High Cut-off Hemodialysis in Patients With Advanced Cardiac AL Amyloidosis and End Stage Renal Disease

Inclusion Criteria: * Diagnosis of AL amyloidosis. * Age ≥ 18 years. * Evidence of a monoclonal light chain in serum and/or urine by positive immunofixation and abnormal FLC κ/λ ratio. * Evidence of cardiac involvement at echocardiography (mean left ventricular wall thickness \> 12 mm in the absence of other causes). * Cardiac stage III (both NT-proBNP \> 332 ng/L and cTnI \> 100 ng/L). * Estimated GFR \< 15 mL/min per 1.73 m2 or requiring dialysis. * NYHA class III or IV. * Initiation of chemotherapy for AL amyloidosis scheduled between day 3 and day 8 after first HCO-HD session. Exclusion Criteria: * Non-AL (e.g. familial, senile) amyloidosis. * Concomitant non-amyloid related clinically significant cardiac diseases. * Involved (amyloidogenic) FLC \< 100 mg/L. * Inability to undergo chemotherapy for AL amyloidosis. * Uncontrolled infection. * Inability to give informed consent. * Previous or ongoing psychiatric illness (excluding reactive depression). * Pregnant or nursing women.