HEMODIALYSIS - AN APPROPRIATE THERAPY IN MYELOMA-INDUCED RENAL-FAILURE

To determine whether vigorous treatment with dialysis is of benefit to patients with myeloma-induced renal failure at presentation, we retro spectively reviewed outcomes in a group of patients diagnosed with mul tiple myeloma between January 1986 and September 1993. Increased age ( P = 0.003), presence of renal impairment (P = 0.006), and failure to e nter plateau phase (P < 0.001) were independently associated with shor tened survival, However, there was no difference in outcome between pa tients with severe renal failure, those treated with dialysis, and tho se with milder renal impairment (median survival, 22 months in both gr oups), nor was reversibility of renal failure associated with any surv ival advantage. The lack of correlation between severity or reversibil ity of the renal failure and survival suggests that there may be chara cteristics of some patients or their underlying myeloma that are respo nsible both for renal impairment and for adverse prognosis, In this st udy, neither age, clinical stage, labeling index, nor response to trea tment was able to account for the difference in outcome between patien ts with and without renal failure. The prolongation of life achieved i n the dialysis patients such that their median survival was identical with that of the group with milder renal impairment was considered to represent a significant benefit to these patients and to justify the o ffer of dialysis to all patients requiring it. (C) 1997 by the Nationa l Kidney Foundation, Inc.