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

Autor: Bertrand Gondouin, Marion Sallée, Jean Christophe Delaroziere, Régis Costello, Vadim Ivanov, Philippe Brunet, Bertrand Dussol, Stéphane Burtey, C. Couchoud, Alexandre Decourt, Noémie Jourde-Chiche
Přispěvatelé: Vascular research center of Marseille (VRCM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Service de Chirurgie et Radiologie Pédiatrique, Université de la Méditerranée - Aix-Marseille 2, Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Service d’hématologie et de thérapie cellulaire, Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Technologies avancées pour le génôme et la clinique (TAGC), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Registre REIN, Agence de la biomédecine [Saint-Denis la Plaine], Physiopathologie de l'Endothelium, Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Rok vydání: 2016
Předmět:
Male
Time Factors
Epidemiology
medicine.medical_treatment
030232 urology & nephrology
[SHS.PSY]Humanities and Social Sciences/Psychology
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Kidney
Critical Care and Intensive Care Medicine
Gastroenterology
0302 clinical medicine
Risk Factors
Cause of Death
Registries
humans
Myeloma cast nephropathy
Kidney transplantation
Cause of death
Aged
80 and over
education.field_of_study
Incidence
light chain deposition disease
Middle Aged
[SHS.ECO]Humanities and Social Sciences/Economics and Finance
3. Good health
multiple myeloma
Treatment Outcome
Nephrology
renal dialysis
Female
France
medicine.medical_specialty
Population
kidney transplantation
Lower risk
Light chain deposition disease
03 medical and health sciences
Internal medicine
medicine
education
Dialysis
Aged
Proportional Hazards Models
amyloidosis
Transplantation
paraproteinemias
business.industry
monoclonal gammopathy
Recovery of Function
Original Articles
medicine.disease
Surgery
[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health
Quality of Life
end stage kidney disease
Kidney Failure
Chronic
Immunoglobulin Light Chains
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
chronic kidney disease
Zdroj: Clinical Journal of the American Society of Nephrology
Clinical Journal of the American Society of Nephrology, American Society of Nephrology, 2016, 11 (3), pp.431-441. ⟨10.2215/CJN.06290615⟩
Clinical Journal of the American Society of Nephrology, 2016, 11 (3), pp.431-441. ⟨10.2215/CJN.06290615⟩
ISSN: 1555-9041
1555-905X
DOI: 10.2215/cjn.06290615
Popis: International audience; 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.
Databáze: OpenAIRE
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