Plasma exchange when myeloma presents as acute renal failure: A randomized, controlled trial

William F. Clark, A. Keith Stewart, Gail A. Rock, Marion Sternbach, David M. Sutton, Brendan J. Barrett, A. Paul Heidenheim, Amit X. Garg, David N. Churchill

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252 Scopus citations

Abstract

Background: Two small, randomized trials provide conflicting evidence about the benefits of plasma exchange for patients with acute renal failure at the onset of multiple myeloma. Objective: To assess the effect of 5 to 7 plasma exchanges on a composite outcome in patients with acute renal failure at the onset of multiple myeloma. Design: Randomized, open, controlled trial, stratified by chemotherapy and dialysis dependence, conducted from 1998 to 2004. Setting: Hospital plasma exchange units in 14 Canadian medical centers. Participants: 104 patients between 18 and 81 years of age with acute renal failure at the onset of myeloma. Intervention: Study participants were randomly assigned to conventional therapy plus 5 to 7 plasma exchanges of 50 mL per kg of body weight of 5% human serum albumin for 10 days or conventional therapy alone. Ninety-seven participants completed the 6-month follow-up. Measurements: The primary outcome was a composite measure of death, dialysis dependence, or glomerular filtration rate less than 0.29 mL · s-2 · m-2 (<30 mL/min per 1.73 m2). Results: At enrollment, the plasma exchange and control groups were similar for dialysis dependence, chemotherapy, sex, age, hypercalcemia, serum albumin level, 24-hour urine protein level, serum creatinine level, and Durie-Salmon staging. The primary composite end point occurred in 33 of 57 (57.9%) patients in the plasma exchange group and in 27 of 39 (69.2%) patients in the control group (difference between groups, 11.3% [95% CI, -8.3% to 29.1%]; P = 0.36). One third of patients in each group died. Limitations: The study was small, used a composite outcome, and did not use renal biopsy as an inclusion criterion. Recruiting physicians were blinded to treatment allocation but not to treatment thereafter. Conclusions: In patients with acute renal failure at the onset of multiple myeloma, there is no conclusive evidence that 5 to 7 plasma exchanges substantially reduce a composite outcome of death, dialysis dependence, or glomerular filtration rate less than 0.29 mL · s-2 · m-2 (<30 mL/min per 1.73 m2) at 6 months.

Original languageEnglish (US)
Pages (from-to)777-784+I-20
JournalAnnals of internal medicine
Volume143
Issue number11
StatePublished - Dec 6 2005

ASJC Scopus subject areas

  • Internal Medicine

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    Clark, W. F., Stewart, A. K., Rock, G. A., Sternbach, M., Sutton, D. M., Barrett, B. J., Heidenheim, A. P., Garg, A. X., & Churchill, D. N. (2005). Plasma exchange when myeloma presents as acute renal failure: A randomized, controlled trial. Annals of internal medicine, 143(11), 777-784+I-20.