Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients

Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

BACKGROUND AND AIMS

Musculoskeletal disorders (MSDs) are commonly encountered in hemodialysis (HD) patients. However, the causes linked to these disorders are still partially defined. The aim of this study was to determine the frequency of MSDs and their relationship to a variety of clinico-social characteristics such as sleep quality, mood disorders, fatigue, and social support, in addition to the patients' clinical and therapeutic profile.

METHOD

The study included 94 patients on maintenance HD. Clinical and Sociodemographic data was gathered. To investigate the prevalence and trends of MSDs, the Nordic Musculoskeletal Questionnaire (NMQ-E) was employed. Patients completed the modified Edmonton Symptom Assessment System, Pittsburgh Sleep Quality Index (PSQI), multidimensional Fatigue Inventory (MFI-20), and Perceived Social Support from Family Scales. Univariate and multivariate regression analysis were used to assess the determinants of MSDs.

RESULTS

The patients' mean age was 49.73 and 59.6% were males. Seventy-two percent of patients were afflicted by MSDs. Knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%), and neck pains (35.1%) were the most reported MSD domains. Pain (p = 0.001), fatigue (p = 0.01), depression (p = 0.015), and anxiety (p = 0.003) scores were substantially higher in patients with MSDs. Furthermore, patients with MSDs engaged in less physical activity (p = 0.02) and perceived less social support (p = 0.029). Patients with MSDs had lower subjective sleep quality, daytime dysfunction domains, and global PSQI scores (p = 0.02, 0.031, 0.036, respectively). Female gender (p = 0.013), fatigue (p = 0.012), depression (p = 0.014), anxiety (p = 0.004), lower activity (p = 0.029), and PSQI score (0.027), use of erythropoiesis-stimulating agents (ESAs), antihypertensive drugs, calcium and Iron supplementation were all significantly associated with MSDs. At the multivariable regression model, administration of ESAs (p = 0.017) and pain score (p = 0.040) were the only independent variables associated with the outcome.

CONCLUSION

MSDs are quite common among HD patients. Female gender, pain, fatigue, depression, anxiety, reduced activity, poor sleep quality, and use of ESAs are all significantly associated with MSDs in HD patients. Patients with MSD perceived less social support compared to the other group. Patients treated with antihypertensive drugs, calcium and iron supplements were more likely to suffer MSDs.

Is Adynamic Bone Always a Disease? Lessons from Patients with Chronic Kidney Disease

Renal osteodystrophy (ROD) is a common complication of end-stage kidney disease that often starts early with loss of kidney function, and it is considered an integral part in management of patients with chronic kidney disease (CKD). Adynamic bone (ADB) is characterized by suppressed bone formation, low cellularity, and thin osteoid seams. There is accumulating evidence supporting increasing prevalence of ADB, particularly in early CKD. Contemporarily, it is not very clear whether it represents a true disease, an adaptive mechanism to prevent bone resorption, or just a transitional stage. Several co-players are incriminated in its pathogenesis, such as age, diabetes mellitus, malnutrition, uremic milieu, and iatrogenic factors. In the present review, we will discuss the up-to-date knowledge of the ADB and focus on its impact on bone health, fracture risk, vascular calcification, and long-term survival. Moreover, we will emphasize the proper preventive and management strategies of ADB that are pivotal issues in managing patients with CKD. It is still unclear whether ADB is always a pathologic condition or whether it can represent an adaptive process to suppress bone resorption and further bone loss. In this article, we tried to discuss this hard topic based on the available limited information in patients with CKD. More studies are needed to be able to clearly address this frequent ROD finding.

MO866: Evaluating Psychosocial Contributions to Musculoskeletal Disorders in Hemodialysis Patients: A Single Center Experience From Egypt

BACKGROUND AND AIMS

Patients with end-stage kidney disease (ESKD) on regular hemodialysis (HD) suffer from a high burden of comorbidities. Musculoskeletal disorders (MSDs) are frequently encountered in those patients. The factors linked to MSDs in HD patients are incompletely defined, therefore this study was done to figure out how often musculoskeletal symptoms are in those patients and identify their association with many psychosocial aspects including quality of sleep, social support and fatigue.

METHOD

This cross-sectional study was carried out in the HD unit at Mansoura University Hospital, Egypt in the period from August to December 2021. The sample included 94 ESRD patients on regular HD for more than 3 months. Sociodemographic characteristics, clinical and therapeutic data were collected. The Nordic Musculoskeletal Questionnaire (NMQ-E) was used to determine the prevalence and patterns of MSDs in various parts of the body areas. Moreover, the modified Edmonton Symptom Assessment System, multidimensional Fatigue Inventory (MFI-20), Pittsburgh Sleep Quality Index (PSQI), Perceived Social Support from Family Scales were completed by the patients. MSDs predictors were evaluated by univariate regression analysis.

