Association between serum erythropoietin levels and renal reversibility in patients with renal impairment from multiple myeloma

Abstract

Renal impairment (RI) is a common clinical presentation in patients with multiple myeloma (MM). Despite treatment with novel agents or management strategies that focus on the disease response, some patients develop irreversible RI. This study aimed to determine the influencing, clinical variables of renal reversibility in patients with RI treated with novel drugs. We analyzed 244 patients newly diagnosed with MM retrospectively. Maximum renal response was assessed according to the criteria for the definition of renal response proposed by the International Myeloma Working Group. Major renal response was defined as the occurrence of complete renal response or partial renal response. RI (a glomerular filtration rate < 50 mL/min/1.73 m2) was observed in 110 patients (45%). In total, 56 patients (51%) achieved a major renal response. Serum erythropoietin (EPO) levels >25 mIU/mL (P < .001) and a percentage of urinary albumin excretion ≤25% (P < .001) were both significant factors that influenced the occurrence of major renal responses. Both remained significant factors associated with renal reversibility in the multivariate analysis. Patients were assigned a score of 1 each for EPO >25 mIU/mL and urinary albumin ≤25%. The estimated 6‐month rates of major renal responses of patients with scores of 2, 1, and 0 were 78.6%, 30.6%, and 0%, respectively (P < .001). In conclusion, a serum EPO level >25 mIU/mL is an independent predictive factor for major renal response and may predict renal reversibility more accurately when urinary albumin level is congruently ≤25%.

Low erythropoietin to albumin ratio in the serum predicts less reversibility of renal impairment with poorer prognosis in multiple myeloma

“…However, the relationship between alterations in serum albumin levels and reversibility of renal function is not well understood. Some studies suggest that serum albumin levels are not associated with renal reversibility in MM [22,23]. In contrast, our preliminary clinical data showed that serum albumin was higher in the non-reversible group compared to the reversible group.…”

“…However, the predictive value of changes in serum albumin for renal reversibility has not been fully elucidated. Some studies have suggested that serum albumin levels are not associated with renal reversibility [22,23]. In our study, by comparing data from the reversible and non-reversible groups of newly diagnosed myeloma patients, we unexpectedly found that level of serum albumin was actually higher in the non-reversible group than that in the reversible group, suggesting that elevated serum albumin levels in these MM patients are associated with decreased residual renal function.…”

“…Previously, several attempts have been made to predict the reversibility of renal function in MM patients using a number of laboratory variables. Kobayashi's team [22] rst showed that EPO was a valid predictor of reversibility for renal function and that the combination of EPO and urinary albumin could more accurately predict the reversibility of major renal function in MM. It is well known that ISS and R-ISS staging are important reference indicators of MM prognosis [21].…”