Outcomes Among Hospitalized Multiple Myeloma Patients with Chronic Kidney Disease That Received Autologous Stem Cell Transplant: A Nationwide Analysis

Introduction: The data regarding multiple myeloma(MM) patients with chronic kidney disease(CKD) who received autologous stem cell transplant(ASCT) is limited. We sought to compare the hospital-related outcomes among MM patients with and without CKD who received ASCT.

Methods: Cases with a diagnosis of MM that received an ASCT were identified from the National Inpatient Sample database from 2016 to 2019 using the International Classification of Disease 10th Revision Diagnosis and Procedure Codes. Intensive Care Unit requirement (ICU) was determined by the presence of a requirement for mechanical ventilation or intravenous infusion of vasopressors. Chi-square tests and T-tests were utilized to compare categorical (sex, race, ICU, severe sepsis, and deaths) and continuous variables (age, length of stay [LOS], total hospitalization charges [TOTCHG], and Charlson Comorbidity Index [CCI]) between CKD and non-CKD cases respectively.

Results: A total of 477,065 MM cases were admitted during 2016-2019. Among them 25,145 received ASCT, out of which 3370(13.4%) had CKD. The mean age (Standard Deviation) was 62.38 (8.83) in CKD and 60.74 (8.78) in non-CKD group, P<0.001. 1185 (11%) females and 2185 (15.2%) males had CKD, P<0.001. Majority of the CKD patients were Caucasians(61.2%), followed by Blacks(23.8%), Hispanics(5.9%) and Asian/Pacific Islanders(2.7%). Type 2 diabetes and hypertension were noted to be in 900 (26.7%) and 2570 (76.3%) of CKD patients respectively. Mean CCI was 6 (1.79) in CKD and 4.19 (1.32) in non-CKD cases, P<0.001. Inpatient death was reported in 25 (0.7%) CKD and 170 (0.8%) non-CKD patients, P=0.811. ICU admission was reported in 65 (1.9%) CKD and 290 (1.3%) non-CKD cases, P=0.006. Severe sepsis was reported in 130 (3.9%) CKD and 430 (2%) non-CKD cases, P<0.001. The mean LOS was 18.11 (7.03) days and 16.40 (6.39) days among CKD and non-CKD cases respectively, P<0.001. The mean total hospitalization charges were $210,631 (129,724) in CKD and $199,885 (136,568) in non CKD patients, P<0.001.

Conclusion: MM patients with CKD who received ASCT were noted to be older and have more comorbidities which might be leading to higher rates of severe sepsis and ICU admission during their hospital stay but no significant difference in inpatient deaths compared to non-CKD patients received ASCT.

No relevant conflicts of interest to declare.