Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Abstract

Background and objectives Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France.Design, setting, participants, & measurements All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed.Results We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97).Conclusions Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.

Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

“…The prevalence of impaired mobility in patients reaching ESRD was 7%-34% among the included studies (32)(33)(34)(35)(36)(37)(38)(39). Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40).…”

“…Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40). Mobility status was assessed in all studies by using data on whether the patient was dependent for transfers and walking without objectifying actual mobility (for instance, by measuring gait speed).…”

Changing survival of people with myeloma and end stage kidney disease: A cohort study using Australian and New Zealand dialysis and transplant registry 1963–2013

“…Our interpretation of this finding is that it is likely to be an issue of selection bias and residual confounding: those fitter and more able, or better supported patients are more likely to choose a home‐based therapy than those less able and with less supportive home environment . There is little comparable published registry data on survival with ESKD and other plasma cell dyscrasia …”

“…It is not clear whether recent advances in myeloma therapy have translated to improved survival for all those with ESKD, and/or whether the new diagnostic and treatment paradigms for myeloma alter the characteristics of those who develop ESKD from their myeloma. Survival for people with ESKD and other plasma cell dyscrasia is less well characterized …”

“…Survival for people with ESKD and other plasma cell dyscrasia is less well characterized. 16 We aimed to describe the characteristics and survival of Australian and New Zealander patients with myeloma or other plasma cell dyscrasia and established ESKD who were treated with dialysis. We also aimed to examine changes in survival on dialysis over time, and to identify any prognostic factors for improved survival, to provide evidence for patient-clinician shared decision making.…”