ABSTRACT
Hemodialysis is associated with deposition of beta-2-microglobulin [beta-2m] in musculoskeletal structures, leading to the syndrome of dialysis related amyloidosis and impairment of hand function. The detection of amyloidosis in several patients on long-term dialysis came as a surprise. The subsequent identification of beta-2m as the main component of dialysis related amyloidosis demonstrated that we were faced with a new, specific complication of long-term renal replacement therapy. To assess the hand function in a cross section of patients undergoing hemodialysis and to correlate it to dialysis duration, efficiency, nutritional status, and other parameters of dialysis. The study comprised two groups: Group A included thirty-nine patients [16 females, 23 males] with end stage renal disease receiving maintenance hemodialysis. Their mean age was 49 +/- 11 years; their mean duration of hemodialysis was 37 +/- 31.8 months. Dialysis efficacy was calculated with the formula of single pool Kt/V. Group B included 20 normal healthy volunteers [8 females and 12 males] as a control group; their mean age was 45 +/- 15 years. All patients and controls were tested as regards kidney functions, hemoglobin, albumin, and parathyroid hormone. Then, the hand function was evaluated with the JAMAR handgrip test [JA Preston Corp, Ontario, Canada] for the dominant and non-dominant hands. beta-2m was significantly elevated in group A in comparison to control group B [34.7 +/- 14.14 versus 3.9 +/- 2.1mg/dl] [p<0.001]. JAMAR hand function test was significantly decreased in patients as compared to controls [25.01 +/- 8.7 versus 42.8 +/- 8.9] [p<0.001]. In group A, 25 out of 39 patients [64%] had abnormal performance of hand function tests used. This percentage was 85% [17 out of 20 patients] for ages above 55 years, while it was 36% [8 out of 19 patients] for ages below 55 years. The JAMAR handgrip test of the dominant hand was highly significant correlated to serum beta-2m levels [r=-0.42, p =0.007], to hemodialysis duration [r=-0.6, p <0.001], and to serum albumin concentration [r=0.57, p <0.01]. While beta-2m positively correlated with hemodialysis duration [r=0.9, p<0.001], it negatively correlated to both parathormone [r=-3.19 p<0.04] and albumin r=-0.55 p<0.001. Hand dysfunction is a common association with long standing chronic dialysis therapy. Hand function negatively correlated to beta-2m, hemodialysis duration. Age and hemodialysis duration were important risk factors for hand dysfunction. We recommend the use of hand function test for the early detection of dialysis related amyloidosis as well as in the serial monitoring of patients on dialysis, especially in patients who are on hemodialysis for at least 5 years and for patients who start dialysis after 55 years of age. This will help to shift those affected patients for using high-flux biocompatible membranes in conjunction with ultra-pure dialysis fluid