{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:57:38Z","timestamp":1791262658363,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018525","name":"Key Research and Development Program of Sichuan Province","doi-asserted-by":"publisher","award":["2023YFS0031"],"award-info":[{"award-number":["2023YFS0031"]}],"id":[{"id":"10.13039\/501100018525","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2502600"],"award-info":[{"award-number":["2022YFC2502600"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2502603"],"award-info":[{"award-number":["2022YFC2502603"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Renal impairment (RI) increases mortality risk in multiple myeloma (MM), yet RI represents a relatively late stage of kidney dysfunction. Whether early indicators of renal dysfunction, such as the estimated glomerular filtration rate (eGFR slope), predict mortality risk in MM remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single center, retrospective study included 974 newly diagnosed MM (NDMM) patients (2008\u20132022), with prospectively monitored creatinine levels and survival status over a median follow\u2010up period of 40\u2009months. The first\u2010year eGFR slope, representing the average annual rate of eGFR change, was calculated by least\u2010squares regression using all monitored eGFR values during the first year. Cox proportional\u2010hazards regression and restricted cubic splines (RCS) analyses were used to explore the association of first\u2010year eGFR slope with all\u2010cause mortality. Subgroup analyses were stratified by first\u2010year treatment response (partial response (PR) or better response group and less than PR group), and baseline eGFR strata (<\u200940, 40\u201390, and \u2265\u200990\u2009mL\/min\/1.73\u2009m\n 2<\/jats:sup>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the overall population, the first\u2010year eGFR slope\u2010mortality association exhibited a U\u2010shaped pattern (\n p<\/jats:italic>\n for nonlinearity 0.0145), indicating that excessive declines and increases in eGFR were linked to elevated mortality. This pattern was consistent across baseline renal function strata. Notably, the association varied substantially by treatment response: in the PR or better group, a rise in eGFR slope conferred a higher mortality risk (HR >\u20091 when annual increment exceeded 4.3\u2009mL\/min\/1.73\u2009m\n 2<\/jats:sup>\n ), whereas in the less than PR group, mortality risk was predominantly driven by eGFR slope declines (HR >\u20091 when slope fell below 1.18\u2009mL\/min\/1.73\u2009m\n 2<\/jats:sup>\n \/year).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Overall, first\u2010year eGFR slope demonstrates a U\u2010shaped association with mortality in NDMM. Importantly, excessive eGFR elevation, particularly in patients achieving PR or better, is paradoxically associated with increased death risk, highlighting the need for response\u2010stratified interpretation of renal dynamics to guide early clinical decision\u2010making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cam4.72168","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T03:31:17Z","timestamp":1788751877000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A U\u2010Shaped Association: The First\u2010Year eGFR Slope and Mortality Risk in Multiple Myeloma"],"prefix":"10.1002","volume":"15","author":[{"given":"Lian","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hematology\/Institute of Hematology, West China Hospital Sichuan University Chengdu China"},{"name":"Department of Cardiovascular Surgery, West China Hospital Sichuan University Chengdu 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