End Stage Renal Disease due to Multiple Myeloma in the United States, 2001-2010

Abstract

Abstract. While the management of myeloma and light chain deposition disease (“MM”) has changed considerably in the last decade, it is unknown how the burden of associated end-stage renal (ESRD) has evolved. Methods. United States Renal Data System data (n = 1,048,683) for the years 2001-2010 were used to calculate incidence rates and outcomes of MM (n = 12,704, 1.3%). Results. Compared to 2001-2002, standardized incidence ratios declined to 0.8 for 2009-2010. Characteristics of MM patients included older age (≥ 65, 63.7% vs. 43.7%) and white race (76.3% vs. 65.1%). Multiple myeloma was associated with a greater likelihood of death (adjusted hazards ratio [AHR] 2.3) and a lower likelihood of listing for (AHR 0.2) a kidney transplant. While hazards ratios for listing increased over time (AHR 1.06 for 2009-2010 Vs. 2001-2002), those for transplant and death did not (AHRs 0.6 and 0.9, respectively). Regional variation in outcomes was apparent, as patients in the South were more likely to die (AHR 1.04 Vs. the Northeast), and more likely to not be listed (AHR 2.4) nor receive a transplant (AHR 2.9). Conclusions. While ESRD due to MM has declined in the United States, outcomes on dialysis remain poor and exhibit substantial geographic variation.