Clinical manifestations of AB-amyloidosis: effects of biocompatibility andflux

Background. Highly permeable biocompatible dialysis membranes may postpone the development of AB-amyloidosis, but the relative contribution of enhance d flux or reduced inflammation by highly biocompatible membranes and steril e dialysis fluid remains unknown. Methods. In this retrospective investigation, 89 patients with end-stage re nal disease maintained on regular haemodialysis for at least 10 years and t reated with one type of dialysis membrane exclusively were selected for ana lysis. They were divided into three groups: low-flux, bioincompatible cellu lose (I), low-flux, intermediately biocompatible polysulphone or PMMA (II), or high-flux, highly biocompatible polys ulphone or AN69 (III). In additio n, the patients were analysed according to the microbiological quality of t he dialysis fluid, which had been tested regularly and was classified eithe r as standard or as intermittently contaminated. The clinical manifestation s indicative of AB-amyloidosis, namely, carpal tunnel syndrome, arthropathy and bone cysts, were diagnosed after recruitment. Results. Clinical symptoms were most pronounced in group I, intermediate in group II, and lowest in group III. Patients treated with intermittently co ntaminated dialysis fluid showed a higher prevalence of AB-amyloidosis than patients with less contaminated dialysis fluid. Logistic regression analys is demonstrated that the flux characteristics of the dialyser and the micro biological quality of the dialysis fluid as well as the biocompatibility of the dialyser were independent determinants of AB-amyloidosis. Conclusion. It would be prudent clinical practice to employ high-flux bioco mpatible membranes in conjunction with ultrapure dialysis fluid for the tre atment of end-stage renal disease patients who need to remain on long-term haemodialysis.