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Deme S, Fisseha B, Kahsay G, Melese H, Alamer A, Ayhualem S. Musculoskeletal Disorders and Associated Factors Among Patients with Chronic Kidney Disease Attending at Saint Paul Hospital, Addis Ababa, Ethiopia. Int J Nephrol Renovasc Dis 2021; 14:291-300. [PMID: 34377009 PMCID: PMC8349525 DOI: 10.2147/ijnrd.s319991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Musculoskeletal disorders contributed from chronic kidney disease are increasing worldwide. Musculoskeletal disorders had a significant health burden and are leading causes of co-morbidities, disability and low productivity, which potentially affect individual's functional status and quality of life. Purpose The aim of this study was to assess the prevalence of musculoskeletal disorders and its associated factors among patients with chronic kidney attending in Saint Paul Hospital, Addis Ababa, Ethiopia. Patients and Methods An institution-based cross-sectional study was conducted on 302 enrolled study participants through systematic random sampling techniques. Face-to-face interview, physical examination and chart reviews were used to collect data using semi-structured questionnaire adapted from a standard Nordic Musculoskeletal Questionnaire and other literatures. Data were entered into Epi Info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables having a p-value less than 0.05 with 95% CI in multivariate analysis were taken as statistically significant. Results The prevalence of musculoskeletal disorders among CKD individuals was found to be 58.6% (95% CI; 53.0, 64.1). Being female (AOR = 0.49; 95% CI 0.26, 0.94), age between 40 and 49 (AOR = 3.34; 95% CI 1.07, 10.44), stage III (AOR = 0.24; 95% CI 0.06, 0.89) and stage IV (AOR = 0.24; 95% CI 0.06, 0.89) chronic kidney disease, having HTN (AOR = 7.47; 95% CI 3.47, 16.06), parathyroid hormone level ≥100 pg/mL (AOR = 0.43; 95% CI 0.21, 0.87), calcium level <8.4 mg/dl (AOR = 5.89; 95% CI 2.66, 13.56) and serum 25 hydroxy vitamin D level <20 ng/mL (AOR = 3.91; 95% CI 1.32, 11.56) were significantly associated with musculoskeletal disorders. Conclusion MSDs were shown to be moderately common in CKD patients. Female gender, age between 40 and 49 yrs, stage III and stage IV CKD, hypertension, higher PTH level, lower calcium level and lower vitamin D level were statistically significant in their association with musculoskeletal disorders.
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Affiliation(s)
- Sisay Deme
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berihu Fisseha
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebreslassie Kahsay
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Sileshi Ayhualem
- Department of human Anatomy, School of Medicine, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
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Abstract
BACKGROUND Vestibular, neurological and musculoskeletal functions are affected in patients with renal failure. These problems can in turn affect the balance system in peritoneal dialysis (PD) patients. Previously, postural balance changes were shown in hemodialysis patients. This is the first study that evaluates whether there are similar changes in patients with PD. OBJECTIVE This study aimed to compare balance and fall risk between patients undergoing PD treatment and healthy subjects, and aimed to determine the correlation between biochemical parameters and fall risk and balance assessments in PD patients. METHODS This controlled study included 58 patients receiving PD treatment (PD Group) and 75 healthy subjects (Control Group). The Berg Balance Scale (BBS) and Tetrax® Interactive Balance System were used for the comparison of balance between groups. For patients in the PD Group, duration of PD, blood pressure, Kt/Vurea (actual mass of urea removed via peritoneal dialysis), and serum biochemical parameters were recorded and correlation analysis was performed between these parameters and balance measurements. RESULTS There were no statistically significant differences between groups in terms of demographics or BBS scores (p> 0.05). The fall risk of patients in the PD Group was significantly higher than those in the Control Group (p< 0.0001) according to Tetrax measurements. Female gender, older age, higher BMI, and higher blood glucose levels were negatively correlated with balance parameters of PD patients (r> 0.3). There was no statistically significant correlation between duration of PD, blood pressure, and Kt/Vurea with balance parameters or fall risk. CONCLUSIONS Balance was impaired in patients undergoing PD in comparison to healthy subjects. Fall risk may be evaluated using the Tetrax® instead of BBS for this population. Serum glucose level, BMI and age appear to affect balance and fall risk. Therefore, optimization of body weight and normalization of serum glucose levels are important factors for improving balance. The duration of PD, blood pressure, and Kt/Vurea do not affect balance system.
