Moist L, Nesrallah G, Kortas C, Espirtu E, Ostbye T, Clark W F
Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ont., Canada.
Am J Nephrol. 1999;19(1):45-50. doi: 10.1159/000013424.
BACKGROUND/AIMS: To evaluate the effect of plasma exchange on renal function in patients with rapidly progressive renal failure secondary to multiple myeloma.
The study was done through a retrospective chart review using a standardized form at a tertiary care centre in southwestern Ontario. Patients were included in the study if they had a diagnosis of multiple myeloma and rapidly progressive renal failure. Multiple myeloma was defined by a bone marrow aspirate >15% plasma cells plus one of the following: serum monoclonal paraproteins, monoclonal light-chain excretion, or lytic lesions. Patients were excluded if they had evidence of chronic renal failure or failed to complete three plasma exchanges. Twenty-six patients were reviewed; of these 24 were followed up to 1 year. All patients received hydration, standard chemotherapy, and plasma exchange. The plasma exchange volume was 50 ml/kg of 50% normal saline and 50% human serum albumin. Primary outcome measures included (1) prevention of acute dialysis and (2) prevention of progression from acute to chronic dialysis; secondary end points included (1) a decrease in creatinine of 25% or more within 3 months of the last plasma exchange and (2) survival at 1 year.
Sixteen of 24 patients, followed up to 1 year, did not require dialysis. Two patients required dialysis initially, but were able to come off dialysis after 3 months. Fourteen patients were alive at 1 year, 13 of whom were dialysis independent. Twelve of 13 dialysis-independent patients had a >25% reduction in creatinine at 3 months. Two patients were lost to follow-up after discharge and were not included in the analysis.
This retrospective study suggests that plasma exchange may offer some benefit in preventing the initiation or continuation of dialysis in patients with rapidly progressive renal failure secondary to multiple myeloma. A randomized controlled prospective study is needed to determine whether plasma exchange should be recommended as a standard treatment for patients with rapidly progressive renal failure due to multiple myeloma.
背景/目的：评估血浆置换对多发性骨髓瘤继发快速进展性肾衰竭患者肾功能的影响。
本研究通过在安大略省西南部的一家三级医疗中心使用标准化表格进行回顾性病历审查。如果患者被诊断为多发性骨髓瘤且患有快速进展性肾衰竭，则纳入本研究。多发性骨髓瘤的定义为骨髓穿刺浆细胞>15%，并伴有以下情况之一：血清单克隆副蛋白、单克隆轻链排泄或溶骨性病变。如果患者有慢性肾衰竭证据或未完成三次血浆置换，则排除在外。共审查了26例患者；其中24例随访了1年。所有患者均接受了补液、标准化化疗和血浆置换。血浆置换量为50ml/kg，由50%的生理盐水和50%的人血清白蛋白组成。主要结局指标包括：（1）预防急性透析；（2）预防从急性透析进展为慢性透析；次要终点包括：（1）在最后一次血浆置换后3个月内肌酐下降25%或更多；（2）1年生存率。
随访1年的24例患者中，16例不需要透析。2例患者最初需要透析，但3个月后能够停止透析。14例患者在1年时存活，其中13例无需透析。13例无需透析的患者中有12例在3个月时肌酐下降>25%。2例患者出院后失访，未纳入分析。
这项回顾性研究表明，血浆置换可能有助于预防多发性骨髓瘤继发快速进展性肾衰竭患者开始透析或继续透析。需要进行一项随机对照前瞻性研究，以确定血浆置换是否应作为多发性骨髓瘤所致快速进展性肾衰竭患者的标准治疗方法。
