ESRD due to Multiple Myeloma in the United States, 2001–2010

Abstract

Although management of multiple myeloma has changed substantially in the last decade, it is unknown whether the burden of ESRD due to multiple myeloma has changed, or whether survival of patients with multiple myeloma on RRT has improved. Regarding ESRD due to multiple myeloma necessitating RRT in the United States, we evaluated temporal trends between 2001 and 2010 for demography-adjusted incidence ratios, relative to rates in [2001][2002], and mortality hazards from RRT initiation, relative to hazards in [2001][2002]. In this retrospective cohort study, we used the US Renal Data System database (n=1,069,343), 2001-2010, to identify patients with ESRD due to multiple myeloma treated with RRT (n=12,703). Demography-adjusted incidence ratios of ESRD from multiple myeloma decreased between 2001-2002 and 2009-2010 in the overall population (demography-adjusted incidence ratio 0.82; 95% confidence interval, 0.79 to 0.86) and in most demographic subgroups examined. Mortality rates were 86.7, 41.4, and 34.4 per 100 person-years in the first 3 years of RRT, respectively, compared with 32.3, 20.6, and 21.3 in matched controls without multiple myeloma. Unadjusted mortality hazards ratios declined monotonically after 2004 to a value of 0.72; 95% confidence interval, 0.67 to 0.77 in 2009-2010, and declines between 2001-2002 and 2008-2009 were observed (P,0.05) in most demographic subgroups examined. Findings were similar when adjustment was made for demographic characteristics, comorbidity markers, and laboratory test values. These data suggest the incidence of RRT from multiple myeloma in the United States has decreased in the last decade, and clinically meaningful increases in survival have occurred for these patients.

Changing survival of people with myeloma and end stage kidney disease: A cohort study using Australian and New Zealand dialysis and transplant registry 1963–2013

“…15 Our finding that those on peritoneal dialysis had improved survival over those on haemodialysis is similar to data from the United States and Europe. 14,15,20 Our interpretation of this finding is that it is likely to be an issue of selection bias and residual confounding: those fitter and more able, or better supported patients are more likely to choose a home-based therapy than those less able and with less supportive home environment. 21 There is little comparable published registry data on survival with ESKD and other plasma cell dyscrasia.…”

“…This paradox might be due to differences in dialysis acceptance criteria across nations, or differences in approach to conservative non‐dialytic care pathways. A recent USRDS study also showed higher mortality rates for people with myeloma on dialysis, with some recent improvement . Our finding that those on peritoneal dialysis had improved survival over those on haemodialysis is similar to data from the United States and Europe .…”

“…The presence and severity of renal disease correlate with patient survival, and overall prognosis is related to response of the renal disease to therapy. Survival with myeloma and established ESKD in case series was previously acknowledged to be universally poor, but more recent studies suggest the prognostic impact of ESKD may be lessening and overall survival improving . It is not clear whether recent advances in myeloma therapy have translated to improved survival for all those with ESKD, and/or whether the new diagnostic and treatment paradigms for myeloma alter the characteristics of those who develop ESKD from their myeloma.…”

“…Survival with myeloma and established ESKD in case series was previously acknowledged to be universally poor, 11,12 but more recent studies suggest the prognostic impact of ESKD may be lessening and overall survival improving. 5,[13][14][15] It is not clear whether recent advances in myeloma therapy have translated to improved survival for all those with ESKD, and/or whether the new diagnostic and treatment paradigms for myeloma alter the characteristics of those who develop ESKD from their myeloma. Survival for people with ESKD and other plasma cell dyscrasia is less well characterized.…”

Trends in Prevalence of Chronic Kidney Disease in the United States

“…And among persons who reported currently taking medications for diabetes, the prevalence of calibrated HbA 1c levels less than 7.0% increased from 39.7% in 1988–1994 to 55.1% in 2005–2010 (39). Additional strides have been made in treatment of less common causes of ESRD, such as multiple myeloma (40). Thus, it is very plausible that better medical management of these conditions has played a large role in halting the previous rising trend in CKD prevalence and which in turn resulted in the recent decline in the incident rate of ESRD.…”