Nephrol Dial Transplant (1992) 7: 908-912
© 1992 European Renal Association-European Dialysis and Transplant Association
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Outcome of patients with secondary amyloidosis in dialysis treatment
Fourth Department of Medicine Helsinki University Central Hospital, Helsinki, Finland
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr C. Grönhagen-Riska, Helsinki University Central Hospital, Fourth Department of Medicine, Division of Nephrology, Unioninkatu 38, SF-00170 Helsinki, Finland.
Between the years 1974 and 1987, 37 patients with secondary amyloidosis entered dialysis treatment at our department. All had amyloidosis secondary to chronic arthritic disease (35) or to other chronic inflammatory causes (2). Only two patientswere maintained on CAPD throughout follow-up; 12 patients (32%) received a kidney transplant. Survival in dialysis at 1 year was 82%, at 2 years 46%, andat 3 years 37%. Survival of amyloidosis patientstransplanted at the Finnish transplant centre within the same period was worse at 1 year, but better at 2and 3 years, 70%, 62%, and 62% respectively, but the difference was not significant. Populations are notcompatible, since patients were selected for trans-plantation. Infection was a common cause of death,7/18 (39%) deaths; cardiac deaths were less common, only two myocardial infarctions and one cardiac arrhythmia (17%). Symptoms of cardiac amyloid infliltration indicated a poor prognosis, although itdid not necessarily predict death of a cardiac cause.Cardiac infiltration of amyloid was more common inautopsy than previously reported (10 of 13 patients),probably indicating longer duration of amyloidosisin patients treated with renal replacement therapy.Patients who died within follow-up had a shorterinterval between the start of primary disease and the development of amyloidosis than those who survived, 11.8 versus 17.7 years (P=0.041), and also a slightly shorter period between diagnosis of amyloidosis and start of dialysis, 3.0 versus 4.4 years (P= 0.129). This indicates that the rate of progression of amyloidosis determines the development of disease-associated complications, and fast progression may predict serious outcome.
Keywords: amyloidosis; causes of death; dialysis; transplantation; survival
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