Reule Scott, Sexton Donal J, Solid Craig A, Chen Shu-Cheng, Foley Robert N
Department of Medicine, University of Minnesota, Minneapolis, Minnesota; and Minneapolis Medical Research Foundation, Minneapolis, Minnesota.
Minneapolis Medical Research Foundation, Minneapolis, Minnesota.
J Am Soc Nephrol. 2016 May;27(5):1487-94. doi: 10.1681/ASN.2014090876. Epub 2015 Oct 29.
Although management of multiple myeloma has changed substantially in the last decade, it is unknown whether the burden of ESRD due to multiple myeloma has changed, or whether survival of patients with multiple myeloma on RRT has improved. Regarding ESRD due to multiple myeloma necessitating RRT in the United States, we evaluated temporal trends between 2001 and 2010 for demography-adjusted incidence ratios, relative to rates in 2001-2002, and mortality hazards from RRT initiation, relative to hazards in 2001-2002. In this retrospective cohort study, we used the US Renal Data System database (n=1,069,343), 2001-2010, to identify patients with ESRD due to multiple myeloma treated with RRT (n=12,703). Demography-adjusted incidence ratios of ESRD from multiple myeloma decreased between 2001-2002 and 2009-2010 in the overall population (demography-adjusted incidence ratio 0.82; 95% confidence interval, 0.79 to 0.86) and in most demographic subgroups examined. Mortality rates were 86.7, 41.4, and 34.4 per 100 person-years in the first 3 years of RRT, respectively, compared with 32.3, 20.6, and 21.3 in matched controls without multiple myeloma. Unadjusted mortality hazards ratios declined monotonically after 2004 to a value of 0.72; 95% confidence interval, 0.67 to 0.77 in 2009-2010, and declines between 2001-2002 and 2008-2009 were observed (P<0.05) in most demographic subgroups examined. Findings were similar when adjustment was made for demographic characteristics, comorbidity markers, and laboratory test values. These data suggest the incidence of RRT from multiple myeloma in the United States has decreased in the last decade, and clinically meaningful increases in survival have occurred for these patients.
尽管在过去十年中多发性骨髓瘤的治疗方法发生了显著变化，但尚不清楚因多发性骨髓瘤导致的终末期肾病（ESRD）负担是否有所改变，以及接受肾脏替代治疗（RRT）的多发性骨髓瘤患者的生存率是否有所提高。关于在美国因多发性骨髓瘤需要进行RRT的ESRD，我们评估了2001年至2010年期间人口统计学调整发病率比值相对于2001 - 2002年发病率的时间趋势，以及RRT开始后的死亡风险相对于2001 - 2002年风险的时间趋势。在这项回顾性队列研究中，我们使用了2001 - 2010年的美国肾脏数据系统数据库（n = 1,069,343），以识别接受RRT治疗的因多发性骨髓瘤导致ESRD的患者（n = 12,703）。在总体人群以及大多数所检查的人口统计学亚组中，2001 - 2002年至2009 - 2010年期间，因多发性骨髓瘤导致的ESRD的人口统计学调整发病率比值下降（人口统计学调整发病率比值为0.82；95%置信区间，0.79至0.86）。RRT治疗的前3年死亡率分别为每100人年86.7、41.4和34.4，而无多发性骨髓瘤的匹配对照组为32.3、20.6和21.3。未调整的死亡风险比值在2004年后单调下降，到2009 - 2010年降至0.72；95%置信区间，0.67至0.77，并且在大多数所检查的人口统计学亚组中观察到2001 - 2002年至2008 - 2009年期间的下降（P < 0.05）。在对人口统计学特征、合并症标志物和实验室检查值进行调整后，结果相似。这些数据表明，在过去十年中，美国因多发性骨髓瘤进行RRT的发病率有所下降，并且这些患者的生存率出现了具有临床意义的提高。
