Receipt of dialysis may be a risk factor for inpatient mortality in patients with multiple myeloma (MM) being treated with high-dose melphalan and autologous stem cell transplantation (HDM-ASCT), according to study results published in the European Journal of Haematology.
To evaluate inpatient mortality trends, investigators conducted a retrospective analysis of hospital admissions for patients with MM and end-stage renal disease or chronic kidney disease who were treated with HDM-ASCT. End-stage renal disease required the use of dialysis, and chronic kidney disease was defined as having a creatinine clearance of below 60 mL/mm/1.73 m2 but without the need for dialysis.
Patient records used for analysis were from 2002 to 2014, and were identified through the National Inpatient Sample database. While the database accounted for approximately 20% of hospital discharges in the United States, weighted estimates allowed for extrapolation to hospitalizations across the nation.
The weighted estimate for inpatient admissions for HDM-ASCT among patients with MM was 47,253; the unweighted total included 10,231 patients with MM. Of the weighted total, only 45 patients received peritoneal dialysis and 1709 received hemodialysis. Using a weighted estimate, the investigators identified 3020 patients with MM and chronic kidney disease who underwent HDM-ASCT.
Presence of end-stage renal disease was independently associated with an increased risk of inpatient mortality (odds ratio [OR], 6.193; 95% CI, 3.585-10.701). However, the odds of mortality were not significant for chronic kidney disease (OR, 1.387; 95% CI, 0.757-2.539).
The inpatient mortality rate for patients receiving peritoneal dialysis was 20.5%. For patients given hemodialysis, the rate was 13.8%. Both of these mortality rates were higher than for the entire cohort of patients with MM, which was 1.1%; however, the difference in inpatient mortality between these dialysis methods was not significant (P =.58).
Inpatient mortality significantly decreased in the last 5 years of the study period for patients with end-stage renal disease (15.6% in 2009 vs 5.0% in 2014; P <.001). The study investigators noted that this inpatient mortality rate was still elevated in comparison with rates for patients in this study without end-stage renal disease.
“The results of our large nationwide study demonstrate persistently high mortality rates in patients with MM on dialysis undergoing HDM-ASCT, even after accounting for other comorbidities,” concluded the investigators.
Disclosure: Some of the authors disclosed financial relationships with pharmaceutical companies and medical device manufacturers. For a full list of disclosures, please refer to the original study.
Mohyuddin GH, Abbasi S, Okoniewski M, et al. Inpatient mortality of patients with multiple myeloma with renal impairment undergoing autologous stem cell transplantation [published online July 14, 2020]. Eur J Haematol. doi: 10.1111/ejh.13487.