The aim of this study was to determine the role that hemodialysis (HD) plays in radiologically assessed osteoarthritis (OA) of the hand, knee, and hip.
Eighty patients who had been on regular HD for at least 2 years were included. Anterior-posterior radiographs of the pelvis, weight-bearing knees, and hands and wrists of each patient were examined. Bone mineral density (BMD) of spine, femur, and forearm was measured.
Radiologic assessment of the 80 patients' hands showed that 41 individuals had osteopenia, 12 had midphalangeal subperiosteal resorption, 11 had cystic bone lesions, eight had bone erosion, four had osteophytic lesions, and three had subchondral sclerosis. Bone erosion in the hands was significantly associated with HD duration, forearm T score, and serum parathyroid hormone level. Radiologically, OA was demonstrated in eight knee and ten hip joints. Minimum joint space in the tibiofemoral compartment correlated with body mass index, and minimum joint space in the hip correlated with age. The mean BMD measurements at all three sites studied in the HD patients were low. Only the duration of HD significantly correlated with forearm BMD.
Osteoarticular complications are common in HD patients.
[Show abstract][Hide abstract] ABSTRACT: Our aim was to determine the prevalence of fibromyalgia syndrome (FS) in chronic haemodialysis (HD) patients and to identify possible links between FS and various clinical and laboratory parameters.
We studied 122 chronic HD patients and 89 healthy age- and sex-matched controls, classified according to the American College of Rheumatology (ACR) classification criteria for FS. Age, sex, causes of renal failure, length of time on dialysis and marital status were recorded, and questions were asked about symptoms related to FS. All subjects completed the Fibromyalgia Impact Questionnaire (FIQ). Laboratory data obtained in the preceding 6 months were re-evaluated.
Nine (7.4%) of the 122 HD patients and four of the 89 control subjects (4.5%) fulfilled the ACR criteria for definite FS (P = 0.56). The mean ages of the subjects who had definite FS and those who did not were similar. Most of the subjects diagnosed with definite FS were female (11 out of 13). The HD patients had higher FIQ scores than the controls, regardless of FS diagnosis. Among the HD patients, those with definite FS had a significantly higher mean FIQ score than all the other HD patients combined. In the all HD patients group, fatigue, irritable bowel syndrome and personal histories of depression were correlated with FS, whereas duration of HD, aetiology of renal failure, laboratory parameters and hepatitis B or C virus infection were not.
The prevalence of FS appeared to be similar in chronic HD patients and the general population; also, FS-related symptoms appear to be similar in HD patients and the general population who have FS. No laboratory parameter was correlated with frequency of FS.
[Show abstract][Hide abstract] ABSTRACT: Bone mineral density (BMD) is important in children and adolescents because of its relationship to long-term skeletal health, and because, in adults with chronic renal failure (CRF), a relationship between low BMD and vascular calcification has been suggested. To investigate the relationship between BMD and manipulable factors that might affect it, i.e. plasma calcium, phosphate and parathyroid hormone (PTH), 64 patients with a median glomerular filtration rate (GFR) of 31 (range 7-60) ml min(-1) 1.73 m(-2) and median age of 10.0 (4.1-16.9) years were followed over 1.3 (0.7-1.7) years at an average of 5 (3-14) clinic visits. At one visit, BMD of the lumbar spine was measured by dual energy X-ray absorptiometry. The mean BMD Z-score was normal (=0.0). Overall mean calcium, phosphate and PTH levels were in their respective normal ranges. The majority of the patients (72%) were treated with calcium carbonate, mean dose 65 mg kg(-1) day(-1); prescription was positively related to serum calcium levels and calcium-phosphate product (P=0.012 and P<0.01 respectively). Almost all patients (98%) were treated with alfacalcidol, mean dose 12 ng kg(-1) day(-1); prescription was not related to investigated factors. Patients grew well; there was no change in height standard deviation score (DeltaHtSDS=0.0). Normal BMD Z-score for age and sex can be achieved in children with CRF managed with the aim of maintaining normal PTH levels by dietary phosphate restriction, calcium-based phosphate binders and small doses of alfacalcidol. Further investigation of the underlying bone by the use of biopsy and histomorphometry is required to determine actual bone health.
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