End-stage renal disease in systemic amyloidosis: clinical course and outcome on dialysis

We studied a group of 48 patients with systemic amyloidosis and end-stage renal disease (ESRD) treated with chronic dialysis to analyze the clinical course and the factors which can influence survival. This group was compared to a control group of 63 nondiabetic patients without amyloidosis with ESRD treated with hemodialysis. The median survival of the experimental group was 52 months; 1-, 2- and 6-year actuarial survival was 72, 62, and 44%, while in the control group it was 95, 91, and 81%, respectively (p less than 0.001). Survival was significantly shorter for patients with amyloidosis who rapidly (less than 3 months) progressed to ESRD or who had an acute deterioration in renal function immediately prior to the need for dialysis. The median survival in these cases was 4 and 1.5 months, respectively. Age, the presence or the degree of renal failure at the moment of diagnosis, and the type of amyloidosis did not affect the survival of these patients. Despite a shorter period of time spent on dialysis, these patients had a similar number of hospital admissions, cardiovascular and infectious events as the control patients, but more gastrointestinal disorders (bleeding and chronic diarrhea) and blood access problems. In conclusion, amyloidotic patients maintained on chronic dialysis have high morbidity and mortality rates. Nevertheless, acceptable survival is predictable in stable patients who progress slowly to ESRD.