title: End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases.
abstract: BACKGROUND
  There are few reports regarding the long-term renal replacement therapy (RRT) outcomes of amyloidosis.
  
  
  METHODS
  In this retrospective, multi-centre, multi-country registry analysis, all patients with and without amyloidosis who commenced RRT for end-stage renal failure (ESRF) in Australia and New Zealand between 1963 and 2010 were included.
  
  
  RESULTS
  Of 58 422 patients who underwent RRT during the study period, 490 (0.8%) had ESRF secondary to amyloidosis. The median survival of amyloidosis patients on dialysis (2.09 years, 95% CI 1.85-2.32 years) was significantly inferior to that of patients with other causes of ESRF (4.45 years, 95% CI 4.39-4.51 years) (log-rank score 242, P < 0.001). The survival of amyloidosis patients receiving peritoneal dialysis (1.9 years, 95% CI 1.58-2.22) was comparable with those receiving haemodialysis (2.17 years, 95% CI 1.89-2.45) (P = 0.18). Fifty-three (13.8%) amyloidosis patients died of amyloidosis complications. Forty-six patients underwent renal transplantation with first graft survival rates of 45% at 5 years and 26% at 10 years. Nine (16.4%) patients experienced amyloidosis recurrence in their allografts, which led to graft failure in six patients. ESRF patients with amyloidosis experienced inferior median first renal allograft survival (4.55 years, 95% CI 1.96-7.15 versus 10.7 years, 95% CI 10.5-11.0, P = 0.001) and transplant patient survival (6.03 years, 95% CI 2.71-9.36 versus 16.8 years, 95% CI 16.4-17.1, P < 0.001) compared with patients with other causes of ESRF. Respective 10-year patient survival rates were 37 and 69%.
  
  
  CONCLUSIONS
  Amyloidosis was associated with poor patient survival following dialysis and/or renal transplantation, poor renal allograft survival and a significant incidence of disease recurrence in the allograft. An appreciable proportion of amyloid ESRF patients died of amyloidosis-related complications.
authors.affiliation: ANZDATA Registry, Adelaide, SA, Australia.
authors.forename: Wen
authors.initials: W
authors.lastname: Tang
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Badve
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.forename: Fiona G
authors.initials: FG
authors.lastname: Brown
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Janak R
authors.initials: JR
authors.lastname: de Zoysa
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult