Abstract
Purpose and methodPatients on hemodialysis develop carpal tunnel syndrome (CTS) due to an accumulation of dialysis-related β2 microglobulin (β2m) amyloid (DRA). In Japan, dialysis technology has progressed remarkably in the past 40 years and has increased the time until patients require surgery for CTS. However, unclear is whether the time from the start of hemodialysis to the first surgery for CTS is associated with β2m clearance by the different hemodialysis techniques. Therefore, we retrospectively evaluated β2m clearance, serum β2m levels, and the change in the length of this period in patients across 4 periods according to the year that first surgery for CTS was performed: period 1, 1982–1989; period 2, 1990–1999; period 3, 2000–2009; and period 4, 2010–2019.ResultA total of 222 patients who met the selection criteria were included. Mean β2m clearance was −1.8 ± 16.7% in period 1, and improved to 65.4 ± 8.6% in period 3. Accordingly, the serum β2m value after hemodialysis decreased significantly. The time from the start of hemodialysis to the first surgery for CTS was 12.4 ± 2.9 years in period 1 but increased to 21.8 ± 6.3 years in period 3. In multivariable linear regression analysis, the significant factors contributing to β2m clearance were periods 2, 3, and 4. In particular, the relation between removal of β2m and the extension of the dialysis vintage in period 1 and 2 was remarkable compared with periods 3 and 4.ConclusionOur findings indicate that improvement of β2m clearance via advances in dialysis technology might result in a significant extension in the time between starting HD and the first surgery for CTS.
Highlights
Advances in hemodialysis (HD) techniques are extending the lives of patients with chronic renal failure [1]
One of the most harmful complications of HD is dialysis-related amyloidosis (DRA), which is due to the deposition of β2 microglobulin (β2m) and adversely affects activities of daily living and quality of life [3, 4]
We examined whether developments in HD techniques over the past 40 years improved β2m clearance and serum β2m levels and affected the time between starting HD and undergoing the first surgery for carpal tunnel syndrome (CTS)
Summary
Advances in hemodialysis (HD) techniques are extending the lives of patients with chronic renal failure [1]. Long-term HD is well known to increase the prevalence of complications. One of the most harmful complications of HD is dialysis-related amyloidosis (DRA), which is due to the deposition of β2 microglobulin (β2m) and adversely affects activities of daily living and quality of life [3, 4]. A common complication of DRA is carpal tunnel syndrome (CTS), in which amyloid deposits compress the median nerve [5]. In 1985, Gejyo et al reported that β2m-amyloid deposition was found in operative specimens from patients undergoing CTS who had been on HD for 8–14 years [6]. Thereafter, with advances in HD technology, the time between starting HD and undergoing the first surgery for CTS increased. We divided patients who underwent CTS surgery in the past 40 years into 4
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