Sens F, et al. - This study assessed renal recovery and survival among dialysis-dependent acute cast nephropathy patients treated with chemotherapy plus intensive hemodialysis (IHD) with an adsorbent polymethylmethacrylate membrane (IHD-PMMA). Findings demonstrated that in this patient population, early free light chains (FLC) removal by IHD-PMMA combined with chemotherapy was related to high rates of renal recovery and survival.

Methods

• Researchers performed a single-center retrospective cohort-study including patients with dialysis-dependent acute cast nephropathy treated with chemotherapy and IHD-PMMA between 2007 and 2014.
• Patients had six 6-h hemodialysis sessions a week, until predialysis serum FLC fell below 200 mg/L, for a maximum of 3 weeks.
• Renal recovery, defined as dialysis independence, and survival were the primary outcomes.

Results

• This analysis included a total of 17 patients, all with stage 3 AKI.
• Data demonstrated that all received chemotherapy, mostly based on bortezomib and steroids (88%).
• It was noted that renal recovery was achieved by 12 patients (71%), usually within 60 days (92%).
• The reported overall hematological response rate at 3 months was 57%; hematological response was maintained for at least 2 years in 86% of responders.
• Findings demonstrated that at 6, 12, and 24 months, 76, 75, and 62% of patients were alive, respectively.
• Also, researchers found an association of higher reduction in involved FLC by day 12 (p = 0.022) and day 21 (p = 0.003) with renal recovery.
• A lower mortality was experienced by patients with FLC reduction rate >50% by day 21 (hazard ratio 0.10, 95% CI 0.02–0.63).