Tratamiento con hemodiálisis del fracaso renal agudo en el mieloma múltiple con filtros de alto poro (high cut-off)

introduction: acute renal failure (arf) occurs in 12%-20% of all multiple myeloma (mm) cases, and the survival of these patients depends on renal function recovery. renal function is not recovered in 75% of dialysis-dependent patients, and their mean survival with replacement therapy is less than one year. renal tubular disease is the most frequent cause of renal failure. it is present in more than 55% of renal failure cases and in 75% of those requiring dialysis. rapid reduction of free light chain levels in the blood is necessary in order to recover renal function. one coadjuvant measure in treating the disease is reducing light chain levels with plasmapheresis, but its efficacy has not yet been clearly proven. our proposal was therefore to use extended haemodialysis sessions with high cut-off dialysers (hco-hd), obtaining a recovery rate of more than 60%. we present the progress of 6 patients with myeloma and acute renal failure who were treated with hco-hd and the complications associated with using this type of haemodialysis. then, we review the pros and cons of this technique. method: six patients diagnosed with mm and arf requiring dialysis and with serum free light chain levels above 500mg/l were treated with 8-hour haemodialysis sessions with an hco-hd filter. before and after each session, serum free light chain levels were measured by nephelometry; other parameters were recorded as well. at the same time, patients underwent chemotherapy according to protocols. results: the symptom onset times of the 3 men and 3 women diagnosed with mm and arf were highly variable, from 7 days to more than 1 year. we performed 90 extended sessions with hco-hd filters, and each patient underwent between 6 and 40 sessions. free light chain levels decreased by a mean of 65% between treatment onset and completion, except in one patient who experienced a 12.6% reduction. the mean percentage of reduction of light chain levels per session was 54.98%±17.27%. a complication occurre