Role of plasmapheresis in the management of myeloma kidney: a systematic review.
Multiple myeloma complicated by acute renal failure is a diagnosis often encountered by the practicing nephrologist. The role of plasmapheresis in such patients has been of interest for decades. Three randomized controlled trials (RCTs) and multiple observational trials have evaluated the potential role of plasmapheresis in the management of this condition. This systematic review presents the results of these trials regarding survival benefits, recovery from dialysis, and improvement in renal function. A comprehensive search revealed 56 articles. Of these, only 8 articles met our inclusion criteria (3 RCTs, 1 correction of results, and 4 observational trials). Two of the 3 RCTs showed no difference in survival benefit. Two of the 3 RCTs showed a greater percentage of patients stopping dialysis in the intervention group; however, these results were not reproduced in the largest trial. All the studies showed an improvement in renal function for patients receiving plasmapheresis; however, only 2 RCTs and 1 retrospective study showed a statistically significant improvement in renal function among patients who received plasmapheresis in comparison with a control group. Our systematic review does not suggest a benefit of plasmapheresis independent of chemotherapy for multiple myeloma patients with acute renal failure in terms of overall survival, recovery from dialysis, or improvement in renal function.
Gupta
Diptesh
D
Department of Internal Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA.
Bachegowda
Lohith
L
Phadke
Gautam
G
Boren
Sue
S
Johnson
Diane
D
Misra
Madhukar
M
D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009101:Multiple Myeloma / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D010956:Plasmapheresis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome