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Renal impairment affects about half of all myeloma patients at some stage and approximately 10% of patients require dialysis. Chronic renal disease (CKD) may also exist due to other health problems such as diabetes and hypertension. Renal impairment can be exacerbated by myeloma treatments and supportive medicines such as bisphosphonates and aminoglycosides.

Dose reductions of myeloma treatments may be required with some chemotherapy and immunomodulatory treatments to avoid myelosuppression and close monitoring is required. Patients may also be at greater risk of anaemia, infection and bone loss and may benefit from treatment with erythropoiesis-stimulating agents.