1
|
Tsuruya K, Arima H, Iseki K, Hirakata H. Association of dialysis-related amyloidosis with lower quality of life in patients undergoing hemodialysis for more than 10 years: The Kyushu Dialysis-Related Amyloidosis Study. PLoS One 2021; 16:e0256421. [PMID: 34428227 PMCID: PMC8384206 DOI: 10.1371/journal.pone.0256421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 08/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dialysis-related amyloidosis (DRA) commonly develops in patients undergoing long-term dialysis and can lead to a decline in activities of daily living and quality of life (QOL), mainly owing to orthopedic complications. METHODS First, we determined utility scores of the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire in 1,323 patients with DRA who had undergone dialysis for more than 10 years and compared the score between those with and without DRA. Second, a 2-year follow-up was also performed, in which patients were divided into three groups: those complicated by DRA from the beginning, those with newly developed DRA within the 2-year period, and those not complicated by DRA throughout the survey period; changes in the EQ-5D-3L utility score were compared. In the group already complicated by DRA at the survey baseline, changes in the EQ-5D-3L utility score were compared according to the dialysis treatment method. RESULTS A total of 1,314 and 931 patients were included in the first and second studies, respectively. EQ-5D-3L utility scores among patients diagnosed with DRA were significantly lower than scores in those not diagnosed with DRA. The reduction in the EQ-5D-3L utility score over the 2-year follow-up was significantly greater in patients newly complicated by DRA during the follow-up period after enrollment but not in those complicated by DRA from the beginning, as compared with patients not complicated by DRA throughout the survey period. The reduction in utility score tended to be lower in patients routinely treated with a β2-microglobulin adsorption column than in untreated patients with DRA. CONCLUSION Complication by DRA in patients undergoing long-term hemodialysis was significantly associated with a decline in QOL.
Collapse
Affiliation(s)
- Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Urasoe, Japan
| | | | | |
Collapse
|
2
|
Mizuno H, Hoshino J, So M, Kogure Y, Fujii T, Ubara Y, Takaichi K, Nakaniwa T, Tanaka H, Kurisu G, Kametani F, Nakagawa M, Yoshinaga T, Sekijima Y, Higuchi K, Goto Y, Yazaki M. Dialysis-related amyloidosis associated with a novel β 2-microglobulin variant. Amyloid 2021; 28:42-49. [PMID: 32875920 DOI: 10.1080/13506129.2020.1813097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Till date, there had been no reported case of dialysis-related amyloidosis (DRA) associated with a β2-microglobulin variant. We report here a 41-year-old haemodialysis patient with systemic amyloidosis, exhibiting macroglossia and swelling salivary glands, uncommon clinical manifestations for DRA. Molecular analysis showed that the patient had a new variant of β2-microglobulin (V27M). Extracted amyloid protein was predominantly composed of variant β2-microglobulin. In vitro analysis revealed that this variant β2-microglobulin had a strong amyloidogenic propensity, probably owing to the decreased stability caused by a bulky methionine residue. Our data clearly show that V27M variant is amyloidogenic and this mutation results in unusual clinical manifestations. To date, only one amyloidogenic β2-microglobulin variant (D76N) has been reported in non-dialysis patients. It is noteworthy that the V27M and D76N variants show substantial differences in both clinical phenotypes and pathomechanical features. This is the first case of DRA associated with a naturally occurring β2-microglobulin variant.
Collapse
Affiliation(s)
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Sciences, Tokyo, Japan
| | - Masatomo So
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Yuta Kogure
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Department of Nephrology & Hypertension, Saitama Medical Center, Kawagoe, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Sciences, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Sciences, Tokyo, Japan
| | | | - Hideaki Tanaka
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Genji Kurisu
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Fuyuki Kametani
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mayuko Nakagawa
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Clinical Laboratory Sciences Division, Shinshu University Graduate of School of Medicine, Matsumoto, Japan
| | - Tsuneaki Yoshinaga
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiichi Higuchi
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Department of Aging Biology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Goto
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.,Clinical Laboratory Sciences Division, Shinshu University Graduate of School of Medicine, Matsumoto, Japan
| |
Collapse
|
3
|
Portales-Castillo I, Yee J, Tanaka H, Fenves AZ. Beta-2 Microglobulin Amyloidosis: Past, Present, and Future. KIDNEY360 2020; 1:1447-1455. [PMID: 35372889 DOI: 10.34067/kid.0004922020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
Almost half a century has elapsed since the first description of dialysis-related amyloidosis (DRA), a disorder caused by excessive accumulation of β-2 microglobulin (B2M). Within that period, substantial advances in RRT occurred. These improvements have led to a decrease in the incidence of DRA. In many countries, DRA is considered a "disappearing act" or complication. Although the prevalence of patients living with RRT increases, not all will have access to kidney transplantation. Consequently, the number of patients requiring interventions for treatment of DRA is postulated to increase. This postulate has been borne out in Japan, where the number of patients with ESKD requiring surgery for carpal tunnel continues to increase. Clinicians treating patients with ESKD have treatment options to improve B2M clearance; however, there is a need to identify ways to translate improved B2M clearance into improved quality of life for patients undergoing long-term dialysis.
