Answer: The strange wrist pain and motion-limiting disorder called carpal tunnel syndrome (CTS) is an increasing problem in those with kidney disease, especially after years of dialysis. We have learned that CTS results from deposit of a big protein called amyloid in the joints, especially on the surface lining of movable joints such as the wrist, ankle, shoulder and knee, provoked by retaining another substance called beta(2)-microglobulin.

One study found that CTS in long-term hemodialysis is caused by amyloid deposited in the nerves of the carpal tunnel. To date, although many treatments have been tested, only kidney transplantation has been shown to slow or halt the progression of the amyloidosis related to dialysis and its CTS. Several studies offer evidence that when dialysis is performed with synthetic membranes that have large pores and/or with ultrapure dialysate, the amyloidosis may be delayed if not prevented.

For the decision about surgery that you now face, however, the operation that releases the wrist nerve works more often than not and is not risky. I advise my patients to go ahead hoping for the best outcome. Most tell me later that they are glad that they did.

Answer provided by Eli A. Friedman, MD. Dr. Friedman is Chief of the Division of Renal Disease for State University of New York, Health Science Center at Brooklyn. He serves as the chairman of AAKP's Medical Advisory Board and is an AAKP Life Member.

The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted.

This article originally appeared in aakpRENALIFE, July 2002 Volume 18 Number 1. 

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