Contributions
Abstract: PB2246
Type: Publication Only
Background
In multiple myeloma, the kidney is a major organ that can be affected during the disease process resulting in 40% of patients developing renal impairment. In an ageing population, there are multiple comorbidities that can have a negative impact on renal function and hence non-paraprotein related disease has previously been described in up to 25% of myeloma patients. Declining renal function in myeloma results in difficulties giving optimum chemotherapy and worse outcomes for patients.
Aims
To optimise management of renal impairment from none myeloma causes
Methods
We reviewed an unselected group of 34 patients, median age 75 (53-87), attending our unit with multiple myeloma and graded their renal function using a combination of glomerular filtration rate (GFR) and Albumin Creatinine Ratio (ACR).
Results
Findings show that 54.8% of the patients have a mild to moderate decrease in renal function and 32.3% show a moderate to severe decrease. 58% of patients had an ACR outside of the normal range (<3mg/ml). See Table. This leaves only 12.9% of patients had no markers of chronic kidney disease (CKD).
We identified 12% of the patients are pre-diabetic (HBA1c 42-47 mmol/mol) and 5.9% of patients are known to be diabetic, but had HBA1C greater than 58 mmol/mol. 24% of patients were identified as having a systolic blood pressure ≥ 140 mmHg.
Conclusion
In patients who have myeloma at least partial remission we follow our algorithm summarised below for monitoring and intervention to preserve renal function
- Clinical testing of Blood pressure, HBA1C, ACR, EGFR at least 12 monthly
- Patients with stage 3b renal failure are referred for a renal opinion
- If the patient is diabetic and poorly controlled despite GP management we refer to endocrinology for intervention
- If they are pre-diabetic or newly diagnoses diabetic then we refer to GP for intervention
- We ask GPs to review for patients with a systolic BP over 140 or diastolic over 90. Initially with ambulatory BP monitoring and pharmaceutical intervention if confirmed.
- If ACR >30 we advise an ACE inhibitor at a dose tolerated by the patient
- We consider addition of a statin if eGFR <60 due to increased cardiovascular risk
The full algorithm defines the frequency of CKD, diabetic and blood pressure monitoring needed for specific patient groups within the multiple myeloma population.
In conclusion, the aim of our patient review and algorithm is to identify, target and manage all possible reversible causes of CKD in the multiple myeloma cohort. We believe this is a cheap and effective intervention to improve quality of life and may have an impact in the overall survival in multiple myeloma by preserving renal function. We intend to monitor our patient cohort longitudinally, but further studies would be useful to prove the effectiveness of these interventions in patients with multiple myeloma.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Renal impairment
Abstract: PB2246
Type: Publication Only
Background
In multiple myeloma, the kidney is a major organ that can be affected during the disease process resulting in 40% of patients developing renal impairment. In an ageing population, there are multiple comorbidities that can have a negative impact on renal function and hence non-paraprotein related disease has previously been described in up to 25% of myeloma patients. Declining renal function in myeloma results in difficulties giving optimum chemotherapy and worse outcomes for patients.
Aims
To optimise management of renal impairment from none myeloma causes
Methods
We reviewed an unselected group of 34 patients, median age 75 (53-87), attending our unit with multiple myeloma and graded their renal function using a combination of glomerular filtration rate (GFR) and Albumin Creatinine Ratio (ACR).
Results
Findings show that 54.8% of the patients have a mild to moderate decrease in renal function and 32.3% show a moderate to severe decrease. 58% of patients had an ACR outside of the normal range (<3mg/ml). See Table. This leaves only 12.9% of patients had no markers of chronic kidney disease (CKD).
We identified 12% of the patients are pre-diabetic (HBA1c 42-47 mmol/mol) and 5.9% of patients are known to be diabetic, but had HBA1C greater than 58 mmol/mol. 24% of patients were identified as having a systolic blood pressure ≥ 140 mmHg.
Conclusion
In patients who have myeloma at least partial remission we follow our algorithm summarised below for monitoring and intervention to preserve renal function
- Clinical testing of Blood pressure, HBA1C, ACR, EGFR at least 12 monthly
- Patients with stage 3b renal failure are referred for a renal opinion
- If the patient is diabetic and poorly controlled despite GP management we refer to endocrinology for intervention
- If they are pre-diabetic or newly diagnoses diabetic then we refer to GP for intervention
- We ask GPs to review for patients with a systolic BP over 140 or diastolic over 90. Initially with ambulatory BP monitoring and pharmaceutical intervention if confirmed.
- If ACR >30 we advise an ACE inhibitor at a dose tolerated by the patient
- We consider addition of a statin if eGFR <60 due to increased cardiovascular risk
The full algorithm defines the frequency of CKD, diabetic and blood pressure monitoring needed for specific patient groups within the multiple myeloma population.
In conclusion, the aim of our patient review and algorithm is to identify, target and manage all possible reversible causes of CKD in the multiple myeloma cohort. We believe this is a cheap and effective intervention to improve quality of life and may have an impact in the overall survival in multiple myeloma by preserving renal function. We intend to monitor our patient cohort longitudinally, but further studies would be useful to prove the effectiveness of these interventions in patients with multiple myeloma.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Myeloma, Renal impairment