Programmed initiation of hemodialysis for systemic amyloidosis patients associated with rheumatoid arthritis

Abstract

Reactive amyloidosis is a serious systemic disease in rheumatoid arthritis (RA). Amyloid protein can be deposited in kidneys, heart or gastrointestinal tract leading to organ failure. Renal involvement is a well-known complication in amyloidosis as this may culminate in end-stage renal disease (ESRD). Hemodialysis (HD) is always considered the treatment of choice for such patients; however, the prognosis is usually poor due to a large number of sudden deaths immediately following HD therapy. To circumvent the problem of HD initiation while instituting HD safety, we devised a plan to start HD and compare patient's survival with our previous data. Sixty-three patients were treated with HD. They were categorized according to the initiation of first dialysis. All patients were divided into planned, unplanned and programmed initiation groups. First dialysis that had been initiated as not urgent was considered 'planned' (20 patients). First dialysis that had been performed urgently for life-threatening renal insufficiency was considered 'unplanned' (31 patients). First dialysis that had been initiated as not urgent and according to our dialysis program was considered 'programmed' (12 patients). Survival of these 63 patients from the initiation of HD at 38 days was 75%, at 321 days was 50% and at 1,784 days was 25%. Patients with unplanned initiation of HD showed a significant poor survival compared with those of both planned and programmed initiation. Additionally, patients with planned and programmed initiation of HD showed no significant difference for the patients' survival. Our study demonstrates that patients with amyloidosis have a higher mortality rate. Nevertheless, programmed initiation of HD will improve the prognosis of patients with ESRD. Such possibility needs to be considered in more detail in the future.

Ferritin in dialysis-related arthropathy: could it be a possible biochemical indicator of articular chronic pain?

“…Rheumatic disease such as rheumatoid arthritis, which may be observed in dialysis patients and which may be a joint pain source [24], was excluded in our cohort. Due to the groups' homogeneity we can exclude the role of the central venous catheter, known to be a potential source of inflammation [25], as a cause of differences in ferritin mean values in the two groups.…”

Developments in the Treatment of Amyloid A Amyloidosis Secondary to Rheumatoid Arthritis

“…However, existing data on patient survival and graft prognosis do not provide conclusive results about whether renal plantation is suitable for patients with AA amyloidosis [101]. An alternative to transplantation is chronic dialysis, but experience with dialysis in patients with AA amyloidosis has not yet as been encouraging [102,103]. Peritoneal dialysis increases the susceptibility to infection and protein loss [104].…”

Exploring New Findings on Amyloidosis

“…However, whether it is calcium dyshomeostasis that provokes Aβ production and accumulation [101], or vice-versa [102], remains to be elucidated. Either way, in addition to the Aβ unbalance, increased levels of Ca 2+ promoted protein tau hyperphosphorylation [103]. It was also suggested that amyloid oligomers induce membrane permeabilization, leading to increased intracellular Ca 2+ concentration [104].…”

“…However, existing data on patient survival and graft prognosis do not provide conclusive results about whether renal plantation is suitable for patients with AA amyloidosis [101]. An alternative to transplantation is chronic dialysis, but experience with dialysis in patients with AA amyloidosis has not yet as been encouraging [102,103]. Peritoneal dialysis increases the susceptibility to infection and protein loss [104].…”