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Seminars in Dialysis
Volume 19 Page 105 - March 2006
doi:10.1111/j.1525-139X.2006.00134.x
Volume 19 Issue 2
UNRESOLVED ISSUES IN DIALYSIS
Dialysis-Related Amyloidosis: Late Finding or Hidden Epidemic?
Laura M. Dember* and Bertrand L. Jaber†
ABSTRACT
Dialysis-related amyloidosis is a complication of end-stage renal disease (ESRD) that results from retention of β2-microglobulin (β2M) and its deposition as amyloid fibrils into osteoarticular tissue. The clinical manifestations usually develop after several years of dialysis dependence and include carpal tunnel syndrome, destructive arthropathy, and bone cysts and fractures. High-flux membranes, daily dialysis, and hemofiltration all would be expected to delay the onset of dialysis-related amyloidosis because, to varying degrees, each increases the clearance of β2M from the plasma. Thus what is currently a late complication of ESRD might become an even later complication as dialysis practices change. The significance of histologically evident but clinically silent β2M amyloid, detectable not only in osteoarticular tissue but also in blood vessels, is unclear. Accumulating evidence that amyloidogenic proteins have direct and specific effects on cell processes irrespective of the extent of amyloid deposition raises the possibility that early, clinically silent β2M amyloid deposits have unrecognized importance.
Here’s an article that may be a little easier to read that explains two of the types of amyloidosis.
Amyloid is protein. Protein normally floats around in your body, but sometimes it builds up in your tissues. If it does, it can damage organs, including kidneys and it can cause joint pain and carpal tunnel syndrome.
Patients who have been on dialysis for years can develop amyloidosis over time. There is great effort to develop better hemodialysis filters (dialyzers) that can remove small protein (beta 2 microglobulin), such as high flux dialyzers. Besides transplant, it appears that nocturnal dialysis may help reduce the risk of this dialysis complication.
Theoretically, nocturnal hemo should help with this, as more of those proteins are removed. I don’t think anyone really knows for sure how theory translates into practice over the long term though - until they have real longer terms studies to go by. But it’s nice to know there’s great potential for improving long term outcomes.
Pierre
For all of you newcomers to dialysis it doesn’t mean much to you now but you will encounter it after 10+ years in dialysis…
Right now no one knows whether daily dialysis nor Nocturnal will slow it down, or halt it, but we already know that it cannot be reversed once damage is done, not even a transplant will reverse it.
There is a possibility that starting the patient on daily dialysis or nocturnal right away MAY slow down amyloidosis buildup.
In reality, a transplant can only prevent this problem, but the transplant should be done asap…
I don’t but at 3 and half years, I haven’t really been on dialysis long enough for this to happen, although, I did develop the symptoms of carpal tunnel syndrome after a couple of years. I never thought of it until now, but I can honestly say I haven’t had it at all since I’ve been on nocturnal.
Pierre