Alcohol Use Disorder and Risk of Kidney Injury, Infectious, and Hematologic Complications in Multiple Myeloma: A Real‑World Propensity‑Matched Cohort Study

Purpose Kidney injury and infectious complications drive much of the morbidity in multiple myeloma (MM)—leading to preventable treatment interruptions and hospitalizations—occurring in up to 50% and 30% of patients, respectively, yet the contribution of alcohol use disorder (AUD) to these core supportive care outcomes is unknown ¹ . Clinicians often suspect that heavy alcohol use worsens tolerance of therapy, but this has rarely been tested in large, real-world datasets. Methods We performed a retrospective cohort study using the TriNetX Global Health Research Network. Adults with MM (ICD-10 C90/C90.0) were identified and stratified by the presence of AUD (F10). Propensity score matching (1:1 nearest neighbor) balanced age, sex, race, and ethnicity. Primary supportive care outcomes were acute kidney injury (AKI), chronic kidney disease (CKD), infection, and hematologic toxicities (anemia, neutropenia, thrombocytopenia, venous thromboembolism). Secondary outcomes were diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Results After matching, 12,762 patients (6,381 per group) were included. Compared with matched controls, patients with AUD had higher risks of AKI (35.7% vs 22.7%; risk ratio [RR] 1.57, 95% CI 1.48–1.66), CKD (34.0% vs 26.3%; RR 1.30, 95% CI 1.23–1.37), infection (32.3% vs 22.3%; RR 1.45, 95% CI 1.36–1.54), and hematologic toxicities (57.2% vs 45.4%; RR 1.26, 95% CI 1.22–1.30; all p < 0.001) ² . Absolute risk increases were 13.0% for AKI (Number Needed to Harm [NNH] 8), 7.7% for CKD (NNH 13), 10.0% for infection (NNH 10), and 11.8% for hematologic toxicities (NNH 8) ² . DKA was more frequent in the AUD group (0.8% vs 0.4%, p = 0.004), while HHS did not differ significantly (0.6% vs 0.4%, p = 0.145) ² . Conclusion In this large, multi-institutional analysis, AUD was independently associated with clinically important increases in kidney injury, infectious, and hematologic complications in MM. These findings support incorporating structured alcohol screening into MM supportive care pathways to identify patients needing closer monitoring and preventive measures.