DIALYSIS MEMBRANES AND DIALYSIS-ASSOCIATED ARTHROPATHY

This review discusses the relationship between dialysis-associated art hropathy (DAA) and beta 2M amyloidosis, which is commonly found in the musculoskletetal system. DAA is probably multifactorial and various f actor may either be amyloidogenic or together with beta 2M deposits le ad to osteoarticular lesions. The influence of dialysis membranes was assessed in a retrospective multicenter study of 171 patients with a m ore than 10-year history of hemodialysis. In contrast with others, thi s study found no evidence that the use of AN 69 for over 90% of treatm ent time had any beneficial effect on the prevalence od DAA (60% in th e AN 69 group vs 49.5% in the cuprophane group). The most striking cli nical feature was the influence of age at the beginning of hemodialysi s on the development of DAA (41.7+/-12 years in patients with DAA vs 3 1.8+/-13 in patients without DAA, p<0.0001). DAA occurs with all forms of dialysis, and can probably antedate maintenance dialysis. It is mo re common in older patients. The prevention of DAA requires a better u nderstanding of all the pathogenic mechanisms involved.