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Prevalence of histological beta2-microglobulin amyloidosis in CAPD patients compared with hemodialysis patients
M Jadoul1, C Garbar, R Vanholder
1Department of Nephrology, Cliniques Universitaires St-Luc, Brussels, Belgium. Jadoul@nefr.ucl.ac.be
Background:
The prevalence of beta2-microglobulin amyloidosis (Abeta2m) in patients on continuous ambulatory peritoneal dialysis (CAPD) is unknown.
Methods:
We prospectively obtained a median of 2 (range 1 to 4) joint samples from 26 CAPD patients aged 44 to 93 (median 73) years at post-mortem evaluation after 4.5 to 126 (median 27) months solely on CAPD (N = 19) or primarily on CAPD (that is, < or = 10% and < or = 1 year of renal replacement therapy time on other modalities; N = 7). The diagnosis of Abeta2m rested on Congo red staining (typical birefringence) and positive immunostaining of amyloid deposits by a monoclonal anti-beta2m antibody.
Results:
Abeta2m was diagnosed in 8 of 26 patients (31%). Prevalence ranged from 20% (2 of 10 patients) within < or = 24 months CAPD to 30% (3 of 10 patients) after 24 to 48 months and 50% (3 of 6 patients) after 49 to 126 months (P = 0.11). The prevalence of Abeta2m was similar in patients without or with one or more peritonitis episodes. No significant difference in prevalence (P = 0.118) was found between CAPD patients (8+/26; 31%) and hemodialysis patients (13+/26; 50%) carefully matched for time on dialysis and age at the onset of dialysis.
Conclusions:
The prevalence of histological Abeta2m reaches 31% after a median duration of 27 months of CAPD. This prevalence is not significantly different from that observed in a group of HD patients matched for age and dialysis duration.
Insights
Beta2-microglobulin amyloidosis (Abeta2m) affects 31% of patients on continuous ambulatory peritoneal dialysis (CAPD) after 27 months. This prevalence is similar to hemodialysis patients, suggesting CAPD does not significantly increase Abeta2m risk.
Area of Science:
- Nephrology
- Pathology
- Rheumatology
Background:
- Beta2-microglobulin amyloidosis (Abeta2m) is a known complication in patients undergoing long-term dialysis.
- The prevalence of Abeta2m in patients specifically on continuous ambulatory peritoneal dialysis (CAPD) has not been previously established.
Purpose of the Study:
- To determine the prevalence of Abeta2m in patients undergoing CAPD.
- To compare the prevalence of Abeta2m in CAPD patients with that of hemodialysis (HD) patients.
Main Methods:
- Prospective collection of joint samples from 26 CAPD patients post-mortem.
- Diagnosis of Abeta2m confirmed by Congo red staining and anti-beta2m antibody immunostaining.
- Patients were on CAPD for a median of 27 months (range 4.5-126 months).
Main Results:
- Abeta2m was diagnosed in 31% (8 of 26) of CAPD patients.
- Prevalence increased with duration on CAPD, reaching 50% after 49-126 months.
- No significant difference in Abeta2m prevalence was found between CAPD patients (31%) and matched HD patients (50%).
Conclusions:
- Histological Abeta2m has a prevalence of 31% after a median of 27 months of CAPD.
- The prevalence of Abeta2m in CAPD patients is not significantly different from that in matched hemodialysis patients.
- These findings suggest CAPD duration and peritonitis episodes do not significantly alter Abeta2m risk compared to HD.