{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:05:25Z","timestamp":1789635925190,"version":"4.0.0"},"reference-count":87,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Renal impairment affects up to half of patients with newly diagnosed multiple myeloma, and roughly 2\u20134% require dialysis at presentation, most often because of light-chain cast nephropathy. In these patients, renal recovery is associated with the speed and magnitude of serum free light-chain (sFLC) reduction in observational cohorts, an association that mainly reflects the hematologic response to chemotherapy; the incremental benefit of removing circulating sFLCs by extracorporeal means remains uncertain, and this narrative review is organized around that question in the current era of effective antimyeloma therapy. Plasma exchange was tested in three small randomized trials before proteasome inhibitors were available, the largest finding no benefit, and two randomized trials of high-cutoff hemodialysis on a bortezomib backbone, MYRE and EuLITE, found no benefit for their primary renal endpoints, with more pulmonary infections in the high-cutoff arm of EuLITE. Medium-cutoff membranes, polymethylmethacrylate adsorptive dialyzers, and hemodiafiltration with endogenous reinfusion have achieved substantial sFLC reduction with less albumin loss in small uncontrolled series, without any randomized comparison against conventional dialysis. Daratumumab-containing induction lowers sFLCs within days and may further narrow the residual rationale for enhanced clearance. Conventional high-flux hemodialysis combined with prompt antimyeloma therapy is therefore the evidence-based standard kidney-replacement modality when dialysis is indicated; the patient subsets in which a time-limited enhanced-removal strategy might still be tested are proposed as hypotheses for prospective trials, without validated thresholds.<\/jats:p>","DOI":"10.3390\/jcm15187211","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:03:17Z","timestamp":1789632197000},"page":"7211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extracorporeal Free-Light-Chain Removal in Myeloma Cast Nephropathy: Plasma Exchange and Hemodialysis Strategies in the Era of Effective Antimyeloma Therapy"],"prefix":"10.3390","volume":"15","author":[{"given":"Guido","family":"Gembillo","sequence":"first","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0171-3358","authenticated-orcid":false,"given":"Luca","family":"Soraci","sequence":"additional","affiliation":[{"name":"Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9112-5540","authenticated-orcid":false,"given":"Lorenzo","family":"Lo Cicero","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2124-4252","authenticated-orcid":false,"given":"Chiara","family":"Terzo","sequence":"additional","affiliation":[{"name":"UOSD Nephrology and Dialysis, Hospital \u201cG. Di Maria\u201d, Contrada Chiusa di Carlo, 96012 Avola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6348-8718","authenticated-orcid":false,"given":"Chiara","family":"Casuscelli","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Cuzzola","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Sudano","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Federica","family":"Ricca","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Scapellato","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Messina","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6904-9445","authenticated-orcid":false,"given":"Alberto","family":"La Spada","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8141-0366","authenticated-orcid":false,"given":"Ankit","family":"Sharma","sequence":"additional","affiliation":[{"name":"Renal Department, University Hospitals of Coventry and Warwickshire, Coventry CV2 2DX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Santoro","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma","volume":"15","author":"Rajkumar","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jama.2022.0003","article-title":"Diagnosis and management of multiple myeloma: A review","volume":"327","author":"Cowan","year":"2022","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4976","DOI":"10.1200\/JCO.2010.30.8791","article-title":"Renal impairment in patients with multiple myeloma: A consensus statement on behalf of the International Myeloma Working Group","volume":"28","author":"Dimopoulos","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/nrneph.2011.168","article-title":"The pathogenesis and diagnosis of acute kidney injury in multiple myeloma","volume":"8","author":"Hutchison","year":"2012","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e293","DOI":"10.1016\/S1470-2045(23)00223-1","article-title":"Management of multiple myeloma-related renal impairment: Recommendations from the International Myeloma Working Group","volume":"24","author":"Dimopoulos","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1034\/j.1600-0609.2000.90221.x","article-title":"Renal failure in multiple myeloma: Reversibility and impact on the prognosis. Nordic Myeloma Study Group","volume":"65","author":"Knudsen","year":"2000","journal-title":"Eur. