Musculoskeletal disorders in hemodialysis patients and its impact on physical function (Zagazig University Nephrology Unit, Egypt)

Abstract

A number of musculoskeletal disorders have been reported in hemodialysis (HD) patients and they exert an impact on their functional status. Objectives This study was designed to determine the most common musculoskeletal system involvement in chronic HD patients and to show its effect on physical function (disability). This study was carried out on HD patients at the Nephrology Unit in Zagazig University Hospitals, Egypt. Pain intensity was measured using a 100-mm pain visual analogue scale. Physical disability was measured using the Health Assessment Questionnaire. A blood sample was obtained to measure calcium, phosphorus, alkaline phosphatase, parathyroid hormone, serum uric acid, serum albumin, serum iron, serum ferritin, and transferrin. Radiography of the symptomatic joints was performed. Dual-energy x-ray absorptiometry was performed at the femoral neck and the lumbar spine. Of the 144 HD patients, 87 patients (60.4%) had musculoskeletal manifestations. The most common musculoskeletal disorder was joint pain (arthralgia) (25.3%), followed by osteoarthritis (17.2%), carpal tunnel syndrome (14.9%), and osteoporosis (13.7%). The results of dual-energy x-ray absorptiometry showed that the median T-score was –1.43 of the hip and –2.76 at the lumbar spine. There were highly significant positive correlations between the duration of HD and parathyroid hormone ( P < 0.02). Higher Health Assessment Questionnaire scores were significantly associated with shoulder pain ( P < 0.02), wrist pain (P < 0.03), small joint pain (P < 0.01), knee pain ( P < 0.04), hip pain ( P < 0.04), osteoarthritis ( P < 0.02), and osteoporosis ( P < 0.00). Musculoskeletal system involvement remains a common problem that limits the physical function of patients with renal failure, in particular, those treated with long-term maintenance dialysis.