Update on the treatment of acute renal failure secondary to multiple myeloma, our experience in 27 cases treated with High Cut Off filters

Abstract

Introduction: Acute renal failure is a frequent complication of multiple myeloma that can affect 18 to 56% of patients and more than 10% will end up needing dialysis. Improved kidney function is also associated with longer survival, so we must eliminate the free light chains responsible for cast nephropathy as quickly as possible. Material and methods: A retrospective analysis of the 27 treatments that were performed with hemodialysis with High Cut Off filters to 24 patients (and 3 recurrences) was carried out in the period between July 2011 and May 2018. 288 sessions were performed in total with an average of 10.66 sessions/treatment. Results: At the end of treatment, 23 of the 27 cases (85.2%) recovered kidney function to allow living independently of dialysis (GFR >15 mL/min), 4 patients needed to continue on dialysis. At 3 months, the number of patients who remained independent of dialysis was 20 of the 27 treated cases (74.1%), 3 patients died before 3 months (11%) due to complications related to myeloma, but without dialysis. Reviewing our data in May 2018, after almost 7 years of having started this type of treatment, we saw that 50% of patients lived without the need for dialysis. Conclusions: Given our experience, we believe that prolonged hemodialysis with High Cut Off filters is effective, safe and with a high rate of renal recovery. Albumin loss during hemodialysis was not a major problem.