期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 25, 期 2, 页码 419-426出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfp488
关键词
acute kidney injury; clinical epidemiology; multiple myeloma; prognosis; survival analysis
资金
- Medical Research Council [MC_U137686857, MC_U137686858] Funding Source: Medline
- MRC [MC_U137686857, MC_U137686858] Funding Source: UKRI
- Medical Research Council [MC_U137686857, MC_U137686858] Funding Source: researchfish
Methods. We have therefore documented the natural history of all 107 patients referred to a large regional renal unit over a 20-year period and investigated factors associated with survival over a long period of time using Cox regression methods. Results. Three factors were found to be significantly and independently associated with survival: use of chemotherapy [hazard ratio (HR) 0.21, 95% CI: 0.08-0.46, P < 0.001], serum albumin (HR 0.49, 95% CI: 0.29-0.82, P = 0.02 for >= 35 g/L versus < 35 g/L) and dialysis independence (HR 0.43, 95% CI: 0.24-0.76, P = 0.005). However, survival was not found to be better for patients presenting in the second decade compared to the first (HR 0.88, 95% CI: 0.52-1.50, P = 0.65). Conclusions. This analysis highlights the need for clinical trials of novel chemotherapy regimens in this complicated group of patients. Furthermore, whether strategies to restore or preserve dialysis-independent renal function provide additional benefit to effective chemotherapy also requires further investigation. The advent of efficacious low toxicity chemotherapy (such as thalidomide and bortezomib) and new dialysis techniques to remove free light chains may radically alter the outcome of this group of patients.
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