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Rapid Generation of Amyloid from Native Proteins In vitro
05:48

Rapid Generation of Amyloid from Native Proteins In vitro

Published on: December 5, 2013

Is beta2-microglobulin-related amyloidosis of hemodialysis patients a multifactorial disease? A new pathogenetic

G Cianciolo1, L Colí, G La Manna

  • 1Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, Bologna, Italy.

The International Journal of Artificial Organs
|November 10, 2007
PubMed
Abstract

Insights

Beta2-microglobulin amyloidosis (Abeta(2)M) complications like bone cysts and carpal tunnel syndrome (CTS) decreased significantly after improved dialysis water treatment. Inflammatory status, low albumin, and low residual GFR are key risk factors for Abeta(2)M.

Area of Science:

  • Nephrology
  • Clinical Medicine
  • Biomaterials Science

Background:

  • Beta2-microglobulin amyloidosis (Abeta(2)M) is a serious long-term complication of hemodialysis.
  • The etiology of Abeta(2)M, particularly its association with dialysis membranes and techniques, remains incompletely understood.
  • Previous studies have yielded inconsistent results regarding the influence of membrane composition and dialysis techniques on Abeta(2)M incidence.

Purpose of the Study:

  • To determine the incidence of bone cysts and carpal tunnel syndrome (CTS) associated with Abeta(2)M.
  • To compare the onset of Abeta(2)M between patients using cellulosic and synthetic dialysis membranes.
  • To identify risk factors for Abeta(2)M beyond membrane type and dialysis technique.

Main Methods:

  • A cohort of 480 hemodialysis (HD) patients treated between 1986 and 2005 was analyzed.
  • Patients were grouped by dialysis membrane type: cellulose, synthetically modified cellulose, synthetic low-flux, and synthetic high-flux.
  • Data were compared between periods before and after the implementation of reverse osmosis (RO) for dialysis water treatment in 1995. Diagnostic tools included radiography, CT, MRI, and electromyography.

Main Results:

  • Incidence of bone cysts decreased from 29.2% before 1995 to 12.2% after 1995 (p<0.0001).
  • CTS incidence dropped from 24% before 1995 to 7.1% after 1995 (p<0.0001).
  • High C-reactive protein (CRP), low albumin, and low residual glomerular filtration rate (GFR) were identified as significant risk factors for Abeta(2)M, while albumin and residual GFR demonstrated protective effects. Dialysis membrane type did not show a significant protective effect.

Conclusions:

  • Abeta(2)M development is multifactorial, influenced by the patient's inflammatory status, nutritional status (albumin levels), and residual renal function.
  • The findings suggest that Abeta(2)M is not solely a side effect of dialysis membrane or technique.
  • Improving dialysis water quality and managing patient-specific factors like inflammation and nutritional status are crucial for mitigating Abeta(2)M.

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