Factors associated with recovery of renal function in patients with multiple myeloma who were treated with hemodialysis.
BACKGROUND
The presence of renal failure in patients with multiple myeloma (MM) has been considered an ominous prognostic factor associated with a significantly decreased life expectancy. The prognostic factors have seldom been analyzed to predict discontinuation of hemodialysis (HD) therapy in MM patients with renal failure after HD initiation. It is clinically very important to predict whether HD can be discontinued after introducing HD in such patients.


METHODS
All medical and HD records were reviewed in MM patients who underwent HD in the National Center for Global Health and Medicine Hospital between January 1995 and May 2009. Thirty-two patients with MM had undergone HD. The clinical features and the factors that might be associated with recovery of renal function leading to discontinuation of HD in MM patients with severe renal failure were examined.


RESULTS
The factors associated with recovery of renal function and discontinuation of HD were: low International Staging System (ISS) score (p = 0.0034); high response to chemotherapy (p = 0.036); low serum Ca (p = 0.006); low Cr (p = 0.019), and low serum β₂-microglobulin (sβ₂M) (p = 0.002). On multivariate analysis, low serum Ca and sβ₂M were significantly associated with HD discontinuation. Moreover, discontinuing HD was the significant factor associated with improved overall survival in MM patients who required HD at least once.


CONCLUSIONS
sβ₂M and Ca were the laboratory parameters that were significant, independent prognostic factors for predicting the probability of recovery from severe renal failure and discontinuation of HD in MM patients who needed HD at least once.
Katagiri
Daisuke
D
Department of Nephrology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.
Hagiwara
Shotaro
S
Minami
Eri
E
Katsuma
Ai
A
Masumoto
Shoichi
S
Hoshino
Taro
T
Inoue
Tsuyoshi
T
Shibata
Maki
M
Tada
Manami
M
Nakamura
Taichi
T
Shimbo
Takuro
T
Hinoshita
Fumihiko
F
D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D015999:Multivariate Analysis; D009607:Nitrosourea Compounds / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D006435:Renal Dialysis; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D001613:beta 2-Microglobulin / Q000097:blood
D015415:Biomarkers; D009607:Nitrosourea Compounds; D001613:beta 2-Microglobulin; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D011239:Prednisolone; D003404:Creatinine; D008558:Melphalan; C020766:ranimustine; D002118:Calcium