title: Serum free-light chain removal by high cutoff hemodialysis: optimizing removal and supportive care.
abstract: In multiple myeloma the predominant cause of irreversible renal failure is cast nephropathy, secondary to excess kappa or lambda serum free light chains (FLCs). These molecules are efficiently cleared by hemodialysis (HD) using the Gambro HCO 1100 dialyzer. To optimize the removal of FLCs by this dialyzer we have studied the effect of dialyzers in series, dialyzer change, and hemodiafiltration in 14 patients with multiple myeloma and renal failure. The clearance rates of both kappa FLCs and lambda FLCs were significantly increased on two dialyzers from 19 (7.3-34)-15.3 (9-28) mL/min to 47 (17-79)-35.5 (20-57) mL/min, respectively. Clearance rates of both FLCs decreased over the course of the dialysis sessions (both P < 0.001). Changing the dialyzer during a HD session increased lambda FLC clearance rates (22.5 [6-41] to 37.6 [9-52] mL/min; P < 0.001) and decreased kappa FLC clearance rates (39.6 [9-72] to 19 [8-59] mL/min; P < 0.003). Ultrafiltration during HD increased the clearance rates of kappa FLCs (R 0.52, P < 0.01) but not lambda FLCs (R -0.25; P < 0.076). Hemodiafiltration increased the clearance rates of both kappa (19 [SD 6.8] to 32 [SD 9.8] mL/min) and lambda FLCs (15 [SD 7.8] to 20 [SD 7.7] mL/min). Albumin replacement requirements for 8 h of HD increased from 12 g for a single dialyzer to 45 g for two dialyzers in series (P < 0.001). Different protocols are required to optimize the removal of kappa and lambda FLCs in patients with myeloma and renal failure.
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital, UK. me@colinhutchison.com
authors.forename: Colin A
authors.initials: CA
authors.lastname: Hutchison
authors.forename: Stephen
authors.initials: S
authors.lastname: Harding
authors.forename: Graham
authors.initials: G
authors.lastname: Mead
authors.forename: Hermann
authors.initials: H
authors.lastname: Goehl
authors.forename: Markus
authors.initials: M
authors.lastname: Storr
authors.forename: Arthur
authors.initials: A
authors.lastname: Bradwell
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
mesh_terms: D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000097:blood / Q000302:isolation & purification*; D007146:Immunoglobulin lambda-Chains / Q000097:blood / Q000302:isolation & purification*; D009101:Multiple Myeloma / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy*; D044967:Serum / Q000737:chemistry; D012709:Serum Albumin / Q000032:analysis
chemical_list: D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D012709:Serum Albumin