Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

• Published in: Clinical journal of the American Society of Nephrology Vol. 11; no. 3; pp. 431 - 441
• Main Authors: Decourt, Alexandre, Gondouin, Bertrand, Delaroziere, Jean Christophe, Brunet, Philippe, Sallée, Marion, Burtey, Stephane, Dussol, Bertrand, Ivanov, Vadim, Costello, Regis, Couchoud, Cecile, Jourde-Chiche, Noemie
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 07.03.2016
• Subjects: Aged; Aged, 80 and over; Amyloidosis - blood; Amyloidosis - epidemiology; Amyloidosis - mortality; Cause of Death; Economics and Finance; Female; France - epidemiology; Human health and pathology; Humanities and Social Sciences; Humans; Immunoglobulin Light Chains - blood; Incidence; Kaplan-Meier Estimate; Kidney - physiopathology; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Kidney Transplantation; Life Sciences; Male; Middle Aged; Multiple Myeloma - epidemiology; Multiple Myeloma - mortality; Original; Proportional Hazards Models; Psychiatrics and mental health; Psychology; Recovery of Function; Registries; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Renal Dialysis - trends; Risk Factors; Santé publique et épidémiologie; Time Factors; Treatment Outcome; light chain deposition disease; chronic kidney disease; multiple myeloma; amyloidosis; end stage kidney disease; paraproteinemias; monoclonal gammopathy; kidney transplantation; humans; renal dialysis; Quality of Life
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.06290615

Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France. All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed. We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97). Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.