Bladé J, Fernández-Llama P, Bosch F, Montolíu J, Lens X M, Montoto S, Cases A, Darnell A, Rozman C, Montserrat E
Department of Hematology, Hospital Clinic, University of Barcelona, Biomedical Investigation Institute August Pi i Sunyer, Spain.
Arch Intern Med. 1998 Sep 28;158(17):1889-93. doi: 10.1001/archinte.158.17.1889.
Twenty percent of patients with multiple myeloma (MM) have renal failure.
To analyze the presenting features, the response to therapy, and the factors associated with renal function recovery and survival in 94 patients with MM and renal failure.
Medical records of patients from our institution with MM and renal failure diagnosed between January 1969 and December 1994 were reviewed. The statistical methods consisted of Kaplan-Meier survival curves, the log-rank test, logistic regression analysis, and the Cox proportional hazards model for survival analysis.
Renal failure was observed in 94 (22.2%) of 423 patients. Patients with renal failure had more advanced disease than the others. Patients with renal failure had a lower response rate to chemotherapy than those with normal renal function (39% vs 56%; P<.001). However, when patients dying within the first 2 months of treatment were excluded, no significant differences in the response rate were found between patients with renal failure and those with normal renal function. Renal function recovery was observed in 26% of patients. Serum creatinine level (<354 micromol/L [<4 mg/dL]), serum calcium level (> or =2.88 mmol/L [> or = 11.5 mg/dL]), and amount of proteinuria (< 1 g/24 h) were associated with renal function recovery. Patients who recovered renal function had a median survival of 28 months vs 4 months for those with nonreversible renal failure (P<.001). In the multivariate analysis, only serum creatinine level (P=.003) and response to chemotherapy (P<.001) were correlated with survival.
Renal failure was present in almost one fourth of patients with MM. Patients with reversible renal failure had longer survival than those not recovering renal function. When patients dying within the first 2 months of treatment were excluded, the response rate was not affected by renal function. Factors associated with renal function recovery were degree of renal failure, presence of hypercalcemia, and amount of proteinuria. Response to chemotherapy and severity of renal failure were the only independent factors associated with survival.
20%的多发性骨髓瘤（MM）患者存在肾衰竭。
分析94例MM合并肾衰竭患者的临床表现、治疗反应以及与肾功能恢复和生存相关的因素。
回顾了我院1969年1月至1994年12月期间诊断为MM合并肾衰竭患者的病历。统计方法包括Kaplan-Meier生存曲线、对数秩检验、逻辑回归分析以及用于生存分析的Cox比例风险模型。
423例患者中有94例（22.2%）出现肾衰竭。肾衰竭患者的疾病进展程度比其他患者更严重。肾衰竭患者对化疗的反应率低于肾功能正常的患者（39%对56%；P<0.001）。然而，排除治疗后前2个月内死亡的患者后，肾衰竭患者与肾功能正常的患者在反应率上未发现显著差异。26%的患者肾功能得到恢复。血清肌酐水平（<354微摩尔/升[<4毫克/分升]）、血清钙水平（≥2.88毫摩尔/升[≥11.5毫克/分升]）和蛋白尿定量（<1克/24小时）与肾功能恢复相关。肾功能恢复的患者中位生存期为28个月，而肾功能不可逆的患者为4个月（P<0.001）。多因素分析显示，只有血清肌酐水平（P=0.003）和化疗反应（P<0.001）与生存相关。
近四分之一的MM患者存在肾衰竭。肾功能可逆的患者比肾功能未恢复的患者生存期更长。排除治疗后前2个月内死亡的患者后，反应率不受肾功能影响。与肾功能恢复相关的因素包括肾衰竭程度、高钙血症的存在以及蛋白尿定量。化疗反应和肾衰竭严重程度是与生存相关的仅有的独立因素。
