Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients
Open Access
- 15 June 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Nephrology
- Vol. 21 (1), 1-8
- https://doi.org/10.1186/s12882-020-01885-8
Abstract
BackgroundAcute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss.MethodsThis is an observational study (2012 to 2018) including nine patients with MM (5 kappa, 4 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5min after initiation of the session and 5min before the end of the procedure.ResultsThe serum levels of kappa and lambda were reduced by a 57.610% and 33.5 +/- 25% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2 and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7 and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 33.3% recovered renal function, 22.2% died during the first year and 44.4% required maintenance dialysis.Conclusions p id=Par Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.Other Versions
This publication has 37 references indexed in Scilit:
- High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): a phase 2 randomised controlled trialThe Lancet Haematology, 2019
- Haemodiafiltration with ultrafiltrate regeneration in the removal of free light chains in multiple myeloma and acute kidney injuryNefrología, 2018
- Renal recovery after severe acute kidney injury in critically ill myeloma patients: a retrospective studyClinical Kidney Journal, 2017
- Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control StudyPLOS ONE, 2016
- International Myeloma Working Group updated criteria for the diagnosis of multiple myelomaThe Lancet Oncology, 2014
- EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERYMediterranean Journal of Hematology and Infectious Diseases, 2013
- Management of myeloma-associated renal dysfunction in the era of novel therapiesExpert Review of Hematology, 2012
- Immunoglobulin free light chain levels and recovery from myeloma kidney on treatment with chemotherapy and high cut-off haemodialysisNephrology Dialysis Transplantation, 2012
- Serum Free‐Light Chain Removal by High Cutoff Hemodialysis: Optimizing Removal and Supportive CareArtificial Organs, 2008
- Efficient Removal of Immunoglobulin Free Light Chains by Hemodialysis for Multiple MyelomaJournal of the American Society of Nephrology, 2007