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1093\/ndt\/gfp679","article-title":"Incidence and outcome of patients starting renal replacement therapy for end-stage renal disease due to multiple myeloma or light-chain deposit disease: An ERA-EDTA registry study","volume":"25","author":"Tsakiris","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1053\/j.ajkd.2011.12.028","article-title":"Clinicopathologic correlations in multiple myeloma: A case series of 190 patients with kidney biopsies","volume":"59","author":"Nasr","year":"2012","journal-title":"Am. J. Kidney Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2147\/IJNRD.S280179","article-title":"Light chain cast nephropathy in multiple myeloma: Prevalence, impact and management challenges","volume":"15","author":"Stoppacciaro","year":"2022","journal-title":"Int. J. Nephrol. Renov. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1093\/ndt\/gfv283","article-title":"Prognostic value of kidney biopsy in myeloma cast nephropathy: A retrospective study of 70 patients","volume":"31","author":"Thierry","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/ejh.12644","article-title":"Patients with multiple myeloma have excellent long-term outcomes after recovery from dialysis-dependent acute kidney injury","volume":"96","author":"Yadav","year":"2016","journal-title":"Eur. J. Haematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1172\/JCI46490","article-title":"Mechanism and prevention of acute kidney injury from cast nephropathy in a rodent model","volume":"122","author":"Ying","year":"2012","journal-title":"J. Clin. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1182\/blood.2019003807","article-title":"Clinicopathologic predictors of renal outcomes in light chain cast nephropathy: A multicenter retrospective study","volume":"135","author":"Royal","year":"2020","journal-title":"Blood"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1053\/j.ajkd.2007.05.007","article-title":"Renal manifestations of plasma cell disorders","volume":"50","author":"Leung","year":"2007","journal-title":"Am. J. Kidney Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"F82","DOI":"10.1152\/ajprenal.00091.2008","article-title":"Silencing megalin and cubilin genes inhibits myeloma light chain endocytosis and ameliorates toxicity in human renal proximal tubule epithelial cells","volume":"295","author":"Li","year":"2008","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1681\/ASN.2010080857","article-title":"Early reduction of serum-free light chains associates with renal recovery in myeloma kidney","volume":"22","author":"Hutchison","year":"2011","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1681\/ASN.2012040388","article-title":"Mechanisms of light chain injury along the tubular nephron","volume":"23","author":"Sanders","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s40620-016-0347-9","article-title":"Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: A position statement of the Onconephrology Work Group of the Italian Society of Nephrology","volume":"29","author":"Fabbrini","year":"2016","journal-title":"J. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1046\/j.1523-1755.2002.00660.x","article-title":"Endocytosis of light chains induces cytokines through activation of NF-\u03baB in human proximal tubule cells","volume":"62","author":"Sengul","year":"2002","journal-title":"Kidney Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1182\/blood-2010-08-302505","article-title":"Immunoglobulin light chains activate nuclear factor-\u03baB in renal epithelial cells through a Src-dependent mechanism","volume":"117","author":"Ying","year":"2011","journal-title":"Blood"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2792","DOI":"10.1172\/JCI125517","article-title":"Immunoglobulin light chains generate proinflammatory and profibrotic kidney injury","volume":"129","author":"Ying","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1172\/JCI115629","article-title":"Pathobiology of cast nephropathy from human Bence Jones proteins","volume":"89","author":"Sanders","year":"1992","journal-title":"J. Clin. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/S0002-9440(10)64142-9","article-title":"Mapping the binding domain of immunoglobulin light chains for Tamm\u2013Horsfall protein","volume":"158","author":"Ying","year":"2001","journal-title":"Am. J. