Abstract: FR-PO830

Renal AA-Amyloidosis in Dialysis-Dependent Drug Addicts

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Madsen, Camilla, Oslo University Hospital, Ulleval, Oslo, Norway
  • Manner, Ingjerd Wangensteen, Oslo University Hospital, Ulleval, Oslo, Norway
  • Gudmundsdottir, Helga, Oslo University Hospital, Ulleval, Oslo, Norway
Background

A substantial increase of dialysis-dependent injecting drug abusers has been observed in Oslo, Norway. The incidence in other parts of the country is low. Longstanding chronic skin infections caused by subcutaneous administration (“skin popping”) of illicit drugs, when the intravenous route is exhausted may induce AA- amyloidosis. The kidneys are the organs most frequently affected. Renal AA-amyloidosis is characterized by nephrotic syndrome and progression to end stage renal disease and the prognosis is poor. The diagnosis can only be confirmed by tissue biopsy. The prevalence of hepatitis B, C and HIV in this population of patients tends to high.

Methods

Retrospective investigation including all patients with past or present injecting drug abuse who started dialysis between January 2005 and June 2017 in the city of Oslo, Norway.

Results

A total of 46 injecting drug addicts were included in the study. All patients were Caucasian, 70% males, mean age was 50.2 ± 8.3 years and they had been injecting drug addicts for 27.3 ± 9.2 (range 9-47) years). A total of 54.3% were crash landers (i.e. referred within 4 months of requiring dialysis). Renal biopsy was performed in 34 patients (74%), and AA-amyloidosis was confirmed in all but one patient. All patients were positive for anti-hepatitis C virus antibodies, and 4.3% were HIV infected. All had a history of repeated chronic suppurative skin infections. All had ongoing drug abuse and all had been offered medication-assisted therapy. No patients fulfilled criteria for renal transplantation due to chronic infections and ongoing drug abuse. The prognosis after starting dialysis was poor with 34% mortality in 1 year. As of today, 16% of our dialysis population are past or present injecting drug addicts with renal failure caused by renal amyloidosis.

Conclusion

Renal AA-amyloidosis is the most common cause of end stage renal disease in injecting drug addicts in Oslo. Morbidity and mortality is high. It is a challenging and complex population without the option of transplantation. More focus is needed on prevention and early intervention.