: Twenty-four patients with multiple myeloma and renal failure severe enough to require dialysis were retrospectively analyzed. Most patients initially presented with renal failure and multiple myeloma was subsequently diagnosed. Intravenous pyelography precipitated irreversible renal failure in 2 patients. Absence of light chain disease and treatment with peritoneal dialysis were associated with increased recovery of renal fraction. The one year survival rate of myeloma patients on chronic dialysis was similar to the general myeloma population but was much worse than a group of age matched non-myeloma chronic dialysis patients. Survival rate was diminished in patients with elevated serum calcium levels.
Metabolic acidosis was demonstrated in a group of anuric CAPD patients. Dialysate HCO3- loss was the major determinant of a negative base balance of 26.4 +/- 23.5 mMol/day. Bicarbonate supplementation corrected the acidosis. A primary respiratory alkalosis was also present in several patients.
1) Hemodialysis for 3-4 hrs with C-3500 without heparin infusion is possible. 2) Hemodialysis without heparin with C-3500 may be preferred for patients with active or potential bleeding. 3) Excessive clotting may occur when blood flow is less than 250 ml/min, blood transfusion is used during dialysis or dialysis is longer than 3.5-4 hrs.
