Dialysis-related amyloidosis of the heart in long-term hemodialysis patients

Background. Dialysis-related amyloidosis (DRA) predominantly occurs in the osteoarticular structures, but it also systemically appears in the extra-articular tissues as well. However, the pathological characteristics of DRA in the hearts of hemodialysis (HD) patients have rarely been reported. Methods, We studied the pathological characteristics of DRA in the hearts of 18 HD patients, including its relationship to calcification. Furthermore, we studied the immunuhistochemical localization of advanced glycation end products (AGEs) using monoclonal anti-imidazolone and anti-N-epsilon-(carboxy-methyl)lysine (CML) antibodies. Results. beta (2)-microglobulin (beta (2)m) amyloid deposits were detected in the hearts of seven patients who had undergone HD for more than 10 years. beta (2)m amyloid deposits in the left atrium were localized in the endocardium, the myocardium, and the walls of small blood vessels, whereas in the left ventricle, they were localized only in the walls of small blood vessels. The extent and prevalence of DRA in the heart were severe in the patients on HD fur more than 15 years. Most calcification areas near mitral valve were dotted with beta (2)m amyloid deposits, while diffuse fine calcification was localized within the beta (2)m amyloid tissues in some cases. Imidazolone and CML were localized not only in massive beta (2)m amyloid deposits, but also in cardiac myocytes. Conclusion. DRAs were localized extensively in the hearts: of long-term HD patients. A strong affinity was observed be tween beta (2)m amyloid deposits and calcification.