CLINICAL CHARACTERISTICS AND OUTCOMES OF PERITONEAL DIALYSIS PATIENTS WITH END-STAGE KIDNEY DISEASE DUE TO MULTIPLE MYELOMA OR AL AMYLOIDOSIS: A SINGLE-CENTER EXPERIENCE

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CLINICAL CHARACTERISTICS AND OUTCOMES OF PERITONEAL DIALYSIS PATIENTS WITH END-STAGE KIDNEY DISEASE DUE TO MULTIPLE MYELOMA OR AL AMYLOIDOSIS: A SINGLE-CENTER EXPERIENCE

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Co-author 1

Yuka Inaba yuka.ina1105@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan *

Co-author 2

Rena Sumura r.sumura1118@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 3

Chiaki Kasahara chiaki_k1101@yahoo.co.jp Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 4

Tomoki Sato aizu-to-s@hotmail.co.jp Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 5

Yumi Kuraguchi yumikuraguchi0508@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 6

Shingo Urate slc22a12@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 7

Mai Yanagi maimew963@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 8

Shohei Yamada innocent.shohei17@gmail.com St. Marianna University School of Medicine Department of Nephrology Kanagawa Japan -

Co-author 9

Yoshitaka Ishibashi yi431204@gmail.com Japanese Red Cross Medical Center Department of Nephrology Tokyo Japan -

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Patients with paraproteinemia-related diseases, such as multiple myeloma and AL amyloidosis, often progress rapidly to end-stage kidney disease (ESKD). Because these conditions are usually diagnosed at an advanced stage of kidney failure, many patients have limited time to choose their modality of kidney replacement therapy. Peritoneal dialysis (PD) may offer advantages such as preserving residual kidney function and providing greater flexibility in daily life. However, the effectiveness of PD in this population remains unclear.

Methods

We retrospectively reviewed patients who initiated PD at our hospital between June 2010 and June 2023 due to kidney failure caused by multiple myeloma or AL amyloidosis. Clinical characteristics, reasons for selecting PD, duration of PD, and the pre-dialysis period after nephrology referral were evaluated.

Results

Seven patients were identified. Among them, six were diagnosed with multiple myeloma and one with AL amyloidosis. The mean age at PD initiation was 67.3 ± 11.7 years. The mean duration of PD, including current and former patients, was 522.9 ± 756.2 days. Four of the seven patients (57%) chose PD primarily for its flexibility and to maintain independence in daily life. At the initiation of dialysis, six patients underwent urgent hemodialysis (HD) before subsequently choosing PD. Five patients started dialysis within one month after their first nephrology consultation. After PD initiation, two patients required combined PD and HD therapy due to a decline in residual kidney function, and one switched to HD because of frailty. Four patients died during the follow-up period, and one died at home while receiving palliative PD.

Conclusion

Patients with ESKD due to multiple myeloma or AL amyloidosis who start PD are often frail and have limited survival. Although many require urgent HD at the start of renal replacement therapy, PD may still help preserve independence in daily life. PD, as well as HD, may be an appropriate dialysis modality for these patients. Early referral to a nephrologist is important to ensure adequate pre-dialysis counseling, and further evidence regarding PD in such cases is warranted.

Kewords