Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis

Clin J Am Soc Nephrol. 2009 Apr;4(4):745-54. doi: 10.2215/CJN.04590908. Epub 2009 Apr 1.


Background and objectives: Extended hemodialysis using a high cut-off dialyzer (HCO-HD) removes large quantities of free light chains in patients with multiple myeloma. However, the clinical utility of this method is uncertain. This study assessed the combination of chemotherapy and HCO-HD on serum free light chain concentrations and renal recovery in patients with myeloma kidney (cast nephropathy) and dialysis-dependent acute renal failure.

Design, setting, participants, & measurements: An open-label study of the relationship between free light chain levels and clinical outcomes in 19 patients treated with standard chemotherapy regimens and HCO-HD.

Results: There were sustained early reductions in serum free light chain concentrations (median 85% [range 50 to 97]) in 13 patients. These 13 patients became dialysis independent at a median of 27 d (range 13 to 120). Six patients had chemotherapy interrupted because of early infections and did not achieve sustained early free light chain reductions; one of these patients recovered renal function (at 105 d) the remaining 5 patients did not recover renal function. Patients who recovered renal function had a significantly improved survival (P < 0.012).

Conclusion: In dialysis-dependent acute renal failure secondary to myeloma kidney, patients who received uninterrupted chemotherapy and extended HCO-HD had sustained reductions in serum free light chain concentrations and recovered independent renal function.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / immunology
  • Acute Kidney Injury / mortality
  • Acute Kidney Injury / physiopathology
  • Acute Kidney Injury / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Down-Regulation
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Immunoglobulin Light Chains / blood
  • Kaplan-Meier Estimate
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Multiple Myeloma / complications
  • Multiple Myeloma / immunology
  • Multiple Myeloma / mortality
  • Multiple Myeloma / physiopathology
  • Multiple Myeloma / therapy*
  • Pilot Projects
  • Prospective Studies
  • Recovery of Function
  • Renal Dialysis* / adverse effects
  • Time Factors
  • Treatment Outcome


  • Immunoglobulin Light Chains