Comment on "Haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma"
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2. the importance of rapid reduction of free light chains blood levels in order to facilitate the recovery of renal function.<span class="elsevierStyleSup">2,3</span> We wish to report our experience in this topic In April 2011 a 43-year-old man, with a previously normal renal function, was admitted to our hospital for severe acute renal failure (ARF) of an unknown cause. The review of the clinical history didn’t revealed any previous disease. For 2 months he was suffering from lumbar pain. We started haemodialysis treatment three times a week. Laboratory investigations and bone marrow biopsy detected a lambda IgG MM. We performed kidney biopsy and we observed glomerular deposition of lambda chains, without histological signs of chronic renal damage, and a negative Congo red stain test. In 2 weeks the patient received 10 haemodialysis (HD) treatment with high cut-off (HCO) dialyzer (Theralite<span class="elsevierStyleSup">®</span>, Gambro Henchingen, Germany). We performed on alternating days HCO HD sessions with standard monitors; they lasted for 5 hours, involved a blood flow of 300ml/min and had an ultrapure dialysate flow rate of 500ml/min. Sodium Reviparine (Clivarina<span class="elsevierStyleSup">®</span>) was applied at 2400IU  in single dose priming. The values ​​of Platelets (60.000/mmc) motivated the prescription on the duration of HCO HD and on the dose of heparin. At the end of each session we didn’t administer albumin. Ultrafiltration was programmed according to the clinical need. Before and after each session, mean free light chain levels were measured in terms of mg/l using nephelometry (N latex test, Siemens)  Initially λ FLC concentration was 5500mg/L. At the end of HCO dialyzer HD cycle, the concentration was 94.80mg/L. The concentrations and ratios of light chain levels from the start to the end of treatment are summarised in Table 1.</p><p class="elsevierStylePara">We didn’t observe any adverse effects. We observed after the first HCO HD a percentage reduction in light chain levels of 74 with dialysis alone before the chemotherapy was initiated. After the third HCO HD the patient started PAD Orlowsky chemotherapy (Bortezomib-Doxorubicin-Dexamethasone) with successful haematological result, but with partial renal function recover. At this moment (10 months after high cut-off dialyzer treatment) the patient is on maintenance HD two times a week. Some reports show a recovery of renal function after several months. We will continue the mixed therapy (HCO HD-chemotherapy according to the protocols of the haematology department) in patients with ARF and MM.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span><br></br>The authors declare that there is no conflict of interest associated with this manuscript.</p><p class="elsevierStylePara"><a href="grande/11392_108_27219_en_11392_t1.jpg" class="elsevierStyleCrossRefs"><img src="11392_108_27219_en_11392_t1.jpg" alt="FLC concentrations and ratios before and after HCO-dialyzer HD"></img></a></p><p class="elsevierStylePara">Table 1. FLC concentrations and ratios before and after HCO-dialyzer HD</p>" "pdfFichero" => "P1-E536-S3515-A11392-EN.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11392_108_27219_en_11392_t1.jpg" "Alto" => 176 "Ancho" => 600 "Tamanyo" => 110674 ] ] "descripcion" => array:1 [ "en" => "FLC concentrations and ratios before and after HCO-dialyzer HD" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "1.\u{A0}Martín-Reyes G, Toledo-Rojas R, Torres-de Rueda A, Sola-Moyano E, Blanca-Martos L, Fuentes-Sánchez L, et al. Haemodialysis using high cut-off\u{A0}dialysers for treating acute renal failure in multiple myeloma. Nefrologia 2012;32:35-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22294003" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "2.\u{A0}Shum HP, Chan KC, Chow CC, Kho BC, Yan WW. Cast nephropathy with acute renal failure treated with HCO-HD in a patient with MM. Hong Kong Med J 2010;16:489-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21135429" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hutchison CA, Cockwell P, Stringer S, Bradwell A, Cook M, Gertz MA, et al. Early\u{A0}reduction of serum-free light chains associates with renal recovery in myeloma kidney.\u{A0}J Am Soc Nephrol 2011;22:1129-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21511832" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003200000003/v0_201502091613/X2013251412001192/v0_201502091614/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003200000003/v0_201502091613/X2013251412001192/v0_201502091614/en/P1-E536-S3515-A11392-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251412001192?idApp=UINPBA000064" ]
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| 2016 July | 137 | 6 | 143 |
| 2016 June | 98 | 0 | 98 |
| 2016 May | 128 | 0 | 128 |
| 2016 April | 92 | 0 | 92 |
| 2016 March | 73 | 0 | 73 |
| 2016 February | 101 | 0 | 101 |
| 2016 January | 90 | 0 | 90 |
| 2015 December | 91 | 0 | 91 |
| 2015 November | 108 | 0 | 108 |
| 2015 October | 88 | 0 | 88 |
| 2015 September | 55 | 0 | 55 |
| 2015 August | 70 | 0 | 70 |
| 2015 July | 64 | 0 | 64 |
| 2015 June | 27 | 0 | 27 |
| 2015 May | 36 | 0 | 36 |
| 2015 April | 9 | 0 | 9 |
Show all
