A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR)

Sonia Pasquali, Francesco Iannuzzella, Mattia Corradini, Silvia Mattei, Achiropita Bovino, Alfredo Stefani, Giuseppe Palladino, Marialuisa Caiazzo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In myeloma cast nephropathy, fast reduction of serum free light chain (FLC) levels correlates with renal recovery. Recently, extracorporeal treatments using filters with a high-molecular weight cut-off have been successfully used for FLC removal. However, using these new filters, high cost and elevated albumin leakage are common drawbacks. We studied a new and cheaper therapeutic approach with adsorbent resins to evaluate its efficacy. Methods: We treated four patients, affected by dialysis-dependent acute kidney injury (AKI) due to biopsy proven de novo FLC myeloma cast nephropathy. Each patient underwent bortezomib chemotherapy and extracorporeal treatment with the supra-hemodiafiltration with endogenous reinfusion (HFR) technique (Supra-HFR, Bellco Mirandola, Modena, Italy). Supra-HFR is a kind of hemodiafiltration that utilizes separated convection, diffusion and adsorption. The sorbent cartridge has a high affinity for FLC (both κ and λ) but is able to re-infuse albumin, avoiding the need for albumin perfusions. Supra HFR treatments (4 h each) were carried out for eight consecutive days and then every other day. Results: All patients showed a significant reduction of serum FLC, whereas serum albumin concentration remained unchanged. Renal function recovered in three out of four patients. Conclusions: FLC removal with adsorbent resins represents an effective therapeutic strategy that does not require replacement with albumin.

Original languageEnglish
Pages (from-to)251-254
Number of pages4
JournalJournal of Nephrology
Volume28
Issue number2
DOIs
Publication statusPublished - Apr 1 2015

Keywords

  • Hemodiafiltration with endogenous reinfusion
  • Kidney failure
  • Multiple myeloma
  • Serum free light chains

ASJC Scopus subject areas

  • Nephrology

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