Application of RIFLE criteria in patients with multiple myeloma with acute kidney injury: a 15-year retrospective, single center, cohort study

Abstract

Although there have been numerous studies of patients with multiple myeloma (MM) and acute kidney injury (AKI), the results from these studies have varied greatly because of inconsistent definitions of AKI. The RIFLE criteria, which were designed to standardize the staging of AKI, have been extensively validated worldwide, but rarely in patients with MM. We retrospectively analyzed the natural history of 78 patients with MM and AKI between July 1995 and December 2010. RIFLE criteria, solely on the basis of the serum creatinine standard, were applied to stage the severity of AKI as risk, injury or failure. Among patients at the risk, injury and failure stage, the chemotherapy response rates were 54.5%, 63.6% and 39.3% (p = 0.26), and the renal response rates were 72.7%, 90.9% and 30.4%, respectively (p < 0.001). Severity of AKI predicted renal response but not chemotherapy response. Older age (odds ratio [OR] = 1.04, p = 0.01), hypercalcemia (OR = 2.57, p = 0.01) and reversibility of renal insufficiency (OR = 3.35 for no vs. yes, p < 0.001) were independent prognostic factors associated with survival. Severity of AKI staged by RIFLE class (OR = 2.04, failure stage vs. risk and injury stages. p = 0.06) was associated with marginally better long-term outcome. The RIFLE criteria may play a critical role in the early prevention and management of AKI in this population.

Keywords::

• Multiple myeloma
• acute kidney injury
• RIFLE criteria
• survival

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