What form of dialysis is best for patients with myeloma?
The use of dialysis is required in up to 10% of new patients with myeloma and AKI. Most often this is hemodialysis via central venous catheters. Until recently, only 15% of patients recovered kidney function, and there was a high mortality. However, long-term use of both peritoneal dialysis and hemodialysis has been used, and survival on dialysis, although reduced, depends on myeoma control by chemotherapy. Survival on dialysis is improved with increased response to newer chemotherapy agents. Kidney recovery with freedom from dialysis is associated with an even greater survival benefit. The use of HCO membranes for hemodialysis offers a novel method to remove large amounts of sFLC over extended dialysis (8 hours duration). In conjunction with chemotherapy, especially bortezomib, it is associated with kidney recovery rates of more than 70%. However, the true independent benefit of HCO, and its additional cost, when compared with the introduction of chemotherapy associated with rapid LC lowering alone, remains unproven by randomized clinical trial and therefore cannot be routinely recommended.
