Polymers in Medicine

Polim. Med.
Scopus CiteScore: 3.3 (CiteScore Tracker 3.5)
Index Copernicus (ICV 2023) – 121.14
MEiN – 70
ISSN 0370-0747 (print)
ISSN 2451-2699 (online) 
Periodicity – biannual

Download original text (EN)

Polymers in Medicine

2019, vol. 49, nr 2, July-December, p. 67–70

doi: 10.17219/pim/122014

Publication type: review article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

The use of different dialysis membranes in therapy of patients with multiple myeloma

Maciej Szymczak1,A,B,C,D,E,F, Dorota Zielińska2,D,F, Aleksandra Musiała1,D,E,F

1 Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland

2 Department of Nephrology and Transplantation Medicine, University Clinical Hospital, Wrocław, Poland

Abstract

Free light chains accumulation is the reason of kidney injury in patients with multiple myeloma. The removal of free light chains can improve patients prognosis and survival, and in some cases allows for dialysotherapy discontinuation. Unfortunately, conventional dialysis is not effective enough in terms of free light chains removal. New high cut-off (HCO) techniques remove free light chains more effectively than conventional dialysis. In some cases, this technique may turn out better than hemodiafiltration. However, there are some differences between specific techniques in the removal of kappa and lambda light chains. Lambda light chains are better removed by polymethyl methacrylate membranes with a change of filter during dialysis. Kappa light chains are thoroughly removed by polymethyl methacrylate membranes and HCO (35,000 Da) polysulfone membranes. Unfortunately, it is very difficult to differentiate between the effect of HCO dialysis therapy and concomitant chemotherapy because some of the data is not fully conclusive. Using the proper technique for an individual patient may give optimally effective treatment results.

Key words

treatment, multiple myeloma, dialysis membranes

References (18)

  1. Menè P, Giammariolia E, Fofia C, et al. Serum free light chains removal by HFR hemodiafiltration in patients with multiple myeloma and acute kidney injury: A case series. Kidney Blood Press Res. 2018;43(4):1263–1272.
  2. Peters NO, Laurain E, Cridlig J, Hulin C, Cao-Huu T, Frimat L. Impact of free light chain hemodialysis in myeloma cast nephropathy: A case-control study. Hemodial Int. 2011;15(4):538–545.
  3. Bridoux F, Carron PL, Pegourie B, et al; MYRE Study Group. Effect of high-cutoff hemodialysis vs conventional hemodialysis on hemodialysis independence among patients with myeloma cast nephropathy: A randomized clinical trial. JAMA. 2017;318(21):2099–2110.
  4. Buus NH, Rantanen JM, Krag SP, Andersen NF, Jensen JD. Hemodialysis using high cut off filters in light chain cast nephropathy. Blood Purif. 2015;40(3):223–231.
  5. Curti A, Schwarz A, Trachsler J, Tomonaga Y, Ambühl PM. Therapeutic efficacy and cost effectiveness of high cut-off dialyzers compared to conventional dialysis in patients with cast nephropathy. PLoS One. 2016;11(7):e0159942. doi:10.1371/journal.pone.0159942
  6. Florens N, Juillard L. Expanded haemodialysis: News from the field. Nephrol Dial Transplant. 2018;33(Suppl 3):iii48–iii52.
  7. Sens F, Chaintreuil D, Jolivot A, et al. Effectiveness of IHD with adsorptive PMMA membrane in myeloma cast nephropathy: A cohort study. Am J Nephrol. 2017;46(5):355–363.
  8. Buti E, Dervishi E, Ghiandai G, et al. Free light chains reduction on acute kidney injury in multiple myeloma: Critical role of high cut-off membranes [In Italian]. G Ital Nefrol. 2014;31(6):gin/31.6.11.
  9. Berni Wennekers A, Martín Azara MP, Dourdil Sahun V, et al. Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters. Nefrologia. 2016;36(4):418–426.
  10. Hudier L, Decaux O, Haddj-Elmrabet A, et al. Intensive haemodialysis using PMMA dialyser does not increase renal response rate in multiple myeloma patients with acute kidney injury. Clin Kidney J. 2018;11(2):230–235.
  11. Santoro A, Grazia M, Mancini E. The double polymethylmethacrylate filter (DELETE system) in the removal of light chains in chronic dialysis patients with multiple myeloma. Blood Purif. 2013;35(Suppl 2):5–13.
  12. Fabbrini P, Sirtori S, Casiraghi E, et al. Polymethylmethacrylate membrane and serum free light chain removal: Enhancing adsorption properties. Blood Purif. 2013;35(Suppl 2):52–58.
  13. Oshihara W, Nagao H, Megano H, Arai J, Koide M, Takada M. Trial use of a polymethylmethacrylate membrane for the removal of free immunoglobulin light chains in dialysis patients. NDT Plus. 2010;3(Suppl 1):i3–i7.
  14. Hanf W, Guillaume C, Jolivot A, et al. Prolonged hemodialysis for acute kidney injury in myeloma patients. Clin Nephrol. 2010;74(4):319–322.
  15. Donati G, Moretti MI, Baraldi O, et al. Removal of free light chains in hemodialysis patients without multiple myeloma: A crossover comparison of three different dialyzers. BMC Nephrol. 2016;17(1):193.
  16. Ouseph R, Hutchison CA, Ward RA. Differences in solute removal by two high-flux membranes of nominally similar synthetic polymers. Nephrol Dial Transplant. 2008;23(5):1704–1712.
  17. Hutchison CA, Cockwell P, Moroz V, et al. High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): A phase 2 randomised controlled trial. Lancet Haematol. 2019;6(4):e217–e228.
  18. Dimopoulos MA, Sonneveld P, Leung N, et al. International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment. J Clin Oncol. 2016;34(13):1544–1557.