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Affiliation(s)
- Pınar Doruk Analan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Rüya Özelsancak
- Department of Nephrology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Ünal HU, Tok F, Adıgüzel E, Gezer M, Aydın İ, Yılmaz B, Oğuz Y. Ultrasonographic evaluation of the femoral cartilage thickness in patients with chronic renal failure. Ren Fail 2016; 38:600-4. [PMID: 26905953 DOI: 10.3109/0886022x.2016.1149685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the effects of chronic renal failure (CRF) on the distal femoral cartilage thickness by using ultrasonography and to determine the relationship between cartilage thickness and certain disease-related parameters. DESIGN Fifty-seven CRF patients (41 male and 16 female) (mean [SD] age, 44.7 [12.1] years) and 60 healthy controls (41 male and 19 female) (mean [SD] age, 43.5 [13.3] years) were enrolled in this study. Demographic and clinical characteristics were recorded. Cartilage thickness measurements were taken from the medial and lateral condyles, and intercondylar areas of both knees. RESULTS Groups were similar in terms of age, weight, height, body mass index and gender (all p>0.05). The mean cartilage thickness was found to be less in CRF patients than in controls (statistically significant for medial condyles and intercondylar areas both in right and the left knees [all p<0.05]). Cartilage thickness showed no correlation with eGFR, and with the levels of serum urea, creatinine, calcium, magnesium, phosphor, hemoglobin, uric acid and as well as steroid use (all p>0.05) in CRF patients. CONCLUSION In the light of our findings, we imply that patients with CRF have thinner femoral cartilage than healthy controls. This result may support the view that patients with CRF are at increased risk for developing early knee osteoarthritis. Last but not least, clinicians should be aware of the importance of rehabilitation strategies aimed at decreasing onset and progression of knee osteoarthritis in patients with CRF.
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Affiliation(s)
- Hilmi Umut Ünal
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Fatih Tok
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Emre Adıgüzel
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Mustafa Gezer
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
| | - İbrahim Aydın
- c Department of Biochemistry , Gulhane Military Medical Academy , Ankara , Turkey
| | - Bilge Yılmaz
- b Department of Physical Medicine and Rehabilitation , Gulhane Military Medical Academy , Ankara , Turkey
| | - Yusuf Oğuz
- a Department of Nephrology , Gulhane Military Medical Academy , Ankara , Turkey
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Miscellaneous arthropathies. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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El-Najjar AR, Amar HA, El wahab Selim HA, El sherbiny EM, Ibrahem M, Fouad M. Musculoskeletal disorders in hemodialysis patients and its impact on physical function (Zagazig University Nephrology Unit, Egypt). EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.147356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kamel SR, Mohamed FA, Darwish AF, Kamal A, Mohamed AK, Ali LH. Sonographic features suggestive of amyloidosis in hemodialysis patients: Relations to serum beta2-microglobulin. THE EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raubenheimer EJ, Noffke CEE, Hendrik HD. Chronic kidney disease-mineral bone disorder: an update on the pathology and cranial manifestations. J Oral Pathol Med 2014; 44:239-43. [PMID: 24646006 DOI: 10.1111/jop.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 01/22/2023]
Abstract
Chronic kidney disease-mineral bone disorder (CKD-MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD-MBD.
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Affiliation(s)
- Erich J Raubenheimer
- Oral Pathology and Consultant for Metabolic Bone Diseases, School of Oral Health Sciences, University of Limpopo, Pretoria, South Africa
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Rheumatic complications of long term treatment with hemodialysis. Rheumatol Int 2011; 32:1161-3. [PMID: 21253734 DOI: 10.1007/s00296-010-1756-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 12/30/2010] [Indexed: 10/18/2022]
Abstract
Patients undergoing hemodialysis therapy develop serious osteoarticular diseases. The treatment is based on prevention. The aim of our study is to determine the frequency and the associated factors to the rheumatic manifestations in hemodialysis patients. A cross-sectional study was conducted, including all hemodialysed patients in our dialysis unit. Information was obtained from patients' symptoms, examination findings, and biological and radiological signs. The frequency of symptoms was 70% in our patients. It was proportional to the duration of hemodialysis and number of hemodialysis sessions per week. Early transplantation is of course a plausible solution, but other therapies such as improved dialysis must be considered.
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Miscellaneous arthropathies including synovial tumors and foreign body synovitis and nephrogenic systemic fibrosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fok WMM, Leung HB. Unresolved lytic lesions following parathyroidectomy in a patient with chronic renal failure. ACTA ACUST UNITED AC 2008; 90:506-9. [PMID: 18378929 DOI: 10.1302/0301-620x.90b4.20308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
With advances in the treatment of patients with chronic renal failure, their life expectancy has increased. In turn, the prevalence of osteitis fibrosa cystica, a manifestation of secondary hyperparathyroidism, and β2 microglobulin amyloidosis, a result of long-term haemodialysis, has risen. While both conditions share similar radiological features, their management is very different. We present the case of a patient with renal failure who had been receiving haemodialysis for over 20 years. Lytic lesions had been observed in the proximal part of both femurs for ten years. A presumptive diagnosis of osteitis fibrosa cystica was made. However, no regression of the lesions occurred after parathyroidectomy. The patient subsequently developed sequential pathological fractures through the lesions, for which bilateral total hip replacements were performed. Histology of the lesions revealed that the patient was in fact suffering from amyloidosis. In patients with chronic renal failure, osseous amyloidosis is a highly probable differential diagnosis, especially if no regression of a lytic lesion is observed after parathyroidectomy.
