Florence Sens1,2,3,4, Déborah Chaintreuil1, Anne Jolivot1, Fitsum Guebre-Egziabher5, Philip Robinson6, Lionel Karlin3,7, Frank Bridoux8, Laurent Juillard1,3,8,9. 1. Hospices Civils de Lyon, Department of Nephrology, Edouard Herriot Hospital, Lyon, France. 2. Lyon 1 Claude Bernard University, Villeurbanne, France. 3. Hospices Civils de Lyon, Department of Medical Information Evaluation and Research, Lyon, France. 4. FCRIN INI-CRCT, Nancy, France. 5. Grenoble University Hospital, Department of Nephrology, Dialysis and Transplantation, La Tronche, France. 6. Hospices Civils de Lyon, Direction de la Recherche Clinique et de l'Innovation, Lyon, France. 7. Hospices Civils de Lyon, Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France. 8. Poitiers University Hospital, Department of Nephrology, Dialysis and Transplantation, Poitiers, France. 9. OPeRa, CARMEN, Lyon 1 Claude Bernard University, Villeurbanne, France.
Abstract
BACKGROUND: In patients with cast nephropathy and acute kidney injury (AKI) requiring dialysis, the reduction of serum free light chains (FLC) using chemotherapy and intensive hemodialysis (IHD) with a high cut-off filter may improve renal and patient outcomes. We evaluated the effectiveness of a combination of chemotherapy and IHD with an adsorbent polymethylmethacrylate membrane (IHD-PMMA) on renal recovery and survival. METHODS: A single-center retrospective cohort-study was conducted. Between 2007 and 2014, patients with dialysis-dependent acute cast nephropathy treated with chemotherapy and IHD-PMMA were included. Patients had six 6-h hemodialysis sessions a week, until predialysis serum FLC fell below 200 mg/L, for a maximum of 3 weeks. Primary outcomes were renal recovery, defined as dialysis independence, and survival. RESULTS: Seventeen patients were included, all with stage 3 AKI. All received chemotherapy, mostly based on bortezomib and steroids (88%). Twelve patients (71%) achieved renal recovery, usually within 60 days (92%). At 3 months, the overall hematological response rate was 57%; hematological response was maintained for at least 2 years in 86% of responders. At 6, 12, and 24 months, 76, 75, and 62% of patients were alive, respectively. Higher reduction in involved FLC by day 12 (p = 0.022) and day 21 (p = 0.003) was associated with renal recovery. Patients with FLC reduction rate >50% by day 21 experienced a lower mortality (hazard ratio 0.10, 95% CI 0.02-0.63). CONCLUSION: In patients with dialysis-dependent myeloma cast nephropathy, early FLC removal by IHD-PMMA combined with chemotherapy was associated with high rates of renal recovery and survival.
BACKGROUND: In patients with cast nephropathy and acute kidney injury (AKI) requiring dialysis, the reduction of serum free light chains (FLC) using chemotherapy and intensive hemodialysis (IHD) with a high cut-off filter may improve renal and patient outcomes. We evaluated the effectiveness of a combination of chemotherapy and IHD with an adsorbent polymethylmethacrylate membrane (IHD-PMMA) on renal recovery and survival. METHODS: A single-center retrospective cohort-study was conducted. Between 2007 and 2014, patients with dialysis-dependent acute cast nephropathy treated with chemotherapy and IHD-PMMA were included. Patients had six 6-h hemodialysis sessions a week, until predialysis serum FLC fell below 200 mg/L, for a maximum of 3 weeks. Primary outcomes were renal recovery, defined as dialysis independence, and survival. RESULTS: Seventeen patients were included, all with stage 3 AKI. All received chemotherapy, mostly based on bortezomib and steroids (88%). Twelve patients (71%) achieved renal recovery, usually within 60 days (92%). At 3 months, the overall hematological response rate was 57%; hematological response was maintained for at least 2 years in 86% of responders. At 6, 12, and 24 months, 76, 75, and 62% of patients were alive, respectively. Higher reduction in involved FLC by day 12 (p = 0.022) and day 21 (p = 0.003) was associated with renal recovery. Patients with FLC reduction rate >50% by day 21 experienced a lower mortality (hazard ratio 0.10, 95% CI 0.02-0.63). CONCLUSION: In patients with dialysis-dependent myeloma cast nephropathy, early FLC removal by IHD-PMMA combined with chemotherapy was associated with high rates of renal recovery and survival.
Authors: M Victoria Pendón-Ruiz de Mier; Raquel Ojeda; M Antonia Álvarez-Lara; Ana Navas; Corona Alonso; Javier Caballero-Villarraso; Pedro Aljama; Miguel A Álvarez; Sagrario Soriano; Mariano Rodríguez; Alejandro Martín-Malo Journal: BMC Nephrol Date: 2020-06-15 Impact factor: 2.388