Effectiveness of haemodiafiltration with ultrafiltrate regeneration in renal failure due to multiple myeloma
Eficacia de la hemodiafiltración con regeneración del ultrafiltrado en la insuficiencia renal por mieloma múltiple
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Victoria Pendón-Ruiz de Mier, Raquel Ojeda-López, M. Antonia Álvarez de Lara-Sánchez, Alejandro Martín-Malo, Pedro Aljama-García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M. Victoria" "apellidos" => "Pendón-Ruiz de Mier" "email" => array:1 [ 0 => "mvictoriaprm@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Raquel" "apellidos" => "Ojeda-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "M. Antonia" "apellidos" => "Álvarez de Lara-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Martín-Malo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Pedro" "apellidos" => "Aljama-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => " Hospital Universitario Reina Sofía, Córdoba, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eficacia de la hemodiafiltración con regeneración del ultrafiltrado en la insuficiencia renal por mieloma múltiple" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11892_16025_46821_en_11892_t1.jpg" "Alto" => 481 "Ancho" => 1434 "Tamanyo" => 129344 ] ] "descripcion" => array:1 [ "en" => "Reduction rates in blood" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor:</span></p><p class="elsevierStylePara">Multiple myeloma (MM) is a clonal proliferation of plasma cells that leads to excessive production of a certain type of immunoglobulin or a fraction thereof. In 12-20% of patients, acute renal failure (ARF) occurs, mainly due to cast nephropathy (myeloma kidney) due to tubular damage. Survival depends on the recovery of renal function.</p><p class="elsevierStylePara">We present the case of a 63-year-old female, without relevant medical history, who was admitted with ARF secondary to MM (kappa light chain cast [LCC]) and remains dependent on renal replacement therapy (RRT) from diagnosis. Online haemodiafiltration was performed four times a week, in sessions lasting 240 minutes, maintaining residual diuresis (RD: 1000 cc/24 h) and serum creatinine levels around 5mg/dl.</p><p class="elsevierStylePara">The aim of MM treatment is to reduce the production of LCC with chemotherapy and corticosteroids and/or autologous bone marrow transplantation. Coadjuvant treatment includes various techniques of extracorporeal clearance.</p><p class="elsevierStylePara">There are currently two types of RRT used as MM coadjuvant treatment: high cut-off haemodialysis (HCO) and haemodiafiltration with regeneration of ultrafiltrate (SUPRA-HFR). There are HCO studies in which these types of patients have a sustained rate of LCC reduction and recovery of renal function.<span class="elsevierStyleSup">1</span> However, in another study in 6 patients, a higher rate of LCC reduction was not associated with the recovery of renal function.<span class="elsevierStyleSup">2</span> SUPRA-HFR has recently been proposed for the removal of LCC in these types of patients.<span class="elsevierStyleSup">3,4</span></p><p class="elsevierStylePara">In our case, after obtaining LCC determinations and response to haematologic treatment, we decided to start SUPRA-HFR, three days a week, in 240 minute sessions.</p><p class="elsevierStylePara">We designed the following study to test the adsorption in resin of the LCC cartridge (kappa and lambda), of albumin and of beta-2-microglobulin with this haemodialysis technique, so that it may contribute to the removal of LCC, but without losing albumin. For this, we obtained blood samples every week pre-and post-haemodialysis and plasma water samples at minute 5 and 235 from the start of the technique, both pre- and post-cartridge.</p><p class="elsevierStylePara">The kappa LCC levels in serum were 105.19mg/l before the first session of SUPRA-HFR, and six weeks after the aforementioned treatment they were 61.18mg/l. The rates of reduction of each parameter both in blood and in plasma water are shown in the following two tables.</p><p class="elsevierStylePara">The results obtained show a mean blood reduction rate of 60% of kappa LCC, 32% of LCC lambda, 59% of beta-2-microglobulin and 3.5 % of albumin (Table 1). In plasma water, the rate of LCC reduction was much higher, both at the start and at the end of treatment: 98-99% of kappa LCC at the start and 80-94% at the end, in the first week of treatment (Table 2).</p><p class="elsevierStylePara">In spite of these results, the patient has not recovered renal function and she remains dependent on RRT, with blood creatinine of 7mg/dl and RD. She is awaiting an autologous bone marrow transplant.</p><p class="elsevierStylePara">With the results obtained, we can conclude that total saturation of resin does not occur, with a good rate of reduction of LCC being maintained (60% mean reduction of kappa LCC in serum), without the loss of albumin. Therefore, SUPRA-HFR is effective in the reduction of LCC as a coadjuvant treatment of MM.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p><p class="elsevierStylePara"><a href="grande/11892_16025_46821_en_11892_t1.jpg" class="elsevierStyleCrossRefs"><img src="11892_16025_46821_en_11892_t1.jpg" alt="Reduction rates in blood"></img></a></p><p class="elsevierStylePara">Table 1. Reduction rates in blood</p><p class="elsevierStylePara"><a href="grande/11892_16025_46822_en_11892_t2.jpg" class="elsevierStyleCrossRefs"><img src="11892_16025_46822_en_11892_t2.jpg" alt="Reduction rates in plasma water"></img></a></p><p class="elsevierStylePara">Table 2. Reduction rates in plasma water</p>" "pdfFichero" => "P1-E550-S4090-A11892-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11892_16025_46821_en_11892_t1.jpg" "Alto" => 481 "Ancho" => 1434 "Tamanyo" => 129344 ] ] "descripcion" => array:1 [ "en" => "Reduction rates in blood" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11892_16025_46822_en_11892_t2.jpg" "Alto" => 566 "Ancho" => 1450 "Tamanyo" => 111303 ] ] "descripcion" => array:1 [ "en" => "Reduction rates in plasma water" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000003/v0_201502091549/X2013251413003072/v0_201502091550/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000003/v0_201502091549/X2013251413003072/v0_201502091550/en/P1-E550-S4090-A11892-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413003072?idApp=UINPBA000064" ]
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