P0631COMPLICATIONS OF TREATMENT WITH HIGH CUT OFF FILTERS FOR ACUTE KIDNEY INJURY SECONDARY TO MULTIPLE MYELOMA
Authors: BERNI WENNEKERS ANA , Coscojuela Otto Ana , DOURDIL MARIA VICTORIA , IÑIGO GIL PABLO , Alvarez Lipe Rafael 
Published: June 2020

Background and Aims

Acute kidney injury is a frequent complication of MM that can affect 18 to 56% of patients and more than 10% end up needing dialysis.

One of the drawbacks associated with the technique is attributed to the albumin loss. The other complications are related with the dialysis technique itself, especially infections, as highlighted by the Eulite study.

The objective of the study is to check that there are no more complications in dialysis with High Cut Off filters than in conventional Hemodialysis.

Method

We are the referral hospital in our community in the treatment of acute kidney injury secondary to myeloma. We have performed 28 treatments of hemodialysis with High cut off filters (HD-HCO).

The HD-HCO protocol includes daily dialysis session of 6 hours during the first 6 days to subsequently switch to dialysis every other dayuntil free light chains levels below 500 mg/L, or until the recovery of renal function allows the independence of dialysis.

All these patients have a chemotherapy regimen based on Bortezomib (25 of the 28 treatments) and Dexamethasone (28 treatments).

A retrospective analysis of the 28 treatments that are performed with HD-HCO after 8 years of experience (July 2011 to May 2019) to demostrate the presence of the same complications as the conventional Hemodialysis.

Results

Loss of albumin is one of the main drawbacks of the technique. Our patients had no changes in albumin levels due to the fact that our protocol includes the infusion of 2 vials of 20% albumin of 50 ml. at the end of each HD-HCO session. Figure 2

Another concern is intradialytic complications. We have reviewed this topic and our results show that patients in HD-HCO do not present a greater number of complications than those who dialyze with HD-HD or other conventional dialysis. The total number of sessions was 298. 21 patients developed hypotension (7%). The number of sessions in which the patient presented fever was 6 (2%), coagulation of the circuit occurred in 23 sessions (7,7%). The catheter dysfunction (when it does not allow to reach 250 ml/min of blood flow) in 26 times(8.7%) and only 13 times the replacement of the catheter (4.26%) was necessary, consequently, in those who required a greater number of dialysis sessions. In only 1 case (patient who required 27 sessions) to place a permanent Tesio catheter was necessary. Figure 1

In referring to complications of dialysis for AKI secondary to myeloma, few studies consider them. These studies focus on quantifying the reduction of light chains and the efficiency of the treatment, but don’t keep in mind the record of the complications.

In the EuLITE study, authors observed a greater number of lung infections in the HD-HCO group (12 vs 3) p = 0.014 and attributed this difference to extended dialysis and albumin loss.We have not observed this problem. The levels of albumin are stable with our infusion protocol of 2 vials of 20% human albumin of 50 ml at the end of each HD-HCO.

There’s no more complications than conventional dialysis, even infection ones. 13 febrile episodes occurred in 6 patients (more than 37,5ºC). Blood cultures were collected in all patients, being positive in only 4 patients. Germs found were: Escherichia coli (treated with Amoxicilin/clavulanic), Staphylococcus aureus (treated with Daptomycin), Staphylococcus epidermidis (treated with Meropenem) and Klebsiella pneumoniae (treated with Meropenem too). This 4 patients were the ones who required the replacement of the catheter.

Conclusion

1. - Our findings indicate that the HD-HCO has the same safety profile as the conventional Hemodialysis.

2.- There is no serious infectious complications in our patients despite of the fact that all of them are immunosuppressed patients (AKI secondary to Multiple Myeloma in patients treated with chemotherapy)