acetylcellulose and Carpal-Tunnel-Syndrome

Topics: Acrylic Resins; Acrylonitrile; Amyloidosis; Arthralgia; beta 2-Microglobulin; Biocompatible Materials; Bone Cysts; Carpal Tunnel Syndrome; Cellulose; Humans; Incidence; Japan; Kidney; Membranes, Artificial; Molecular Weight; Peritoneal Dialysis; Permeability; Polymers; Polymethyl Methacrylate; Prospective Studies; Renal Dialysis; Sulfones; Uremia

A long-term retrospective evaluation (5 years) compares two groups of RDT patients (group 1 on continuous treatment with cellulosic membranes and group 2 with synthetic membranes) regarding survival, general clinical morbidity, and beta 2M-related morbidity. The results showed no significant long-term differences between the groups either for survival or general morbidity despite some differences in biocompatibility. The higher intradialytic removal of beta 2M by synthetic membranes did not lead to a reduction in either pre-dialysis beta 2M values or beta 2M related morbidity. The higher cost of synthetic over cellulosic membranes and the disappointing of many clinical expectations suggest that the use of such membranes, in association with alternative techniques, should take place only according to certain "elective" indications such as old age, diabetes, vascular instability or intradialytic disequilibrium syndrome.

Topics: beta 2-Microglobulin; Carpal Tunnel Syndrome; Cellulose; Histocompatibility Antigens Class I; Humans; Lymphocytes; Median Nerve; Membranes, Artificial; Middle Aged; Neural Conduction; Polymers; Renal Dialysis; Retrospective Studies

Since 1977, our patients have undergone chronic HD with ultra-pure dialysate (UPD), defined as having endotoxin levels below 0.008 ng/ml and less than 1 bacteria/ml of dialysate. We evaluated the incidence of carpal tunnel syndrome (CTS) in three groups of patients. Group I (GI), 84 patients, dialysed for 6.1 +/- 3.2 years (mean +/- SD) with UPD only; Group II (GII), 39 patients, first dialysed for 3.7 +/- 2.3 years with non-UPD and afterwards for 8.4 +/- 2.1 years with UPD; Group III (G III), 103 patients treated for 6 +/- 5.9 years exclusively with non-UPD. All patients were dialysed with cuprophan or cellulose acetate membranes. Results, expressed by Kaplan-Meier actuarial survival curves as the percent of patients without CTS, show that CTS occurred significantly less in GI than in GIII. This may be due to less stimulation of monocytes resulting from the absence of bacteria, endotoxins and pyrogens in the dialysate, which would reduce the stimulation of cytokines release, interleukin 1 and 6, and tumor necrosis factor, known to stimulate beta 2 microglobulin synthesis.

Topics: Actuarial Analysis; beta 2-Microglobulin; Carpal Tunnel Syndrome; Cellulose; Evaluation Studies as Topic; Female; Hemodialysis Solutions; Humans; Incidence; Male; Membranes, Artificial; Middle Aged; Renal Dialysis; Water