Journal Article

Online high-efficiency haemodiafiltration achieves higher serum free light chain removal than high-flux haemodialysis in multiple myeloma patients: preliminary quantitative study

Alexandre Granger Vallée, Leila Chenine, Hélène Leray-Moragues, Laure Patrier, Chantal Cognot, Guillaume Cartron, Jean-Paul Cristol and Bernard Canaud

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 11, pages 3627-3633
Published in print November 2011 | ISSN: 0931-0509
Published online April 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr180
Online high-efficiency haemodiafiltration achieves higher serum free light chain removal than high-flux haemodialysis in multiple myeloma patients: preliminary quantitative study

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Background. Fast reduction of serum free light chain (FLC) levels correlate with renal recovery in cast nephropathy. Because convection has the capacity to remove proteins of higher molecular weights, we hypothesized that haemodiafiltration (HDF) would be superior to haemodialysis (HD) for FLC clearance.

Methods. We retrospectively identified all renal replacement therapy (RRT) sessions performed in multiple myeloma patients with pre- and post-treatment FLC measurements during a 2-year period. Using kinetic modelling, we calculated reduction percentages corrected for net ultrafiltration, effective clearances, net mass removal and Kt/V for both kappa (κ) and lambda (λ) serum FLC.

Results. We analysed 27 (10 HD and 17 HDF) RRT sessions realized in a total of six subjects. HDF resulted in higher FLC removal rates when compared to HD. Moreover, high-efficiency (i.e. substitution volume > 15 L/session) HDF demonstrated median efficient FLC clearances roughly twice superior to high-flux HD for both κ (59.0 versus 33.8 mL/min, respectively; P < 0.01) and λ (40.5 versus 19.7 mL/min, respectively; P = 0.02) FLC. In post-dilution HDF treatments, corrected FLC reduction percentages positively correlated with substitution volumes. Total plasma proteins increased during RRT in the HDF group.

Conclusions. This preliminary quantitative study demonstrates the superiority of high-efficiency HDF over high-flux HD for serum FLC removal in multiple myeloma patients on RRT. No negative impact on total plasma proteins was noted.

Keywords: haemodiafiltration; haemodialysis; kidney failure; multiple myeloma; serum free light chains

Journal Article.  4210 words.  Illustrated.

Subjects: Nephrology

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