title: Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.
abstract: High-cut-off hemodialysis (HCO-HD) can effectively reduce high concentrations of circulating serum free light chains (sFLC) in patients with dialysis-dependent acute kidney injury (AKI) due to multiple myeloma (MM). Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD) or HCO-HD.
  
  
  
  The final cohort consisted of 59 patients treated with HCO-HD (n = 42) or conv. HD (n = 17). A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3%) compared with conv. HD patients (29.4%; p = 0.007). The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014). Multivariate regression and decision tree analysis (recursive partitioning) revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI) 1.5-24.5], p = 0.011) and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045) as independent and paramount variables associated with a favorable renal outcome.
  
  
  
  In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Gerth
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Michele
authors.initials: M
authors.lastname: Pohlen
authors.affiliation: Institute of Biostatistics and Clinical Research, University Hospital of Muenster, Muenster, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Görlich
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Thölking
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kropff
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Pavenstädt
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Brand
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital of Muenster, Muenster, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kümpers
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000503:physiopathology*; D017582:Renal Replacement Therapy