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SAT0102 Bone and joint problems in haemodialysis patients
  1. GG Demirel,
  2. M Yelkovan,
  3. H Yılmaz,
  4. B Görçin
  1. Physical Medicine and Rehabilitation Centre, Ist. Phys. Medicine and Rehabilitation Centre, Istanbul, Turkey

Abstract

Background Patient receiving maintenance haemodialysis suffer from various problems of the joints, soft tissues and tendons. These effects include avascular necrosis, osseous abnormalities, ligamentous laxity, destructive arthropathies and soft tissue calcifications. IN end stage renal disease, average bone mineral density has been reported modestly reduced.

Objectives To estabilish the incidence and nature of osteoarticular disease in patients receiving long term treatment with haemodialysis we surveyed all of our patients who had received dialysis.

Methods The subjects were 123 patients who were dialysed for one year to 22 years. We also analysed clinical factors such as age, haemodialysis duration, underlying disorder of chronic renal insufficiency, haemotologic parameters. All patients were seen at an extraclinic attendance when they were asked to evaluate pain and stiffness in each joint. A diagnosis of dialysis associated arthropathy was made in patients by three investigators, using as criteria single or combined presence of carpal tunnel syndrome, erosions and bone cysts of the joints and destructive spondylarthropathy. Plasma üre, creatinin, haemoglobin, ferritin, calcium, phosphorous, ürate, paratthyroid hormon concentrations, alkaline phospatase, magnesium, aliminium, B2 microglobulin, osteocalcin, vit D, hepatit markers were measured before dialysis in patients. Radiographs of the hands were obtained in all patients, in some patients painful joints were also axamined by radiography. We used dual-energy X-Ray absorbtiometry to detect changes in bone mineral density.

Results We found carpal tunnel syndrome in 29 (23.8%) patients, spondylarthropathy in14 (11.5%) patients, skeletal deformities in 29 (23.8%) patients, tensynovitis in 6 (4.8) patients, periarthritis in 10 (8.2%) patients, periarthritis in10 (8.2%) patients and bone cysts in26 (20.7%) patients. When we compared groups according to durationof hemodialysis treatment; carpal tunnel syndrome, bone cysts and periarthritis were found more frequently in patients receiving hemodialysis treatment for longer time. Bone mineral density was reduced in dialysis patients of both sexes in comparison with the healty subjects. There was significant correlation between bone mineral density and the mean serum B2 microglobulin, magnesium, cretinin and ferritin, alkaline phosphatase levels. Strong relationship was found out among hemodialysis duration and osteoporosis. Depression was observed 66.3%patients.

Conclusion Changes of the locomotor apparatus in prolonged hemodialysis treatment determine the quality of life with all its consequences for the patient.

References

  1. Levenson JL, Glocheski S. Psychological factors affecting end-stage renal disease. Psychosomatics 1993;32,382–8

  2. Ferrari AJL, Rothfuss S, Schumacher HR. Dialysis arthropathy; identification and evaluation of a subset of patients with unexplained inflammatory effusions. J Rheumatol. 1997;24(9):1780–6

  3. Loevner LA, Adler RS, Martel W. Dialysis related arthropathy in patients on long term hemodialysis: radiographic features. J Clin Rheumatol.1995;1:81–9

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