Dialysis-related amyloidosis: a review from case series

In Japan, dialysis first started in 1963 with intermittent peritoneal dialysis, followed by hemodialysis in 1966. The introduction of dialysis made it possible to treat end-stage renal failure, which at that time was a fatal or malignant disease, making it a benign disease and enabling long-term survival. However, patients who survived on dialysis for more than 10 years often developed dialysis-related amyloidosis (DRA), a serious dialysis complication that causes bone and joint lesions such as carpal tunnel syndrome, cervical destructive spondyloarthropathy (DSA), and lumbar DSA. DRA led to impaired activities of daily living (ADL) and quality of life (QOL), and ultimately, death. Because DRA was caused by the deposition of beta-2 microglobulin (beta 2MG), treatment methods were devised to remove serum beta 2MG, i.e., dialysis fluid was purified, dialyzers with dialysis membranes were developed, and hemodiafiltration was introduced. These approaches not only greatly reduced the beta 2MG concentration in the blood, but they also significantly increased the number of years until the onset of DRA and decreased the amount of deposited amyloid. Unfortunately, continuous ambulatory peritoneal dialysis (CAPD) removes less beta 2MG than hemodialysis and patients who undergo CAPD for more than ten years can develop lumbar DSA, which decreases their ADL and can cause death. This article describes the history of treatment of dialysis amyloidosis at our hospital, a pioneering institution for dialysis in Japan, with reference to relevant publications.