Clinical manifestations of AB-amyloidosis: effects of biocompatibility and flux.
BACKGROUND
Highly permeable biocompatible dialysis membranes may postpone the development of AB-amyloidosis, but the relative contribution of enhanced flux or reduced inflammation by highly biocompatible membranes and sterile dialysis fluid remains unknown.


METHODS
In this retrospective investigation, 89 patients with end-stage renal disease maintained on regular haemodialysis for at least 10 years and treated with one type of dialysis membrane exclusively were selected for analysis. They were divided into three groups: low-flux, bioincompatible cellulose (I), low-flux, intermediately biocompatible polysulphone or PMMA (II), or high-flux, highly biocompatible polysulphone or AN69 (III). In addition, the patients were analysed according to the microbiological quality of the dialysis fluid, which had been tested regularly and was classified either as standard or as intermittently contaminated. The clinical manifestations indicative of AB-amyloidosis, namely, carpal tunnel syndrome, arthropathy and bone cysts, were diagnosed after recruitment.


RESULTS
Clinical symptoms were most pronounced in group I, intermediate in group II, and lowest in group III. Patients treated with intermittently contaminated dialysis fluid showed a higher prevalence of AB-amyloidosis than patients with less contaminated dialysis fluid. Logistic regression analysis demonstrated that the flux characteristics of the dialyser and the microbiological quality of the dialysis fluid as well as the biocompatibility of the dialyser were independent determinants of AB-amyloidosis.


CONCLUSIONS
It would be prudent clinical practice to employ high-flux biocompatible membranes in conjunction with ultrapure dialysis fluid for the treatment of end-stage renal disease patients who need to remain on long-term haemodialysis.
Schiffl
H
H
Department of Internal Medicine, Klinikum Innenstadt, University of Munich, Germany.
Fischer
R
R
Lang
S M
SM
Mangel
E
E
D000180:Acrylic Resins; D000181:Acrylonitrile / Q000031:analogs & derivatives; D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D001672:Biocompatible Materials; D001845:Bone Cysts / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D016017:Odds Ratio; D011108:Polymers; D019904:Polymethyl Methacrylate; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D013450:Sulfones
D000180:Acrylic Resins; D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700; C016892:AN-69; D019904:Polymethyl Methacrylate; D000181:Acrylonitrile