# Incidence, Clinical Features, and Prognostic Value of New‐Onset Renal Impairment in Multiple Myeloma

## TL;DR

This study shows that new kidney problems after a multiple myeloma diagnosis are common and linked to worse survival, highlighting the need for early detection and prevention.

## Contribution

The study is the first to comprehensively analyze new-onset renal impairment after multiple myeloma diagnosis and its impact on survival.

## Key findings

- 16.6% of patients developed new-onset renal impairment, mostly within 2 years of diagnosis.
- New-onset renal impairment was an independent risk factor for mortality, with a 55% higher risk of death.
- Patients who recovered kidney function had significantly longer survival than those who did not.

## Abstract

Previous studies mainly focused on renal impairment (RI) at multiple myeloma (MM) diagnosis, with few investigating new‐onset RI post‐MM diagnosis. This study aims to indicate the incidence, clinical characteristics and predictive value of new‐onset RI in MM patients.

We conducted a multicenter, retrospective cohort study including 1953 newly diagnosed MM patients from West China Hospital from July 1, 2008, to February 30, 2024 and the international MMRF‐CoMMpass database. Among them, 1770 patients received novel therapeutic agents including immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) as first‐line therapy. RI was defined as serum creatinine higher than 2 mg/dL or impaired creatinine clearance (< 40 mL/min/1.73m2). The association between new‐onset RI and mortality risk was investigated by Kaplan–Meier analysis and Cox proportional hazard models.

Of the cohort, 16.6% developed new‐onset RI, with the majority (67.1%) occurring within 2 years post‐MM diagnosis. The median overall survival (OS) was significantly shorter in new‐onset RI than in those without RI (68 vs. 122 months, p < 0.001). New‐onset RI was an independent risk factor for mortality (HR 1.55, 95% CI 1.28–1.88, p < 0.001), and earlier onset of RI was associated with a higher mortality risk. Moreover, patients with recovery of renal function had prolonged OS compared to those without recovery (95 vs. 64.8 months, p = 0.01). Older age, higher stage of the international stage system (ISS) and RI at diagnosis seemed to be risk factors for new‐onset RI, while first‐line therapy with PIs and IMiDs combinations was associated with a lower risk of RI development (HR 0.69, 95% CI 0.51–0.94, p = 0.017).

In conclusion, the incidence of new‐onset RI is high in MM, and is a significant risk factor for mortality, posing a substantial threat to MM patients. Early identification of high‐risk patients for new‐onset RI and prompt preventive strategies is critical for improving MM prognosis.

This study was registered by the Chinese Clinical Trial Registry (ChiCTR2400081476, https://www.chictr.org.cn)