Clinical characteristics and risk factors of multiple myeloma patients with renal impairment / 中华肾脏病杂志

ABSTRACT

Objective:To explore the clinical and cytogenetic characteristics and risk factors of multiple myeloma (MM) patients with renal impairment (RI).Methods:A total of 113 newly diagnosed patients with MM in the department of nephrology and hematology in Zhongnan Hospital of Wuhan University from January 2013 to December 2017 were enrolled. The patients were divided into RI group and non-renal impairment (NRI) group according to whether serum creatinine (Scr) at the time of diagnosis was higher than 177 μmol/L. The clinical and laboratory data of two groups were compared. The risk factors of RI in MM patients were analyzed by binary logistic regression, and then the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of these risk factors.Results:The incidence of RI in 113 MM patients was 34.5%. Compared with NRI group, levels of white blood cells, serum uric acid, blood urea nitrogen, neutrophil-to-lymphocyte ratio (NLR), cystatin C, β 2-microglobulin (β 2-MG), blood phosphorus, urine light chain, bone-marrow plasma cell percentage, International Staging System (ISS) stage III percentage, light chain type percentage, positive urinary Bence-Jones protein percentage and positive urinary protein percentage were higher in RI group, while levels of estimated glomerular filtration rate (eGFR), serum bicarbonate concentration and globulin were lower in RI group (all P<0.05). There were no significant differences in other clinical variables between the two groups (all P>0.05). Fluorescence in situ hybridization (FISH) was applied to 42 MM patients to detect the following five genetic abnormalities IgH rearrangement, 1q21 amplification, RB1 deletion, D13S319 deletion and P53 deletion. Among them, 29 (69.0%) patients were abnormal. The incidence of RB1 deletion in RI group was higher than NRI group ( P<0.05), and there were no significant differences in the incidences of other genetic abnormalities (all P>0.05). Further logistic regression analysis showed that increase of NLR ( OR=1.589, 95% CI 1.115-2.266, P=0.010), bone-marrow plasma cell percentage ( OR=1.053, 95% CI 1.008-1.101, P=0.021) and β 2-MG ( OR=22.166, 95% CI 2.146-228.927, P=0.009), light chain type ( OR=15.399, 95% CI 1.002-236.880, P=0.049), and hyperuricemia ( OR=11.707, 95% CI 1.580-86.717, P=0.016) were the independent risk factors for RI in MM patients. The comparison of area under the ROC ( AUC) among these risk factors showed the AUC of β 2-MG was larger than that of NLR or uric acid (both P<0.05), while there were no significant differences in the rest of pairwise comparison (all P>0.05). The AUC of β 2-MG predicting RI was the largest ( AUC=0.907, 95% CI 0.853-0.962, P<0.001). Conclusions:MM patients have high morbidity of RI, and there are more RI patients with RB1 deletion in RI patients. Light chain type, hyperuricemia, high level of NLR, high bone-marrow plasma cell percentage and increased β 2-MG are the independent risk factors for RI in MM patients. Among them, β 2-MG is the best predictor for RI, and NLR plays an important role in predicting RI as a convenient and effective inflammatory marker.