Nephrology Dialysis Transplantation, Vol 13, Issue 90007 61-64, Copyright © 1998 by Oxford University Press
M Jadoul
The histological prevalence of dialysis-related amyloidosis (DRA) is much
greater than suspected on clinical grounds: one-third of patients are
affected after less than 4 years on haemodialysis (HD) and over 90% after
more than 7 years HD. Risk factors include the time on dialysis, the type
of HD membrane, and the age of the patient at onset of dialysis. The
protective effect of high-flux membranes such as AN69 probably results
mainly from the greater clearance of {beta}2-microglobulin. Other
potential but more controversial explanations include a protective
influence on residual renal function, a lower stimulation of
{beta}2-microglobulin synthesis or release, or a beneficial influence on
advanced glycosylation end (AGE) products. The higher risk of DRA in older
patients has recently been suggested to result from an age-related
AGE-modification of osteoarticular collagen. The best prevention and
treatment of DRA is successful renal transplantation. In patients
unsuitable for transplantation, high flux membranes such as AN69 should be
used from the start of dialysis. Palliative treatment includes analgesics,
low dose prednisone in severe cases, and surgical treatment of
complications.
ORIGINAL ARTICLES
Dialysis-related amyloidosis: importance of biocompatibility and age
Department of Nephrology, Cliniques Universitaires St Luc, University of Louvain Medical School, 1200 Brussels, Belgium
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