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Hudier L, Decaux O, Haddj-Elmrabet A, Lino M, Mandart L, Siohan P, Renaudineau E, Sawadogo T, Lamy De La Chapelle T, Oger E, Bridoux F, Vigneau C. Intensive haemodialysis using PMMA dialyser does not increase renal response rate in multiple myeloma patients with acute kidney injury. Clin Kidney J 2017; 11:230-235. [PMID: 29644064 PMCID: PMC5887381 DOI: 10.1093/ckj/sfx079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023] Open
Abstract
Background Intensive haemodialysis (IHD) in addition to bortezomib-based chemotherapy might be efficient to rapidly decrease serum immunoglobulin-free light chains removal in patients with multiple myeloma (MM) and to improve renal prognosis and survival. Methods The aim of this retrospective multi-centre study was to compare the efficacy (renal recovery rate) of IHD and of standard haemodialysis (SHD) in patients with MM and dialysis-dependent acute kidney injury (AKI), concomitantly treated with bortezomib-based chemotherapy. Results We selected 41 patients with MM and dialysis-dependent AKI, most likely due to myeloma cast nephropathy (MCN), and who were treated in eight French hospitals between January 2007 and June 2011. Patients were classified in two groups according to dialysis regimen: IHD [n = 21, with a mean of 11.3 dialysis sessions all with poly(methyl methacrylate) (PMMA) membranes for 13.2 days] and SHD (n = 20 patients, mostly three times per week, 31% with PMMA membrane). The main outcome was dialysis-independence at 3 months. At 3 months, 15 patients could stop dialysis: 8 (38.1%) in the IHD and 7 (35%) in the SHD group (P = 1). Moreover, 14 (56%) of the 25 patients who did show haematological response and only one of the 16 patients who did not were dialysis-independent (P = 0.002) at 3 months. Conclusions The results of this retrospective study did not show any clear renal benefit of IHD in patients with MM and MCN compared with SHD. Conversely, they underline the importance of the haematological response to chemotherapy for the renal response and patient prognosis.
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Affiliation(s)
- Laurent Hudier
- Centre hospitalier Broussais, Service de Néphrologie-Hémodialyse, Saint-Malo, France
| | - Olivier Decaux
- CHU Rennes, Service de Médecine Interne, Rennes, France
- CHU Rennes, Service de Néphrologie, Rennes, France
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
| | | | - Marie Lino
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
| | - Lise Mandart
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
| | - Pascale Siohan
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
| | - Eric Renaudineau
- Centre hospitalier Broussais, Service de Néphrologie-Hémodialyse, Saint-Malo, France
| | - Theophile Sawadogo
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
| | - Thierry Lamy De La Chapelle
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
- Université de Rennes 1, Inserm U917, Rennes, France
| | - Emmanuel Oger
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
| | - Frank Bridoux
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
| | - Cécile Vigneau
- CHU Rennes, Service de Néphrologie, Rennes, France
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
- Université de Rennes 1, Inserm U917, Rennes, France
- Université de Rennes 1, IRSET, Rennes, France
- Correspondence and offprint requests to: Cécile Vigneau; E-mail:
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