Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters

Wennekers, Ana Berni; Azara, María Pilar Martín; Sahun, Victoria Dourdil; Liberal, Beatriz Bergasa; Laiglesia, Jose Esteban Ruiz; Perna, Patricia Vernet; Lipe, Rafael Álvarez

doi:10.1016/j.nefroe.2016.10.003

Cited by 3 publications

(6 citation statements)

References 31 publications

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“…No serious complications associated with dialysis occurred during HCO-HD ( 36 , 45 – 47 , 50 , 51 , 60 ), and major reported adverse effects were almost always attributable to chemotherapy. The side effects related to hemodialysis included hypotension, fever, infections, muscle weakness, and thrombosis in the catheter.…”

Section: Adverse Effects Associated With Hco-hdmentioning

confidence: 99%

“…Berni et al. performed a 6-h session of HCO-HD in combination with chemotherapy, which resulted in a 40.2%–75.4% decrease in FLCs per session ( 45 ). Steiner et al.…”

Section: Hco-hd Research and The Removal Of Flcsmentioning

confidence: 99%

“…demonstrated that HCO-HD will result in the loss of 1.5 g and 5.7 g of albumin per hour in a single HCO1100 and a series of HCO1100, and at least 12 g and 45 g of albumin will be needed for 8-h HCO-HD, respectively ( 41 ). Twenty grams of albumin was frequently supplied after HCO-HD with Theralite ® ( 40 , 45 ). During HCO-HD, the loss of electrolytes, such as calcium and magnesium, is common ( 47 , 62 ).…”

Section: Adverse Effects Associated With Hco-hdmentioning

confidence: 99%

“…A session is usually conducted intermittently for durations longer than 4 h. A serum FLC concentration of 500 mg/L has been set as the threshold for myeloma cast nephropathy ( 63 ). Thus, most studies terminated HCO-HD when the serum FLC concentration dropped below 500 mg/L ( 45 , 49 , 50 , 54 ) and kept using HF-HD if dialysis was still needed until the eGFR was more than 15 ml/min/1.73 m 2 . Blood and dialysate flow were set to 250–350 and 500 ml/min, respectively, with ultrafiltration performed according to clinical needs.…”

Section: Protocols For Hco-hdmentioning

confidence: 99%

“…Whether HCO-HD is the most cost-effective option is also still under debate due to the increased cost of HCO filters, albumin supplementation, and careful monitoring of electrolytes. However, some studies concluded that the total cost of HCO dialyzers was comparable to those of standard dialyzers ( 54 ), and some even demonstrated significant cost savings ( 45 ). This difference may be due to the different reimbursement policies in different countries.…”

Section: What We Should Knowmentioning

confidence: 99%

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High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

Xing

Yan²,

Yu³

et al. 2022

Front. Oncol.

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Multiple myeloma (MM), an incurable hematological malignancy with clonal proliferation of plasma cells, is mainly characterized by excessive production of monoclonal immunoglobulins and free light chains (FLCs). Kidney injury is one of the main clinical manifestations and is also a significant predictor of the prognosis of symptomatic MM patients, especially those who require dialysis-supported treatment. Overproduction of FLCs is the trigger for kidney injury, as they can induce the transcription of inflammatory and profibrotic cytokines in the proximal tubule and bind to Tamm–Horsfall protein in the distal tubules to form casts that obstruct the tubules, leading to kidney injury and even renal fibrosis. In addition to traditional antimyeloma treatment, high-cutoff hemodialysis (HCO-HD), which can effectively remove FLCs in vitro, has attracted much attention in recent years. Due to its greater membrane pore size, it has significant advantages in removing larger molecules and can be applied in rhabdomyolysis, sepsis, and even myeloma cast nephropathy. However, mounting questions have recently been raised regarding whether HCO-HD can truly provide clinical benefits in MM patients with acute kidney injury (AKI). Therefore, in this study, we discussed the pathological causes of AKI secondary to MM and summarized the current situation of HCO-HD in MM patients compared with other available extracorporeal techniques. In addition, pivotal clinical trials that reflect the ability of the clearance of FLCs and the side effects of HCO-HD are highlighted, and the relevant protocol of HCO-HD is also provided to assist clinicians in decision-making.

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Section: Adverse Effects Associated With Hco-hdmentioning

confidence: 99%

“…Berni et al. performed a 6-h session of HCO-HD in combination with chemotherapy, which resulted in a 40.2%–75.4% decrease in FLCs per session ( 45 ). Steiner et al.…”

Section: Hco-hd Research and The Removal Of Flcsmentioning

confidence: 99%

Section: Adverse Effects Associated With Hco-hdmentioning

confidence: 99%

Section: Protocols For Hco-hdmentioning

confidence: 99%

Section: What We Should Knowmentioning

confidence: 99%

See 3 more Smart Citations

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

Xing

Yan²,

Yu³

et al. 2022

Front. Oncol.

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Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: a position statement of the Onconephrology Work Group of the Italian Society of Nephrology

et al. 2016

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Acute kidney injury (AKI) is a frequent complication of multiple myeloma and is associated with increased short-term mortality. Additionally, even a single episode of AKI can eventually lead to end-stage renal disease (ESRD), significantly reducing quality of life and long-term survival. In the setting of multiple myeloma, severe AKI (requiring dialysis) is typically secondary to cast nephropathy (CN). Renal injury in CN is due to intratubular obstruction from precipitation of monoclonal serum free light chains (sFLC) as well as direct tubular toxicity of sFLC via stimulation of nuclear factor (NF)κB inflammatory pathways. Current mainstays of CN treatment are early removal of precipitating factors such as nephrotoxic drugs, acidosis and dehydration, together with rapid reduction of sFLC levels. Introduction of the proteasome inhibitor bortezomib has significantly improved the response rates in multiple myeloma due to its ability to rapidly reduce sFLC levels and has been referred to as "renoprotective" therapy. As an adjunct to chemotherapy, several new extracorporeal techniques have raised interest as a further means to reduce sFLC concentrations in the treatment of CN. Whether addition of extracorporeal therapies to renoprotective therapy can result in better renal recovery is still a matter of debate and there are currently no guidelines in this field. In this positon paper, we offer an overview of the available data and the authors' perspectives on extracorporeal treatments in CN.

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

Ramos-Terrades

Senín

Azancot

et al. 2023

Clinical Kidney Journal

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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 a MM patient population: standard dialysis procedure versus IHD with either PMMA or hemodiafiltration with endogenous reinfusion (HFR). Methods Multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary of MM requiring RRT were included. Patients that underwent IHD received 6 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 six months follow-up. Results A total of 25 patients were included. Seventeen patients received IHD and 8 standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, fourteen (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared to those who remained in HD (92.9% vs 36.4%, p:0.007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared to standard dialysis group (p = 0.024). Conclusion Early reduction of FLC with IHD as an adjuvant treatment along with MM targeted therapy may exert a positive impact on renal recovery.

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Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters

Cited by 3 publications

References 31 publications

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: a position statement of the Onconephrology Work Group of the Italian Society of Nephrology

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

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