RESULTS

The mean age of the studied patients was 49.73 years and more than half of them (59.6%) were males. MSDs affected nearly three quarters (72.3%) of patients. The most frequently encountered MSD domains were knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%) and neck pain (35.1%) (Figure 1).

Regarding Pain and symptom burden, patients with MSDs had significantly higher scores of pain (P &lt; 0.001), fatigue (P = 0.01), depression (P = 0.015) and anxiety (P = 0.003). Regarding MFI scale, patients with MSDs experienced reduced activity (P = 0.02). Subjective sleep quality, daytime dysfunction domains and global PSQI score were worse among patients with MSDs (P = 0.02, 0.031 and 0.036, respectively). Patients with MSDs perceived less social support (P = 0.029). Female gender (P = 0.013), higher scores of fatigue (P = 0.012), depression (P = 0.014), anxiety (P = 0.004), reduced activity (P = 0.029) domains and PSQI score (0.027) were the significant predictors of MSDs in the studied HD patients (Table 1).

CONCLUSION

MSDs appears to frequently occur in HD patients. Female gender, fatigue, depression, anxiety, reduced activity and poor sleep quality can predict the occurrence of MSDs in HD patients.

MO804: Clinical and Ultrasonographic Features of 104 Knee Joints in Haemodialysis Patients and Their Association with Semiquantitative Measurement of Suprapatellar Effusion and Influence of Age, Gender and Duration of Haemodialysis

BACKGROUND AND AIMS

Musculoskeletal disorders remain a major problem in haemodialysis (HD) patients. The aim of this study was to determine knee clinical and ultrasonographic (US) abnormalities in HD patients to evaluate the influence of age, gender and HD duration.

METHOD

This cross-sectional descriptive study was conducted on 52 patients (104 knee joints) who had been on regular HD for at least 6 months. Demographic, clinical, therapeutic and laboratory data were recruited. Participants were questioned about the presence of chronic knee pain and its duration, severity and laterality. Both knees were evaluated for the presence of joint swelling, crepitus and tenderness.

All patients underwent musculoskeletal (MSUS) evaluation of both knees, which was conducted according to EULAR standardized procedures. MSUS was used to determine the presence of suprapatellar effusion, synovial thickening and Baker's cyst and to detect any abnormalities in the cartilage morphology. Quadriceps and patellar tendons and menisci were also sonographically assessed. Cartilage thickness was measured bilaterally from the central points of the medial condyle and lateral condyle patients were then compared according to age, gender and HD duration.

RESULTS

The mean age of the patients was 52.4 ± 14.15 years,  25 females and 27 males,  and the median duration of HD was 3.5 (0.6–13) years.  Chronic knee pain was present in 31/104 (29.8%) knees. Among the scanned 104 knee joints, there was at least one US abnormality in 91 (87.5%); suprapatellar effusion was found in 57 (54.8%), synovial thickening in 13 (12.5%), abnormal cartilage morphology in 68 (65.4%), quadriceps tendon abnormalities in 58 (55.8%), patellar tendon abnormalities in 34 (32.7), medial meniscus abnormalities in 30 (28.8%), lateral meniscus abnormalities in 13 (12.5%) and Baker’s cyst in 5 (4.8%) (Fig. 1).

MSUS abnormalities were significantly more frequent in HD patients aged &gt;40 years (94.9% versus 65.4; P = .000) than others. Chronic knee pain and abnormal cartilage morphology were more likely to occur in females (40% versus 20.4% and 74.1% versus 56%, respectively) than in males (Fig. 2).

According to HD duration, quadriceps and patellar tendons showed more frequent US abnormalities in patients with HD duration &gt; 3 years (86.5% versus 42% and 38.9% versus 26%, respectively) than in others.

The prevalence of mild, moderate and severe suprapatellar effusion was 37.5%, 14.4% and 2.9%, respectively. There was a significant association between semiquantitative measurement of suprapatellar effusion and synovial thickening (P = .000), abnormal cartilage morphology (P = 0.023), quadriceps (0.002) and patellar tendon abnormalities (0.011) (Table 1).

CONCLUSION

Knee US abnormalities are prevalent among HD patients, especially those with female gender, older age and higher HD duration. These abnormalities may be subclinical. The severity of suprapatellar effusion is usually related to other knee structural abnormalities.