity and mortality among patients with multiple myeloma (MM). High cut-off haemodialysis (HCO-HD) has proven to be effective in the removal of serum light chains but the effect on clinical outcomes, especially renal recovery, remains uncertain. Methods A systematic review and meta-analysis were performed examining all randomized controlled trials (RCTs) and observational studies (OBSs) assessing the effect of HCO-HD on clinical outcomes of patients with MM complicated by cast nephropathy–induced severe AKI. The primary outcome was all-cause mortality at the end of the study. The secondary outcomes included all-cause mortality at 12 months, HD independence and serum kappa and lambda light chain reduction. Pooled analysis was performed using random effects models. Results We identified five studies, comprising two RCTs and three retrospective cohort studies, including 276 patients with a mean follow-up of 18.7 months. The majority of the studies were of suboptimal quality and underpowered. Compared with patients treated with conventional HD, HCO-HD was not associated with a survival benefit at 12 months {five studies, 276 patients, relative risk [RR] 1.02 [95% confidence interval (CI) 0.76–1.35], I2 = 33.9%} or at the end of the studies at an average of 34 months [five studies, 276 patients, RR 1.32 (95% CI 0.71–2.45), I2 = 62.0%]. There was no difference in HD independence at 90 days [two trials, 78 patients, RR 2.23 (95% CI 1.09–4.55)], 6 months [two studies, 188 patients, RR 1.19 (95% CI 0.68–2.06)] or 12 months [two studies, 188 patients, RR 1.14 (95% CI 0.58–2.26)]. Patients receiving HCO dialysis, however, had a greater reduction in serum kappa [two studies, 188 patients, weighted mean difference (WMD) 46.7 (95% CI 38.6–54.7), I2 = 52.0%] and lambda [two studies, 188 patients, WMD 50.3 (95% CI 21.4–79.3), I2 = 95.1%] light chain levels. Conclusion Current evidence from RCTs and OBSs suggests HCO dialysis is able to reduce serum free light chains but makes no significant improvement in all-cause mortality and renal outcomes compared with conventional HD for patients with myeloma cast nephropathy. However, there is a trend towards better renal outcomes with the use of HCO dialysis. The lack of long-term data and the small sample sizes of the included studies limit this analysis. Therefore further large-scale RCTs with longer follow-up are needed to assess the effect of HCO dialysis on clinical outcomes in patients with myeloma cast nephropathy.

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“…Patients treated as such demonstrated improved survival and renal recovery rates compared with patients treated with conventional dialysis. However, prospective studies, including the EuLite (34) and the MYRE (35) trials, may provide more robust evidence of this treatment modality being a superior option (36).…”

Section: Hd Alone Hd With Anti-myeloma Therapy Treatment ------------mentioning

confidence: 99%

Impact of hemodialysis on the prognosis of multiple myeloma: A nationwide population‑based study and single‑institute analysis

et al. 2018

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Myeloma-associated kidney disease (MRKD) occurs in ≤40% patients with multiple myeloma (MM). The impact of hemodialysis (HD) on patients with MM was investigated. Between 2000 and 2010, a total of 1,610 patients in Taiwan were enrolled from the National Health Institute Research Database. MM was an independent risk factor for HD following adjustment via multivariate logistic regression analysis (adjusted hazard ratio, 7.347; 95% confidence interval, 6.156-8.768; log-rank test, P<0.001). In addition, a notable decrease in survival rate was determined in patients with MM who underwent HD in the first year since diagnosis of MM. A total of 198 (61.49%) patients received HD in the first year. Patients with MM with a lower frequency of HD in the first year had a relatively good prognosis. The present study confirmed that MM was a risk factor for HD. Significant early mortality in the first year was determined in patients with MM who underwent HD; however, renal recovery following therapeutic management was a prognostic factor. In addition to anti-myeloma therapy, early initiation of HD was beneficial following risk stratification of MRKD; however, an increased probability of recovery of renal function and discontinuation of dialysis, was demonstrated in patients with MM following HD, compared with patients with MM without HD.

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Therapeutic Efficacy and Cost Effectiveness of High Cut-Off Dialyzers Compared to Conventional Dialysis in Patients with Cast Nephropathy

Cited by 18 publications

References 24 publications

The urine light chain/glomerular filtration rate (GFR) quotient shows a high sensitivity and specificity to detect cast nephropathy in monoclonal light chain disease

The urine light chain/glomerular filtration rate (GFR) quotient shows a high sensitivity and specificity to detect cast nephropathy in monoclonal light chain disease

Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: a systematic review and meta-analysis

Impact of hemodialysis on the prognosis of multiple myeloma: A nationwide population‑based study and single‑institute analysis

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