Assessment of tendon involvement in chronic hemodialysis patients : an ultrasonographic study

Abstract EN

Aim of the work The aim of this study was to detect changes occurring in some tendons, for example, Achilles, quadriceps, and supraspinatus tendons, using musculoskeletal ultrasound (MSUS) imaging in patients with chronic kidney disease (CKD) on regular hemodialysis and to evaluate associations of these changes with patients’ clinical status, parathyroid hormone (PTH) level as well as other laboratory parameters.

Patients and methods This study was carried out on 35 patients and a group of 25 age-matched and sex-matched apparently healthy participants as a control group.

All patients underwent history taking; clinical examination; and shoulder, knee, and ankle plain radiography.

Laboratory investigations including PTH level were done.

MSUS was performed on the selected tendons for all patients and controls.

Results The ankle was the most clinically affected joint.

US abnormalities most commonly affected the Achilles tendon (15.2%) having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure, followed by the quadriceps tendon (2.9%), whereas the supraspinatus tendon was the least affected (2.3%).

There were highly statistically significant differences between patients with CKD and controls regarding mean tendon thickness, with the quadriceps tendon and supraspinatus tendons being thicker in the study group (P<0.001).

Significant positive correlations of PTH level with age, the duration of dialysis, and PO4 level were observed.

Conclusion There were significant tendon involvements among patients with CKD with the Achilles tendon mostly involved having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure.

Tendon abnormalities occurred mainly in older patients with longer durations of dialysis, hypercalcemia (Ca), hyperphosphatemia (PO4), and a higher Ca×PO4 product.

MSUS is a simple, noninvasive, and a substantial tool in the diagnosis and follow-up of tendon involvement among patients with CKD.