Preventing and treating DRA

If you were going to start dialysis today, how could you reduce your chance of having a harmful build-up of amyloid in your body? There are two main steps you can take:

1. Choose a treatment that removes more β₂m:
   • PD and standard in-center HD take out some β₂m, but not enough to keep blood levels normal. Better HD membranes mean more β₂m is removed today than in the past.
   • Daily and nocturnal HD remove much more β₂m.
   • A kidney transplant will also remove more β₂m. Getting a transplant before starting dialysis is called preemptive transplant.
2. Use ultrapure water for dialysis. Inflammation seems to make DRA occur faster. Ultrapure water has less endotoxin (toxic pieces of the cell walls of dead bacteria). It may cause less inflammation in your body. Ask your clinic if it uses ultrapure water for dialysis.

There is no pill to treat amyloidosis. Treatment is based on trying to help ease the symptoms or fix the damage. Some things that have been tried include:

• Steroid injections to help reduce inflammation
• NSAID pills to help with pain (though these can reduce kidney function and cause stomach bleeding)
• Physical therapy to help movement
• Surgery to remove amyloid from the carpal tunnel or other joints
• Switching to a form of dialysis that takes out more β₂m
• A kidney transplant

An adsorptive column used at dialysis has been found in studies to remove large amounts of β₂m from the blood. The column attracts β₂m like a magnet. This is costly and not yet in wide use, but it may help treat DRA in the future.

With so much research going on, you'll want to keep an eye on science news. New breakthroughs will occur to prevent or treat DRA. If you have amyloidosis, you may want to join a clinical trial (www.clinicaltrials.gov). Often, free treatment is given to people in clinical trials.