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1172\/JCI119218","article-title":"Localization of a single binding site for immunoglobulin light chains on human Tamm\u2013Horsfall glycoprotein","volume":"99","author":"Huang","year":"1997","journal-title":"J. Clin. Investig."},{"key":"ref_25","first-page":"460","article-title":"Hypercalcemia can potentiate the nephrotoxicity of Bence Jones proteins","volume":"110","author":"Smolens","year":"1987","journal-title":"J. Lab. Clin. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.2215\/CJN.11161111","article-title":"Urinary albumin excretion patterns of patients with cast nephropathy and other monoclonal gammopathy-related kidney diseases","volume":"7","author":"Leung","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/s41408-023-00806-w","article-title":"Multiple myeloma with acute light chain cast nephropathy","volume":"13","author":"Leung","year":"2023","journal-title":"Blood Cancer J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1038\/ki.1995.421","article-title":"Acute myeloma kidney","volume":"48","author":"Winearls","year":"1995","journal-title":"Kidney Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1002\/cncr.20888","article-title":"Bortezomib in recurrent and\/or refractory multiple myeloma: Initial clinical experience in patients with impaired renal function","volume":"103","author":"Jagannath","year":"2005","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2604","DOI":"10.1182\/blood-2006-09-046409","article-title":"Activity and safety of bortezomib in multiple myeloma patients with advanced renal failure: A multicenter retrospective study","volume":"109","author":"Kaufman","year":"2007","journal-title":"Blood"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.3324\/haematol.11463","article-title":"Reversal of acute renal failure by bortezomib-based chemotherapy in patients with multiple myeloma","volume":"92","author":"Ludwig","year":"2007","journal-title":"Haematologica"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/ajh.24335","article-title":"Bortezomib-based triplets are associated with a high probability of dialysis independence and rapid renal recovery in newly diagnosed myeloma patients with severe renal failure or those requiring dialysis","volume":"91","author":"Dimopoulos","year":"2016","journal-title":"Am. J. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1038\/leu.2012.182","article-title":"The role of novel agents on the reversibility of renal impairment in newly diagnosed symptomatic patients with multiple myeloma","volume":"27","author":"Dimopoulos","year":"2013","journal-title":"Leukemia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6086","DOI":"10.1200\/JCO.2009.22.2232","article-title":"VMP (bortezomib, melphalan, and prednisone) is active and well tolerated in newly diagnosed patients with multiple myeloma with moderately impaired renal function, and results in reversal of renal impairment: Cohort analysis of the phase III VISTA study","volume":"27","author":"Dimopoulos","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1200\/JCO.20.00298","article-title":"Randomized trial comparing double versus triple bortezomib-based regimen in patients with multiple myeloma and acute kidney injury due to cast nephropathy","volume":"38","author":"Bridoux","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1182\/asheducation-2010.1.431","article-title":"Renal insufficiency and failure","volume":"2010","author":"Dimopoulos","year":"2010","journal-title":"Hematol. Am. Soc. Hematol. Educ. Program."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E226","DOI":"10.1002\/ajh.27001","article-title":"Prospective phase 2 trial of daratumumab with dexamethasone in patients with relapsed\/refractory multiple myeloma and severe renal impairment or on dialysis: The DARE study","volume":"98","author":"Kastritis","year":"2023","journal-title":"Am. J. Hematol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Leypoldt, L.B., Gavriatopoulou, M., Besemer, B., Salwender, H., Raab, M.S., Nogai, A., Khandanpour, C., Runde, V., Jauch, A., and Zago, M. (2023). Daratumumab, bortezomib, and dexamethasone for treatment of patients with relapsed or refractory multiple myeloma and severe renal impairment: Results from the phase 2 GMMG-DANTE trial. Cancers, 15.","DOI":"10.3390\/cancers15184667"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1182\/bloodadvances.2025015901","article-title":"Early daratumumab therapy improves renal outcomes in newly diagnosed patients with myeloma admitted with kidney injury","volume":"9","author":"Kim","year":"2025","journal-title":"Blood Adv."