[Kidney and bone update : the 5-year history and future of CKD-MBD. Treatment for dialysis-related amyloidosis update].

Dialysis-related amyloidosis (DRA) is a serious complication in patients undergoing long-term dialysis treatment. Deposited β(2)-microglobulin-related amyloid induces various osteoarticular disorders. The pathogenetic interaction of DRA with chronic kidney disease-minenal bone disorder (CKD-MBD) is still unclear, while clinical managements for both osteoarticular disorder and DRA is commonly required in dialysis patients. Recently, practical guidelines for DRA are published in Japan. Those make possible to assess DRA with not only pathological examination but also clinical manifestations, such as carpal tunnel syndrome, destructive spondyloarthropathy, joint pains, and so on. Treatments for DRA include hemodialysis with biocompatible high-flux dialysis membrane and/or ultrapure dialysate, hemodiafiltration, and β(2)-microglobulin adsorbent column. Recent studies suggested that these treatments have efficacy on the onset and severity of DRA, even mean age in patients are getting older with long term dialysis treatment.