Stage 3 Renal Failure with Complications

Ask Our Experts Dr. John Agar, Nephrologist
1

My mom has stage 3 renal failure and she has been receiving chemotherapy for multiple myeloma for nearly 2 years. Her last 6 months of chemo has ruined her kidneys. She is now on dialysis. Forgive me for not knowing all the terms, but it’s the type where she injects solution into her abdomen at home every 4 hours. Her last cancer numbers came back showing her cancer is nearly in remission at 1%.

Her nephrologist has told her that even with dialysis, she has only about 12-18 months to live and is forcing her into counseling to talk about “death and dying”.

She is 63 years old and the other health conditions she has include hypertension (stable with medication) and arthritis.

I’m just curious how her nephrologist can predict her life span at this point? I’m sure without her full medical history, it might be difficult for any other doctors to comment on this, but perhaps I’m looking for some “in general” comments about what factors contribute to longevity on dialysis? Does it shorten her life span if she needed to start chemo again, is that the problem?

Obviously, I want my mom to have more time…especially since she has nearly beaten her cancer and might have a chance at life again…but now this news from her nephrologist…I’m confused…and sad…and scared…I can only imagine what she must be feeling. Any input here? Thanks sooooo much!

2

Dear Gogogypsy
I am sorry to hear your mum has multiple myeloma (MM) and is now on dialysis. More likely than not, hers will have been a sudden and unexpected illness, and will not have given either of you much time to adjust to the concepts of illness, marrow cancers, and dialysis.
Regarding survival … I am not a personal fan of putting duration boundaries to survival as we are all different, and have such different responses to pretty much any treatment, that survival time can be very difficult to predict in any one individual. As a result, we tend to fall back on reported series in the medical literature but - in the case of MM - many of these are now 2 or more decades old and there are yet to be a similar set of newer studies to look again at the survival data in the light of newer developments.
In the intervening time, many newer treatments: bortezomib, lenalidomide, thalidomide, a number of other monoclonal antibody drugs (or immune-modulating agents) … these all have a ‘-mib’ ending … and even marrow transplantation have all been added to the MM war-chest. For those with renal failure from the outset, treatment with haemodialysis using so-called ‘high cut-off’ dialysers (artificial kidneys that are highly permeable to light chains and can significantly remove them from the circulation) has certainly helped some who were initially dialysis-dependent to shake free from dialysis. This latter option (the use of high cut-off membranes) was very enthusiastically embraced from around 2010 to 2013/4, and to be truthful, we were buoyed by some early successes here, too, but as the cost is high and the successes patchy, enthusiasm has waned somewhat from the headier early days 3-4 years ago.
Obviously, I do not know the details of your mum’s case - nor which (if any) of these drugs and options she has been treated with - and your treating team are in a much better position to advise you with certainty. But, I think it is fair to say there has been a significant improvement in survival in MM - even for some who remain dialysis-dependent - though I am afraid that renal failure and dialysis do still have a significant impact on survival.
I am not sure if that helps - clearly I can’t use any specifics to advise about any one patient, but the survival data quoted in all of those papers back around the 1990’s to 2000’s is now old data and while MM is still a commonly mortal disease, survival is now generally significantly better than it used to be - even with renal failure as a complication.

3

Dear Gogogypsy

I am sorry to hear your mum has multiple myeloma (MM) and is now on dialysis. More likely than not, hers will have been a sudden and unexpected illness, and will not have given either of you much time to adjust to the concepts of illness, marrow cancers, and dialysis.

Regarding survival … I am not a personal fan of putting duration boundaries to survival as we are all different, and have such different responses to pretty much any treatment, that survival time can be very difficult to predict in any one individual. As a result, we tend to fall back on reported series in the medical literature but - in the case of MM - many of these are now 2 or more decades old and there are yet to be a similar set of newer studies to look again at the survival data in the light of newer developments.

In the intervening time, many newer treatments: bortezomib, lenalidomide, thalidomide, a number of other monoclonal antibody drugs (or immune-modulating agents) … these all have a ‘-mib’ ending … and even marrow transplantation have all been added to the MM war-chest.

For those with renal failure from the outset, treatment with haemodialysis using so-called ‘high cut-off’ dialysers (artificial kidneys that are highly permeable to light chains and can significantly remove them from the circulation) has certainly helped some who were initially dialysis-dependent to shake free from dialysis. This latter option (the use of high cut-off membranes) was very enthusiastically embraced from around 2010 to 2013/4, and to be truthful, we were buoyed by some early successes here, too, but as the cost is high and the successes patchy, enthusiasm has waned somewhat from the headier early days 3-4 years ago.

Obviously, I do not know the details of your mum’s case - nor which (if any) of these drugs and options she has been treated with - and your treating team are in a much better position to advise you with certainty. But, I think it is fair to say there has been a significant improvement in survival in MM - even for some who remain dialysis-dependent - though I am afraid that renal failure and dialysis do still have a significant impact on survival.

I am not sure if that helps - clearly I can’t use any specifics to advise about any one patient, but the survival data quoted in all of those papers back around the 1990’s to 2000’s is now old data and while MM is still a commonly mortal disease, survival is now generally significantly better than it used to be - even with renal failure as a complication.