Abnormal US findings of the shoulders in Mexican patients with end-stage renal disease: association with long-term hemodialysis

Abstract

Introduction: Ultrasound (US) findings of the shoulders of end-stage renal disease (ESRD) patients on hemodialysis therapy have been insufficiently researched. This study aimed to describe the abnormal US findings in Mexican patients with ESRD and their relationship with long-term hemodialysis treatment. Material and Methods: In this cross-sectional study, we performed US grayscale examination of the shoulders of adult ESRD patients. We assessed qualitative abnormal US findings, such as non-homogeneous and loss of the regular fibrillar pattern and hyperechogenic or hypoechogenic material in the tendons and/ or bursae. We also quantitatively assessed the thickening of the supraspinatus, subscapularis, and long head biceps (LHB) tendons of the rotator cuff (RC). Results: One hundred seventy shoulders from 85 ESRD patients on hemodialysis were examined. At least one US shoulder abnormality was found in 51 (60.0%) of the 85 patients. RC thickening was the most common abnormality (n = 49, 96.0%). The diameters of the supraspinatus, subscapularis, and LHB tendons were significantly thicker in ESRD patients with abnormal shoulder US findings. RC thickening was found in 44 (51.8%) of 85 right shoulders and 27 (31.8%) left shoulders. Eleven (27.0%) of the patients with less than 1 year of hemodialysis had no RC thickening in the right shoulders, while only 2 (5.0%) had thickening (p = 0.001). In the 1 to 3-year range of hemodialysis, 24 (59.0%) did not have RC thickening, while 18 (41.0%) had thickening. After 4 to 6 years of dialysis, 5 (12.0%) had no thickening, while 16 (36.0%) had thickening. In patients with more than 7 years of hemodialysis, only one (2.0%) had no RC thickening compared to 8 (18.0%) with thickening (p < 0.001). In the left shoulders, RC thickening was also significant with long-term hemodialysis (p < 0.004). Conclusion: This study showed a high frequency of abnormal US findings in the shoulders of ESRD patients on hemodialysis. Longer duration of hemodialysis was associated with RC thickening.