Rheumatic and musculoskeletal manifestations in renal hemodialysis patients

Objectives: To determine the frequency of Rheumatic and Musculoskeletal Diseases (RMDs) in patients with renal failure on regular hemodialysis. Methods and findings: The present study included forty-nine patients (28 males and 21 females) with renal failure on regular hemodialysis. Full history taking and clinical examination were documented for all patients. Blood samples were collected for laboratory investigations before the mid-week session. Dual Energy X-ray Absorptiometry (DXA) was performed to all patients to assess bone mineral density (BMD). Kt/V was used as a marker of dialysis adequacy. Mean age for all patients was 54.41 ± 15.9 years, and the dialysis duration was 3 ± 2.3 years. The detected RMDs included (in order of descending frequency): fibromyalgia syndrome (51%), myalgias (37%), arthralgia (37%), flexor tenosynovitis (29%), cramps (29%), ectopic calcifications (25%), flexion deformity of the elbow (16%), carpal tunnel syndrome (14%), destructive spondyloarthritis (8%) and Vasculitis (4.1%). Positive anti-CCP was detected in 1 female and rheumatoid factor in 4 females and 1 male. The BMD was reduced with the DXA t-score at lumbosacral spine, hip and forearm -1.5 ± 1.8, -1.7 ± 1.6, -1.9 ± 1.9 respectively. Overall, there was a tendency to a higher frequency of musculoskeletal findings in males. Other co-morbidities included: diabetes mellitus (45%), hypertension (96%), cardiovascular (33%), cerebrovascular stroke (6%), hyperuricemia (37%), hepatitis C (16%) and amyloidosis (8%). Conclusion: Rheumatic and musculoskeletal diseases are frequent and overlooked among hemodialysis patients especially males and usually associated with chronic pain.