1998 Volume 31 Issue 1 Pages 31-36
To identify risk factors for destructive spondyloarthropathy (DSA) in hemodialysis patients, we performed a cross-sectional study of 314 patients undergoing long-term hemodialysis. DSA was found in 40 patients (12.7%), and occurred predominantly at the cervical spine, particularly between the 4th and 6th vertebrae (80%). Comparison of patients with DSA and without DSA indicated that patients with DSA were older, and that the duration of hemodialysis was longer in these patients than in those without DSA (61.2±1.5 vs 55.6±0.7 years old, P=0.005, 119±10 vs 91±4 months, P=0.007). DSA was also found in 9 patients with a history of hemodialysis of less than 6 years. Among the various parameters related to bone disorder, the existence of bone cysts and carpal tunnel syndrome were found to be significant risk factors for developing DSA (X2=35.2, P<0.0001; X2=12.4, P=0.0004; respectively), whereas no risk was observed with secondary hyperparathyroidism, hypoparathyroidism and osteoporosis. These results suggest that patients with a history of long-term dialysis and those with an advanced age are candidates for DSA. Furthermore, a close relationship between dialysis-related amyloidosis and DSA was suggested. Multivariate analysis revealed that only the bone cyst formation and the advanced age were significant risk factors for development of DSA; long-term hemodialysis and carpal tunnel syndrome were not selected. These results suggest that long-term hemodialysis might not be essential for the development of DSA. The patients who developed DSA despite a short hemodialysis history were aged (64.6±3.9 years), and the proportion of aged patients among those who newly started hemodialysis is increasing. Therefore, close examination of each patient is important to prevent the serious complications accompanied with severe DSA.
