Beta-2 Microglobulin Amyloidosis: Past, Present, and Future
Ignacio Portales-Castillo1,2, Jerry Yee3, Hiroshi Tanaka4
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Abstract:
Almost half a century has elapsed since the first description of dialysis-related amyloidosis (DRA), a disorder caused by excessive accumulation of β-2 microglobulin (B2M). Within that period, substantial advances in RRT occurred. These improvements have led to a decrease in the incidence of DRA. In many countries, DRA is considered a "disappearing act" or complication. Although the prevalence of patients living with RRT increases, not all will have access to kidney transplantation. Consequently, the number of patients requiring interventions for treatment of DRA is postulated to increase. This postulate has been borne out in Japan, where the number of patients with ESKD requiring surgery for carpal tunnel continues to increase. Clinicians treating patients with ESKD have treatment options to improve B2M clearance; however, there is a need to identify ways to translate improved B2M clearance into improved quality of life for patients undergoing long-term dialysis.
Insights
Dialysis-related amyloidosis (DRA), caused by beta-2 microglobulin (B2M) buildup, is decreasing due to RRT advances. However, rising end-stage kidney disease (ESKD) patients may see increased DRA interventions.
Area of Science:
- Nephrology
- Biomedical Science
Background:
- Dialysis-related amyloidosis (DRA) results from beta-2 microglobulin (B2M) accumulation.
- Advances in renal replacement therapy (RRT) have reduced DRA incidence.
- Despite RRT improvements, kidney transplantation access is limited for some patients.
Purpose of the Study:
- To examine the current status and future trends of dialysis-related amyloidosis.
- To highlight the need for improved quality of life for patients with end-stage kidney disease (ESKD).
Main Methods:
- Literature review and analysis of epidemiological trends in DRA.
- Examination of treatment options for improving B2M clearance in ESKD patients.
Main Results:
- DRA incidence has decreased globally due to RRT advancements.
- A potential increase in DRA interventions is predicted due to rising ESKD prevalence and limited transplant access.
- Japan shows a rising trend in surgeries for carpal tunnel syndrome, a DRA manifestation.
Conclusions:
- While DRA is less common, it remains a concern for a growing ESKD population.
- Strategies to translate improved B2M clearance into enhanced patient quality of life are crucial.
- Further research is needed to optimize management and improve outcomes for long-term dialysis patients at risk of DRA.
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