Ultrasonographic alterations in Achilles tendon in relation to parathormone in chronic hemodialysis patients

Bone alterations and soft-tissue calcifications are often encountered in patients with end-stage renal disease and have been comprehensively investigated. Less common musculoskeletal manifestations, such as spontaneous tendon ruptures, have been sporadically reported. Their etiology and predisposing factors remain unknown.

Achilles tendons in 59 hemodialysis patients (mean age 60.3 +/- 12.4 years, mean duration of hemodialysis 4.6 +/- 3.1 years) and 42 Achilles tendons in 21 age- and sex-matched healthy controls were studied by high-resolution ultrasound. Ultrasonographic features were evaluated and compared. Clinical (duration of hemodialysis) and biochemical (serum intact parathormone levels) predictors were correlated to detected tendon abnormalities of the patient cohort.

Anteroposterior diameter of the Achilles tendon exceeded 6 mm at the distal and middle third in 30.5% and 32.2% of patients, respectively. Distorted tendon echostructure was found in 44.1% and calcific foci in 23.7%, while altered peritenon and pain during probe palpation were identified in 35.6% and 11.9% of patients, respectively. In the cohort of healthy controls, no defects were found. Abnormal tendon thickness was significantly more frequent in patients with parathormone levels >300 pg/mL and <150 pg/mL. Mean duration of hemodialysis of >6 years was significantly correlated to tendon abnormalities.

Ultrasonographic Achilles tendon abnormalities can be found in >30% of patients with end-stage renal disease, especially after a mean duration of hemodialysis of 6 years. Increased tendon thickness (>6 mm) characterizes patients with parathormone levels outside the recommended range of 150-300 pg/mL.