| Background: Renal impairment is a common complication of multiple myeloma and has been thought to be related to poor prognosis.Current chemotherapy regimens based on proteasome inhibitors have significantly ameliorated renal complications in patients,but kidney function still fails to return to normal in about half of patients.The treatment of renal impairment is mainly hydration and chemotherapy for the primary disease.There is no accurate model to predict the reversibility of renal impairment.Although renal biopsy is suggestive,it is seldom performed clinically in patients with multiple myeloma,and it is invasive.Method: To identify predictors of renal function reversibility among non-invasive indicators,we retrospectively analyzed the clinical characteristics of 213 newly diagnosed adult patients with multiple myeloma at Hangzhou First People’s Hospital from January 2009 to April2020.We compared the survival of patients who used proteasome inhibitors at first with renal complete response and those without,and tried to identify the independent predictors of reversibility of renal impairment with logistics regression analysis.Results: Results showed that patients who with renal impairment and without renal complete response had shorter survival times(log-rank P=0.001,HR 0.213,95%CI0.085–0.536).β2 microglobulin was the only independent risk factor among these variables(P<0.001,HR 0.741,95% CI 0.637–0.863).The best cutoff for β2 microglobulin level was determined to be 7.8 mg/L.This had a specificity of 0.806,sensitivity of 0.759,and area under the curve(AUC)of 0.805(P<0.001,95% CI0.688–0.921).Conclusion: Patients with renal impairment when diagnosed who have a complete renal response live longer than those who do not.Protease inhibitors do not completely correct the effects of renal dysfunction on survival.β2 microglobulin may be an independent predictive factor of renal complete response. |
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