Chronic dialysis in patients with systemic amyloidosis: The experience in Northern Italy

The clinical outcome of 61 patients with renal amyloidosis treated with chronic dialysis was reviewed. Eighteen patients, 4 with primary or AL amyloidosis and 14 with reactive or AA amyloidosis, died within one month from starting treatment. The other 43 patients were treated with dialysis for 3 to 199 months and are the object of this study. Sixteen patients had AL amyloidosis and 27 had AA amyloidosis. Thirty-five patients were treated with hemodialysis (HD) for a mean period of 40±47 months and 8 were treated with continuous ambulatory peritoneal dialysis (CAPD) for 20±15 months. Patient survival rate at 1 and 5 years was 68% and 30% respectively. There was no difference in survival rate between patients treated with HD and those treated with CAPD, while patients younger than 45 had a better 5-year survival rate. Twenty four (60%) patients achieved a satisfactory rehabilitation with dialysis. At the last follow-up, 15 patients (14 on HD, 1 on CAPD) were alive 61±58 months after starting dialysis. Twenty-eight patients died after 30±20 months. The main causes of death were: cardiovascular accident (11), stroke (3), sepsis (5) and cachexia (5). The most important extra-renal complications of amyloidosis were related to cardiovascular involvement (heart failures, arrhythmias, hypotension) and gastrointestinal involvement (malabsorbtion). Intradialytic hypotension in patients on HD and peritonitis in patients on CAPD were the main problems related to dialytic procedure. This study confirms that life expectancy and the quality of life of dialysis patients with systemic amyloidosis are poorer than those of general dialysis population. However, some patients can show a prolonged survival and an acceptable degree of rehabilitation. Multisystemic involvement of amyloidosis before dialysis is probably the most important risk factor for these patients.