Nephrol Dial Transplant Vol. 19 No. 12 © ERA-EDTA 2004; all rights reserved
Letter
Timing of acute renal failure in multiple myeloma: two distinct outcomes?
Sir,It is known that renal failure carries a poor prognosis to patients with multiple myeloma (MM), reducing the survival from 36 to 18 months [1]. The prognosis is even worse in patients without renal function recovery [2,3]. Most studies addressed patients with renal failure and newly diagnosed MM. To our knowledge, there is no information on the outcome of patients who develop acute renal failure during MM chemotherapy.
We retrospectively studied 26 patients with MM and renal failure, admitted to a university hospital, between 1998 and 2003. Patients with known chronic renal failure or those who were submitted to bone marrow transplantation were excluded. We compared patients who had renal failure at the time of MM diagnosis and had not received any MM treatment (group 1, n = 15) with patients who developed renal failure after MM diagnosis and were already under treatment (group 2, n = 11). Statistical analysis was performed using unpaired t-test, 
2 test and Kaplan–Meier survival curve.
The frequency of severe infection, need for ICU, mechanical ventilation or vasoactive agents was similar. Also the distribution of MM classes was similar in both groups: 7/15 IgG, 2/15 IgA, 1/15 IgM and 4/15 light chain in group 1 compared with 6/11, 2/11, 0/11 and 3/11 in group 2. Group 1 presented higher levels of serum ß2-microglobulin (25.4±4.1 vs 8.7±3.4 mg/ml, P<0.01) and Bence-Jones proteinuria >1 g/24 h (11/11 vs 6/9, P = 0.04), but other markers of MM severity were similar to group 2 (Table 1).
|
Acute renal failure in group 2 was acquired during hospitalization (7/11), while in group 1 the majority of patients presented renal failure already at hospital admission (13/15). In addition, group 1 needed dialysis more often (64% vs 18%, P = 0.04). There was a trend toward a higher peak of plasma creatinine in group 1 as shown in the Table 1. This finding can explain the higher levels of serum ß2-microglobulin in group 1.
Survival was much better in group 1. At 30 days, it was 67% vs 18% (P = 0.01), as shown in the Figure 1. This difference in mortality was not explained by clinical deterioration or MM therapeutic refractoriness.
|
Although preliminary, these results indicate that the timing of renal failure occurrence in relation to chemotherapy strongly affects the prognosis of patients with MM. The prognosis is even worse in patients who develop renal failure during MM chemotherapy.
Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo Disciplina de Nefrologia São Paulo, SP Brazil Email: alexandreliborio{at}yahoo.com.br
References
- Knudsen LM, Hjorth M, Hippe E for the Nordic Myeloma Study Group. Renal failure in multiple myeloma: reversibility and impact on the prognosis. Eur J Haematol 2000; 65: 175–181[CrossRef][ISI][Medline]
- Bernstein SP, Humes HD. Reversible renal insufficiency in multiple myeloma. Arch Intern Med 1982; 142: 2083–2086[Abstract]
- Torra R, Bladé J, Cases A et al. Patients with multiple myeloma requiring long-term dialysis: presenting features, response to therapy and outcome in a series of 20 cases. Br J Haematol 1995; 91: 854–859[ISI][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||