Intensive Dialysis Restores Renal Function in Myeloma
Dialysis success hinges on effective concurrent chemotherapy
FRIDAY, April 3 (HealthDay News) -- An intensive dialysis regimen can restore renal function in patients with multiple myeloma-induced cast nephropathy, but only when there is effective concurrent chemotherapy, according to research published in the April 1 issue of the Clinical Journal of the American Society of Nephrology.
Colin A. Hutchison, M.D., of University Hospital in Birmingham, United Kingdom, and colleagues used a high cut-off dialyzer (HCO-HD) to treat 19 multiple myeloma patients with cast nephropathy and resulting high serum levels of free light chains (FLC). The rigorous dialysis schedule began with eight-hour sessions daily for five days, then eight hours on alternate days for 12 days, then six hours three times per week thereafter. Standard chemotherapies were conducted concurrently.
In 13 of the patients, there were early reductions in FLC serum concentrations (median 85 percent), and those patients became dialysis-independent at a median of 27 days, the researchers report. Six patients contracted infections that interrupted their chemotherapy and did not have improved FLC concentrations. One of those restarted chemotherapy and became dialysis-independent at 105 days. The remaining patients did not recover renal function during the study period, the authors note.
"These results support the finding of previous mathematical modeling, which indicated that sustained reductions in serum FLC concentrations require effective chemotherapy. Direct removal of FLCs by HCO-HD in this setting may then lead to more rapid lowering of FLCs. However, it is not clear that HCO-HD will provide an additional clinical benefit over standard high-flux HD," Hutchison and colleagues write.
One of the study authors is affiliated with The Binding Site Ltd., of Birmingham, United Kingdom, a supplier of dialysis equipment.