Presentation and Outcome of Patients with Systemic Amyloidosis Undergoing Dialysis

Bollée, Guillaume; Guery, Benoît; Joly, Dominique; Snanoudj, Renaud; Terrier, B.; Allouache, Mahmoud; Mercadal, Lucile; Péraldi, Marie-Noëlle; Viron, B; Fumeron, Christine; Elie, Caroline; Fakhouri, Fádi

doi:10.2215/cjn.02470607

Cited by 60 publications

(39 citation statements)

References 22 publications

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“…Survival of patients with ALA was comparable with data from the Australia and New Zealand Dialysis and Transplant Registry, comprising 490 patients with ALA or amyloid A (AA) amyloidosis on chronic dialysis (16), and a smaller French cohort of patients with ALA (17). Survival was better (39 months) in a British cohort of 221 patients with ALA (10) but worse (11 months) in an Italian cohort of 59 patients (18).…”

Section: Discussionmentioning

confidence: 53%

“…Frailty has already been described as an independent risk factor of mortality in chronic dialysis (22,23), and CHF is a major prognostic factor in patients with ALA (17). The surprising association of high BP at the initiation of dialysis with a reduced risk of death has been reported before in dialysis (24) and could be of particular relevance in patients with ALA, where low BP can be caused by CHF or dysautonomia.…”

Section: Discussionmentioning

confidence: 81%

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Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Decourt¹,

Gondouin²,

Delaroziere

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Monoclonal gammopathies (MGs) with renal involvement can lead to ESRD caused by myeloma cast nephropathy (MCN), immunoglobulin light chain amyloidosis (ALA), or light-chain deposition disease (LCDD). Few studies have focused on the prognosis of patients with MG on chronic dialysis. We evaluated the outcomes of patients with MG incident on chronic dialysis in France.Design, setting, participants, & measurements All incident patients registered in the Renal Epidemiology and Information Network Registry between 2002 and 2011 with ESRD caused by ALA, LCDD, or MCN were included. Patient's survival, censored for renal transplantation, renal recovery, and loss to follow-up, as well as renal outcomes were analyzed and compared with a control group. Risk factors and causes of death were analyzed.Results We included 1459 patients, comprising 265 (18%) patients with ALA, 334 (23%) patients with LCDD, and 861 (59%) patients with MCN. Median age was 72 years, and 56% were men. Median follow-up was 13.1 months. Renal recovery was observed in 9.1% of patients and more frequent after 2006. Kidney transplantation was rare in this population (2.3%). Among 1272 patients who remained on dialysis, 67% died. Median survival on dialysis was 18.3 months. Main causes of death were malignancies (34.4%), cardiovascular diseases (18%), infections (13.3%), and cachexia (5.2%). Independent risk factors of death were age (hazard ratio [HR], 1.03 per year increase; 95% confidence interval [95% CI], 1.02 to 1.03), frailty (HR, 1.93; 95% CI, 1.58 to 2.36), congestive heart failure (HR, 1.54; 95% CI, 1.23 to 1.93), and dialysis initiation on a central catheter (HR, 1.40; 95% CI, 1.11 to 1.75). Factors associated with a lower risk of death were year of dialysis initiation (HR, 0.95 per year increase; 95% CI, 0.91 to 0.99) and high BP (HR, 0.80; 95% CI, 0.67 to 0.97).Conclusions Survival of patients with ALA, LCDD, or MCN on chronic dialysis is poor but has improved over time. Progressive malignancy is the main cause of death in this population. Renal recovery has increased since 2006.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 81%

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Decourt¹,

Gondouin²,

Delaroziere

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Esteve et al found that survival time in AL patients was shorter than in those with secondary amyloidosis (AA): 58% and 19% at 12 and 24 month vs 55% and 44%, respectively [3]. Bollée et al also observed that median survival in AL dialyzed patients was only 26 months [9]. A long-term survival of patients with primary amyloidosis was described by Kyle et al, who observed 10 years or more survival in 4.7% of 810 patients with AL [10].…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the observation in the current case: the female lost the possibility to be treated by PD because of peritonitis. Esteve et al found that mean the survival time of 12 and 24 months after the start of dialysis was 30% and 5%, respectively [9]. Gude et al have also described a case of short-time PD treatment in primary amyloidosis [7].…”

Section: Discussionmentioning

confidence: 99%

Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis

Grzebalska¹,

Sak²,

Prystupa³

et al. 2017

J Pre Clin Clin Res.

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Grzebalska A M, Sak J, Prystupa A, Książek A. Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis. J PreClin Clin Res. 2017; 11(1): 22-24. doi: 10.26444/jpccr/75444 Abstract Introduction. Amyloidosis, both primary and secondary, is a systemic disease characterized by extracellular deposition of fibrillar protein in vital organs, leading to their injury and even insufficiency. It results in a poor diagnosis, especially for patients with primary amyloidosis. Kidney involvement is typical and usually manifests by proteinuria, mainly nephrotic range, leading to end-stage renal disease (ESRD). Patients with ESRD need renal replacement therapy (RRT). Some data claim that better results and longer patient , survival are observed in peritoneal dialysed rather than in haemodialysed patients. Case report. The case is described of 19-year-old Caucasian woman with primary amyloidosis. Inherited primary amyloidosis with abnormal apolipoprotein A-I was established. The patient was successfully treated with peritoneal dialysis for 87 months. After this period, she was transferred for haemodialysis. Such a long survival time on peritoneal dialysis (PD) in a patient with primary amyloidosis has not been found. It is believed that the lowering of immunoglobulin levels in blood and normalization of total protein in serum effectively removed, through dialysate, the pathological polyclonal proteins. This effect probably also sustained cardio-circulatory sufficiency of the patient and significantly prolonged her survival. Conclusion. Peritoneal dialysis is an effective and recommended method of treatment in patients suffering from primary amyloidosis. Peritoneal dialysis should be the first choice therapy in ESRD patient; contrary to haemodialysis, peritoneal dialysis removes pathological proteins and allows the avoidance of intra-dialytic hypotension.

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“…Time from diagnosis to dialysis is shorter for AL than for AA amyloidosis. Mean time to dialysis in AL amyloidosis was 15 months, mean survival on dialysis was 24 months; mortality is signifi cantly higher in patients with AL than with AA amyloidosis [30]. Hemodialysis in AL amyloidosis is complicated by a strong tendency towards intradialytic hypotension due to cardiac involvement, continuous ambulatory peritoneal dialysis by peritonitis [31].…”

Section: Renal Replacement Therapy In Amyloidosismentioning

confidence: 99%

Renal aspects of amyloidosis

Heininger

2012

memo

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Presentation and Outcome of Patients with Systemic Amyloidosis Undergoing Dialysis

Abstract: Conclusions: Survival of patients with amyloidosis undergoing dialysis, especially AL type, is probably better than previously reported. However, mortality is higher in AL than AA type, especially in the setting of cardiac involvement.

Cited by 60 publications

References 22 publications

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Trends in Survival and Renal Recovery in Patients with Multiple Myeloma or Light-Chain Amyloidosis on Chronic Dialysis

Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis

Renal aspects of amyloidosis

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