Positron Emission Tomography Can Support the Diagnosis of Dialysis-Related Amyloidosis

Abstract

Background: The improvements in dialysis have not eliminated long-term problems, including dialysis-related amyloidosis (DRA), caused by Beta-2 microglobulin deposition. Several types of scintigraphy have been tested to detect DRA, none entered the clinical practice. Aim of the study was to assess the potential of PET-FDG scan in the diagnosis of DRA. Methods: Forty-six dialysis patients with at least one PET scan (72 scans) were selected out 162 patients treated in 2016–2018. Subjective global assessment (SGA), malnutrition inflammation score (A), Charlson Comorbidity Index (CCI), were assessed at time of scan; 218 age-matched cases with normal kidney function were selected as controls. PET scans were read in duplicate. Carpal tunnel syndrome was considered a proxy for DRA. A composite “amyloid score” score considered each dialysis year = 1 point; carpal tunnel-DRA = 5 points per site. Logistic regression, ROC curves and a prediction model were built. Results: The prevalence of positive PET was 43.5% in dialysis, 5% in controls (p < 0.0001). PET was positive in 14/15 (93.3%) scans in patients with carpal tunnel. PET sensitivity for detecting DRA was 95% (specificity 64%). Carpal tunnel was related to dialysis vintage and MIS. A positive PET scan was significantly associated with dialysis vintage, MIS and amyloid score. A prediction model to explain PET positivity combined clinical score and MIS, allowing for an AUC of 0.906 (CI: 0.813–0.962; p < 0.001). Conclusions: PET-FDG may identify DRA, and may be useful in detecting cases in which inflammation favours B2M deposition. This finding, needing large-scale confirmation, could open new perspectives in the study of DRA.

Half a century of haemodialysis: two patient journeys

“…Severe lesions, including destructive spondiloarthopathy are still found in long-term dialysis patients (12-13). Unfortunately, cardiovascular complications of long-standing HD 220 have persisted despite the improvement in CKD management and RRT strategies [ 12 , 14 , 15 ]. Such complications are highlighted in our second case.…”

Amiloidosis Asociada a Hemodiálisis: Revisión Literaria

“…La tomografía por emisión de positrones (PET) permite identi car casos de in amación intensa asociada a la formación rápida de depósitos osteoarticulares; además, permite identicar in amación crónica en varias articulaciones grandes [35]. La ventaja de este método es que se pueden identi car los depósitos amiloides en fase temprana e instaurar a un tratamiento antiin amatorio temprano, impactando en el curso de la enfermedad.…”

Visualization of Dialysis-Related Amyloid Arthropathy on 18F-FDG PET-CT Scan

“…We report a case where the 18 F-FDG PET-CT allows the identification of several DRA-associated lesions in the articular and periarticular soft tissues in a patient under long-term dialysis therapy. There were only a few reports dealing with 18 F-FDG PET-CT findings on DRA [ 3 , 4 ]. It suggests that 18 F-FDG PET-CT could be a non-invasive imaging modality showing the extent and distribution of osseous, articular and soft-tissue involvement in dialysis-related amyloid arthropathy.…”