Major contributors to musculoskeletal pain among children receiving hemodialysis.

Background: Children who are undergoing hemodialysis are vulnerable to musculoskeletal (MSK) abnormalities. These conditions can potentially lead to functional impairments and diminished health-related quality of life. Hence, this study was to explore the prevalence of MSK pain in children receiving hemodialysis and the factors associated with this MSK pain.

Methods: This cross-sectional study was conducted on a group of children undergoing hemodialysis at the nephrology unit, Mansoura University Children's Hospital, from December 2022 to January 2024. Patient demographics, clinical data, musculoskeletal findings, physical function, quality of life assessment parameters, laboratory data, and Dual Energy X-ray Absorptiometry (DEXA) results were collected. All patients were classified into two groups: patients with MSK pain and those without any MSK pain.

Results: The total number of cases with MSK pain was 32 (64%). The most frequent musculoskeletal manifestations were: osteoporosis/osteopenia (64%), myalgia (64%), cramps (60%), arthralgia/arthritis (32%), and regional pain (32%). MSK pain was independently associated with longer dialysis duration, the presence of comorbidity, childhood health assessment questionnaire results, pediatric quality of life inventory, hemoglobin level, serum uric acid, calcium × phosphate product, and DEXA (Z-score).

Conclusions: Involvement of the MSK system is a common morbidity in children with hemodialysis. Calcium × phosphate product (p = 0.026) and vitamin D level (p = 0.003) were the most significant factors associated with MSK pain in multivariate regression analysis.