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s12185-026-04205-2","article-title":"Renal recovery and clinical outcomes with daratumumab, lenalidomide, and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma with severe renal impairment","volume":"124","author":"Horigome","year":"2026","journal-title":"Int. J. Hematol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1681\/ASN.2006080821","article-title":"Efficient removal of immunoglobulin free light chains by hemodialysis for multiple myeloma: In vitro and in vivo studies","volume":"18","author":"Hutchison","year":"2007","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1038\/ki.1988.127","article-title":"Controlled plasma exchange trial in acute renal failure due to multiple myeloma","volume":"33","author":"Zucchelli","year":"1988","journal-title":"Kidney Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1001\/archinte.1990.00390160111022","article-title":"Treatment of renal failure associated with multiple myeloma: Plasmapheresis, hemodialysis, and chemotherapy","volume":"150","author":"Johnson","year":"1990","journal-title":"Arch. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/0003-4819-143-11-200512060-00005","article-title":"Canadian Apheresis Group. Plasma exchange when myeloma presents as acute renal failure: A randomized, controlled trial","volume":"143","author":"Clark","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1038\/ki.2008.108","article-title":"Improvement of cast nephropathy with plasma exchange depends on the diagnosis and on reduction of serum free light chains","volume":"73","author":"Leung","year":"2008","journal-title":"Kidney Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1056\/NEJMc1101834","article-title":"Renal improvement in myeloma with bortezomib plus plasma exchange","volume":"364","author":"Burnette","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Salur, H., Atas, U., Alhan, N., Vural, E., Iltar, U., Yucel, O.K., and Salim, O. (2026). The role of therapeutic plasma exchange in the management of myeloma-related cast nephropathy: A 10-year real-world cohort study. J. Clin. Med., 15.","DOI":"10.3390\/jcm15020417"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1111\/j.1525-1594.2008.00653.x","article-title":"Serum free-light chain removal by high cutoff hemodialysis: Optimizing removal and supportive care","volume":"32","author":"Hutchison","year":"2008","journal-title":"Artif. Organs"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1038\/s41581-018-0002-x","article-title":"Haemodialysis membranes","volume":"14","author":"Ronco","year":"2018","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Rousseau-Gagnon, M., Agharazii, M., De Serres, S.A., and Desmeules, S. (2015). Effectiveness of haemodiafiltration with heat sterilized high-flux polyphenylene HF dialyzer in reducing free light chains in patients with myeloma cast nephropathy. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0140463"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"745","DOI":"10.2215\/CJN.04590908","article-title":"Treatment of acute renal failure secondary to multiple myeloma with chemotherapy and extended high cut-off hemodialysis","volume":"4","author":"Hutchison","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00277-011-1383-0","article-title":"Extracorporeal light chain elimination: High cut-off (HCO) hemodialysis parallel to chemotherapy allows for a high proportion of renal recovery in multiple myeloma patients with dialysis-dependent acute kidney injury","volume":"91","author":"Heyne","year":"2012","journal-title":"Ann. Hematol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/aor.12248","article-title":"Clearance of drugs for multiple myeloma therapy during in vitro high-cutoff hemodialysis","volume":"38","author":"Krieter","year":"2014","journal-title":"Artif. Organs"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1001\/jama.2017.17924","article-title":"Effect of high-cutoff hemodialysis vs conventional hemodialysis on hemodialysis independence among patients with myeloma cast nephropathy: A randomized clinical trial","volume":"318","author":"Bridoux","year":"2017","journal-title":"JAMA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.1016\/S2352-3026(19)30014-6","article-title":"High cutoff versus high-flux haemodialysis for myeloma cast nephropathy in patients receiving bortezomib-based chemotherapy (EuLITE): A phase 2 randomised controlled trial","volume":"6","author":"Hutchison","year":"2019","journal-title":"Lancet Haematol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e174","DOI":"10.1016\/S2352-3026(19)30044-4","article-title":"Myeloma cast nephropathy: The dusk of high cutoff haemodialysis","volume":"6","author":"Burtey","year":"2019","journal-title":"Lancet Haematol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1016\/S2352-3026(19)30090-0","article-title":"High cutoff haemodialysis in myeloma cast nephropathy: Further investigation is needed","volume":"6","author":"Bridoux","year":"2019","journal-title":"Lancet Haematol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1093\/ckj\/sfaa220","article-title":"Effect of high cut-off dialysis for acute kidney injury secondary to cast nephropathy in patients with multiple myeloma: A systematic review and meta-analysis","volume":"14","author":"Ye","year":"2021","journal-title":"Clin. Kidney J."