Dialysis for Myeloma

Overview
In some cases of myeloma, cancer cells secrete abnormal proteins, leading to the development of complications known as amyloidosis and light chain deposition disease. In these conditions, the abnormal proteins cause damage and symptoms when they are deposited into the body’s tissues. About 50 percent of people diagnosed with multiple myeloma develop kidney problems or chronic kidney disease as a consequence of abnormal proteins damaging the kidneys.

Some people with myeloma and kidney problems experience improvement in kidney function with effective myeloma treatment. Others undergo plasmapheresis to limit kidney damage. In about 10 percent of people with multiple myeloma, abnormal proteins cause kidney damage severe enough to require kidney replacement therapy. Dialysis is the most common type of kidney replacement therapy.

What does it involve?
There are two main types of dialysis, hemodialysis and peritoneal dialysis. Both types of dialysis provide a means of filtering waste products from the blood, taking over the role from the failing kidneys.

Hemodialysis
Hemodialysis is the more common type of dialysis with which most people are familiar. Hemodialysis filters waste products from the blood using a machine as an artificial kidney, known as a dialyzer. Hemodialysis can be done at a dialysis center, in a hospital, or at home. If you receive hemodialysis at a dialysis center, you will likely need to go two or three times each week. Hemodialysis will take three to five hours each time you go. If you do hemodialysis at home, you may choose more frequent treatments (four to seven times each week) for shorter periods of time.

A few weeks before you begin receiving hemodialysis, you will receive minor surgery to create an access for the dialysis treatment. During the surgery, the doctor will either create a fistula or graft in your arm or place a catheter in your neck. When it is time to receive hemodialysis, technicians will place needles into the access and attach tubes that go to the dialyzer. During hemodialysis, your blood will go through the tubes, into the machine for cleaning, and then return to your body through the access point.

Peritoneal dialysis
In peritoneal dialysis, the peritoneum, or tissue lining your abdomen, is used to filter waste products from the blood. Before you begin receiving peritoneal dialysis, you will receive minor surgery to place a soft tube in your abdomen. There are two main types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) or automated peritoneal dialysis (APD).

In CAPD, you will perform dialysis by attaching a plastic bag to the tube and emptying approximately two quarts of sterile cleansing fluid (dialysate) into your belly by raising the bag up to your shoulders. Later, you will drain the dialysate (now containing waste products from your blood) from your belly into another bag. Each cycle (known as an exchange) of dialysis takes 30 to 45 minutes, and you will perform three to five exchanges each day during waking hours. You can perform CAPD as you go about your normal daytime activities.

In CCPD/APD, you will connect a machine (called a cycler) to the tube in your abdomen when you go to sleep. The machine will pump in the dialysate and drain it automatically overnight.

One advantage of peritoneal dialysis is that your body does not build up as much fluid and waste as it does with hemodialysis. Stress on your heart and arteries is reduced. It is also easier to maintain a normal work schedule with peritoneal dialysis.

Constraints
Your health insurance program may not pay for 100 percent of your dialysis costs.

You may experience cramps, nausea, headaches, or dizziness during hemodialysis.

People who are receiving hemodialysis need to change their diet to prevent certain side effects. In general, you will need to eat more protein and limit your intake of certain nutrients.

Your access device may become infected or develop a clot.

If you travel, you will need to schedule hemodialysis appointments in the areas where you are traveling.

If you are morbidly obese or have had multiple abdominal surgeries, your belly may not be appropriate for peritoneal dialysis.

You must have good vision to perform peritoneal dialysis correctly and prevent infection.

Peritonitis, an infection of the peritoneum, is a rare but serious complication of peritoneal dialysis.

After some time on either hemodialysis or peritoneal dialysis, you may develop nutritional deficiencies, anemia, and bone problems.

For more details about this treatment, visit:

Myeloma and the kidney – Myeloma UK
https://www.myeloma.org.uk/wp-content/uploads/2...

Treatment of multiple myeloma with renal involvement: the nephrologist’s view – Clinical Kidney Journal
https://academic.oup.com/ckj/advance-article/do...

Dialysis – National Kidney Foundation
https://www.kidney.org/atoz/content/dialysisinfo

Hemodialysis Access – American Kidney Foundation
https://www.kidney.org/atoz/content/hemoaccess

Peritoneal Dialysis: What You Need to Know – American Kidney Foundation
https://www.kidney.org/atoz/content/peritoneal

Epidemiology, pathogenesis, and etiology of kidney disease in multiple myeloma and other monoclonal gammopathies – UpToDate
https://www.uptodate.com/contents/epidemiology-...