Microsoft Word - NEF389BF

Dr. J.L. Miguel Alonso, Servicio de Nefrología, Hospital La Paz, Castellana 261, E-28046 Madrid (Spain) Table 1. Clinical data Group HD CAPD Dear Sir, We have read with interest the letter by Sethi et al. [1]. Since the first report by Ballardie et al. in 1986 [2] the question has not been answered. Until now, few studies have been published showing evidence of dialysis-associated amyloidosis (DAA) in continuous ambulatory peritoneal dialysis (CAPD) patients. Even though descriptions on the presence of beta-2-microglobulin (B2M) in carpal tunnel syndrome (CTS) are scanty, cases with bone lesions similar to those found in hemodialysis (HD) patients with amyloid arthropathy (AA) have been published [3]. We carried out a comparative study in 51 patients, 14 on CAPD and 39 on HD (mainly with cuprophan membranes), who were selected for a treatment period longer than 4.5 years (table 1). Rheumathological, radiological, and electromyographical evaluations as well as biochemical determinations of hemoglobin, Ca, Ca2+, P, Mg, alkaline phosphatase, parathyroid hormone, blood urea nitrogen, serum creatinine, uric acid, iron, ferritin, B2M, sedimentation rate, and Creactive protein were performed. Radiological examination was carried out by 3 different observers who analyzed the existence of lytic lesions, destructive spondyloarthropathy (discitis), and the degree of secondary hyperparathyroidism. The results are summarized in table 2. The incidence of CTS was similar in both HD and CAPD groups, with a mean duration of 107 ± 47.5 and 40.5 ± 16.07 months, respectively, the intensity of symptoms being lesser in the CAPD group. Bone cysts were found mainly in the carpus, although in 61.5% of the cases there were associations with other localizations. Evaluating the existence of either CTS, lytic lesions, or discitis, 36% of the HD and 50% of the CAPD patients failed to show any of them.