Myeloma-Induced Acute Kidney Injury: Medicine vs Machine

Tejas P. Desai, MD


November 02, 2020

Nephrologists often consider extracorporeal therapy as a medical advancement — through its use to help patients with sepsis or COVID-19, for example. However, studies that analyze the effectiveness of extracorporeal therapy are mixed, with results that are more positive in theory than in actuality.

A good case in point is the MYRE study from 2017 which randomly assigned dialysis-dependent patients with presumed myeloma-induced acute kidney injury (AKI) to high-cutoff vs high-flux dialysis. Patients in the high-cutoff arm experienced more freedom from dialysis after 3 months but the results were not statistically significant. In the subsequent EuLITE trial, high-cutoff dialyzers were associated with more harm (increased infections) than good in patients with myeloma-induced AKI-dialysis.

Trials like these remind us that high-tech isn't necessarily synonymous with medical progress. That brings us to the 2020 MYRE study, which focuses on medicine rather than high-cutoff dialyzers. Those patients screened for the original MYRE study who did not need hemodialysis were randomly assigned to receive standard care with dexamethasone plus bortezomib vs triple therapy with dexamethasone, bortezomib, and cyclophosphamide. It was hoped that the addition of cyclophosphamide would accelerate time to resolution of AKI.

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There was a trend toward quicker resolution of AKI using the triple therapy, but the results were not statistically significant, perhaps owing to the small sample size. Both MYRE studies remind us that more aggressive therapy is not synonymous with medical benefit. Although both MYRE studies were small in size, they teach us a valuable lesson about the disconnect between "intense" treatment and "progress." The 2020 MYRE study falls short, in my humble opinion, because it didn't compare standard therapy against high-flux dialysis for patients with AKI-dialysis. Do these patients fare better with medicine or machine? Share your examples and perspectives of medicine vs machine in the comments section.

Tejas Desai is a practicing nephrologist in Charlotte, North Carolina. His academic interests include the use of social media for physician, student, and patient education. He is the founder of NOD Analytics, a free social media analytics group that serves the medical education community. He has two wonderful children and enjoys spending time with them and his wife.

Follow Tejas P. Desai, MD, on Twitter: @nephondemand

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