University of Birmingham, Birmingham, UK.
Nephrol Dial Transplant. 2012 Oct;27(10):3823-8. doi: 10.1093/ndt/gfr773. Epub 2012 Jan 23.
To determine the efficacy of immunoglobulin free light chain (FLC) removal by high cut-off haemodialysis (HCO-HD) as an adjuvant treatment to chemotherapy for patients with acute kidney injury complicating multiple myeloma (MM).
Sixty-seven patients with dialysis-dependent renal failure secondary to MM were treated with HCO-HD and chemotherapy.
The population was predominantly male (62.7%) with new presentation MM (75%) and did not have a history of chronic kidney disease (84%). The mean serum creatinine at presentation was 662 (SD = 349) μmol/L and of the 56.7% of patients who had a renal biopsy, 86.7% had cast nephropathy as the principal diagnosis. Eighty-five percent of patients were treated with a chemotherapy regime consisting of dexamethasone in combination with a novel agent (bortezomib or thalidomide). The median number of HCO-HD sessions was 11 (range 3-45), 97% received an extended dialysis regime. Seventy-six percent of the population had a sustained reduction in serum FLC concentrations by Day 12, of these 71% subsequently became independent of dialysis. In total, 63% of population became independent of dialysis. Factors which predicted independence of dialysis were the degree of FLC reduction at Days 12 (P = 0.002) and 21 (P = 0.005) and the time to initiating HCO-HD (P = 0.006).
The combination of extended HCO-HD and chemotherapy resulted in sustained reductions in serum FLC concentrations in the majority of patients and a high rate of independence of dialysis.
为了确定高截留量血液透析（HCO-HD）清除免疫球蛋白游离轻链（FLC）作为合并多发性骨髓瘤（MM）急性肾损伤的化疗辅助治疗的疗效。
对 67 例因 MM 导致透析依赖型肾衰竭的患者进行 HCO-HD 和化疗。
该人群主要为男性（62.7%），新发 MM（75%），且无慢性肾脏病病史（84%）。就诊时血清肌酐均值为 662（SD = 349）μmol/L，56.7%的患者行肾活检，86.7%的患者主要诊断为管型肾病。85%的患者接受地塞米松联合新型药物（硼替佐米或沙利度胺）化疗方案治疗。HCO-HD 治疗中位数为 11 次（范围 3-45 次），97%的患者接受延长的透析方案。76%的患者在第 12 天血清 FLC 浓度持续降低，其中 71%随后不再依赖透析。总体而言，63%的患者不再依赖透析。预测不再依赖透析的因素包括第 12 天（P = 0.002）和第 21 天（P = 0.005）FLC 降低程度和开始 HCO-HD 的时间（P = 0.006）。
延长的 HCO-HD 与化疗联合使用可使大多数患者血清 FLC 浓度持续降低，并使很高比例的患者不再依赖透析。
