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

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