Evaluación de la hemodiafiltración con reinfusión endógena en el tratamiento del riñón del mieloma

Abstract

Introduction: Multiple myeloma (MM) is a hematologic disease that causes acute renal failure (ARF), requiring hemodialysis 10% of cases. This renal failure, called myeloma kidney, is caused by the formation of urinary casts in the renal tubules from free light chains (FLCs). The tubular obstruction if not treated early, causes glomerular damage and chronic kidney disease.
Treatment of myeloma kidney focuses on reducing the formation of FLCs with chemotherapy and the elimination of existing chains reducing its concentration in plasma.
Techniques traditionally used in the clearance of FLCs, using very high permeability membranes, and have the disadvantage of the high albumin loss. Recently hemodiafiltration with endogenous reinfusion (HFR) has emerged, a technique that combines diffusion, convection and adsorption.
This technique uses a high permeability membrane to extract ultrafiltrate, and could be used for eliminating
FLCs, overcoming the albumin loss.
Aim. To analyze the elimination of FLCs with this technique and its relationship to the recovery of renal function, and monitoring of serum albumin in three patients treated by ARF due to MM.
Material and methods: Three patients with ARF by MM, with a mean age of 64 years and treated with HFR were studied.
All patients were treated with chemotherapy and HFR for the elimination of FLCs using formulaTM
2000 monitors and Kit Supra 17 from Bellco®. The treatment is personalized according to the levels of FLCs, maintained during hemodialysis.
To evaluate the elimination of FLCs, blood samples and ultrafiltrates of the week were analyzed.
Pre- and post- session FLCs and serum albumin concentrations were determined, calculating the reduction ratio.
In ultrafiltrates, FLCs and albumin concentrations before and after passing through the adsorptive resin, at
the beginning and end of the session were determined.
Results: 30, 59 and 66 sessions were made, resulting in mean reduction rates of FLCs concentrations of 63, 53.8 and 38% respectively, without changes in the albumin levels.
Reduction rates of 98, 99 and 99% at the beginning of the session were obtained. At the end rates were of 79, 58 y 72%, without changes in albumin levels when passing through the resin. Only one patient recovered renal function.
Conclusions: Evidence shows that the HFR technique eliminates the FLCs and maintains this elimination during the session without saturation of the resin and without albumin loss.
Despite the small sample, we can conclude that the HFR is a technique that achieves a significant and sustained reduction of FLCs in patients with AFR due to MM with no loss of albumin. Moreover, its early use contributes to the recovery of renal function in these patients.