title: Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis.
abstract: OBJECTIVE
  Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France.
  
  
  METHODS
  All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed.
  
  
  RESULTS
  We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97).
  
  
  CONCLUSIONS
  Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.
authors.affiliation: Departments of *Nephrology.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Decourt
authors.affiliation: Departments of *Nephrology.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Gondouin
authors.affiliation: Public Health, and.
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Delaroziere
authors.affiliation: Departments of *Nephrology.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brunet
authors.affiliation: Departments of *Nephrology.
authors.forename: Marion
authors.initials: M
authors.lastname: Sallée
authors.affiliation: Departments of *Nephrology.
authors.forename: Stephane
authors.initials: S
authors.lastname: Burtey
authors.affiliation: Departments of *Nephrology.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.affiliation: Immuno-Hematology, Assistance Publique-Hôpitaux de Marseille, Conception Hospital, Aix-Marseille University, Marseille, France; and.
authors.forename: Vadim
authors.initials: V
authors.lastname: Ivanov
authors.affiliation: Immuno-Hematology, Assistance Publique-Hôpitaux de Marseille, Conception Hospital, Aix-Marseille University, Marseille, France; and.
authors.forename: Regis
authors.initials: R
authors.lastname: Costello
authors.affiliation: French Biomedical Agency, Renal Epidemiology and Information Network Registry, St. Denis, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: Departments of *Nephrology, noemie.jourde@ap-hm.fr.
authors.forename: Noemie
authors.initials: N
authors.lastname: Jourde-Chiche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007147:Immunoglobulin Light Chains
keywords: amyloidosis; chronic kidney disease; end stage kidney disease; humans; kidney transplantation; light chain deposition disease; monoclonal gammopathy; multiple myeloma; paraproteinemias; renal dialysis