Abstract

Dialysis-related amyloidosis (DRA) is a well-known complication in patients undergoing long-term hemodialysis. β2-microglobulin (β2m) amyloid fibrils deposits in osteoarticular tissue, causing severe impairment of its function. High β2m plasma levels are considered a prerequisite for developing DRA, but HD duration, age, and chronic inflammation are also significant risk factors. Our dialysis facility has provided combination therapies of "extended-hours hemodialysis" and "no dietary restrictions". "Extended-hours hemodialysis" promotes the removal of β2m from the blood. "No dietary restrictions" improves the nutritional status of patients. We evaluated the clinical efficacy of extended-hours hemodialysis without dietary restrictions on the risk of developing DRA in long-term dialysis patients. In extended-hours hemodialysis without dietary restrictions, plasma β2m concentration and the severity of median nerve compression of the wrist, which is an indicator of carpal tunnel syndrome, was low. In addition, we showed that dialysis time is a predictor of median nerve compression. The effect of extended-hours hemodialysis without dietary restrictions against the risk of developing DRA may not only be because of suppressed plasma β2m levels but also due to properly maintained nutrition. The coexistence of malnutrition and inflammation is common in many dialysis patients. Nutrient deficiencies are said to make them vulnerable to inflammatory diseases. Reduced inflammation by maintaining proper nutrition through extended-hours hemodialysis without dietary restrictions may explain the reduced risk of developing DRA. In conclusion, extended-hours hemodialysis without dietary restrictions reduces the risk of developing DRA and maintains nutrition. Therefore, we propose that extended-hours hemodialysis without dietary restrictions are the preferred method for maintaining a patients' quality of life.

Keywords: β2-microglobulin; Amyloid fibrils; DRA; Extended-hours hemodialysis