Photo by Anna Frodesiak
New research suggests the risk of end-stage renal disease (ESRD) caused by multiple myeloma (MM) is declining, and survival is lengthening for patients who do develop ESRD due to MM.
Researchers said these findings are encouraging, but efforts are still needed to develop effective MM treatments with fewer side effects.
They noted that MM treatment has changed substantially in the last decade.
But it hasn’t been clear whether the burden of ESRD due to MM has changed or whether survival has improved for patients with ESRD due to MM.
To gain some insight, Robert Foley, MD, of the University of Minnesota in Minneapolis, and his colleagues examined data from the US Renal Data System database spanning the period from 2001 to 2010.
They reported their findings in the Journal of the American Society of Nephrology.
The team found that, of the 1,069,343 patients with ESRD who were on renal replacement therapy (RRT), 12,703 had developed ESRD due to MM.
However, the incidence of ESRD from MM decreased from 2001 to 2010. Compared to 2001-2002 (1.00), the standardized incidence ratios of ESRD due to MM were 0.96 for 2003-2004 (P<0.05), 0.99 for 2005-2006 (P>0.05), 0.89 for 2007-2008 (P<0.001), and 0.82 for 2009-2010 (P<0.001).
The demography-adjusted incidence ratio for ESRD due to MM decreased (P<0.05) between 2001-2002 and 2009-2010 in the overall population and in most of the subgroups examined.
The exceptions were patients younger than 40, Hispanic patients, and those belonging to the “other” race category. (The race categories were “white,” “black,” and “other,” while the ethnicity categories were “Hispanic” and “non-Hispanic.”)
The data also showed improvements in survival over time among patients with ESRD due to MM.
Compared to 2001-2002, the adjusted hazard ratios (AHRs) for death were 1.02 for 2003-2004 (P=0.5), 0.93 for 2005-2006 (P=0.02), 0.86 for 2007-2008 (P<0.001), and 0.74 for 2009-2010 (P<0.001). (This analysis was adjusted for age, sex, race, ethnicity, ischemic heart disease, diabetes, mode of RRT, estimated glomerular filtration rate, body mass index, serum albumin, and hemoglobin.)
AHRs for death were highest in the first year after RRT initiation (AHR=2.6; P<0.001) and decreased in year 3 (AHR=1.59; P<0.001).
The AHR for death in patients with ESRD due to MM compared to those with ESRD due to all other causes was 2.05 (P<0.001).
“Myeloma is the commonest malignancy leading to kidney failure,” Dr Foley said. “It’s encouraging that we found that kidney failure due to multiple myeloma declined considerably over the last decade.”
