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Assessment of tendon involvement in chronic hemodialysis patients: an ultrasonographic study


Aim of the work

The aim of this study was to detect changes occurring in some tendons, for example, Achilles, quadriceps, and supraspinatus tendons, using musculoskeletal ultrasound (MSUS) imaging in patients with chronic kidney disease (CKD) on regular hemodialysis and to evaluate associations of these changes with patients’ clinical status, parathyroid hormone (PTH) level as well as other laboratory parameters.

Patients and methods

This study was carried out on 35 patients and a group of 25 age-matched and sex-matched apparently healthy participants as a control group. All patients underwent history taking; clinical examination; and shoulder, knee, and ankle plain radiography. Laboratory investigations including PTH level were done. MSUS was performed on the selected tendons for all patients and controls.


The ankle was the most clinically affected joint. US abnormalities most commonly affected the Achilles tendon (15.2%) having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure, followed by the quadriceps tendon (2.9%), whereas the supraspinatus tendon was the least affected (2.3%). There were highly statistically significant differences between patients with CKD and controls regarding mean tendon thickness, with the quadriceps tendon and supraspinatus tendons being thicker in the study group (P<0.001). Significant positive correlations of PTH level with age, the duration of dialysis, and PO4 level were observed.


There were significant tendon involvements among patients with CKD with the Achilles tendon mostly involved having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure. Tendon abnormalities occurred mainly in older patients with longer durations of dialysis, hypercalcemia (Ca), hyperphosphatemia (PO4), and a higher Ca×PO4 product. MSUS is a simple, noninvasive, and a substantial tool in the diagnosis and follow-up of tendon involvement among patients with CKD.


  1. Allavena P, Giovanni G, Mantovani A. Molecular links between inflammation and cancer. Syst Biol Cancer 2015; 2:273–281.

    Article  Google Scholar 

  2. Allon M. Evidence-based cardiology in hemodialysis patients. J Am Soc Nephrol 2013; 24:1934–1943.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Yuen KN, Ananthakrishnan S, Campbell MJ. Hyperparathyroidism of renal disease. Perm J Summer 2016; 20:78–83.

    Google Scholar 

  4. El-Desoky A, Sherif M. Subcutaneous nodules in a child on long-term dialysis: Answers. Pediatr Nephrol 2014; 29:1177.

    Article  Google Scholar 

  5. Chew K, Stevens KJ, Wang TG, Fredericson M, Lew HL. Introduction to diagnostic musculoskeletal ultrasound, examination of the lower limb. Am J Phys Med Rehabil 2008; 87:238–248.

    Article  PubMed  Google Scholar 

  6. Geraldino-Pardilla L, Gartshteyn Y, Piña P, Marina C, Jon TG, Afshin Z, Joan MB, et al. ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis. Lupus Sci Med 2016; 3:168.

    Article  Google Scholar 

  7. Sharma SK, Rathi M, Sahoo S, Prakash M, Dhir V, Singh S. Assessment of premature atherosclerosis in systemic lupus erythematosus patients with and without nephritis. Lupus 2015; 25:525–531.

    Article  PubMed  Google Scholar 

  8. Onut R, Balanescu AP, Constantinescu D, Calmac L, Marinescu M, Dorobantu PM. Imaging atherosclerosis by carotid intima-media thickness in vivo: how to, where and in whom? Maedica 2012; 7:153–162.

    PubMed  PubMed Central  Google Scholar 

  9. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64:2677–2686.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hussein DA, El-Azizi NO, Abdel Meged AH, Al-Hoseiny SA, Hamada AM, Sabry MH. Ultrasonographic tendon alteration in relation to parathyroid dysfunction in chronic hemodialysis patients. Clin Med Insights: Arthritis Musculoskelet Disord 2015; 8:9–14.

    Google Scholar 

  11. Maxime A, Dougados F. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2014; 73:62–68.

    Google Scholar 

  12. Magee DJ. Orthopedic physical assessment. Elsevier Health Sci 2014; 6:36–39.

    Google Scholar 

  13. Rutten M, Spaargaren G, Loon T, de Wall Maletif MC, Lambert ALM, Jager GJ. Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol 2010; 20:450–457.

    Article  PubMed  Google Scholar 

  14. Nikpour M, Urowitz MB, Ibanez D, Harvey PJ, Gladman DD. Importance of cumulative exposure to elevated cholesterol and blood pressure in development of atherosclerotic coronary artery disease in systemic lupus erythematosus: a proof of-concept cohort study. Arthritis Res Ther 2011; 13:156.

    Article  Google Scholar 

  15. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001; 44:331–337.

    Article  Google Scholar 

  16. Karina de L, Andries J, Eric de G, van Roon AM, Cees G, Marc B. Longitudinal study on premature atherosclerosis in patients with systemic lupus erythematosus. Atherosclerosis 2009; 206:546–550.

    Article  Google Scholar 

  17. El Saadany H, El-Sergany M, Kasem E, El-Batch M. Biochemical and genetic risk factors for atherosclerosis in systemic lupus erythematosus. Egypt Rheumatol 2011; 12:3335–3343.

    Google Scholar 

  18. Ali U, Adem K, Abdullah I, Erkan C, Davut S, Sevket A, Rabia A. Plasma atherogenic index is an independent indicator of subclinical atherosclerosis in systemic lupus erythematosus. Eurasian J Med 2017; 49:193–197.

    Article  Google Scholar 

  19. Botter LA, Barbosa RA, Sicca JA, George OR. Ultrasonography evaluation of tendon thickness in hemodialysis patients. Einstein 2006; 4:303–308.

    Google Scholar 

  20. Nasri H, Kheiri S. Effects of diabetes mellitus, age, and duration of dialysis on parathormone in chronic hemodialysis patients. Saudi J Kidney Dis Transplat 2008; 19:608–613.

    Google Scholar 

  21. Isaka Y, Yoshitsugu T, Atsushi T, et al. Hyperuricemia-induced inflammasome and kidney diseases. Nephrol Dial Transplant 2015; 31: 890–896.

    Article  PubMed  Google Scholar 

  22. Kannus P, Józsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 1991; 73: 1507–1525.

    Article  CAS  PubMed  Google Scholar 

  23. Bardin T. Musculoskeletal manifestations of chronic renal failure. Curr Opin Rheumatol 2003; 15: 48–54.

    Article  PubMed  Google Scholar 

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Correspondence to Rasha M. Fawzy PhD.

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Abdelomnem, S.M., Egila, S.E., Fawzy, R.M. et al. Assessment of tendon involvement in chronic hemodialysis patients: an ultrasonographic study. Egypt Rheumatol Rehabil 46, 154–161 (2019).

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