Long-term complications of dialysis: pathogenic factors with special reference to amyloidosis.

Amyloidosis, caused by amyloid containing beta 2-microglobulin (beta 2m), is a frequent complication of long-term hemodialysis. The precise mechanism of its pathogenesis is not known. While beta 2m is an amyloid protein, other factors likely are involved in the pathogenesis of such amyloidosis. In treating patients with dialysis-related amyloidosis, it is essential to remove as much beta 2m from the blood as possible. In this respect, progress has been made in developing a column to adsorb beta 2m from the blood. Using a combination of a high-flux dialyzer and an adsorption column, it becomes possible to efficiently eliminate beta 2m. We have treated four patients with this column in combination with a high-flux dialyzer three times a week for periods of one month or one year. The absorbent column eliminates beta 2m from the blood, and may thus halt or slow the progression of beta 2m-related amyloidosis. However, such treatment is still in a preliminary phase; long-term studies are required to determine clinical efficacy.