Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: an ERA-EDTA Registry study

• Published in: Nephrology, dialysis, transplantation Vol. 25; no. 4; pp. 1200 - 1206
• Main Authors: Tsakiris, Dimitrios J., Stel, Vianda S., Finne, Patrik, Fraser, Emily, Heaf, James, de Meester, Johan, Schmaldienst, Sabine, Dekker, Friedo, Verrina, Enrico, Jager, Kitty J.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2010
• Subjects: Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cause of Death; Emergency and intensive care: renal failure. Dialysis management; Female; haemodialysis; Humans; Immunoglobulin Light Chains; Incidence; Intensive care medicine; International Agencies; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; light-chain deposit disease; Male; Medical sciences; Middle Aged; multiple myeloma; Multiple Myeloma - complications; Multiple Myeloma - mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Paraproteinemias - complications; Paraproteinemias - mortality; peritoneal dialysis; Registries; Renal failure; Renal Replacement Therapy; Risk Factors; survival; Survival Rate; Time Factors; transplantation; Treatment Outcome; Human; Kidney disease; Immunopathology; Replacement therapy; multiple myeloma; Urinary system disease; Prognosis; Hemodialysis; haemodialysis; Terminal stage; Malignant hemopathy; Light peptide chain; EDTA; Myeloma; Survival; Peritoneal dialysis; Incidence; Extrarenal dialysis; Immunoglobulinopathy; Lymphoproliferative syndrome; Renal failure; transplantation; light-chain deposit disease; Cancer
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp679

Background. Information on demographics and survival of patients starting renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to multiple myeloma (MM) or light-chain deposit disease (LCDD) is scarce. The aim of this study was to describe the incidence, characteristics, causes of death and survival rates of RRT for ESRD due to MM or LCDD in the ERA-EDTA Registry. Methods. Thirteen national registries providing data on patients who started RRT from 1986–2005 to the ERA-EDTA Registry participated. Incidence per million population (pmp) of RRT for ESRD due to MM or LCDD and other causes (non-MM) was observed overtime. Patient survival on RRT was examined, unadjusted and adjusted for age and gender. Results. Of the 159 637 patients on RRT, 2453 (1.54%) had MM or LCDD. The incidence of RRT for ESRD due to MM or LCDD, adjusted for age and gender, increased from 0.70 pmp in 1986–1990 to 2.52 pmp in 2001–2005. MM and LCDD patients compared to non-MM patients were older and a higher percentage was on haemodialysis at day 91 after the start of RRT. The most common causes of death in MM and LCDD patients were malignancy (36.1%), cardiovascular causes (17.2%) and infection (14.7%). MM and LCDD patients had a 2.77 (95% CI, 2.65–2.90) higher risk of death compared to non-MM patients. The unadjusted median survival on RRT was 0.91 years in MM and LCDD patients and 4.46 years in non-MM patients. During follow-up, 35 patients were transplanted and their mean survival was 9.6 years. Conclusion. The incidence of RRT for ESRD due to MM or LCDD has increased over the past 20 years in Europe. The median patient survival on RRT for MM and LCDD patients was 0.91 years, compared to 4.46 years for non-MM patients. These results suggest that dialysis, and in selected cases even transplantation, should be offered to MM and LCDD patients.