Haemodiafiltration with ultrafiltrate regeneration in the removal of free light chains in multiple myeloma and acute kidney injury

Cavoli, Gioacchino Li; Passanante, Silvia; Schillaci, Onofrio; Servillo, Franca; Zagarrigo, Carmela; Cavoli, Tancredi Vincenzo Li; Palmeri, Mattia; Palma, Benedetta Dalla; Rotolo, Ugo

doi:10.1016/j.nefro.2017.06.007

Cited by 6 publications

(2 citation statements)

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“…Moreover, no complications associated with the technique were observed. [20][21][22], our study is the first that analyzes the concentration of FLC and albumin in both, blood and ultrafiltrate. The FLC reduction ratio obtained in the ultrafiltrate was greater than in blood.…”

Section: Resultsmentioning

confidence: 99%

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Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Mier

Ojeda

Alvarez‐Lara

et al. 2020

Preprint

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Background Acute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss. Methods This is an observational study (2012 to 2018) including eleven patients with MM (6 kappa, 5 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 minutes after initiation of the session and 5 minutes before the end of the procedure. Results The serum levels of kappa and lambda were reduced by a 53±14% and 33±22% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2% and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7% and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 36.4% recovered renal function, 18.2% died during the first year and 45.45% required maintenance dialysis. Conclusions Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.

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Section: Resultsmentioning

confidence: 99%

“…Testa et al showed that this technique removes FLC,particularly kappa, in patients with both monoclonal and polyclonal gammopathies[15]. The removal of FLC reported in other recent studies has been around 84% for kappa[20] and 32.2 -49.5%[21] or 69.3%[20] for lambda chains. Although other groups have shown a reduction of serum FLC with…”

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confidence: 93%

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Mier

Ojeda

Alvarez‐Lara

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients

et al. 2020

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) occurs in 12-20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-CutOff membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss. Methods: This is an observational study (2012 to 2018) including nine patients with MM (5 kappa, 4 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 min after initiation of the session and 5 min before the end of the procedure. Results: The serum levels of kappa and lambda were reduced by a 57.6 ± 10% and 33.5 ± 25% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2 and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7 and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 33.3% recovered renal function, 22.2% died during the first year and 44.4% required maintenance dialysis. Conclusions: Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.

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Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte parameters and β-globin mRNA expression

Abdelrahman,

Marzouk,

Altayeb

et al. 2024

BMC Nephrol

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Background Sudanese children with End-Stage Kidney Disease (ESKD) often show limited improvement in hemoglobin levels despite treatment with recombinant human erythropoietin (rHuEPO). This study aims to assess the response to rHuEPO therapy by analyzing β-globin mRNA expression and reticulocyte parameters. Additionally, it classifies anemia among Sudanese pediatric patients based on iron status, considering age and gender as biological markers for evaluating treatment response. Methods A prospective observational cohort study was conducted from January 2019 to February 2020 in Khartoum, Sudan, involving 45 anemic children aged 2 to 15 years diagnosed with ESKD. The treatment protocol included rHuEPO injections and maintenance hemodialysis. Laboratory assessments consisted of complete blood count (CBC), absolute reticulocyte count, ferritin, and transferrin measurements. β-globin mRNA expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and reticulocyte parameters, including Reticulocyte Hemoglobin Content (CHr), percentage of hypochromic reticulocytes (HYPO%), and Immature Reticulocyte Fraction (IRF), were measured via flow cytometry. Results Significant variations in hemoglobin levels were observed across different age groups ( p = 0.011). Gender analysis revealed a significant association with IRF, showing a lower IRF in male patients ( p = 0.017). However, there were no significant differences in hemoglobin levels between genders ( p = 0.999). β-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels ( r = 0.875, p < 0.0001). Conclusion Age and gender significantly influence treatment responses in children with ESKD, highlighting the need to consider growth physiology in anemia management. This study underscores the variability in β-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-024-03806-5.

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Haemodiafiltration with ultrafiltrate regeneration in the removal of free light chains in multiple myeloma and acute kidney injury

Cited by 6 publications

References 3 publications

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients.

Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients

Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte parameters and β-globin mRNA expression

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