Multiple myeloma as a predictor of in-hospital outcomes in ESRD patients: A nationwide analysis.

Abstract

e23068 Background: Multiple Myeloma (MM) has a 3-year survival rate of about 60% in frail patients. It is a precursor to acute kidney injury and chronic kidney disease progression, particularly in patients with high tumor burden, potentially leading to end-stage renal disease (ESRD). Emerging treatments have shown promising results in reversing kidney disease progression in some cases of MM, making it essential to identify the role of MM in the outcomes of ESRD. However, limited research is available regarding the in-hospital outcomes of ESRD patients with MM. This study aims to assess the impact of MM in hospitalized ESRD patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2020 and ICD-10 codes were used to identify adult hospitalizations of ESRD. We evaluated the effect of MM on mortality, morbidity, and resource utilization in patients with ESRD. Categorical variables were compared using chi-square test, while continuous variables were compared using t-test. Multivariate analysis, adjusted for confounders, was conducted to derive the odds ratio, and all weighted analyses were carried out using STATA MP 17.0. Results: A total of 5,549,620 ESRD hospitalizations were identified. Of these, 1.1% were diagnosed with MM. The mean age of ESRD patients with MM was 68 years, and 41% of them were female. Additionally, 41.1% of ESRD patients with MM were from the Southern region of the U.S., nearly double the percentage from other regions. After adjusting for confounders, ESRD patients with MM had higher odds of mortality and worse outcomes compared to those without MM (Table). MM with ESRD was also associated with higher resource utilization, including a longer length of stay by 1.4 days and higher hospital charges by $10,377. Conclusions: MM independently portends worse outcomes in ESRD hospitalizations, highlighting the need for targeted treatments aimed at reversing disease progression. ESRD patients with MM should be treated as a unique group with risk-specific outcomes contrary to other ESRD patients, emphasizing the need for further prospective studies to establish causation. Chi-square and multivariate regression analysis showing impact of MM on ESRD hospitalizations. Outcomes with MM(%) without MM(%) Adjusted Odds Ratio* 95% Confidence Interval p-value Mortality 7.8 5.1 1.26 1.18-1.35 P<0.001 Sepsis 13.4 10.9 1.16 1.09- 1.22 P<0.001 Fluid Overload 8.31 10.1 0.90 0.84-0.97 P<0.001 Thrombosis 5.6 4.1 1.27 1.17-1.39 P<0.001 ICU admission 0.5 0.7 0.60 0.46-0.77 P<0.001 Anemia 84.0 76.0 1.76 1.67-1.85 P<0.001 Thrombocytopenia 21.0 9.4 2.43 2.32-2.55 P<0.001 Hyperkalemia 22.4 26.5 0.90 0.86-0.94 P<0.001 *Adjusted for patient and hospital level characteristics, baseline demographics and confounders.