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Abstract: TH-PO343

Renal Survival in Patients with Multiple Myeloma Requiring Renal Replacement Therapy – A Single Centre Experience

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ratnayake, Aruni, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Srikantharajah, Mukunthan, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Stern, Simon C., Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
  • Makanjuola, David, Epsom and St Helier University Hospitals NHS Trust, London, United Kingdom
Background

Renal impairment is a recognised complication of multiple myeloma (MM). The incidence of renal impairment at diagnosis of MM ranges between 20-50%; of these, approximately 10% present with acute kidney injury (AKI) requiring renal replacement therapy (RRT). Advances in MM treatments have improved overall patient survival and can result in complete or partial recovery of renal function. We reviewed outcomes of patients with MM requiring RRT over a 14 year period.

Methods

Patients diagnosed with MM requiring RRT between January 2003 and December 2017 were identified. Patient data was obtained from electronic records.

Results

38 patients met the inclusion criteria. Median age was 62 years (range 45-86); 53% were male, 76% were Caucasian. Median follow up time was 37 months (range 6–168 months).

55% required RRT at presentation with a new diagnosis of MM. Of the rest, 21% started RRT within a year of diagnosis and 24% started RRT >12 months after diagnosis. Additional factors contributing to initiating RRT included infection (21%), hypercalcaemia (13%) and fluid overload (10%). Median creatinine at start of RRT was 550µmol/l (range 235-1372µmol/l). 37% of all patients had a renal biopsy, which identified cast nephropathy (43%), amyloidosis (43%), light chain deposition disease (7%), and other diagnoses (7%).

44% of patients requiring RRT at presentation recovered sufficient renal function to stop RRT, with a median time to dialysis independence of 1 month (range 1 week - 21 months) and median eGFR 42 mls/minute (range 12-78mls/minute). Only 6% of the cohort who required dialysis later (not at presentation) recovered adequate renal function to stop dialysis.

Overall 1 year survival was 93% (N=36), and 5 year survival was 48% (N=21). 47% of all patients had died by the end of 2017; of these, 94% were dialysis-dependent at time of death, with a median time on dialysis of 1 year (range <1 week to 8 years).

Conclusion

In our cohort, more patients (55%) presented with AKI requiring RRT at the time of diagnosis of myeloma than in published literature (10% in Evison et al, British Journal of Haematology 2016); 44% of these patients became dialysis-independent. Our data demonstrates a positive correlation between recovery of renal function and reduced mortality, further reinforcing the importance of prompt treatment of myeloma.