Myeloma-Related Kidney Failure Declined in Recent Years

The risk for end-stage renal disease (ESRD) that required renal replacement therapy (RRT) due to multiple myeloma appears to have declined significantly between 2001 and 2010, according to the results of an observational study published in Journal of the American Society of Nephrology.

“We found that adjusted incidence ratios of ESRD from multiple myeloma declined by nearly 20% between 2001–2002 and 2009–2010, a trend that was largely independent of major demographic characteristics,” wrote researchers led by Scott Reule, MD, of the University of Minnesota.

According to background information in the study, multiple myeloma is the most common cancer that causes ESRD and the rate of patients with myeloma who ultimately develop ESRD is high. With the improvements in multiple myeloma treatments seen in the last 10 years, the researchers conducted this study to determine if any similar improvement in the occurrence of myeloma-related ESRD has occurred.

Reule and colleagues looked at data from 12,703 patients with ESRD due to myeloma treated with RRT taken from more than 1 million patients in the US Renal Data System database. They evaluated temporal trends between 2001 and 2010 for demography-adjusted incidence ratios (AIR), relative to rates in 2001–2002, and mortality hazards from RRT initiation, relative to hazards in 2001–2002.

Data revealed lower rates of myeloma-related ESRD among patients aged younger than 40 years and those of “other” race/ethnicity, and higher rates among patients aged 65 years or older, men, and non-Hispanic blacks.

“Interestingly, we demonstrate a more than two-fold higher incidence of ESRD due to multiple myeloma in black vs white patients, but a lower hazard of death compared with white patients in both unadjusted and adjusted models,” the researchers wrote.

Overall, the researchers found that the AIR for ESRD decreased from 2001–2002 to 2009–2010 (P < .005) in all groups except patients aged younger than 40, Hispanics, and “other” race/ethnicity. Higher mortality rates were observed for patients with ESRD due to myeloma compared with matched controls without myeloma. The mortality rates were 86.7, 41.4, and 34.4 per 100 person-years for the first 3 years of treatment compared with 32.3, 20.6, and 21.3 for controls.

Reule and colleagues found that the mortality hazard ratios decreased monotonically after 2004 to a value of 0.72 in 2009–2010. Significant decreases in mortality hazard ratios from 2001–2002 to 2009–2010 were seen in all groups in the study except those aged younger than 40 and Hispanics.

According to the researchers, these findings were consistent even after adjustments were made for demographic characteristics, comorbidity markers, and laboratory test values.

In their conclusions, the researchers wrote that it is “tempting to speculate that the salutary trends in the management and outlook of multiple myeloma include effects on kidney disease; however, true cause-effect relationships cannot be determined in our study due to its observational nature.”