Results of a nationwide screening for Anderson-Fabry disease among dialysis patients.
Anderson-Fabry disease is possibly underdiagnosed in patients with end-stage renal disease. Nationwide screening was therefore undertaken for Anderson-Fabry disease among dialysis patients in Austria. Screening for alpha-galactosidase A (AGAL) deficiency was performed by a blood spot test. In patients with a positive screening test, AGAL activity in leukocytes was determined. Individuals with decreased leukocyte AGAL activity were subjected to mutation testing in the GLA gene. Fifty (90.9%) of 55 Austrian hemodialysis centers participated in this study; 2480 dialysis patients (80.1% of the Austrian dialysis population) were screened. In 85 patients, the screening test was positive (85 of 2480, 3.42%; women, 3.32%; men, 3.50%). Among these 85 patients, 4 men (in 3 of whom Anderson-Fabry disease was already known before screening) had a severely decreased and 11 subjects had a borderline low AGAL activity. Genetic testing revealed mutations associated with Fabry disease in all four men with severely decreased AGAL activity resulting in a prevalence of 0.161% for the entire study population. A nationwide screening of dialysis patients permitted detection of a hitherto unknown man with Anderson-Fabry disease. The overall prevalence among dialysis patients was at least ten times higher as compared with recent registry data. Screening programs among patients with end-stage renal disease, especially men, should be put in place to identify families with Anderson-Fabry disease who probably may benefit from specific clinical care, and perhaps from enzyme replacement therapy. In dialysis patients, however, there is no evidence to support enzyme replacement therapy at present.
Kotanko
Peter
P
Krankenhaus der Barmherzigen Brüder, Teaching Hospital of the Karl Franzens University Graz, Department of Internal Medicine, Graz, Austria.
Kramar
Reinhard
R
Devrnja
Danijela
D
Paschke
Eduard
E
Voigtländer
Till
T
Auinger
Martin
M
Pagliardini
Severo
S
Spada
Marco
M
Demmelbauer
Klaus
K
Lorenz
Matthias
M
Hauser
Anna-Christine
AC
Kofler
Hans-Jörg
HJ
Lhotta
Karl
K
Neyer
Ulrich
U
Pronai
Wolfgang
W
Wallner
Manfred
M
Wieser
Clemens
C
Wiesholzer
Martin
M
Zodl
Herbert
H
Födinger
Manuela
M
Sunder-Plassmann
Gere
G
D000368:Aged; D001317:Austria; D000795:Fabry Disease / Q000150:complications / Q000175:diagnosis* / Q000235:genetics*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D006435:Renal Dialysis; D000519:alpha-Galactosidase / Q000235:genetics*
D000519:alpha-Galactosidase