Destructive spondyloarthropathy (DSA) has recently been recognized in hemodialysis patients. This study was undertaken to assess the prevalence, preferred sites, risk factors, early radiological manifestations, magnetic resonance imaging (MRI) and relation to other radiological features and biochemical variables in DSA. In 405 patients undergoing dialysis for 0.2-20.5 years (average 8.2) with a mean age of 51.9 years (range 24-84), a diagnosis of DSA was made for 37 (9.1%). The preferred site of DSA was the lower cervical spine. MRI indicated a low signal intensity of the involved vertebral regions on both T₁ and T₂-weighted images and thus appeared useful in the exclusion of osteomyelitis showing high-intensity T₂-weighted images. The patients were divided into three groups according to radiological findings: those showing (A) the presence of DSA, (B) vertebral rim erosion (VRE) without DSA, and (C) the absence of DSA and VRE. Patient age at onset of dialysis (p < 0.01) and duration of hemodialysis (p < 0.05) appeared to be the associated risk factors for DSA. DSA was found correlated with carpal tunnel syndrome (p < 0.01), carpal bone cystic radiolucency (p < 0.01), and amyloid deposit (p < 0.01). All the groups were essentially the same with respect to the incidence of ectopic calcification, secondary hyperparathyroidism, biochemical markers and sex distribution. The results of this study show DSA to be associated with dialysis amyloidosis.

Background: This work aimed to examine the predictive value for death of various clinical variables after long-term hemodialysis (HD).Design, setting, participants, and measurements: A total of 947 patients (597 men and 350 women, aged 21 to 93 yr) who were undergoing maintenance HD in Niigata, Japan, were stratified into two cohorts: Those with >10 yr of prior HD at study enrollment (n ‫؍‬ 391) and those with <10 yr of previous therapy (n ‫؍‬ 556). The survival of patients was examined for up to 40 mo (1999 to 2003) with the Cox proportional hazards model. Baseline clinical and dialysis data and serum biochemistries were used as independent variables. For adjustment for bias in patient selection, patient survival in either cohort was analyzed separately.Results: In patients with >10 yr of HD, high pulse pressure, cerebrovascular disease, low serum creatinine, and low Kt/V values were the mortality risk predictors, whereas for those with <10 yr of HD, age and cerebrovascular disease were independent risk predictors for death. Diabetes, coronary artery disease, serum albumin, and C-reactive protein were NS predictors in those with long-term HD.Conclusions: Providing adequate dosage of dialysis and achieving a better control of pulse pressure may further improve survival in selected patients who had undergone HD for >10 yr.

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