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Gerth, H.U., Pohlen, M., G\u00f6rlich, D., Th\u00f6lking, G., Kropff, M., Berdel, W.E., Pavenst\u00e4dt, H., Brand, M., and K\u00fcmpers, P. (2016). Impact of high-cut-off dialysis on renal recovery in dialysis-dependent multiple myeloma patients: Results from a case-control study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154993"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Curti, A., Schwarz, A., Trachsler, J., Tomonaga, Y., and Amb\u00fchl, P.M. (2016). Therapeutic efficacy and cost effectiveness of high cut-off dialyzers compared to conventional dialysis in patients with cast nephropathy. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0159942"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1159\/000547342","article-title":"The role of extracorporeal therapy in light chain cast nephropathy","volume":"57","author":"Heybeli","year":"2026","journal-title":"Am. J. Nephrol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"18448","DOI":"10.1038\/srep18448","article-title":"MCO membranes: Enhanced selectivity in high-flux class","volume":"5","author":"Voigt","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/ndt\/gfw310","article-title":"Performance of hemodialysis with novel medium cut-off dialyzers","volume":"32","author":"Kirsch","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_64","first-page":"367","article-title":"Experience of using haemodialysis with medium cut-off dialyser in cast nephropathy","volume":"40","author":"Guerrero","year":"2020","journal-title":"Nefrologia"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Schaaf, C.W., Braunisch, M.C., Holzmann-Littig, C., Pfister, F., Hannemann, L., Hausinger, R.I., Verbeek, M., Schmaderer, C., Renders, L., and Heemann, U. (2023). Extracorporeal light-chain elimination in myeloma with simple medium cutoff membrane hemodialysis: A retrospective cohort study. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1193504"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/sdi.13115","article-title":"The use of medium cutoff dialyzers in patients with multiple myeloma and acute kidney injury requiring hemodialysis: A systematic review","volume":"36","author":"Koniman","year":"2023","journal-title":"Semin. Dial."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Skerget, M., Vajdic Trampuz, B., Starman, T., and Gubensek, J. (2026). Use of high- and medium-cut-off membrane hemodialysis for removal of free light chains in patients with multiple myeloma: A single-center experience. J. Clin. Med., 15.","DOI":"10.3390\/jcm15082917"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1159\/000350837","article-title":"The double polymethylmethacrylate filter (DELETE system) in the removal of light chains in chronic dialysis patients with multiple myeloma","volume":"35","author":"Santoro","year":"2013","journal-title":"Blood Purif."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Donati, G., Moretti, M.I., Baraldi, O., Spazzoli, A., Capelli, I., Comai, G., Marchetti, A., Sarma, M., Mancini, R., and La Manna, G. (2016). Removal of free light chains in hemodialysis patients without multiple myeloma: A crossover comparison of three different dialyzers. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0405-5"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1159\/000481461","article-title":"Effectiveness of IHD with adsorptive PMMA membrane in myeloma cast nephropathy: A cohort study","volume":"46","author":"Sens","year":"2017","journal-title":"Am. J. Nephrol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1093\/ckj\/sfad022","article-title":"Role of light chain clearance in the recovery of renal function in multiple myeloma: Another point of view","volume":"16","author":"Senin","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Pend\u00f3n-Ruiz de Mier, M.V., Ojeda, R., \u00c1lvarez-Lara, M.A., Navas, A., Alonso, C., Caballero-Villarraso, J., Aljama, P., \u00c1lvarez, M.A., Soriano, S., and Rodr\u00edguez, M. (2020). Hemodiafiltration