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Here you will find brief educational videos that cover a variety of topics related to multiple myeloma. These videos are hosted by nurses from leading myeloma treatment centers.
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Survivorship Care Plan: Renal Health

Sandra Kurtin, RN, MSN, AOCN, ANP-C, Assistant Professor of Clinical Medicine, University of Arizona College of Medicine; Adjunct Assistant Professor of Nursing, University of Arizona College of Nursing, Tucson, AZ, discusses survivorship care plans to help maintain renal health in patients with multiple myeloma.

Tip Sheet about this topic

Hello. I’m Sandra Kurtin, and welcome to the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Renal Health.

In this video, we’ll discuss recommendations to help patients living with multiple myeloma preserve renal function. For additional resources, visit the Multiple Myeloma Center for Nurses website.

Between 20% and 25% of patients with multiple myeloma present with renal insufficiency at diagnosis, usually with serum creatinine concentration below 4 milligrams per deciliter, indicating a moderate degree of renal failure.2

However, as many as 10% of newly diagnosed patients may have renal insufficiency requiring dialysis.2

Renal insufficiency may be reversible, but recovery rates are highly variable, ranging from 20% to 60%. Predictive factors for recovery include serum creatinine level of less than 4 milligrams per deciliter, 24-hour urine protein excretion of less than 1 gram per 24 hours, and serum calcium level of greater than 11.5 milligrams per deciliter. A serum creatinine level higher than 4 milligrams per deciliter reduces the recovery rate to less than 10%.2

Although other forms of renal damage can occur in multiple myeloma, such as immunoglobulin tissue deposition and tubular dysfunction, also called Fanconi syndrome, the IMWG says the association is not characteristic of multiple myeloma and these should not be considered defining events unless they meet other diagnostic criteria.1

Light chain tubular damage, or myeloma kidney, is the cause of renal insufficiency, and the presence of myeloma casts in the distal tubes and collecting ducts is the characteristic feature of myeloma kidney.1,2

Damage to the kidneys can be asymptomatic at first.3 However, as the kidneys start to fail, they can no longer rid the body of excess salt, fluid, and waste, which can result in a condition known as uremia.3

Guidelines from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative note that patients with renal dysfunction may need to alter their diets to ensure that they are getting the nutrients they need in the correct amounts.4

For example, depending on the extent of kidney dysfunction, protein intake may need to be altered to prevent protein wastes from building up in the blood.4

Patients may also need to monitor their intake of sodium, phosphorus, calcium, and potassium.4

Sodium is found in most foods and in salt. It can affect blood pressure and water balance in the body.4

In patients with renal dysfunction, the National Kidney Foundation notes that sodium and fluids can build up in the body and contribute to high blood pressure and edema in the ankles, fingers, or eyes.4

Phosphorus buildup in the body can also be an issue. Phosphorous buildup makes the calcium levels in the blood drop, so the body starts taking needed calcium from the bones.4 This can contribute to weakened bones and fractures.3,4

In addition to avoiding foods high in phosphorous, patients with renal dysfunction may need to take phosphate binders and avoid eating calcium-fortified foods, according to the National Kidney Foundation.4

Many foods high in phosphorus are also high in calcium.4

Patients may need to take vitamin D supplements to control levels of a circulating hormone called parathyroid hormone (or PTH). Remind patients not to take over-the-counter vitamin D supplements without first talking with their healthcare provider; many of these supplements contain calcium.4

Finally, too much or too little potassium in the blood can also have adverse consequences.4 The right amount of potassium may vary for each patient depending on their level of kidney function.4

Patients will need to talk with their healthcare provider about their dietary needs based on their level of kidney function.

Along with dietary considerations, the National Kidney Foundation also recommends that patients with renal dysfunction may need reduced dosages or adjustments.5 A comprehensive medication review, including both prescription and over-the-counter medications, should occur at every visit.

You should refer to the medication prescribing information for each specific medication for renal dosing recommendations if required.

Patients will need to speak with their healthcare providers to determine which medications may need dose adjustment to prevent renal damage and to adjust doses accordingly if renal function improves.5

This concludes the Multiple Myeloma Center for Nurses video: Survivorship Care Plan: Renal Health. To find out more on this and other topics related to multiple myeloma, please see additional videos and resources on this site.

Here you will find a number of educational tools, including tip sheets to help you discuss these topics with your patients, answers to common questions, and other downloadable materials.

Thank you.

 

References

1. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:e538-548.

2. Bladé J, Rosiňol L. Complications of multiple myeloma. Hematol Oncol Clin N Am. 2007;21:1231-1246.

3. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1).

4. National Kidney Foundation. Nutrition and chronic kidney disease (stages 1-4). www.kidney.org/sites/default/files/docs/nutrikidfail_stage1-4.pdf. Accessed December 12, 2014.

5. National Kidney Foundation. E-kidney newsletter May 2013. www.kidney.org/news/ekidney/may13/5meds. Accessed December 12, 2014.