Webster Angela C, Irish Ashley B, Kelly Patrick J
Sydney School of Public Health, University of Sydney, New South Wales, Australia.
Centre for Transplant and Renal research, Westmead Hospital, Westmead, New South Wales, Australia.
Nephrology (Carlton). 2018 Mar;23(3):217-225. doi: 10.1111/nep.12985.
It is unclear whether recent advances in myeloma therapy have improved survival for all those with myeloma and end stage kidney disease (ESKD).
Population-based registry cohort study using Australia and New Zealand Dialysis and Transplant Registry data 1963-2013. We measured survival of people with myeloma and other plasma cell dyscrasias and ESKD over time, and investigated prognostic factors for improved survival using survival analysis (results expressed as hazard ratios (HR) with 95% confidence intervals).
We included 65 940 people (207 595 person-years); 1067 people (1.6%) with myeloma and 572 (0.9%) with other plasma cell dyscrasia. Myeloma ESKD rose from 0.8% before 1994 to 2.2% in 2004 and remained stable. People with myeloma were older, and age increased over time, from 62.5 before 1994 to 70.1 years from 2010, but the non-myeloma group age increased more steeply (52.0 before 1994; 62.2 from 2010). In myeloma patients, survival improved (P < 0.001) with recent predicted 5 year survival of 27.5% aged <55, 32.2% aged 55-64, 16.3% for 65-74 and 12.7% aged ≥75 years. Survival did not improve for plasma cell dyscrasia patients (P = 0.70). Myeloma patients on peritoneal dialysis had improved survival compared with those on haemodialysis (HR 0.7, CI 0.6-0.9), but those aged ≥65 had poorer survival (65-74 years HR 1.5, CI1.2-1.9; ≥75 HR 1.7, CI1.3-2.1), as did diabetics (HR 1.3, CI1.1-1.6).
The proportion of people with myeloma and ESKD remains stable, but their survival has progressively improved in Australia and New Zealand. On starting ESKD treatment with myeloma, a 59 year old without diabetes on peritoneal dialysis can expect a 45% 5 year survival, where a 75-year-old diabetic on haemodialysis has 9% 5 year survival.
骨髓瘤治疗方面的最新进展是否改善了所有骨髓瘤合并终末期肾病（ESKD）患者的生存率尚不清楚。
基于人群的登记队列研究，使用1963 - 2013年澳大利亚和新西兰透析与移植登记数据。我们测量了骨髓瘤及其他浆细胞异常增生合并ESKD患者随时间的生存率，并使用生存分析研究改善生存的预后因素（结果以风险比（HR）及95%置信区间表示）。
我们纳入了65940人（207595人年）；1067人（1.6%）患有骨髓瘤，572人（0.9%）患有其他浆细胞异常增生。骨髓瘤合并ESKD的比例从1994年前的0.8%升至2004年的2.2%，并保持稳定。骨髓瘤患者年龄较大，且随时间推移年龄增加，从1994年前的62.5岁增至2010年的70.1岁，但非骨髓瘤组年龄增长更为陡峭（1994年前为52.0岁；2010年为62.2岁）。在骨髓瘤患者中，生存率有所提高（P < 0.001），近期预测的5年生存率为：年龄<55岁者为27.5%，55 - 64岁者为32.2%，65 - 74岁者为16.3%，≥75岁者为12.7%。浆细胞异常增生患者的生存率未改善（P = 0.70）。接受腹膜透析的骨髓瘤患者比接受血液透析的患者生存率更高（HR 0.7，CI 0.6 - 0.9），但年龄≥65岁者生存率较差（65 - 74岁HR 1.5，CI 1.2 - 1.9；≥75岁HR 1.7，CI 1.3 - 2.1），糖尿病患者也是如此（HR 1.3，CI 1.1 - 1.6）。
在澳大利亚和新西兰，骨髓瘤合并ESKD患者的比例保持稳定，但其生存率已逐步提高。对于一名59岁、无糖尿病且接受腹膜透析的骨髓瘤患者，在开始ESKD治疗时，其5年生存率预计为45%，而一名75岁、患有糖尿病且接受血液透析的患者5年生存率为9%。
