Risk Factors Of Multiple Myeloma With Renal Injury

Background:According to the survey,the global incidence of malignant tumors has increased significantly compared with previous years,and the incidence of multiple myeloma(MM)has also increased year by year.The pathogenesis of multiple myeloma is not clear.The kidney is an important target organ.Myeloma cells damage the kidney in various ways and cause different degrees of damage to the kidney.Multiple studies at home and abroad have shown that multiple myeloma-related kidney injury has a high incidence and a high mortality rate.Therefore,multiple myeloma with renal injury should be valued by clinicians in order to achieve early detection,early treatment and early prevention.Objective:By analyzing the general situation,medical history,laboratory examination data,etc.of patients with multiple myeloma complicated with renal injury,the risk factors affecting the incidence of patients with MM and renal injury were explored.To provide an effective basis for the prevention of MM with renal injury in clinical work.Method:Screening of inpatients from the Department of Hematology,the First Affiliated Hospital of Kunming Medical University from January 1,2017 to December 31,2019,inclusion criteria:those who meet the diagnostic criteria of MM in "Diagnosis and Treatment Guidelines for Multiple Myeloma in China",and judge the occurrence of renal impairment according to Durine-Salmon(DS)staging,that is,serum creatinine(serum creatinine,SCr)<176.8 ?mol/L is normal renal function,SCr?176.8 ? mol/L is renal impairment.According to the definition and classification of acute kidney injury(AKI)by Kidney Disease(Improving Global Outcomes,KDIGO)in 2012,those who meet one of the following conditions can be diagnosed as AKI:(1)Increased serum creatinine?0.3 mg/dl within 48 hours;(2)Confirmed or speculated that serum creatinine increased?1.5 times the baseline value within 7 days;(3)Urine volume<0.5 ml/(kg·h)exceeded 6 h.And exclude:?Patients aged<18 years;?Patients with incomplete data;?People who have used nephrotoxic drugs in the past 3 months;?Patients with kidney damage due to diabetes and hypertension;?People with previous kidney disease.In the past 3 years,a total of 197 patients who met the criteria were collected.They were divided into two groups by judging whether or not they had kidney injury.Among them,97 patients had kidney injury and 100 patients had no kidney injury.Analyze the clinical characteristics of patients,the incidence of MM combined with renal injury,risk factors and so on.Results:1.197 patients with MM,97 patients with renal injury,including 33 patients with AKI,with an average age of 59.99 ± 14.68 years old,the incidence of kidney injury was 49.24%(97/197).Among them,69 were male,accounting for 71.13%(69/97),and 28 were female,accounting for 28.87%(28/97).2.Univariate Logistic regression analysis showed that:age(t=1.456,p=0.147),gender(?2=3.186,p-0.074),and the p-values of the two groups were greater than 0.05,indicating that the difference was not statistically significant.Hyperuricemia(p<0.001,OR=0.482),increased white blood cell count(p=0.025,OR=0.159),hypertension(p<0.001,OR=0.270),anemia(p<0.001,OR=0.380)Chemotherapy(p<0.001,OR=0.280)is a high risk factor for patients with multiple myeloma and renal injury.Blood phosphorus(p=0.235,OR=0.085),blood potassium(p=0.055,OR=0.137),blood calcium(p=0.793,OR=-0.019),diabetes(p=0.482,OR=0.050),p>The difference of 0.05 was not statistically significant.3.Multivariate Logistic regression analysis showed:hyperuricemia(p<0.001,OR=2.480),anemia(p<0.001,OR=2.277),hypertension(p=0.017,OR=1.091),chemotherapy(p<0.001,OR=2.492).The p values were all less than 0.05.The differences were statistically significant,suggesting that hyperuricemia,anemia,hypertension,and chemotherapy were independent risk factors for MM with renal injury.4.There were no deaths in patients with renal injury group after treatment such as active fluid replacement,chemotherapy,and treatment of primary disease;renal function returned to normal in 30 cases(30.93%),partial relief in 10 cases(10.31%),and 9 cases(9.28%)need to maintain hemodialysis.Conclusion:1.MM is a common tumor in the blood system,which is more common in middle age,more common in men than women.2.Hyperuricemia,anemia,chemotherapy,and hypertension are independent risk factors for kidney injury in MM patients.3.Kidney injury is a common serious complication of MM.The incidence of kidney injury in MM patients is 49.24%.The incidence of kidney injury in MM patients will be greatly increased by chemotherapy.4.Early and timely detection and treatment of MM kidney injury,the renal function of most patients can be restored or stabilized.When there are relevant high-risk factors,clinicians should pay attention to the prevention and individualized treatment of kidney injury.