Collapse
Affiliation(s)
- Ignacio Portales-Castillo
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Hiroshi Tanaka
- Division of Nephrology, Department of Medicine, Mihara Red Cross Hospital, Mihara, Japan
| | - Andrew Z Fenves
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Hoshino J. Introduction to clinical research based on modern epidemiology. Clin Exp Nephrol 2020; 24:491-499. [PMID: 32212004 PMCID: PMC7248022 DOI: 10.1007/s10157-020-01870-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 11/02/2022]
Abstract
Over the past 20 years, recent advances in science technologies have dramatically changed the styles of clinical research. Currently, it has become more popular to use recent modern epidemiological techniques, such as propensity score, instrumental variable, competing risks, marginal structural modeling, mixed effects modeling, bootstrapping, and missing data analyses, than before. These advanced techniques, also known as modern epidemiology, may be strong tools for performing good clinical research, especially in large-scale observational studies, along with relevant research questions, good databases, and the passion of researchers. However, to use these methods effectively, we need to understand the basic assumptions behind them. Here, I will briefly introduce the concepts of these techniques and their implementation. In addition, I would like to emphasize that various types of clinical studies, not only large database studies but also small studies on rare and intractable diseases, are equally important because clinicians always do their best to take care of many kinds of patients who suffer from various kidney diseases and this is our most important mission.
Collapse
Affiliation(s)
- Junichi Hoshino
- Toranomon Hospital, Nephrology Center, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| |
Collapse
|
5
|
Nishi S, Yamamoto S, Hoshino J, Takaichi K, Naiki H. The features of bone articular lesions in dialysis-related amyloidosis (DRA) and criteria for the clinical diagnosis of DRA. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0205-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
6
|
Santagati G, Cataldo E, Columbano V, Chatrenet A, Penna D, Pelosi E, Hachemi M, Gendrot L, Nielsen L, Cinquantini F, Saulnier P, Arena V, Boursot C, Piccoli GB. Positron Emission Tomography Can Support the Diagnosis of Dialysis-Related Amyloidosis. J Clin Med 2019; 8:jcm8091494. [PMID: 31546847 PMCID: PMC6781261 DOI: 10.3390/jcm8091494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/31/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The improvements in dialysis have not eliminated long-term problems, including dialysis-related amyloidosis (DRA), caused by Beta-2 microglobulin deposition. Several types of scintigraphy have been tested to detect DRA, none entered the clinical practice. Aim of the study was to assess the potential of PET-FDG scan in the diagnosis of DRA. METHODS Forty-six dialysis patients with at least one PET scan (72 scans) were selected out 162 patients treated in 2016-2018. Subjective global assessment (SGA), malnutrition inflammation score (A), Charlson Comorbidity Index (CCI), were assessed at time of scan; 218 age-matched cases with normal kidney function were selected as controls. PET scans were read in duplicate. Carpal tunnel syndrome was considered a proxy for DRA. A composite "amyloid score" score considered each dialysis year = 1 point; carpal tunnel-DRA = 5 points per site. Logistic regression, ROC curves and a prediction model were built. RESULTS The prevalence of positive PET was 43.5% in dialysis, 5% in controls (p < 0.0001). PET was positive in 14/15 (93.3%) scans in patients with carpal tunnel. PET sensitivity for detecting DRA was 95% (specificity 64%). Carpal tunnel was related to dialysis vintage and MIS. A positive PET scan was significantly associated with dialysis vintage, MIS and amyloid score. A prediction model to explain PET positivity combined clinical score and MIS, allowing for an AUC of 0.906 (CI: 0.813-0.962; p < 0.001). CONCLUSIONS PET-FDG may identify DRA, and may be useful in detecting cases in which inflammation favours B2M deposition. This finding, needing large-scale confirmation, could open new perspectives in the study of DRA.
Collapse
Affiliation(s)
| | | | | | | | - Daniele Penna
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Ettore Pelosi
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Mammar Hachemi
- Medecine Nucleaire, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | | | - Louise Nielsen
- Néphrologie, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | | | | | - Vincenzo Arena
- Affidea IRMET, PET CENTER, Torino via Onorato Vigliani 89, 10135 Torino, Italy.
| | - Charles Boursot
- Medecine Nucleaire, Centre Hospitalier du Mans, 72037 Le Mans, France.
| | - Giorgina Barbara Piccoli
- Néphrologie, Centre Hospitalier du Mans, 72037 Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy.
| |
Collapse
|
7
|
Doxycycline treatment in dialysis related amyloidosis: discrepancy between antalgic effect and inflammation, studied with FDG-positron emission tomography: a case report. BMC Nephrol 2017; 18:285. [PMID: 28874122 PMCID: PMC5586015 DOI: 10.1186/s12882-017-0698-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/23/2017] [Indexed: 12/24/2022] Open
Abstract
Background No effective treatment is currently available and dialysis related amyloidosis continues to be invalidating in long-term dialysis patients. A recent case series reported reduction of osteoarticular pain on doxycycline treatment, extending the indications of this drug, used in other uncommon forms of amyloidosis, to dialysis patients. Explanations of the antalgic effect were the anti-inflammatory properties and anti-coiling effects of tetracycline. Case presentation Our report regards a 54-year-old woman, who was never transplanted and has been on hemodialysis and hemodiafiltration for overall 37 years, due to renal hypoplasia. In spite of high efficiency hemodiafiltration, she complained of increasing, invalidating osteoarticular pain; history and imaging suggested beta-2 microglobulin amyloid. Positron emission tomography (PET scan) identified metabolically active lesions in the involved settings. Low-dose doxycycline (100 mg/day) was started, leading to a considerable decrease in pain (over 6 months, from 7 to 8 to 4–5 on a 0–10 scale). At 6 months, a PET scan showed unmodified or increased uptake in the involved settings. Conclusions In summary, the previously described antalgic effect of doxycycline in dialysis related amyloidosis is confirmed in our case, the first studied using PET scan. The pattern at PET can suggests that the antalgic effect is independent from inflammation and points to other factors, such as interaction with fibril geometry or with bone structure.
Collapse
|