Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage

  • Sandrine Hage
  • Valérie HageEmail author
  • Nathalie el-Khoury
  • Hiba Azar
  • Dania Chelala
  • Nelly Ziadé
Brief Report


Musculoskeletal disorders remain a major problem in hemodialysis patients. The aim of the study was to estimate the prevalence of musculoskeletal manifestations in hemodialysis patients and identify disease cluster profiles. We performed a cross-sectional study including all adult patients in the hemodialysis unit at Hotel-Dieu de France Hospital. We collected demographic characteristics, musculoskeletal symptoms, biologic parameters, and treatments. Musculoskeletal disorders were classified by a rheumatologist into predefined diagnostic categories. Prevalence was presented, and a cluster analysis was performed. Eighty-nine patients were included, mean age was 67.5 ± 12 years, and 43.8% were female. Dialysis vintage was 5.7 ± 5.37 years. Musculoskeletal symptoms were reported by 76.4% of the patients. Pain was the most frequent symptom (44.9%). The main diagnoses were osteoarthritis (53.9%) and fracture (27%). Musculoskeletal symptoms and disorders were significantly associated with dialysis vintage and age. Cluster analysis identified three patient profiles: younger with low calcium levels, younger but long dialysis vintage with osteoarthritis and carpal tunnel syndrome, and older with long dialysis vintage and fractures. The prevalence of musculoskeletal manifestations is high in the hemodialysis population and increases with dialysis vintage. Musculoskeletal disorders cluster according to age and dialysis vintage.

Key Points

• Musculoskeletal symptoms are highly prevalent among hemodialysis patients (76.4%).

• All musculoskeletal disorders are associated with dialysis vintage and age.

• Three clusters are identified among hemodialysis patients: young with low calcium levels, young but long dialysis vintage with osteoarthritis and carpal tunnel syndrome and old with long dialysis vintage with fractures.


Calcium Fracture Hemodialysis Musculoskeletal Osteoarthritis 



Chronic kidney disease


Secondary hyperparathyroidism


International unit


Carpal tunnel syndrome


Chronic kidney disease-mineral and bone disorders


Bone mineral density


Fibroblast growth factor 23


Calcium phosphate product



The authors would like to thank Dr. Ghada Abi Karam and Dr. Fouad Fayad for providing access to their respective rheumatology files.

Authors’ contributions

NZ designed the study. HA and DC provided expertise and approval to include the patients. SH and NK conducted the study and collected the data. NZ analyzed and interpreted the data. VH drafted the manuscript. NZ, HA, and DC critically reviewed the manuscript.

