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Abstract: SA-PO051

Use of Medium Cut-Off Dialyzers in AKI Associated With Multiple Myeloma

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Zonoozi, Shahrzad, The George Washington University Hospital, Washington, District of Columbia, United States
  • Nakity, Rasha, The George Washington University Hospital, Washington, District of Columbia, United States
  • Collins, Ashte K., The George Washington University Hospital, Washington, District of Columbia, United States
  • Regunathan-Shenk, Renu, The George Washington University Hospital, Washington, District of Columbia, United States
  • Rangaswami, Janani, The George Washington University Hospital, Washington, District of Columbia, United States
Introduction

The pathogenesis of myeloma cast nephropathy (MCN) involves precipitation of serum free light chains (FLC) with uromodulin leading to acute kidney injury (AKI). The benefits of rapidly removing circulating FLC in MCN has not been established. Available literature suggests that along with chemotherapy, intensive hemodialysis using high and medium cut off (MCO) dialyzers is associated with a larger reduction in FLC and a higher rate of renal recovery compared to high flux dialyzers.

Case Description

We describe two patients with multiple myeloma (MM) and AKI requiring kidney replacement therapy (KRT) who along with chemotherapy were managed with MCO dialyzers (Theranova 400).

Patient 1 is a 72 year old male with history of IgG lambda MM and CKD 4 with dialysis-dependent AKI and work up revealed elevated lambda FLC.

Patient 2 is a 58 year old male with history of IgG kappa MM treated with stem cell transplantation and chemotherapy presenting for ongoing care for COVID-19 infection. Course was complicated by respiratory failure, infections and AKI. Rising kappa FLC led to patient receiving chemotherapy.

Table 1 shows the trend of albumin, kappa and lambda FLC. MCO dialyzer was initiated on Day 0. After use of MCO dialyzer, Patient 1 had a reduction in lambda FLC of 377.5mg/L and albumin of 0.4g/dL while Patient 2 had an increase in kappa FLC of 3168mg/L and albumin of 0.8g/dL. During follow up neither patient had signs of recovery of kidney function.

Discussion

The utility of MCO dialyzers in the management of MCN remains unclear. In our patients, one had a reduction in FLC burden while the other had an increase. Further longitudinal research is required to elucidate the utility of MCO dialyzers in patients with MM.

Table 1. Trend of albumin, β2M and serum free light chains with use of medium cut off dialyzer and other treatments
FLC-k = kappa free light chain; FLC-l = lambda free light chain; β2M = beta 2 microglobulin, PLEX = plasmapheresis; D = daratumumab; VD = bortezomib (velcade) and dexamethasone; CyBorD = cyclophosphamide, bortezomib, dexamethasone; dexa = dexamethasone; MCO = medium cut off dialyzer