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Affiliation(s)
- W. M. M. Fok
- Department of Orthopaedics and Traumatology, 51F, Professional Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - H. B. Leung
- Department of Orthopaedics and Traumatology, 51F, Professional Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
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Kay J, Bazari H, Avery LL, Koreishi AF. Case records of the Massachusetts General Hospital. Case 6-2008. A 46-year-old woman with renal failure and stiffness of the joints and skin. N Engl J Med 2008; 358:827-38. [PMID: 18287606 DOI: 10.1056/nejmcpc0708697] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jonathan Kay
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, USA
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Khalfallah M, Faure A, Hamel O, Cantarovich D, Doe K, Raoul S, Bord E, Robert R. [Dialysis-associated spondyloarthropathy. Case report and literature review]. Neurochirurgie 2006; 51:165-72. [PMID: 16389902 DOI: 10.1016/s0028-3770(05)83472-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hemodialysis has considerably prolonged the life of patients suffering from terminal renal failure. However, long-term hemodialysis leads to new bone complications and spinal disorders such as destructive spondyloarthropathy (DSA). At the present time DSA is reported in 8% to 18% of the dialysed patients. Diagnosis is based on severe narrowing of the intervertebral disk, erosions and geodes of the adjacent vertebral plates simulating infectious spondylitis. Lesions progressively involve posterior joints and may lead to severe destruction of the spine. The pathogenesis of this syndrome is still unknown. Several factors have been implicated, including microcrystal deposition, amyloidosis, inflammatory and foreign body reactions and suggest that the pathogenesis of erosive spondyloarthropathies of hemodialysed patients is multifactorial. Spinal instability inducing myelopathy and radiculopathy were observed in 8% of the cases. Treatment must be accorded to the natural disease course and to the quality of the bone. We report the case of a chronic dialysed patient with destructive spondyloarthropathy involving the cervical and thoracic spine. Pathogenesis, radiological datas and therapeutic approach are discussed.
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Affiliation(s)
- M Khalfallah
- Servie de Neurochirurgie, Centre Hospitalier de la Côte-Basque, 64109 Bayonne
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Revaz S, Theumann N, Lobrinus JA, So AKL, Dudler J. Leg pain due to bilateral focal recurrent myositis in a hemodialysis patient. Am J Kidney Dis 2005; 45:e7-11. [PMID: 15696437 DOI: 10.1053/j.ajkd.2004.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Leg pain is a common symptom in dialysis patients. In most cases, the cause is easily identified, but some rare causes have been recognized. We describe a case of focal myositis as the source of recurrent leg pain in a hemodialysis patient. This disease usually is self-limited and has a spontaneously favorable outcome. We review the differential diagnosis of leg pain in this patient population.
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Affiliation(s)
- Sylvie Revaz
- Service de Rhumatologie, Médecine Physique et Rééducation, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Kart-Köseoglu H, Yucel AE, Niron EA, Köseoglu H, Isiklar I, Ozdemir FN. Osteoarthritis in hemodialysis patients: relationships with bone mineral density and other clinical and laboratory parameters. Rheumatol Int 2004; 25:270-5. [PMID: 14999425 DOI: 10.1007/s00296-003-0431-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Accepted: 11/30/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION Osteoarticular complications are common in HD patients.
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MESH Headings
- Adult
- Aged
- Arthrography
- Bone Density/physiology
- Bone Diseases/diagnostic imaging
- Bone Diseases/epidemiology
- Bone Diseases/etiology
- Bone Diseases, Metabolic/diagnostic imaging
- Bone Diseases, Metabolic/epidemiology
- Bone Diseases, Metabolic/etiology
- Bone Resorption/diagnostic imaging
- Bone Resorption/epidemiology
- Bone Resorption/etiology
- Bone and Bones/diagnostic imaging
- Female
- Humans
- Joints/pathology
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/etiology
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/etiology
- Prevalence
- Renal Dialysis/adverse effects
- Risk Factors
- Turkey/epidemiology
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Affiliation(s)
- Hamide Kart-Köseoglu
- Rheumatology Division, Baskent University Faculty of Medicine, Fevzi cakmak cad. 10.sok, Bahcelievler, Ankara, Turkey 06490.
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Abstract
There are a number of pathologies that are associated with the development of renal failure. Once renal function has deteriorated beyond a point where life is not sustainable without dialysis, new sets of pathologic processes develop. These are, in part, related to the continuation of poor renal function and to the process of dialysis itself. This article addresses the processes that are believed to be due to dialysis, among which are disorders of bone, deposition of metals and amyloid within a number of tissues, and local problems such as inflammation and tumors related to the dialysis site.
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Affiliation(s)
- A J Freemont
- Department of Osteoarticular Pathology, The Medical School, University of Manchester, United Kingdom.
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