End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2013-02, Vol.28 (2), p.455-461
• Main Authors: Tang, Wen, McDonald, Stephen P, Hawley, Carmel M, Badve, Sunil V, Boudville, Neil, Brown, Fiona G, Clayton, Philip A, Campbell, Scott B, de Zoysa, Janak R, Johnson, David W
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amyloidosis - complications; Australia - epidemiology; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kaplan-Meier Estimate; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Kidney Transplantation; Male; Middle Aged; New Zealand - epidemiology; Prognosis; Recurrence; Registries; Renal Replacement Therapy; Retrospective Studies; Survival Rate; Treatment Outcome; Young Adult
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs492

There are few reports regarding the long-term renal replacement therapy (RRT) outcomes of amyloidosis. In this retrospective, multi-centre, multi-country registry analysis, all patients with and without amyloidosis who commenced RRT for end-stage renal failure (ESRF) in Australia and New Zealand between 1963 and 2010 were included. Of 58 422 patients who underwent RRT during the study period, 490 (0.8%) had ESRF secondary to amyloidosis. The median survival of amyloidosis patients on dialysis (2.09 years, 95% CI 1.85-2.32 years) was significantly inferior to that of patients with other causes of ESRF (4.45 years, 95% CI 4.39-4.51 years) (log-rank score 242, P < 0.001). The survival of amyloidosis patients receiving peritoneal dialysis (1.9 years, 95% CI 1.58-2.22) was comparable with those receiving haemodialysis (2.17 years, 95% CI 1.89-2.45) (P = 0.18). Fifty-three (13.8%) amyloidosis patients died of amyloidosis complications. Forty-six patients underwent renal transplantation with first graft survival rates of 45% at 5 years and 26% at 10 years. Nine (16.4%) patients experienced amyloidosis recurrence in their allografts, which led to graft failure in six patients. ESRF patients with amyloidosis experienced inferior median first renal allograft survival (4.55 years, 95% CI 1.96-7.15 versus 10.7 years, 95% CI 10.5-11.0, P = 0.001) and transplant patient survival (6.03 years, 95% CI 2.71-9.36 versus 16.8 years, 95% CI 16.4-17.1, P < 0.001) compared with patients with other causes of ESRF. Respective 10-year patient survival rates were 37 and 69%. Amyloidosis was associated with poor patient survival following dialysis and/or renal transplantation, poor renal allograft survival and a significant incidence of disease recurrence in the allograft. An appreciable proportion of amyloid ESRF patients died of amyloidosis-related complications.