RENAL REPLACEMENT THERAPY IN MULTIPLE-MYELOMA AND SYSTEMIC AMYLOIDOSIS

Renal failure frequently complicates both multiple myeloma and systemi c amyloidosis. Renal replacement therapy (RRT) may be poorly tolerated and its role in such patients is not clearly defined. Of fifty patien ts (26 males and 24 females) referred to a single centre because of re nal failure associated with multiple myeloma or systemic amyloidosis 3 7 progressed to end-stage renal failure and 30 of these patients recei ved RRT. Nine patients have been treated by CAPD, 13 by haemodialysis, and 8 patients have required both forms of dialysis. Overall one year and two year survival rates were 66% and 57% respectively. The median duration on RRT was 7.5 months (range 1-96 months) with a 51% one yea r, and a 46% two year survival rate. Of 7 patients with amyloidosis wh o underwent renal transplantation, 3 died within 6 months of transplan tation. Undiagnosed cardiac involvement contributed to this early mort ality. We conclude that renal replacement therapy is appropriate for s ome patients with multiple myeloma and systemic amyloidosis who develo p endstage renal failure. Careful asssessment and selection of patient s is necessary prior to renal transplantation.