Radiolucent Bone Cysts and the Type of Dialysis Membrane Used in Patients Undergoing Long-Term Hemodialysis

Abstract

The relationship between the types of dialysis membrane used and the prevalence and severity of radiolucent bone cysts (which are a main radiological feature of dialysis amyloidosis) was studied in 30 patients on hemodialysis for more than 10 years. One of them was treated exclusively with cuprophane; the other 29 were dialyzed with cuprophane, and then treated with polyacrylonitrile AN 69. In 12 of the 30 patients, radiolucent bone cysts (at least 5 mm in diameter in the wrists and at least 10 mm in the shoulders or hips) were observed. The patients with bone cysts spent significantly more time on cuprophane dialysis and significantly less time on AN 69 dialysis than the group of patients without bone cysts. Nine of the 14 patients who had been treated with cuprophane for more than 8 years had bone cysts; whereas bone cysts were observed in only 2 of the 12 patients dialyzed for more than 8 years with AN 69. The frequency of bone cysts was significantly different for each of the two groups. There was, however, no significant difference in the total duration of dialysis between the two groups. The severity of the cystic bone lesions correlated positively with the duration of dialysis using cuprophane and negatively with the duration of dialysis using AN 69. These findings suggest that the development of osteoarticular amyloidosis may be related to the type of dialysis membrane used. Hemodialysis using AN 69 membranes may prevent, or at least postpone the development of dialysis amyloidosis.

Severe Gastrointestinal Complications of Dialysis-Related Amyloidosis in Two Patients on Long-Term Hemodialysis

“…Long duration of hemodialysis appears to be important, with the prevalence of DRA in patients treated for more than 15 years reaching 30-100% [ 19,33,34], Advanced age is also proposed to be of importance in the development of DRA [35,36], possibly due to agerelated changes in the extramatrix composition, such as crosslinking of collagen [37], The use of more biocompati ble membranes, such as polyacrylonitrile or polymethyl methacrylate, has been expected to decrease the preva lence of DRA in comparison with the use of cuprophane [35,38,39], but the epidemiological data concerning the role of different membranes in the development of DRA are not conclusive.…”

Clinical Studies of Destructive Spondyloarthropathy in Long-Term Hemodialysis Patients

“…Polyacrylonitrile AN 69, a more biocompatible membrane than cuprophane, might prevent or postpone the development of CTS [29,30] and cystic bone radiolucency [29,31,32]. This membrane might also prohibit the occur rence of DSA.…”

Beta-2-Microglobulin-Associated Amyloidosis

“…Radiology, computed tomography and magnetic reso nance imaging have also been used to search for evidence of Ap2M amyloidosis [16,23,56,[194][195][196][197][198], However, as discussed above, unless very strict diagnostic criteria are fulfilled, these methods too suffer from nonspecificity. The problems of nonspecificity also relate to the use of conventional bone scans in Ap2M amyloidosis [199,200].…”

“…A cross-sectional study comparing standard Cuprophane hemodialysis and CAPD detected no difference in the prevalence of carpal tunnel syndrome amongst the two treatment groups [216]. Five studies so far have compared the prevalence of ApiM amyloid-associated symptoms in patients treated with hemodialysis using either Cuprophane dialyzers or high-flux acrylonitrile (AN 69®) hemodialyzers [28,82,195,217,218]. A detailed analysis of these stud ies, as published elsewhere [215], can be summarized as follows: The study, which is both the largest and least prone to criticism, namely the study of van Ypersele de Stihou et al [28], suggests that there appears to be a posi tive effect of long-term treatment with acrylonitrile he modialyzers on some, though not all AP2M amyloidosisassociated symptoms.…”