Osteoarticular pathology in hemodialysis patients: A study about 22 patients

Background: Chronic kidney disease (CKD), particularly in its end-stage (ESKD), is associated with multiple systemic complications, among which osteoarticular disorders represent a major cause of morbidity. These complications are largely driven by CKD-related mineral and bone disorders (CKD-MBD), long-term dialysis exposure, and metabolic disturbances.
Objective: To describe the epidemiological, clinical, radiological, and therapeutic characteristics of osteoarticular complications in chronic hemodialysis patients, and to analyze the underlying pathophysiological mechanisms. 
Methods: We conducted a retrospective, descriptive, single-center study including 22 patients on maintenance hemodialysis treated for osteoarticular disorders between 2018 and 2024. Data regarding demographics, clinical presentation, imaging findings, biological parameters, and management were analyzed.
Results: The mean age was 55 years with a slight male predominance. Fractures were the most frequent complication (68.2%), predominantly affecting the femur. Quadriceps tendon ruptures were observed in 22.7% of cases, frequently bilateral, and carpal tunnel syndrome in 9.1%. Radiological findings included fractures (75%), calcifications, and bone demineralization. Biological abnormalities were consistent with CKD-MBD, including hypocalcemia (67%), hyperphosphatemia (79%), and elevated parathyroid hormone levels (52.9%). Surgical management was required in most cases. One-year mortality following lower limb fractures was significant.
Conclusion: Osteoarticular complications in hemodialysis patients are frequent and severe, reflecting complex metabolic and structural bone alterations. Early diagnosis and multidisciplinary management are essential to reduce morbidity and improve functional outcomes.