Acute kidney injury (AKI) occurs in 12–20% of multiple myeloma (MM) patients. Several studies have shown a reduction of free light chains (FLC) using hemodialysis with High-Cut-Off membranes. However, this technique entails albumin loss. Hemodiafiltration with ultrafiltrate regeneration is a technique that includes a process of adsorption. The aim of this study was to evaluate the effectiveness of hemodiafiltration with ultrafiltrate regeneration in reducing FLC levels without causing albumin loss. This is an observational study (2012 to 2018) including nine patients with MM (5 kappa, 4 lambda) and AKI. All patients were treated with chemotherapy and hemodiafiltration with ultrafiltrate regeneration. Blood Samples (pre and post-dialysis) and ultrafiltrate were collected pre and post-resin at 5 min after initiation of the session and 5 min before the end of the procedure. The serum levels of kappa and lambda were reduced by a 57.6 ± 10% and 33.5 ± 25% respectively. Serum albumin concentration remained unchanged after the procedure. In the ultrafiltrate, the mean FLC reduction ratio shortly after initiation of the dialysis procedure was: 99.2 and 97.06% for kappa and lambda respectively, and only 0.7% for albumin; and at the end of the session the percent reduction was: 63.7 and 33.62% for kappa and lambda respectively, and 0.015% for albumin. Patients clinical outcome was: 33.3% recovered renal function, 22.2% died during the first year and 44.4% required maintenance dialysis. Hemodiafiltration with ultrafiltrate regeneration reduces FLC levels without producing a significant loss of albumin; and, FLC removal is maintained throughout the session. Therefore, hemodiafiltration with ultrafiltrate regeneration may be considered an effective adjunctive therapy in patients with MM.

中文翻译：

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具有超滤液再生的血液透析滤过可减少多发性骨髓瘤患者的游离轻链而无白蛋白损失。

12-20% 的多发性骨髓瘤 (MM) 患者发生急性肾损伤 (AKI)。多项研究表明，使用高截留膜进行血液透析可减少游离轻链 (FLC)。然而，这种技术需要白蛋白损失。具有超滤液再生的血液透析滤过是一种包括吸附过程的技术。本研究的目的是评估血液透析滤过与超滤液再生在降低 FLC 水平而不导致白蛋白损失方面的有效性。这是一项观察性研究（2012 年至 2018 年），包括 9 名患有 MM（5 kappa，4 lambda）和 AKI 的患者。所有患者均接受化疗和血液透析滤过超滤液再生治疗。在会话开始后 5 分钟和程序结束前 5 分钟，在树脂前和树脂后收集血样（透析前和透析后）和超滤液。kappa 和 lambda 的血清水平分别降低了 57.6 ± 10% 和 33.5 ± 25%。手术后血清白蛋白浓度保持不变。在超滤液中，透析程序开始后不久的平均 FLC 减少率为：κ 和 λ 分别为 99.2% 和 97.06%，白蛋白仅为 0.7%；在会话结束时，减少百分比为：kappa 和 lambda 分别减少 63.7% 和 33.62%，白蛋白减少 0.015%。患者的临床结果是：33.3% 的肾功能恢复，22.2% 在第一年死亡，44.4% 需要维持透析。具有超滤液再生的血液透析滤过可降低 FLC 水平，而不会造成白蛋白的显着损失；并且，在整个会话期间保持 FLC 移除。因此，具有超滤液再生的血液透析滤过可被认为是 MM 患者的有效辅助治疗。