Table 1.

Clinical manifestations of dialysis-related amyloidosis

Anatomic LocationPrevalence after 10 Yr of HemodialysisClinical ManifestationsDiagnostic Clues
Carpal tunnel syndrome10%–20% (15)Hand pain, paresthesias, grip weaknessBilateral manifestations in patients on dialysis
Tendons15% (53)Tendinitis: shoulder pain, stiffness, trigger fingerUltrasound or MRI findings of thickened supraspinous or subscapularis tendons, with lesser involvement of infraspinatus or teres minor tendons
Spine20%DSA: back pain, neck pain, radicular pain, cord compressionFindings by conventional radiography or CT of narrowing of intervertebral spaces, severe bone erosions, cysts, and end-plate destruction without significant amount of osteophyte formation
Gastrointestinal>30% of patients with evidence of DRAa (9,70)Pseudo-obstruction, bleeding, ischemia
CardiacUncommonb (16)Heart failure, hypotension
  • Prevalence of dialysis-related amyloidosis increases with dialysis vintage. MRI, magnetic resonance imaging; DSA, destructive spondyloarthropathy; CT, computed tomography; DRA, dialysis-related amyloidosis.

  • a Prevalence of gastrointestinal amyloidosis was derived mainly from histologic samples of patients exposed to older hemodialytic therapies who had no gastrointestinal complications.

  • b Prevalence: Exact calculation of prevalence is not possible and depends on a number of risk factors that increase with dialysis vintage. Symptomatic disease is uncommon before 10 yr of dialysis vintage. Diagnosis: The gold standard is histopathologic demonstration of amyloidosis formation.