Renal failure in multiple myeloma: reversibility and impact on the prognosis

The purpose of the present study was to analyse the importance and prognost ic value of renal failure in multiple myeloma patients. The frequency and r eversibility of renal failure in 775 multiple myeloma patients diagnosed be tween 1984-86 and 1990-92 in the Nordic countries were studied. Renal failu re, defined as plasma creatinine > 130 mu mol/l. was observed in 29% of the cases at the time of diagnosis. During the first year after diagnosis 58% achieved normalisation of p-creatinine, and this was achieved mainly during the first 3 months. Reversibility of renal failure was more frequently obs erved in patients with moderate renal failure, hypercalcaemia and low Bence -Jones protein excretion. In a multivariate analysis renal failure, high ag e, stage III disease and hypercalcaemia were independent prognostic factors for survival. Patients who needed dialysis had a poor prognosis, with a me dian survival of 3.5 months. A 12-months landmark analysis showed that reve rsibility of renal failure was a more important prognostic factor than resp onse to chemotherapy. It is concluded that renal failure in multiple myelom a is reversible in about half the cases, and reversibility of renal failure improves long-term survival.