The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Risk Factors and Reversibility of Renal Failure in Patients with Newly Diagnosed Multiple Myeloma

다발성 골수종에서 신부전 발생의 위험인자 및 신기능 회복 예측인자

  • Whang, Hyun Chul (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Koh, Eun Sil (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Jeong Gwan (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Chung, Sungjin (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Shin, Seok Joon (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Park, Cheol Whee (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Chang, Yoon Sik (Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 황현철 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 고은실 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 김정관 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 정성진 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 신석준 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 박철휘 (가톨릭대학교 의과대학 내과학교실 신장내과) ;
  • 장윤식 (가톨릭대학교 의과대학 내과학교실 신장내과)
  • Received : 2013.05.14
  • Accepted : 2013.05.31
  • Published : 2014.02.01
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Abstract

Background/Aims: Multiple myeloma (MM) is frequently accompanied by renal insufficiency, which has been regarded as a poor prognostic factor for MM. It is known that the incidence and characteristics of MM in Asia differ from those in Western countries. The aim of this study was to evaluate risk factors for renal impairment and to investigate reversible factors for renal failure in patients with MM. Methods: Patients newly diagnosed with MM from 2005 to 2008 were included. We investigated factors associated with renal insufficiency and those related to recovery from renal dysfunction after 12 weeks of treatment of MM. Results: Renal failure was recognized in 86 (39%) of 221 patients at diagnosis. In the binary logistic regression analysis, low hemoglobin (odds ratio [OR], 0.813; p = 0.02), high ${\beta}2microglobulin$ (OR, 1.006; p < 0.01), and use of angiotensin-converting enzyme inhibitors (ACEi) (OR, 2.783; p < 0.04) at initial presentation were independent risk factors for renal failure in patients with multiple myeloma. After 12 weeks of treatment, 25 of 86 (29%) patients with renal failure had recovered renal function. Good response to chemotherapy (OR, 6.044; p < 0.01) and higher eGFR (OR, 1.084; p < 0.01) were associated with renal function recovery. Conclusions: Levels of hemoglobin and ${\beta}2microglobulin$, and use of ACEi were independent risk factors for the development of renal failure in MM patients. The response to chemotherapy and eGFR at diagnosis significantly influenced recovery of renal function.

목적: 신부전은 다발성 골수종에서 종종 발생하며 나쁜 예후를 보인다. 아시아의 다발성 골수종의 발생빈도와 특징은 서양과는 다른 것으로 알려져 있다. 이 연구의 목적은 다발성 골수종 환자들에서 신부전 발생의 위험인자 및 치료후 신기능 회복 인자를 찾고자 하였다. 방법: 2005년부터 2008년까지 처음 다발성 골수종을 진단받은 환자를 대상으로 하여 신부전의 발생과 관련된 인자를 조사하였고, 12주간의 치료 후에 신부전의 회복과 관련된 인자를 찾았다. 결과: 진단 당시 221명의 환자 중 86명(39%)에서 신부전이 발생하였다. 이변량 로지스틱 회기 분석에서 낮은 헤모글로빈(OR = 0.813, p = 0.02), 높은 베타-2 마이크로글로불린(OR = 1.006, p < 0.01), ACEi (OR = 2.783, p = 0.04) 사용이 신부전 발생의 독립적인 위험인자로 나타났다. 12주간의 치료 후, 86명 중에서 25 (29%)명의 신기능이 회복되었다. 항암치료에 반응을 보인 경우(OR = 6.044, p < 0.01)와 높은 eGFR (OR = 1.084, p < 0.01)이 회복과 연관된 인자로 나타났다. 결론: 헤모글로빈 수치, 베타-2 마이크로글로불린, ACEi의 사용이 한국 다발성 골수종 환자에 있어 신부전 발생의 독립적인 위험인자이며 항암 치료에 반응여부와 진단 시의 eGFR이 신기능 회복의 예측인자이다.

Keywords

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