Hemodialysis 101 | Long-Term Dialysis Patients with Joint Pain Should Beware of Dialysis-Related Amyloidosis (DRA)

Hemodialysis is a critical treatment method for various end-stage kidney disease patients to sustain life. However, with increasing dialysis vintage among patients, various complications related to hemodialysis gradually emerge. Among them, Dialysis-Related Amyloidosis (DRA) is a major disabling complication. Today, let's learn together with the editor about what DRA is.

1. What is DRA?

Amyloid substances deposit in the bones and surrounding tissues of patients (bones, synovium, muscles, tendons, and ligaments), leading to disabling lesions in bones and joints. Clinical manifestations include carpal tunnel syndrome, cystic bone lesions, pathologic fractures, osteoarthritis, and destructive arthropathy. Extra-articular involvement is less common, but with prolonged dialysis vintage, late-stage DRA can affect organs such as the heart, gastrointestinal tract, and lungs.

2. Incidence of DRA

The incidence increases with patient dialysis vintage and age. Clinical studies show that the incidence of DRA is 0% in patients with less than 5 years of dialysis vintage, 50% at 12 years, and 100% at 20 years.

3. Risk Factors for Promoting DRA

1. Longer dialysis vintage

2. Older age at the start of dialysis

3. Loss of residual kidney function

4. Use of low-flux dialyzers

5. Dialyzers with poor biocompatibility and contaminated dialysate

4. Diagnosis of DRA

DRA can present as varying degrees of joint and bone pain. Tissue biopsy is the gold standard for diagnosing β2-MG amyloidosis. Since early stages are asymptomatic or have atypical symptoms, histopathological examination is challenging for screening. Therefore, imaging combined with medical history aids in diagnosing DRA.

5. How to Prevent DRA

Reducing blood β2M levels is fundamental in treating and preventing DRA.

1. Increase β2M Clearance

Extend dialysis time, increase dialysis frequency, use high-flux dialyzers, employ β2M adsorption columns, and utilize high-flux hemodialysis (HFHD) and hemodiafiltration (HDF) treatment modes to enhance β2M clearance rates.

2. Reduce β2M Production Due to Inflammatory Reactions

Use biocompatible membranes and ultrapure dialysis to reduce inflammatory reactions, minimizing β2M production.

3. Symptomatic Treatment

Administer drug and surgical treatments based on physician consultation.

DRA is a significant health issue faced by long-term dialysis patients. Enhancing understanding of DRA helps patients better manage daily prevention and treatment, improving quality of life.

In the next issue, the editor will bring more hemodialysis knowledge. Kidney friends, please click to bookmark, follow, and share. If you have any other suggestions or topics of interest, feel free to leave us a message anytime.

Let's learn more about hemodialysis in the next issue together!

References:

[1] Dong Jianhua, Ge Yongchun. Dialysis-Related Amyloidosis. Journal of Kidney Disease and Dialysis Transplantation. 2020, 29(01), 77-82.

[2] Yao Ying, Zhang Youkang. β2 Microglobulin and Dialysis-Related Amyloidosis. Chinese Journal of Nephrology Research Online. 2019, 8(03), 128-131.

[3] Wang Xiaoguang et al. Analysis of Related Risk Factors for Dialysis-Related Amyloidosis in Maintenance Hemodialysis Patients. Journal of Clinical Nephrology. 2015, 15(05), 264-267.

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