Dialysis-related Arthropathy in Patients on Long-term Hemodialysis: Radiographic Features

The purpose of this study was to evaluate the character and evolution of bone lesions attributable to amyloid deposition in patients on long-term dialysis. Thirty-five patients who were treated with hemodialysis for 5 to 22 years were studied by a review of medical records and hand radiographs. The frequency, distribution, character, and evolution of skeletal cyst-like lesions believed to be secondary to amyloid deposition were evaluated in relation to dialysis duration. The number and size of these lesions increased with dialysis duration, present in 28% of the patients after 5 through 9 years of hemodialysis and in 91% after 15 through 22 years. In contrast, the changes of hyperparathyroidism decreased. Of patients with skeletal wrist lesions, radiographs of symptomatic large joints were available in 15; five had bone abnormalities. Skeletal amyloid deposition was verified pathologically in nine sites (five patients). It is concluded that skeletal lesions believed to be due to amyloid deposition increase with dialysis duration and most commonly affect the wrists. They have a distinctive character, distribution, and evolution and are often associated with carpal tunnel syndrome.