Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Alexandre Decourt , Bertrand Gondouin (1) , Jean Christophe Delaroziere (2) , Philippe Brunet (1) , Marion Sallée (1) , Stéphane Burtey (3, 1) , Bertrand Dussol (3, 1) , Vadim Ivanov (4) , Régis Costello (5) , Cecile Couchoud (6) , Noemie Jourde-Chiche (1, 7, 8)

1 VRCM - Vascular research center of Marseille
2 Service de Chirurgie et Radiologie Pédiatrique
3 Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM]
4 Service d’hématologie et de thérapie cellulaire
5 TAGC - Technologies avancées pour le génôme et la clinique
6 Registre REIN
7 Physiopathologie de l'Endothelium
8 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]

Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France. All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed. We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97). Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.

Mots clés: Quality of Life; end stage kidney disease; humans; multiple myeloma; paraproteinemias; renal dialysis; monoclonal gammopathy; kidney transplantation; light chain deposition disease; amyloidosis; chronic kidney disease

Domaines: Santé publique et épidémiologie; Economies et finances; Psychologie; Psychiatrie et santé mentale

Alexandre Decourt, Bertrand Gondouin, Jean Christophe Delaroziere, Philippe Brunet, Marion Sallée, et al.. Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis. Clinical Journal of the American Society of Nephrology, 2016, 11 (3), pp.431-441. ⟨10.2215/CJN.06290615⟩. ⟨hal-01482660⟩