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

Lay Summary This is a retrospective multicenter study that evaluated the effectiveness of intensive haemodialysis (IHD) vs standards dialysis on renal recovery in patients with acute kidney injury (AKI) associated with myeloma multiple (MM). In this paper, we demonstrated that IHD for early light ch...

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Autores: Terrades, Natàlia Ramos, Senín, Alicia, Azancot, Maria A., Gironella, Mercedes, Toapanta, Nestor, Bermejo, Sheila, Martin, Lucia, Caravaca Fontán, Fernando, Cuellar, Clara, Martínez López, Joaquín, Rodríguez, Eva, Bestard Matamoros, Oriol, Soler, María José
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/205242
Acceso en línea:https://hdl.handle.net/2445/205242
Access Level:acceso abierto
Palabra clave:Hemodiàlisi
Càncer de ronyó
Hemodialysis
Renal cancer
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spelling Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of viewTerrades, Natàlia RamosSenín, AliciaAzancot, Maria A.Gironella, MercedesToapanta, NestorBermejo, SheilaMartin, LuciaCaravaca Fontán, FernandoCuellar, ClaraMartínez López, JoaquínRodríguez, EvaBestard Matamoros, OriolSoler, María JoséHemodiàlisiCàncer de ronyóHemodialysisRenal cancerLay Summary This is a retrospective multicenter study that evaluated the effectiveness of intensive haemodialysis (IHD) vs standards dialysis on renal recovery in patients with acute kidney injury (AKI) associated with myeloma multiple (MM). In this paper, we demonstrated that IHD for early light chain reduction was associated with a better renal prognosis. Another finding is the importance of maintenance diuresis as a marker of good prognosis of renal function. To our knowledge few studies have been focused in the comparison between IHD vs standard dialysis in MM patients with AKI. We consider that if we manage to recover the renal function, we achieve a great clinical impact since the patient with chronic kidney disease and especially in hemodialysis, an increased risk of mortality as well as poorer quality of life. 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 an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR). Methods This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six 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 6 months follow-up. Results A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .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.Oxford University Press (OUP)2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/205242Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1093/ckj/sfad022Clinical Kidney Journal, 2023, vol. 16, num. 6, p. 1014-1021https://doi.org/10.1093/ckj/sfad022cc by-nc (c)Terrades, Natàlia Ramos et al., 2023http://creativecommons.org/licenses/by-nc/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2052422026-05-27T06:46:51Z
dc.title.none.fl_str_mv Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
title Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
spellingShingle Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
Terrades, Natàlia Ramos
Hemodiàlisi
Càncer de ronyó
Hemodialysis
Renal cancer
title_short Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
title_full Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
title_fullStr Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
title_full_unstemmed Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
title_sort Role of light chain clearance in the recovery of renal function in multiple myeloma: another point of view
dc.creator.none.fl_str_mv Terrades, Natàlia Ramos
Senín, Alicia
Azancot, Maria A.
Gironella, Mercedes
Toapanta, Nestor
Bermejo, Sheila
Martin, Lucia
Caravaca Fontán, Fernando
Cuellar, Clara
Martínez López, Joaquín
Rodríguez, Eva
Bestard Matamoros, Oriol
Soler, María José
author Terrades, Natàlia Ramos
author_facet Terrades, Natàlia Ramos
Senín, Alicia
Azancot, Maria A.
Gironella, Mercedes
Toapanta, Nestor
Bermejo, Sheila
Martin, Lucia
Caravaca Fontán, Fernando
Cuellar, Clara
Martínez López, Joaquín
Rodríguez, Eva
Bestard Matamoros, Oriol
Soler, María José
author_role author
author2 Senín, Alicia
Azancot, Maria A.
Gironella, Mercedes
Toapanta, Nestor
Bermejo, Sheila
Martin, Lucia
Caravaca Fontán, Fernando
Cuellar, Clara
Martínez López, Joaquín
Rodríguez, Eva
Bestard Matamoros, Oriol
Soler, María José
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Hemodiàlisi
Càncer de ronyó
Hemodialysis
Renal cancer
topic Hemodiàlisi
Càncer de ronyó
Hemodialysis
Renal cancer
description Lay Summary This is a retrospective multicenter study that evaluated the effectiveness of intensive haemodialysis (IHD) vs standards dialysis on renal recovery in patients with acute kidney injury (AKI) associated with myeloma multiple (MM). In this paper, we demonstrated that IHD for early light chain reduction was associated with a better renal prognosis. Another finding is the importance of maintenance diuresis as a marker of good prognosis of renal function. To our knowledge few studies have been focused in the comparison between IHD vs standard dialysis in MM patients with AKI. We consider that if we manage to recover the renal function, we achieve a great clinical impact since the patient with chronic kidney disease and especially in hemodialysis, an increased risk of mortality as well as poorer quality of life. 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 an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR). Methods This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six 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 6 months follow-up. Results A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/205242
url https://hdl.handle.net/2445/205242
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1093/ckj/sfad022
Clinical Kidney Journal, 2023, vol. 16, num. 6, p. 1014-1021
https://doi.org/10.1093/ckj/sfad022
dc.rights.none.fl_str_mv cc by-nc (c)Terrades, Natàlia Ramos et al., 2023
http://creativecommons.org/licenses/by-nc/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc (c)Terrades, Natàlia Ramos et al., 2023
http://creativecommons.org/licenses/by-nc/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Oxford University Press (OUP)
publisher.none.fl_str_mv Oxford University Press (OUP)
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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