Carpal Tunnel Surgery as Proxy for Dialysis-Related Amyloidosis: Results from the Japanese Society for Dialysis Therapy

Abstract

Background/Aims: This study aims to identify current risk factors for developing dialysis-related amyloidosis using carpal tunnel syndrome (CTS) as proxy for general amyloidosis. Methods: The cohort consisted of 166,237 patients on dialysis (mean age 66.1 ± 12.4 years; mean dialysis vintage 7.2 ± 6.4 years) who could be followed for a year between 2010 and 2011. Of these, 2,157 (1.30%) needed first-time CTS surgery during the study period. Odds ratios (ORs) for CTS were calculated at a 95% confidence interval (95% CI) after adjusting for age, gender, primary kidney disease, history of smoking, history of hypertension vintage, dialysis modality, use of high-flux membrane, body mass index, serum albumin, Kt/V, normalized protein catabolic rate, C-reactive protein, pretreatment β₂-microglobulin (β₂MG), and β₂MG clearance. Results: Adjusted ORs of first-time CTS for vintages 10-15, 15-20, 20-25 (referent), 25-30, and >30 years were, respectively, 0.18 (0.12-0.26), 0.43 (0.31-0.62), 1.00, 2.37 (1.64-3.40), and 3.87 (2.52-5.93). Adjusted ORs for ages 40-50, 50-60 (referent), 60-70, 70-80, and >80 were 0.53 (0.30-0.94), 1.00, 1.89 (1.41-2.52), 1.52 (1.08-2.14), and 1.04 (0.60-1.80). Female gender, low serum albumin, and diabetic nephropathy were also associated with CTS. Pretreatment serum β₂MG and β₂MG clearance <80% were not significant, although β₂MG clearance >80% was negatively associated with CTS [OR 0.34 (0.13-0.90)]. Conclusion: ORs of first-time CTS almost doubled with every 5-year increase in dialysis vintage. ORs of CTS were highest for patients aged 60-70. Other factors associated with CTS were gender, serum albumin, and diabetic nephropathy. β₂MG clearance >80% may decrease the incidence of CTS.

Sonographic examination of the median nerve in dialysis patients and after renal transplantation

“…; Hoshino et al. ; Nishi ). Another consideration is that an increased vulnerability of the median nerve in cases of pre‐existing polyneuropathy could predispose for entrapment neuropathy (Kwon et al.…”

Amylose cervicale à bêta-2-microglobuline chez un patient hémodialysé

“…Le syndrome du canal carpien est le plus souvent bilatéral, débutant préférentiellement du côté de l'abord vasculaire. Sa prévalence double tous les 5 ans avec une fréquence plus importante chez les patients de plus de 60-70 ans et atteint tous les dialysés après 20 ans de traitement [3]. L'arthropathie amyloïde touche le plus souvent les épaules, les hanches, les poignets et les genoux, mais toutes les articulations peuvent être touchées.…”

Hemodialysis‐related amyloidosis: Is it still relevant?

“…Using this 2010 cohort, we showed that other factors associated with CTS besides dialysis duration were age, gender, serum albumin, and diabetic nephropathy. We also indicated that β2M clearance >80% may contribute to decrease the incidence of CTS (Figure ).…”