Koniman Riece, Teo Su Hooi, Kaushik Manish, Nagarajan Chandramouli, Tan Melinda Si Yun, Tan Han Khim, Ramirez Maria Erika Gapas, Lim Cynthia Ciwei
Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Department of Haematology, Singapore General Hospital, Singapore, Singapore.
Semin Dial. 2023 Jan;36(1):12-17. doi: 10.1111/sdi.13115. Epub 2022 Jul 15.
Patients with multiple myeloma and high serum levels of circulating free light chains (FLC) have increased risk of acute kidney injury (AKI) secondary to cast nephropathy and is associated with poor survival. Despite removal of FLC by medium cutoff (MCO) dialyzer, the role of MCO hemodialysis (HD) in the treatment of cast nephropathy and its clinical benefits remain unknown.
A systematic review was conducted to establish the effectiveness of MCO dialyzer and clinical outcomes, compared to other forms of dialyzers in the removal of FLC, in myeloma patients with AKI. The primary outcome was effectiveness of MCO-HD in reducing serum FLC. The secondary outcomes were HD independence, estimated glomerular filtrate rate, mortality rates, length of hospitalization, rebound of serum FLC before the next dialysis, removal of other molecules during dialysis, and adverse events.
We identified three case series, with a total of 17 patients. There were no randomized controlled trials (RCTs) or cohort studies. These case series showed that MCO dialyzer was effective in the removal of FLC and led to a reduction in FLC concentration post-dialysis. The majority of the case series did not have comparator arm and renal and/or other clinical outcomes.
MCO dialyzer appeared to be effective in the removal of FLC based on the existing limited data. However, more data, particularly large-scale RCTs, are needed to assess the use of MCO dialyzer in reducing serum FLC and its effect on clinical outcomes in patients with multiple myeloma and AKI.
多发性骨髓瘤患者且循环游离轻链（FLC）血清水平较高者，继发于管型肾病的急性肾损伤（AKI）风险增加，且与生存率低相关。尽管采用中分子截留（MCO）透析器可清除FLC，但MCO血液透析（HD）在管型肾病治疗中的作用及其临床益处仍不明确。
进行一项系统评价，以确定与其他形式透析器相比，MCO透析器在清除AKI骨髓瘤患者FLC方面的有效性及临床结局。主要结局是MCO-HD降低血清FLC的有效性。次要结局包括脱离HD、估计肾小球滤过率、死亡率、住院时间、下次透析前血清FLC的反弹、透析期间其他分子的清除以及不良事件。
我们确定了3个病例系列，共17例患者。没有随机对照试验（RCT）或队列研究。这些病例系列表明，MCO透析器在清除FLC方面有效，并导致透析后FLC浓度降低。大多数病例系列没有对照臂以及肾脏和/或其他临床结局。
根据现有有限数据，MCO透析器似乎在清除FLC方面有效。然而，需要更多数据，尤其是大规模RCT，以评估MCO透析器在降低多发性骨髓瘤和AKI患者血清FLC中的应用及其对临床结局的影响。
