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

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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 .

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Conflict of interest

G.P. is an employee of Bellco srl. The other authors have nothing to declare.

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Authors and Affiliations

  1. Department of Internal Medicine, Nephrology and Dialysis Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42123, Reggio Emilia, Italy

    Sonia Pasquali, Francesco Iannuzzella, Mattia Corradini, Silvia Mattei, Achiropita Bovino & Alfredo Stefani

  2. Scientific Affairs, Bellco srl, Mirandola, Modena, Italy

    Giuseppe Palladino

  3. Department of Clinic, Diagnostic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy

    Marialuisa Caiazzo

Authors
  1. Sonia Pasquali
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  2. Francesco Iannuzzella
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  3. Mattia Corradini
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  4. Silvia Mattei
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  5. Achiropita Bovino
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  6. Alfredo Stefani
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  7. Giuseppe Palladino
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  8. Marialuisa Caiazzo
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Corresponding author

Correspondence to Francesco Iannuzzella.

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Pasquali, S., Iannuzzella, F., Corradini, M. et al. A novel option for reducing free light chains in myeloma kidney: supra-hemodiafiltration with endogenous reinfusion (HFR). J Nephrol 28, 251–254 (2015). https://doi.org/10.1007/s40620-014-0130-8

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  • DOI: https://doi.org/10.1007/s40620-014-0130-8

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