with ultrafiltrate regeneration reduces free light chains without albumin loss in multiple myeloma patients. BMC Nephrol., 21.","DOI":"10.1186\/s12882-020-01885-8"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.21873\/invivo.12890","article-title":"Efficacy of Supra-HFR in removing FGF23 and cytokines: A single session analysis","volume":"36","author":"Donati","year":"2022","journal-title":"In Vivo"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1007\/s40620-025-02257-x","article-title":"Hemoadsorption and plasma adsorption: Two current options for the 3rd dimension of dialysis purification","volume":"38","author":"Morisi","year":"2025","journal-title":"J. Nephrol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1007\/s40620-021-01226-4","article-title":"Management of acute kidney injury in frail patients with biopsy-proven cast nephropathy: A combined approach with chemotherapy plus Supra-hemodiafiltration with post-adsorption endogenous reinfusion","volume":"35","author":"Murgia","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"100993","DOI":"10.1016\/j.xkme.2025.100993","article-title":"Evaluation of light chain removal rates in blood purification therapy for light chain cast nephropathy","volume":"7","author":"Kamido","year":"2025","journal-title":"Kidney Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"i17","DOI":"10.1093\/ckj\/sfab202","article-title":"The membrane perspective of uraemic toxins: Which ones should, or can, be removed?","volume":"14","author":"Bowry","year":"2021","journal-title":"Clin. Kidney J."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Veldman, W.A., Weerman, D.J., Molog, S., Diepenbroek, A., Roeloffzen, W.W.H., Stegeman, C.A., and Franssen, C.F.M. (2025). Kinetics of serum-free light chain removal by high-cutoff hemodialysis in patients with multiple myeloma and acute renal failure. Medicina, 61.","DOI":"10.3390\/medicina61111977"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2311600","DOI":"10.1080\/16078454.2024.2311600","article-title":"Renal outcome in multiple myeloma patients with cast nephropathy: A retrospective analysis of potential predictive values on clinical and renal outcome","volume":"29","author":"Kozakowski","year":"2024","journal-title":"Hematology"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/ejh.70116","article-title":"Survival and renal recovery in newly diagnosed multiple myeloma patients presenting with dialysis-requiring severe renal impairment","volume":"116","author":"Sharma","year":"2026","journal-title":"Eur. J. Haematol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2215\/CJN.06290615","article-title":"Trends in survival and renal recovery in patients with multiple myeloma or light-chain amyloidosis on chronic dialysis","volume":"11","author":"Decourt","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e409","DOI":"10.1038\/bcj.2016.17","article-title":"Evolution in the treatment of multiple myeloma and impact on dialysis independence: Data from a French cohort from 1999 to 2014","volume":"6","author":"Laforet","year":"2016","journal-title":"Blood Cancer J."},{"key":"ref_83","unstructured":"(2026, July 23). Study Details | NCT07085728 | Testing the Investigational Agent Combination of Daratumumab, Bortezomib, and Dexamethasone Compared to the Usual Treatment of Cyclophosphamide, Bortezomib, and Dexamethasone in Newly Diagnosed Multiple Myeloma Patients with Light Chain Cast Nephropathy [Internet], Available online: https:\/\/clinicaltrials.gov\/study\/NCT07085728."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1111\/ejh.14403","article-title":"Improved outcomes of myeloma cast nephropathy in newly diagnosed multiple myeloma with modern anti-myeloma therapies","volume":"114","author":"Hughes","year":"2025","journal-title":"Eur. J. Haematol."},{"key":"ref_85","unstructured":"(2026, July 23). Study Details | NCT04398745 | A Study of Belantamab Mafodotin Monotherapy in Multiple Myeloma Participants with Normal and Varying Degree of Impaired Renal Function | ClinicalTrials.gov [Internet], Available online: https:\/\/clinicaltrials.gov\/study\/NCT04398745."},{"key":"ref_86","unstructured":"(2026, July 23). Study Details | NCT05429515 | Effect of HFR-SUPRA in the Treatment of Multiple Myeloma-Related Acute Kidney Injury | ClinicalTrials.gov [Internet], Available online: https:\/\/clinicaltrials.gov\/study\/NCT05429515."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Gembillo, G., Soraci, L., Floris, M., Lo Cicero, L., Lo Re, C., Filicetti, E., Calderone, M., Benenati, C.G., Corsonello, A., and Santoro, D. (2026). Personalized Hemodialysis Approaches in Frail Older Individuals. 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