Factores clínicos y paraclínicos asociados a terapia de reemplazo renal en pacientes incidentes con mieloma múltiple

Abstract

Introduction: Up to 50% of newly diagnosed multiple myeloma patients present with acute renal injury secondary to the neoplasia, which is produced by multifactorial events, being tubular damage due to precipitation and direct toxicity of tubular cells the most-understood mechanism. The need for renal replacement therapy at diagnosis has been described in approximately 10% of these patients at diagnosis. However, in some cases kidney damage is irreversible, requiring long-term dialysis therapy, altering the quality of life of patients with myeloma and limiting treatment offer. Likewise, the requirement for renal replacement therapy is today a known risk factor for worse outcomes in patients with multiple myeloma, negatively impacting the overall survival of patients. Recognizing risk factors for acute kidney injury secondary to myeloma as a need for aggressive rapid intervention may affect the evolution of the disease and the patient's recovery process. Objective: the aim of this trial was to estimate the clinical and paraclinical factors that are associated with the requirement of renal replacement therapy in incident patients with multiple myeloma at Hospital Universitario Mayor Méderi in Bogotá during 2013 to 2020. Methods: this was an observational, cross-sectional study with an analytical component, which aimed to explore the outcome of renal replacement therapy for kidney disease secondary to multiple myeloma, and related factors with its requirement. For this purpose, we did a retrospective research of clinical records of patients. Emphasis was placed on the patient's antecedents, as well as the CRAB criteria at the onset of the disease, its immunophenotype and the therapy offered both for the disease and for renal impairment. Results: a total of 189 patients were diagnosed and treated between the years 2013 and 2020. Most of the patients were women. The average age was 67.2 years and 25% of the population was at most 61 years old. Median serum creatinine at diagnosis was 3gr/dL, and renal survival at 6 months was 28%. Regarding CRAB criteria and immunophenotype, hemoglobin levels was a direct factor associated to requirement of renal replacement therapy. The ISS stage showed significant differences (p <0.05) in renal survival at 6 months, as well as the lambda immunophenotype (p= 0.008). Thus, the worst 6-month renal survival (dialysis requirement at the end of induction treatment) was found in patients with ISS 3 and with lambda-type light chains. Finally, Beta 2 microglobulin behaved as a protective factor, that is, an increase of one unit in the level of B2M decreased renal survival by 0.116%. Conclusions: kidney injury at multiple myeloma diagnosis implies a worse prognosis. Here, we identified some laboratory and immunophenotype factors that were associated with a higher risk of developing renal injury and were associated with less renal survival. We believe the identification of these poor prognostic factors in patients with MM at the onset, allows a closer follow-up of these patients in order to be able to make early interventions in the course of the disease.