ABSTRACT
This study aimed at exploration of dialysis-related amyloidosis [DRA] as a medical problem in end stage renal disease patients [ESRD] on regular hemodialysis [HD], as well as estimation of s. beta-2 microglobulin [B2M] changes in those patients. It comprised 55 patients with ESRD on regular HD therapy, 36 males and 19 females, with a mean age of 11.45 +/- 3.22 years. They were compared to 20 healthy subjects. The patients were subjected to clinical evaluation, biochemical investigations included serum B2M, serum creatinine, creatinine clearance and blood urea nitrogen. S. B2M estimation was repeated after changing the dialyzer membrane from unsubstituted cellulose to synthetic polysulfone in 10 patients. Radiographic examination for cervical and lumbar vertebrae and big joints, M-mode and 2-dimensional echocardiography were done. Pathologic examination for DRA was performed in subcutaneous fat biopsy from 25out of the 55 studied patients. There was a significant higher concentration of s. B 2M in patients 10280 +/- 647 ng/ml compared to the control group 1570 +/- 710 ng/ml p<0.001. A significantly better clearance was achieved by using the synthetic polysulfone membrane dialyzer [14181 +/- 378 dropped to 3 590 +/- 590 ng/ml] p<0.001. Radiographic and echocardiographic findings correlated positively with s. B2M. Four of the biopsied patients [16%] had positive amyloid deposits. Their median duration of dialysis was 33 months and all of them had clinical manifestations of carpal tunnel syndrome [CTS] and bilobed interatrial septal thickening in the echocardiography. To conclude, the ESRD patients receiving regular HD are vulnerable to DRA. S. B 2M as a potential precursor for DRA is significantly elevated in those patients. Better clearance of B 2M can be achieved by using synthetic polysulfone dialyzers