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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor&#44;</span></p><p class="elsevierStylePara">We comment on a recent study on haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma&#44; and we send our personal experience&#46;</p><p class="elsevierStylePara">We read with interest the article of&#160; Dr&#46; Mart&#237;n-Reyes et al&#46;<span class="elsevierStyleSup">1</span> We agree with the motivation of their study&#58; 1&#46; the survival of the patients suffering from Multiple Myeloma &#40;MM&#41; depend on whether or not they recover renal function&#44; not only due to the complications derived from the renal failure itself&#44; but also from the reduced possibility of access to more effective treatments&#59; 2&#46; the importance of rapid reduction of free light chains blood levels in order to facilitate the recovery of renal function&#46;<span class="elsevierStyleSup">2&#44;3</span> We wish to report our experience in this topic In April 2011 a 43-year-old man&#44; with a previously normal renal function&#44; was admitted to our hospital for severe acute renal failure &#40;ARF&#41; of an unknown cause&#46; The review of the clinical history didn&#8217;t revealed any previous disease&#46; For 2 months he was suffering from lumbar pain&#46; We started haemodialysis treatment three times a week&#46; Laboratory investigations and bone marrow biopsy detected a lambda IgG MM&#46; We performed kidney biopsy and we observed glomerular deposition of lambda chains&#44; without histological signs of chronic renal damage&#44; and a negative Congo red stain test&#46; In 2 weeks the patient received 10 haemodialysis &#40;HD&#41; treatment with high cut-off &#40;HCO&#41; dialyzer &#40;Theralite<span class="elsevierStyleSup">&#174;</span>&#44; Gambro Henchingen&#44; Germany&#41;&#46; We performed on alternating days HCO HD sessions with standard monitors&#59; they lasted for 5 hours&#44; involved a blood flow of 300ml&#47;min and had an ultrapure dialysate flow rate of 500ml&#47;min&#46; Sodium Reviparine &#40;Clivarina<span class="elsevierStyleSup">&#174;</span>&#41; was applied at 2400IU &#160;in single dose priming&#46; The values &#8203;&#8203;of Platelets &#40;60&#46;000&#47;mmc&#41; motivated the prescription on the duration of HCO HD and on the dose of heparin&#46; At the end of each session we didn&#8217;t administer albumin&#46; Ultrafiltration was programmed according to the clinical need&#46; Before and after each session&#44; mean free light chain levels were measured in terms of mg&#47;l using nephelometry &#40;N latex test&#44; Siemens&#41;&#160; Initially &#955; FLC concentration was 5500mg&#47;L&#46; At the end of HCO dialyzer HD cycle&#44; the concentration was 94&#46;80mg&#47;L&#46; The concentrations and ratios of light chain levels from the start to the end of treatment are summarised in Table 1&#46;</p><p class="elsevierStylePara">We didn&#8217;t observe any adverse effects&#46; We observed after the first HCO HD a percentage reduction in light chain levels of 74 with dialysis alone before the chemotherapy was initiated&#46; After the third HCO HD the patient started PAD Orlowsky chemotherapy &#40;Bortezomib-Doxorubicin-Dexamethasone&#41; with successful haematological result&#44; but with partial renal function recover&#46; At this moment &#40;10 months after high cut-off dialyzer treatment&#41; the patient is on maintenance HD two times a week&#46; Some reports show a recovery of renal function after several months&#46; We will continue the mixed therapy &#40;HCO HD-chemotherapy according to the protocols of the haematology department&#41; in patients with ARF and MM&#46;</p><p class="elsevierStylePara">&#160;</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&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11392&#95;108&#95;27219&#95;en&#95;11392&#95;t1&#46;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&#46; FLC concentrations and ratios before and after HCO-dialyzer HD</p>"
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