Imaging in the dialysis patient: Dialysis Bone Disease

Abstract

The bone disease associated with end-stage renal failure (ESRD) and treatment are complex and multifactorial, and has changed in both clinical and imaging features over the past three decades. Whereas previously features of vitamin D deficiency (rickets/osteomalacia) and intense, and prolonged, secondary hyperparathyroidism (bone resorption, osteosclerosis, metastatic calcification) predominated, these features are now rarely evident radiologically. This has occurred through the better understanding of vitamin D metabolism and improvements in therapeutic management. However, metastatic calcification in soft tissues and 'adynamic" bone continue to be problematic. New complications have developed as a consequence of treatment (dialysis and transplantation), including amyloid deposition, noninfective sponyloarthropathy, osteonecrosis, and osteopenia/osteoporosis). Radiographs remain the most widely used imaging technique in examining for skeletal disease in patients with ESRD on maintenance dialysis. Occasionally, more sophisticated imaging (CT, MRI, nuclear medicine scanning) are helpful (parathyroid tumor localization, differentiation between infection and amyloid deposition). Developments in quantitative methods to assess bone density enable the effects of ESRD and treatment to be studied and monitored. Technical developments in computed tomography (rapid, multislice scanning) allow quantitation and monitoring of metastatic cardiac calcification in patients on hemodialysis, which has relevance to prognosis.

Unusual hand radiographic presentation in a patient on hemodialysis

“…Whereas previously, radiologic findings were more intense, improvements in therapeutic management of secondary hyperparathyroidism in hemodialysis result in significant decrease of radiologic evidence 2,3. In our case, bone alterations on hands are not typical of renal osteodystrophy.…”

A Comprehensive Review on Revivification for ESRD Patients - Haemodialysis

“…As a result of the therapy (dialysis and transplantation), new problems have emerged, including amyloid deposition, noninfective sponyloarthropathy, osteonecrosis, and osteopenia/ osteoporosis. [25] 2.5.8. ANEMIA: Patients with chronic renal disease frequently have the complication of anaemia.…”