The Impact of Chronic Kidney Disease - Mineral and Bone Disorder on the Locomotor System and Quality of Life in Hemodialysis Patients

OBJECTIVE: Chronic kidney disease - mineral and bone disorder (CKD -BMD) is a worldwide challenge in hemodialysis patients (HD). Widespread use and improved methods of HD may have changed the spectrum of locomotor system disorders in this population. Locomotor system disorders have an impact on health-related quality of life (QOL). The objective of this study was to assess the effect of CKD-BMD on the locomotor system (bone, joint, muscle, tendon and bursa) and document the prevalence of locomotor system disorders in HD populations and its impact in QOL.

MATERIAL and METHODS: 550 HD patients were enrolled in this study. Each HD patient received complete locomotor system examination and specific diagnostic investigation. iPTH level classified study population into three groups. Group 1. (149 patients) iPTH level < 100 pg/ml, low- turnover renal osteopathy, Group 2. (126 patients) iPTH from 150-300 pg/mL, Group 3. (275 patients) iPTH > 300 pg/ mL, high turnover bone disease. Patients were offered a self-administered QOL questionnaire, which assessed various QOL variables.

RESULTS: 75% of hemodialysis patients suffered from one or more locomotor system disorders and the commonest was bone pain 60%, followed by muscle cramps 36%, proximal muscle weakness 30%, osteoarthritis 25%, osteoporosis 16%, rotator cuff syndrome15%, gout pre-HD 12.5%, carpal tunnel syndrome 12%, bone fracture 7%, fibromyalgia 7%, tenosynovitis 6%, periarticular calcification 5%, Dupuytren’s contracture 2%, septic arthritis 0.9% and osteomyelitis 0.9%. The three studied groups were represented by 27%, 23% and 50% respectively. The prevalence of osteoarthritis, muscle cramps, bone pain, spontaneous bone fracture and osteoporosis were higher in the third group. 30% of our HD patients completed the QOL questionnaire without assistance and their mean functional status, psychological status, pain scale, fatigue scale, global assessment and joint count were 3.24±2.24, 3.13 ±1.67, 4.07 ±1.7, 4.95 ±1. 8, 3.97 ±1.55 and 9.65±9.95 respectively. QOL variables pronouncedly worsen in HD patients, however the second group patients have a better quality of life than other groups (P<0.001).

CONCLUSION: Locomotor system involvement is still very common in our HD patients, especially in high turnover bone disease group and can compromise the QOL.