Multiple myeloma and light chain-associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival.

AIMS: The patient characteristics and clinical course of nephropathy associated with multiple myeloma/light chain disease (MMN) has not been described for a national sample of end-stage renal disease patients.
METHODS: 375,152 patients in the United States Renal Data System were initiated on ESRD therapy between January 1, 1992 and June 30, 1997, and were analyzed in a retrospective registry study of MMN (PDIS=2030A, 2030B, 2030Z, and 203Z).
RESULTS: Of the study population, 3298 (0.88%) had MMN. Patients with MMN were disproportionately male (59.5% vs. 53.2%) and Caucasian (76.2% vs. 64.1%, p < 0.01 by Chi-square for both comparisons) and older (68.00+/-11.78 vs. 60.69+/-16.55 years, p < 0.01 by Student's t-test). In logistic regression analysis, patients with MMN were more likely male and Caucasian, were older, had lower serum hemoglobin, higher creatinine, and more likely to have been started on hemodialysis than peritoneal dialysis. The two-year all-cause mortality of patients with MMN during the study period was 58% vs. 31% in all other patients (p < 0.01 by log rank test). In Cox regression, MMN was independently associated with decreased all-cause patient survival (p < 0.01, hazard ratio for mortality=2.52, 95% CI 2.38-2.67).
CONCLUSIONS: MMN was associated with Caucasian race, male gender, and older age, compared with other ESRD patients. Patients with MMN had evidence of poorer medical condition on initiation of dialysis compared to other patients. MMN was associated with decreased patient survival after initiation of dialysis, although better than in some previous reports, and patients with MMN may be initiated on dialysis at a lower level of renal function than other patients with ESRD.