PREDICTORS FOR EARLY MORTALITY IN MYELOMA-RELATED KIDNEY DISEASE

ABSTRACT

BACKGROUND AND AIMS: Renal failure severe enough to require dialysis is an independent predictor of poor survival outcomes in multiple myeloma (MM). Significant early mortality (EM) was also determined in patients with MM infected by COVID-19. To evaluate the EM rate and investigate the risk factors associated with EM in MM patients. METHOD: Medical records of patients from the hematology unit of UHC 'Mother Teresa' with MM between January 2020 and March 2021 were reviewed. Out of 183 patients, 33.3% have in presentation myeloma-related kidney disease (MRKD). The statistical methods consisted of Kaplan-Meier survival curves, the log-rank test, logistic regression analysis and the ROC curve for mortality analysis. RESULTS: We evaluated 61 patients with MRKD, with 67.2% men;the mean age was 66.2+ (8.7) years. The incidence of MRKD was 41%, and 19.7% of MRKD patients underwent haemodialysis treatment. The 1-year mortality rate was found 29.5% (P < .01), where the EM rate was 13.1%, from which 62.5% needed dialysis. During follow-up, 10% of patients with MRKD had confirmed positive SARS-COV2 tests, associated with a high mortality rate of around 67%. AUC for creatinine value was 0.828, while it had a specificity of 88.37% and a sensitivity of 77.78% at a cut-off value >4 mg/dL (Figure 1). Multivariate logistic regression found creatinine >4 mg/dL, haemodialysis and COVID-19 remained independent predictors of high mortality in MRKD patients after being adjusted for cofounders (Figure 2). CONCLUSION: High incidence of MRKD indicates under recognition of MM. Mortality from COVID-19 infection in MRKD was relatively high, 22.2%. Renal failure is the second most common cause, after infection, of EM in MM patients. It is potentially reversible, so it is of high-interest early diagnosis and management of MRKD for more prolonged survival. Prophylactic measures in patients with preexisting-kidney failure may further reduce this risk.