Dawson Dean

Multiple Myeloma and Dialysis/Plasma Exchange Simulator

Source Code

ON  OFF  OFF Dialysis Duration  Hrs Dialysis Every  Days Exchange Vol  L

Patient Info Weight  kg Height  cm

Initial Lab Values Serum Protein  grams/dL Urine Protein   grams/day Number Cells   1012 cells Protein Synth Rate  10-12/cell/day Light Chain Permeability Coefficient

ON  ON  ON  ON Show Values:  ON  ON  ON

	Plasma
	Interstitial
	Extracellular Fluid

Dialysis Running

Dialysis Notes

• For now, I do not distinguish between kappa and lambda myeloma, as they are both usually affected the same by dialysis (exceptions are noted below). Kappa proteins are 22.5 kD monomers, while lambda are 45 kD dimers, but dialyzers like the Gambro 1100 have a 50 kD cutoff. There is still a difference in the clearance, but I am ignoring that for now.
• We assume all dialysis uses a Gambro 1100. Really, Gambro has replaced the 1100 with a new model, but I don't have specs on that yet.
  • Clearance 17.15 mL/min if single HD
  • Clearance 41.25 mL/min if two HD units in series
  • Clearance 37.6 mL/min if two HD units with a filter change for lambda and 19 mL/min two HD units with a filter change for kappa
  • Clearance for kappa light chains reduced if UF at the same time
• The dashed line is 0.3 g/dL or 3 g/L, which is MGUS.

Plasma Exchange Notes

• I assume plasma exchange replaces 3 liters of blood volume over a 4 hour period.

References

• Colin A. Hutchison, Stephen Harding, Graham Mead, Hermann Goehl, Markus Storr, Arthur Bradwell, Paul Cockwell, Serum Free-Light Chain Removal by High Cutoff Hemodialysis: Optimizing Removal and Supportive Care, Artificial Organs, Volume 32, Issue 12 December 2008 Pages 910–917