title: Outcome of patients with reactive amyloidosis associated with rheumatoid arthritis in dialysis treatment.
abstract: The aim was to analyze the clinical outcome of a group of 51 patients diagnosed with systemic amyloidosis associated with rheumatoid arthritis who received hemodialysis (HD) as renal replacement therapy. We monitored the clinical course of the disease and factors that could influence survival. Determination of the onset of the underlying disorder was made retrospectively by reviewing the patient's chart when a diagnosis of amyloid was confirmed. During a 96.9 person-year follow-up, 42 patients died. Survival of these 51 patients from the initiation of HD at 251 days was 50%. Poor prognosis in amyloid patients was mainly due to a large number of sudden deaths immediately following HD therapy. Out of 51 patients 21 needed unplanned initiation of HD. The unplanned initiation was significantly associated with poor survival. Seventy-five percentile of creatinine clearance (Ccr) was 9.7 ml/min, and 75% of these patients who initiated HD had highly impaired renal functional states. These data indicated that amyloidotic patients with HD showed a high mortality rate; therefore, planned initiation of HD was highly recommended to improve the patient's survival. Particular attention was given to the Ccr levels, because the levels of serum creatinine may not be a useful marker for some patients with amyloidosis.
authors.affiliation: Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata City 951-8510, Japan. kurodat@med.niigata-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kuroda
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Hiroe
authors.initials: H
authors.lastname: Sato
authors.forename: Jyunya
authors.initials: J
authors.lastname: Ajiro
authors.forename: Yoko
authors.initials: Y
authors.lastname: Wada
authors.forename: Syuichi
authors.initials: S
authors.lastname: Murakami
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakatsume
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakano
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015996:Survival Rate; D016896:Treatment Outcome