Hudier Laurent, Decaux Olivier, Haddj-Elmrabet Atmann, Lino Marie, Mandart Lise, Siohan Pascale, Renaudineau Eric, Sawadogo Theophile, Lamy De La Chapelle Thierry, Oger Emmanuel, Bridoux Frank, Vigneau Cécile
Centre hospitalier Broussais, Service de Néphrologie-Hémodialyse, Saint-Malo, France.
CHU Rennes, Service de Médecine Interne, Rennes, France.
Clin Kidney J. 2018 Apr;11(2):230-235. doi: 10.1093/ckj/sfx079. Epub 2017 Aug 22.
Intensive haemodialysis (IHD) in addition to bortezomib-based chemotherapy might be efficient to rapidly decrease serum immunoglobulin-free light chains removal in patients with multiple myeloma (MM) and to improve renal prognosis and survival.
The aim of this retrospective multi-centre study was to compare the efficacy (renal recovery rate) of IHD and of standard haemodialysis (SHD) in patients with MM and dialysis-dependent acute kidney injury (AKI), concomitantly treated with bortezomib-based chemotherapy.
We selected 41 patients with MM and dialysis-dependent AKI, most likely due to myeloma cast nephropathy (MCN), and who were treated in eight French hospitals between January 2007 and June 2011. Patients were classified in two groups according to dialysis regimen: IHD [ = 21, with a mean of 11.3 dialysis sessions all with poly(methyl methacrylate) (PMMA) membranes for 13.2 days] and SHD ( = 20 patients, mostly three times per week, 31% with PMMA membrane). The main outcome was dialysis-independence at 3 months. At 3 months, 15 patients could stop dialysis: 8 (38.1%) in the IHD and 7 (35%) in the SHD group (P = 1). Moreover, 14 (56%) of the 25 patients who did show haematological response and only one of the 16 patients who did not were dialysis-independent (P = 0.002) at 3 months.
The results of this retrospective study did not show any clear renal benefit of IHD in patients with MM and MCN compared with SHD. Conversely, they underline the importance of the haematological response to chemotherapy for the renal response and patient prognosis.
在基于硼替佐米的化疗基础上进行强化血液透析（IHD），可能有助于快速降低多发性骨髓瘤（MM）患者血清游离免疫球蛋白轻链水平，改善肾脏预后和生存情况。
这项回顾性多中心研究旨在比较IHD和标准血液透析（SHD）对MM合并依赖透析的急性肾损伤（AKI）患者的疗效（肾脏恢复率），这些患者同时接受基于硼替佐米的化疗。
我们选取了41例MM合并依赖透析的AKI患者，最可能病因是骨髓瘤管型肾病（MCN），这些患者于2007年1月至2011年6月期间在法国8家医院接受治疗。根据透析方案将患者分为两组：IHD组（n = 21，平均进行11.3次透析，均使用聚甲基丙烯酸甲酯（PMMA）膜，持续13.2天）和SHD组（n = 20例患者，大多每周3次，31%使用PMMA膜）。主要观察指标是3个月时停止透析。3个月时，15例患者可停止透析：IHD组8例（38.1%），SHD组7例（35%）（P = 1）。此外，25例出现血液学缓解的患者中有14例（56%）在3个月时无需透析，而16例未出现血液学缓解的患者中只有1例（P = 0.002）。
这项回顾性研究结果表明，与SHD相比，IHD对MM合并MCN患者未显示出明显的肾脏益处。相反，研究强调了化疗的血液学缓解对肾脏恢复及患者预后的重要性。
