Chang Chao-Feng, Chien Wu-Chien, Chung Chi-Hsiang, Lee Jih-Chin, Hsu Shun-Neng, Chen Jia-Hong
Department of Medicine, Division of Gastroenterology, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan, R.O.C.
Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan, R.O.C.
Oncol Lett. 2018 Aug;16(2):1991-2002. doi: 10.3892/ol.2018.8857. Epub 2018 May 31.
Myeloma-associated kidney disease (MRKD) occurs in ≤40% patients with multiple myeloma (MM). The impact of hemodialysis (HD) on patients with MM was investigated. Between 2000 and 2010, a total of 1,610 patients in Taiwan were enrolled from the National Health Institute Research Database. MM was an independent risk factor for HD following adjustment via multivariate logistic regression analysis (adjusted hazard ratio, 7.347; 95% confidence interval, 6.156-8.768; log-rank test, P<0.001). In addition, a notable decrease in survival rate was determined in patients with MM who underwent HD in the first year since diagnosis of MM. A total of 198 (61.49%) patients received HD in the first year. Patients with MM with a lower frequency of HD in the first year had a relatively good prognosis. The present study confirmed that MM was a risk factor for HD. Significant early mortality in the first year was determined in patients with MM who underwent HD; however, renal recovery following therapeutic management was a prognostic factor. In addition to anti-myeloma therapy, early initiation of HD was beneficial following risk stratification of MRKD; however, an increased probability of recovery of renal function and discontinuation of dialysis, was demonstrated in patients with MM following HD, compared with patients with MM without HD.
骨髓瘤相关性肾病（MRKD）发生于≤40%的多发性骨髓瘤（MM）患者中。研究了血液透析（HD）对MM患者的影响。2000年至2010年期间，从台湾国家卫生研究院研究数据库中纳入了总共1610例患者。经多因素逻辑回归分析调整后，MM是进行HD的独立危险因素（调整后的风险比为7.347；95%置信区间为6.156 - 8.768；对数秩检验，P<0.001）。此外，确诊MM后第一年接受HD的MM患者生存率显著下降。共有198例（61.49%）患者在第一年接受了HD。第一年HD频率较低的MM患者预后相对较好。本研究证实MM是HD的一个危险因素。确诊MM后第一年接受HD的患者确定存在显著的早期死亡率；然而，治疗管理后的肾脏恢复是一个预后因素。除抗骨髓瘤治疗外，在对MRKD进行风险分层后早期开始HD是有益的；然而，与未进行HD的MM患者相比，进行HD的MM患者肾功能恢复和停止透析的可能性增加。
