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Cisplatin-induced Kidney Damage in Myeloma

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Cisplatin-induced kidney damage is a common side effect cancer patients undergoing cisplatin therapy.  For myeloma patients, the risk of kidney damage is greater because many NDMM patients present with kidney damage.

The article linked and excerpted below highlights the dangers of cisplatin’s nephrotoxicity. Multiple myeloma itself can also can cause kidney damage.

I am a long-term MM survivor and MM cancer coach. Experience has taught me that kidney damage is almost a separate health problem from multiple myeloma. Meaning, each health challenge should be treated separately. As you can see below, cisplatin-induced kidney damage is only one of many different kidney problems faced by MM patients.

How many ways can multiple myeloma patients experience kidney damage?

  1. Cast Nephropathy (Myeloma Kidney):
    • This is the most common cause of kidney damage in multiple myeloma. Light chains (Bence Jones proteins) produced by the myeloma cells can precipitate in the renal tubules, forming obstructive casts. These casts cause tubular damage and interstitial inflammation, leading to renal insufficiency.
  2. Light Chain Deposition Disease (LCDD):
    • In this condition, light chains are deposited in various tissues, including the kidneys. The deposition of these proteins in the glomeruli, tubules, and interstitium can lead to progressive kidney damage and renal failure.
  3. Amyloidosis (AL Amyloidosis):
    • This occurs when the light chains misfold and form amyloid fibrils, which are deposited in various organs, including the kidneys. The amyloid deposits can disrupt normal kidney structure and function, leading to nephrotic syndrome and progressive renal failure.
  4. Hypercalcemia:
    • Multiple myeloma often causes elevated calcium levels in the blood due to increased bone resorption. Hypercalcemia can lead to renal vasoconstriction, dehydration, and nephrocalcinosis, all of which contribute to kidney damage.
  5. Hyperuricemia:
    • Rapid turnover of myeloma cells can increase uric acid levels, leading to gout and uric acid nephropathy, which can damage the kidneys.
  6. Infections:
    • Multiple myeloma patients are prone to infections due to immunosuppression. Recurrent or severe kidney infections (pyelonephritis) can cause direct kidney damage.
  7. Medications and Therapies:
    • Some treatments for multiple myeloma, such as certain chemotherapeutic agents, bisphosphonates, and antibiotics, can be nephrotoxic and contribute to kidney damage.
  8. Renal Vein Thrombosis:
    • Increased blood viscosity and hypercoagulability associated with multiple myeloma can lead to thrombosis in the renal veins, impairing renal function.
  9. Tumor Lysis Syndrome:
    • This syndrome can occur after the initiation of therapy, leading to the rapid release of intracellular contents into the bloodstream, which can result in acute kidney injury due to elevated levels of potassium, phosphate, and uric acid.

I believe there are two basic problems with the “risk score” discussed below.

  1. First, I believe that kidney damage is not yes/no or on/off. I think MM survivors can experience small amounts of kidney damage during their active treatment yet not become formally AKI. Kidney diagnostic markers, creatinine, eGFR and BUN, can all fluctuate over the course of therapy.
  2. Secondly, the study discussed below tracks patients who undergo cisplatin for only 14 days post therapy. Light chains may gum up the MM patient’s kidney function long after treatment ends.

man hand holding his nutritional supplemets, healthy lifestyle background.

In my opinion, any MM patient who undergoes cisplatin should consider their kidney function to be compromised- even if you do not get a formal diagnosis of AKI.

And therefore build kidney-friendly therapies into their lifestyles. I do this with my chemotherapy-induced heart damage. Diet, supplementation, and lifestyle therapies are a fairly straightforward approach to insuring kidney health for the rest of your life.

Cisplatin-induced kidney damage is serious. Please consider both conventional and non-conventional kidney health therapies.

Are you a newly-diagnosed myeloma patient? Is your kidney function already compromised? Are you a MM survivor whose kidney function is not quite 100%? Email me if you’d like to discuss evidence-based non-conventional kidney therapies- David.PeopleBeatingCancer@gmail.com


David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Can a Risk Score Predict Kidney Injury After Cisplatin?

“Cisplatin is a preferred treatment for a wide range of cancers, including breast, head and neck, lung, ovary, and more. However, its side effects — particularly nephrotoxicity — can be severe. Kidney injury on cisplatin is associated with higher mortality and can jeopardize a patient’s eligibility for other therapies…

Other risk scores and risk prediction models have been developed to help clinicians assess in advance whether a patient might develop AKI after receiving cisplatin, so that more careful monitoring, dose adjustments, or an alternative treatment, if available, might be considered…

Gupta and Leaf believe their risk score for predicting severe AKI after intravenous (IV) cisplatin, published online in The BMJ, is “more accurate and generalizable than prior models for several reasons,” they told Medscape Medical News in a joint email…

The primary outcome was cisplatin-induced AKI (CP-AKI), defined as a twofold or greater increase in serum creatinine or kidney replacement therapy within 14 days of a first dose of IV cisplatin.

The researchers found that the incidence of CP-AKI was 5.2% in the derivation cohort and 3.3% in the validation cohort. Their simple risk score consisting of nine covariates — age, hypertension, type 2 diabetes, hemoglobin level, white blood cell count, platelet count, serum albumin level, serum magnesium level, and cisplatin dose — predicted a higher risk for CP-AKI in both cohorts…

Patients in the highest risk category had 24-fold higher odds of CP-AKI in the derivation cohort and close to 18-fold higher odds in the validation cohort than those in the lowest risk category…

“Let’s say someone has abnormal kidney function at baseline — ie, creatinine is higher than the normal range — and they were on dialysis 5 years ago for something else, and now, they have cancer and may be given cisplatin. They worry about their chances of getting AKI and needing dialysis again,” she said. “That’s just one scenario in which I might be asked to answer that question and the tool would certainly be useful”

Other scenarios could include someone who has just one kidney because they donated a kidney for transplant years ago, and now, they have a malignancy and wonder what their actual risk is of getting kidney issues on cisplatin.

Oncologists could use the tool to determine whether a patient should be treated with cisplatin, or if they’re at high risk, whether an alternative that’s not nephrotoxic might be used. By contrast, “if somebody’s low risk and an oncologist thinks cisplatin is the best agent they have, then they might want to go ahead and use it,” Shirali said…

Future research could take into consideration that CP-AKI is dose dependent, she suggested, because a prediction score that included the number of cisplatin doses could be even more helpful to determine risk. And, even though the derivation and validation cohorts for the new tool are representative of the US population, additional research should also include more racial/ethnic diversity, she said…

If a patient is at high risk, the clinical team can consider preventive measures such as administering more IV fluids before receiving cisplatin or monitoring kidney function more closely afterward, they suggested.”




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