Comparison of ultrasonic changes in achilles tendon and determination of related factors in chronic and non-dialysis dialysis patients

Musculoskeletal problems include motor movement constraints in hemodialysis patients, which affects their quality of life. Ultrasonography is currently used to evaluate superficial tendons and ligaments attached to the joint. The aim of this study was to determine the frequency and Achilles tendon’s changes as an example of tendon involvement in patients with renal failure under regular hemodialysis using ultrasound examination and its related factors.

This case-control study was performed among healthy individuals and patients referred to hemodialysis unit in dialysis unit of Rasoul Akram hospital in a period of one year (from April 2017 to April 2018). The inclusion criteria were end stage renal disease (ESRD) and regular hemodialysis for at least 6 months three times a week and 4 hours each session. Patients were excluded from the study because of systemic inflammatory disease, such as rheumatoid arthritis, systemic lupus erythematosus as the cause of renal failure, previous trauma and bone fracture, TB disease. The control group was selected among healthy volunteers. An ultrasound evaluation was performed using probes with dynamic and linear array scanners with a frequency of 12 MHz.

Thirty patients and 30 healthy subjects were enrolled. In the ultrasonography of the tendon in patients, the median and proximal areas of the right and left Achilles were compared in two groups. The ultrasonic indexes of the different parts of the Achilles tendon were higher in the patients than healthy subjects. Of course, this difference was statistically significant only in the left Achilles proximal area. In general, the elastography of left and right Achilles tendon was lower in the healthy group. There was no correlation between the mean elastography of right and left Achilles tendon with age and PTH in participant groups.

Finally, the findings from the study showed that in the patients’ group, the thickness and area of Achilles tendon and left ventricle were higher than the control group. Also, evaluation of elastography indices showed tenderness of elasticity of tendon in dialysis patients compared to healthy subjects.