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Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.
- Source :
-
BMC nephrology [BMC Nephrol] 2020 Jun 15; Vol. 21 (1), pp. 227. Date of Electronic Publication: 2020 Jun 15. - Publication Year :
- 2020
-
Abstract
- Background: Acute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss.<br />Methods: This is an observational study (2012 to 2018) including nine patients with MM (5 kappa, 4 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 min after initiation of the session and 5 min before the end of the procedure.<br />Results: The serum levels of kappa and lambda were reduced by a 57.6 ± 10% and 33.5 ± 25% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2 and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7 and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 33.3% recovered renal function, 22.2% died during the first year and 44.4% required maintenance dialysis.<br />Conclusions: Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.
- Subjects :
- Acute Kidney Injury etiology
Acute Kidney Injury therapy
Aged
Aged, 80 and over
Creatinine blood
Female
Humans
Male
Middle Aged
Multiple Myeloma complications
Acute Kidney Injury blood
Hemodiafiltration methods
Immunoglobulin kappa-Chains blood
Immunoglobulin lambda-Chains blood
Multiple Myeloma blood
Serum Albumin analysis
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2369
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 32539688
- Full Text :
- https://doi.org/10.1186/s12882-020-01885-8