Schaaf Christian W, Braunisch Matthias C, Holzmann-Littig Christopher, Pfister Frederick, Hannemann Liya, Hausinger Renate I, Verbeek Mareike, Schmaderer Christoph, Renders Lutz, Heemann Uwe, Küchle Claudius
Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
Department of Nephropathology of the Institute of Pathology, School of Medicine, University of Erlangen, Erlangen, Germany.
Front Oncol. 2023 Sep 8;13:1193504. doi: 10.3389/fonc.2023.1193504. eCollection 2023.
We determined the efficacy of free light chain (FLC) removal by regular dialysis equipment (high-flux filtration) with medium cutoff (MCO) membrane hemodialysis (HD) as an adjuvant treatment to standard chemotherapy for patients with acute kidney injury complicating multiple myeloma (MM) and its impact on further dialysis dependency.
Sixty patients with acute dialysis-dependent renal failure secondary to MM were treated with MCO-HD (55 patients) or HCO (high cutoff)-HD (5 patients) as a control. FLC serum concentration, total protein, immunoglobulins, and LDH were measured throughout the dialysis therapy. The kidney function of the patients was followed up for 1 year.
The median age was 69 years; 25 female and 35 male patients were enrolled. HD significantly reduced FLC kappa levels in the MCO/HCO group by 58%/84% (MCO/HCO group; < 0.05) and FLC lambda by 39%/33% (MCO/HCO group; < 0.05). Single HD data (MCO) showed a relative reduction of 70% in kappa and 37% in lambda FLC concentration, as expected by the different sizes of the light chains. Renal function improved significantly and continuously from starting creatinine 5.7/3.8 mg/dl (MCO/HCO group) before HD to 1.4/2.0 mg/dl (MCO/HCO group; < 0.001) after 1 year. No significant alteration of total protein, immunoglobulins, and LDH concentrations by HD (HCO and MCO group) was observed. After 1 year, 37 of 60 patients were alive and 34 of them were off dialysis.
FLC elimination with MCO-HD is effective, technically easy, and less cost-intensive as compared with HCO-HD. Kidney function recovery in MM patients is achievable.
我们确定了使用具有中等截留量（MCO）膜的常规透析设备（高通量过滤）进行血液透析（HD）清除游离轻链（FLC）作为急性肾损伤合并多发性骨髓瘤（MM）患者标准化疗辅助治疗的疗效及其对进一步透析依赖的影响。
60例因MM导致急性透析依赖性肾衰竭的患者接受MCO-HD（55例患者）或HCO（高截留量）-HD（5例患者）作为对照治疗。在整个透析治疗过程中测量FLC血清浓度、总蛋白、免疫球蛋白和乳酸脱氢酶。对患者的肾功能进行了1年的随访。
中位年龄为69岁；纳入25例女性和35例男性患者。HD使MCO/HCO组的FLC κ水平显著降低58%/84%（MCO/HCO组；P<0.05），FLC λ水平降低39%/33%（MCO/HCO组；P<0.05）。单次HD数据（MCO）显示κ和λ FLC浓度分别相对降低70%和37%，这与轻链的不同大小预期一致。肾功能从HD前的肌酐5.7/3.8 mg/dl（MCO/HCO组）显著且持续改善至1年后的1.4/2.0 mg/dl（MCO/HCO组；P<0.001）。未观察到HD（HCO和MCO组）对总蛋白、免疫球蛋白和乳酸脱氢酶浓度有显著改变。1年后，60例患者中有37例存活，其中34例不再需要透析。
与HCO-HD相比，MCO-HD清除FLC有效、技术操作简便且成本较低。MM患者的肾功能恢复是可以实现的。