Compliance with ethical standards




  1. 1.
    Yamamoto S, Kazama JJ, Maruyama H et al (2008) Patients undergoing dialysis therapy for 30 years or more survive with serious osteoarticular disorders. Clin Nephrol 70:496–502CrossRefGoogle Scholar
  2. 2.
    Kuntz D, Naveau B, Bardin T, Druëke T, Treves R, Dryll A (1984) Destructive spondylarthropathy in hemodialysed patients: a new syndrome. Arthritis Rheum 27:369–375CrossRefGoogle Scholar
  3. 3.
    Rubin LA, Fam AG, Rubinstein J, Campbell J, Saiphoo C (1984) Erosive azotemie osteoarthropathy. Arhtritis Rheum 27:1086–1094CrossRefGoogle Scholar
  4. 4.
    KDIGO (2009) Guideline for chronic kidney disease-mineral and bone disorder (CKD-MBD). Chapter 1: Introduction and definition of CKD–MBD and the development of the guideline statements. Kidney Int 76(Suppl 113):S3–S8Google Scholar
  5. 5.
    Harris SAC, Brown EA (1998) Patients surviving more than 10 years on haemodialysis. The natural history of the complications of treatment. Nephrol Dial Transplant 13:1226–1233CrossRefGoogle Scholar
  6. 6.
    Akasbi N, Houssaini T, Tahiri L et al (2012) Rheumatic complications of long term treatment with hemodialysis. Rheumatol Int 32:1161–1163CrossRefGoogle Scholar
  7. 7.
    Hurton S, Embil JM, Smallwood S, Wall C et al (2010) Upper extremity complications in patients with chronic renal failure receiving haemodialysis. J Ren Care 36:203–211 Back to cited text noCrossRefGoogle Scholar
  8. 8.
    Limaye V, Frankham A, Disney A, Pile K (2001) Evaluation of hand function in patients undergoing long term haemodialysis. Ann Rheum Dis 60:278–280CrossRefGoogle Scholar
  9. 9.
    Kessler M, Netter P, Azoulay E, Mayeux D, Pere P, Gaucher A (1992) Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. Br J Rheumatol 31:157–162CrossRefGoogle Scholar
  10. 10.
    Khalil G, Mallat S, Topouchian D, Sleilaty G, Roukoz S, Baddoura (2009) Etude des facteurs de risque de limitations fonctionnelles permanentes chez 210 patients hémodialysés. J Med Liban 57(4):237–242Google Scholar
  11. 11.
    Brown EA, Gower PE (1982) Joint problems in patients on maintenance haemodialysis. Clin Nephrol 18:247–250PubMedGoogle Scholar
  12. 12.
    Kurer MHJ, Baillod RA, Madgwick JCA (1991) Musculoskeletal manifestations of amyloidosis. A review of 83 patients on haemodialysis for at least 10 years. J Bone Joint Surg 73-B:271–276CrossRefGoogle Scholar
  13. 13.
    Davison SN (2003) Pain in hemodialysis patients: prevalence, cause, severity, and management. Am J Kidney Dis 42(6):1239–1247CrossRefGoogle Scholar
  14. 14.
    Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil 21(9):1145–1153CrossRefGoogle Scholar
  15. 15.
    Ensrud KE, Lui LY, Taylor BC et al (2007) Renal function and risk of hip and vertebral fractures in older women. Arch Intern Med 167:133–139CrossRefGoogle Scholar
  16. 16.
    Dukas L, Schacht E, Stähelin HB (2005) In elderly men and women treated for osteoporosis a low creatinine clearance of , 65 ml/min is a risk factor for falls and fractures. Osteoporos Int 16:1683–1690CrossRefGoogle Scholar
  17. 17.
    Nickolas TL, Cremers S, Zhang A et al (2011) Discriminants of prevalent fractures in chronic kidney disease. J Am Soc Nephrol 22:1560–1572CrossRefGoogle Scholar
  18. 18.
    Jamal SA, West SL, Miller PD (2012) Bone and kidney disease: diagnostic and therapeutic implications. Curr Rheumatol Rep 14:217–223CrossRefGoogle Scholar
  19. 19.
    Miller PD (2012) Unrecognized and underappreciated secondary causes of osteoporosis. Endocrinol Metab Clin N Am 41:613–628CrossRefGoogle Scholar
  20. 20.
    Jüppner H, Wolf M, Salusky IB (2010) FGF-23: more than a regulator of renal phosphate handling? J Bone Miner Res 25:2091–2097CrossRefGoogle Scholar
  21. 21.
    Cejka D, Herberth J, Branscum AJ et al (2011) Sclerostin and Dikkopf-1 in renal osteodystrophy. Clin J Am Soc Nephrol 6:877–882CrossRefGoogle Scholar
  22. 22.
    Ghannage-Yared MH, Maalouf G, Khalife S et al (2009) Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women. Br J Nutr 101(4):487–491CrossRefGoogle Scholar
  23. 23.
    Ball AM, Gillen DL, Sherrard D et al (2002) Risk of hip fracture among dialysis and renal transplant recipients. JAMA 288:3014–3018CrossRefGoogle Scholar
  24. 24.
    Ohno I, Ichida K, Okabe H, Hikita M, Uetake D, Kimura H, Saikawa H, Hosoya T (2005) Frequency of gouty arthritis in patients with end-stage renal disease in Japan. Intern Med 44:706–709CrossRefGoogle Scholar
  25. 25.
    Chaaya M, Slim Z, Habib R et al (2012) High burden of rheumatic diseases in Lebanon: a COPCORD study. Int J Rheum Dis 15:136–143CrossRefGoogle Scholar
  26. 26.
    Miskulin DC, Majchrzak K, Tighiouart H et al (2015) Ergocalciferol supplementation in hemodialysis patients with vitamin D deficiency: a randomized clinical trial. J Am Soc Nephrol. CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Sandrine Hage
    • 1
  • Valérie Hage
    • 2
    Email author
  • Nathalie el-Khoury
    • 3
  • Hiba Azar
    • 4
  • Dania Chelala
    • 4
  • Nelly Ziadé
    • 3
  1. 1.Saint-Joseph UniversityBeirutLebanon
  2. 2.Division of Nephrology, Centre Hospitalier de Bhannes, Mount Lebanon, Nephrology DepartmentHotel-Dieu de France Hospital, Saint-Joseph UniversityBeirutLebanon
  3. 3.Rheumatology Department, Hotel-Dieu de France HospitalSaint-Joseph UniversityBeirutLebanon
  4. 4.Nephrology Department, Hotel-Dieu de France HospitalSaint-Joseph UniversityBeirutLebanon

Personalised recommendations