Trece tratamientos de la insuficiencia renal aguda secundaria a mieloma múltiple con filtros de high cut off

Berni Wennekers, A. ; Martín Azara, M.P. (Universidad de Zaragoza) ; Dourdil Sahun, V. ; Bergasa Liberal, B. (Universidad de Zaragoza) ; Ruiz Laiglesia, J.E. (Universidad de Zaragoza) ; Vernet Perna, P. ; Alvarez Lipe, R.

Resumen: Introduction Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis. Methods We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m2 HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days. Results A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session. Conclusions Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed.

Idioma: Español

DOI: 10.1016/j.nefro.2016.03.011

Año: 2016

Publicado en: Nefrologia 36, 4 (2016), 418-426
ISSN: 2013-2514

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)