Dialysis-related amyloidosis: importance of biocompatibility and age

The histological prevalence of dialysis-related amyloidosis (DRA) is much g reater than suspected on clinical grounds: one-third of patients are affect ed after less than 4 years on haemodialysis (HD) and over 90% after more th an 7 years HD. Risk factors include the time on dialysis, the type of HD me mbrane, and the age of the patient at onset of dialysis. The protective eff ect of high-flux membranes such as AN69 probably results mainly from the gr eater clearance of beta 2-microglobulin. Other potential but more controver sial explanations include a protective influence on residual renal function , a lower stimulation of beta 2-microglobulin synthesis or release, or a be neficial influence on advanced glycosylation end (AGE) products. The higher risk of DRA in older patients has recently been suggested to result from a n age-related AGE-modification of osteoarticular collagen. The best prevent ion and treatment of DRA is successful renal transplantation. In patients u nsuitable for transplantation, high nux membranes such as AN69 should be us ed from the start of dialysis. Palliative treatment includes analgesics, lo w dose prednisone in severe cases, and surgical treatment of complications.