Citrate Extended High Cut-Off Hemodiafiltration for Renal Recovery in Patients With Multiple Myeloma.
We proposed a combination of convective and diffusive transport mechanisms as high cut-off (HCO) post-dilution hemodiafiltration dialysis technique to optimize serum immunoglobulin free light chains (FLCs) removal which may improve dialysis dependent renal failure in patients with multiple myeloma. To reduce bleeding risk regional citrate anticoagulation was successfully used for the first 7 h followed by 1 h anticoagulant-free hemodiafiltration to avoid citrate accumulation. We retrospectively assessed the effect of FLCs reduction on the renal outcome of 28 patients treated with 133 citrate extended post-dilution HCO (Theralite 2100; Gambro, Lund, Sweden) hemodiafiltration sessions between 2010 and 2016. Renal recovery was demonstrated in 61% of all patients. Twenty-three patients achieved more than 50% reduction of FLCs concentrations and 88% of those became dialysis independent. Our experience supports the extended citrate HCO hemodiafiltration as a good treatment strategy that enable a sustained reduction in serum FLCs concentration and recovery of renal function.
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Andreja
A
Marn Pernat
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Bojan
B
Medved
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Jakob
J
Gubenšek
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Vladimir
V
Premru
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Bojan
B
Knap
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Jadranka
J
Buturovic-Ponikvar
University Medical Center Ljubljana, Department of Nephrology, Ljubljana, Slovenia.
Rafael
R
Ponikvar
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019343:Citric Acid / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000925:Anticoagulants; D007147:Immunoglobulin Light Chains; D019343:Citric Acid
Acute kidney injury; Citrates; Hemodiafiltration; Multiple myeloma