Frequency of destructive spondyloarthropathy among patients on regular hemodialysis

Objective
Musculosk eletal complications occur in patients suffering from chronic kidney diseases. The cause of destructive spondyloarthropathy (DSA) among those patients is not well known. This study aims to study the frequency of DSA among hemodialysis patients.
Patients and methods
The study was conducted on 75 patients known to be end-stage renal disease patients: they were divided into three groups: chronic kidney disease on regular hemodialysis for more than or equal to 5 years group (=25), patients on regular hemodialysis for less than 5 years group (=25), and end-stage renal disease prior to hemodialysis as a control group (=25). All of them were subjected to: full medical history, clinical examination, and plain radiographs of the whole spine in two views. Serum beta 2-microglobulin (β2-M) levels were determined.
Results
A comparison of β2-M serum levels in three groups showed a highly significant difference being highest in group I and lowest in group III (<0.001). There was high statistically significant increase in the frequency of DSA in group I compared with group II and in group II compared with group III (<0.001). As regards the affected site among positive cases, DSA was observed to affect the cervical region in 82.35% more than the lumbar in 11.76%, and rarely to involve both cervical and lumbar in the same patient in 5.88%, DSA was observed to affect men (58.8%) more than the women (41.2 %). Comparison of age, duration of dialysis, and intact parathyroid hormone levels between positive and negative DSA cases revealed that DSA is significantly more prevalent in older age patients (<0.05), and those with long dialysis duration (<0.001), and those having higher intact parathyroid hormone levels (<0.001).
Conclusion
DSA is the most serious spinal complication in patients on long-term hemodialysis. Serum β2-M is elevated in patients receiving long-term hemodialysis (>5 years) and is positively correlated with destructive changes (DSA).