title: A clinical staging score to measure the severity of dialysis-related amyloidosis.
abstract: BACKGROUND
  The ongoing effort to prevent dialysis-related amyloidosis (DRA) has been hampered by lack of any way to measure DRA's severity. Yet, such measurement is essential for assessing the effect of DRA treatment. Accordingly, we developed a scoring system focused on the physical manifestations of DRA.
  
  
  METHODS
  Forty-four patients on maintenance hemodialysis with DRA, and 96 without it, were enrolled. The SF-36v2 Health Survey ascertained whether patients experienced general bodily pain and/or physical dysfunction with any attendant specific pain (dysfunction). If so, the association of those conditions with a finding of DRA was analyzed-including laboratory and radiographic data-and a scoring system reflecting the extent of that dysfunction was devised using the significant variables in the multivariate analysis.
  
  
  RESULTS
  Both dysfunction and general bodily pain were severe in patients with DRA. Presence of polyarthralgia, trigger finger, carpal tunnel syndrome (CTS), and dialysis-related spondyloarthropathy (DRS) were associated with that dysfunction after appropriate adjustments. The new scoring system used those four variables in the model, with a 3 given for polyarthralgia and DRS, and 2 for trigger finger and CTS (possible range 0-10). Based on the physical functioning score of SF-36v2, we categorized A-score into three stages: mild (A-score 3-4), moderate (5-7), and severe (8-10). The corresponding area under the receiver-operating characteristics curve for diagnosis of DRA was 0.9345 when we set the cutoff value as 4.
  
  
  CONCLUSIONS
  This validated scoring system for quantitatively estimating the severity of DRA can serve as A useful measure in clinical practice.
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan. hoshino@toranomon.gr.jp.|Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan. hoshino@toranomon.gr.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawada
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Imafuku
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.|Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.|Okinaka Memorial Institute, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.affiliation: Nephrology Center, Toranomon Hospital, Tokyo, Japan.|Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatsu, Kawasaki, Kanagawa, 213-8587, Japan.|Okinaka Memorial Institute, Tokyo, Japan.
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D019540:Area Under Curve; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000209:etiology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011788:Quality of Life; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D025242:Spondylarthropathies / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D052582:Trigger Finger Disorder / Q000175:diagnosis / Q000209:etiology
keywords: Amyloidosis; Clinical staging; Dialysis; Physical dysfunction; Scoring system