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Myeloma-Related Renal Failure on the Decline

doi: 10.1097/01.COT.0000475235.91567.fa
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The risk of kidney failure caused by multiple myeloma appears to be declining, and for those who do develop such end-stage renal disease (ESRD), the survival rate is increasing. The findings, now online ahead of print in Journal of the American Society of Nephrology (doi:10.1681/ASN.2014090876 ), are encouraging, the researchers said, emphasizing, though that efforts are still needed to develop alternative and effective treatments with fewer side effects.

The researchers, led by Scott Reule, MD, Professor of Medicine at the University of Minnesota, explain that because of the known risk of ESRD associated with myeloma, it has been important to monitor patients and to try to minimize any further damage to the kidneys.

Treatment for multiple myeloma has changed substantially in the last decade, but it is not clear whether the burden of ESRD due to the disease has changed, or whether the survival of kidney failure patients with multiple myeloma has improved. To look at the trends between 2001 and 2010, Reule and his colleagues—senior author was Robert Foley, MD—analyzed information from the U.S. Renal Data System database.

The results showed that of the 1,069,343 patients with ESRD who were on dialysis, 12,703 had developed ESRD due to multiple myeloma.

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20% Decrease

The incidence of ESRD from multiple myeloma decreased by about 20 percent from 2001-2002 to 2009-2010; and ESRD patients with myeloma are living longer than before: Their likelihood of dying within three years after initiating dialysis declined by 28 percent from the earlier to the latter period, the results showed.

“Myeloma is the most common malignancy leading to kidney failure,” Foley said in a news release. “It's encouraging that we found that kidney failure due to multiple myeloma declined considerably over the last decade.”

The results also showed a more than two-fold higher incidence of ESRD due to multiple myeloma in black versus white patients, but a lower risk of death compared with white patients.

“These results mirror recent findings from a SEER Program study, in which survival rates in black patients with multiple myeloma were significantly higher than in white patients,” the researchers wrote. “This survival benefit is likely not entirely explained by improved dialysis survival among black versus white patients, suggesting disease heterogeneity by race, since African Americans are less likely to undergo autologous stem cell transplant or receive chemotherapy than other races are.”

The authors conclude that even though there are limitations, the study does provide useful information. “Although research efforts to develop alternative efficacious treatments with fewer side effects are clearly needed, it is encouraging that the risk of ESRD caused by multiple myeloma which then requires renal replacement therapy [RRT], appears to be declining, and survival lengthening. While developing mechanism-based targeted treatments are of fundamental importance, findings such as associations between ethnicity, lack of pre-RRT care, temporary dialysis access, and mortality suggest that configuration of nephrology care could also be important in patients with multiple myeloma.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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