Haemodialysis using high cut-off dialysers in acute kidney injury in multiple myeloma – first experience

Authors: J. Orság 1;  T. Pika 1;  Z. Kosatíková 1;  P. Lochman 2;  K. Žamboch 1;  J. Minařík 1;  M. Hrubý 1;  V. Ščudla 1;  J. Zadražil 1
Authors‘ workplace: III. interní klinika - nefrologická, revmatologická a endokrinologická, Lékařská fakulta UP a Fakultní nemocnice Olomouc 1;  Oddělení klinické biochemie a imunogenetiky, Fakultní nemocnice Olomouc 2
Published in: Klin. Biochem. Metab., 21 (42), 2013, No. 2, p. 88-92


Renal failure requiring haemodialysis occurs in 10-20 % of all multiple myeloma (MM) cases and it is associated with a greatly increased morbidity and mortality. The main cause of renal injury is cast nephropathy, as a direct consequence of high concentrations of monoclonal free light chains (FLCs) in patients´ sera. Rapid reduction of FLCs levels plays a key role in renal recovery. Evidence of benefit of plasmapheresis in removing serum FLC has been controversial. According to the recent experience, haemodialysis using high cut-off dialysers reduces effectively the level of FLCs concentrations and improves renal functions in long term when combined with an effective chemotherapy. In our single centre study we assessed efficacy of parallel treatment for patients with new diagnosed MM and acute renal failure due to excess of serum FLCs with combination of bortezomib-based chemotherapy and haemodialysis using high cut-off dialysers.

Material and methods:
The studied group consisted of 4 patients with new diagnosed MM and acute renal failure requiring haemodialysis and with serum FLCs levels („dominant FLC“) above 500 mg/l. They all were treated with bortezomib- based chemotherapy and simultaneously they underwent haemodialysis sessions with the high cut-off membranes (Theralite™ 2100, Gambro Dialysatoren GmbH, Hechingen, Germany). At the beginning and before the end of each session, free light chain levels in serum as well as in dialysate were measured (Freelite™, The Binding Site,UK). Percentage reduction in serum free light chains in the hemodialysis session as well as at the end of treatment was determined by calculation from the reached data. The efficacy of the treatment and clinical state of the patients were observed as well.

27 sessions of haemodialysis with high cut-off membranes (HCO HD) were performed, each patient underwent between 3 and 11 sessions. At the same time, patients underwent bortezomib-based chemotherapy. Free light chain levels decreased by a mean of 93.7± 8.8 % between treatment onset and completion, while the mean percentage of reduction of FLC levels per session was 55.30 ± 20.04 %. Mean clearance of FLCs was 62.7 ± 37.2 ml/min resp. 29.0 ± 26.1 ml/min at the beginning resp. at the end of HCO HD. Renal function was recovered in 3 patients, who are alive and dialysis-free. One patient died of ischemic stroke not related to haemodialysis procedure during treatment.

We demonstrated haemodialysis using high cut-off membranes is an effective method to remove free light chains rapidly and to recover renal functions in acute renal injury in multiple myeloma in combination with chemotherapy using bortezomib. Further experiences and studies are needed to examine the clinical benefit and to select the optimum regimen.

Key words:
multiple myeloma, acute renal failure, free light chains, high cut-off haemodialysis


1. Rajkumar, S. V. Multiple myeloma. Curr. Probl. Cancer, 2009, 33, p. 7-64.

2. Hutchison, C. A., Bradwell, A. R., Cook, M. et al. Treatment of acute renal failure secondary to multiple myeloma with chemotheraphy and extended high cut-off hemodialysis. Clin. J. Am. Soc. Nephrol., 2009, 4, p. 745-754.

3. Hutchison, C. A., Batuman, V., Behrens, J. et al. The pathogenesis and diagnosis of acute kidney injury in multiple myeloma. Nat. Rev. Nephrol., 2012, 8, p. 43 – 51.

4. Heyne, N., Denecke, B., Guthoff, M. et al. Extracorporal light chain elimination: high cut-off (HCO) hemodia-lysis parallel to chemotherapy allows for a high proportion of renal recovery in multiple myeloma patients with dialysis-dependent acute kidney injury. Ann. Hematol., 2012, 91, p. 729-735.

5. Clark, W. F., Stewart, A. K., Rock, G. A. et al. Plasma exchange when myeloma presents as acute renal failure: A randomized, controlled trial. Ann. Intern. Med., 2005, 143, p. 777-784.

6. Burnette, B. L., Leung, N., Rajkumar, S. V. Renal improvement in myeloma with bortezomib plus plasma exchange. N. Engl. J. Med., 2011, 364, p. 2365-2366.

7. Hutchison, C. A., Cockwell, P., Reid, S. et al. Efficient removal of immunoglobulin free light chains by hemodia-lysis for multiple myeloma: in vitro and in vivo studies. J. Am. Soc. Nephrol., 2007, 18, p. 886-895.

8. Hutchison, C. A., Harding, S., Mead, G. et al. Serum free-light chain removal by high cutoff hemodialysis: optimizing removal and supportive care. Artif. Organs, 2008, 32,12, p. 910-917.

9. Hutchison, C. A., Cockwell, P. Management options for cast nephropathy in multiple myeloma. Curr. Opin. Nephrol. Hypertens., 2010, 19, p. 550-555.

10. Wirk, B. Renal failure in multiple myeloma: a medical emergency. Bone Marrow Transplantation, 2011, p. 1-13.

11. Hutchison, C. A., Cockwell, P., Stringer, S. et al. Early reduction of serum-free light chains associates with renal recovery in myeloma kidney. J. Am. Soc. Nephrol., 2011, 22, p. 1129-1136 .

12. Martín-Reyes, G., Toledo-Rojas, R., Torres-Rueda, Á. et al. Haemodialysis using high cut-off dialysers for treating acute renal failure in multiple myeloma. Nefrologia 2012, 32,1, p. 35-43.

13. Khalafallah, A., Loi, S. W., Love, S. et al. Early application of high cut-off haemodialysis for de-novo mye-loma nephropathy is associated with long-term dialysis-independency and renal recovery. Mediterr. J. Hematol. infect. Dis., 2013, 5(1), e2013007.

14. Sinisalo, M., Silvennoinen, R., Wirta, O. High cut-off hemodialysis and bortezomib-based therapy to rescue kidneys in myeloma-dependent cast nephropathy. Am. J. Hematol., 2012, 87, 6, p. 640.

15. Hutchison, C. A., Cook, M., Heyne, N. et al. European trial of free light chain removal by extended hemodialysis in cast nephropathy (EuLITE): a randomised control trial. Trials, 2008, 9, p. 55.

Clinical biochemistry Nuclear medicine Nutritive therapist
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account