Sonographic evaluation of entheseal sites of the lower extremity in patients undergoing hemodialysis

Kerimoglu, U.; Hayran, M.; Ergen, F.B.; Kirkpantur, A.; Turgan, C.

Journal of Clinical Ultrasound Jcu 35(8): 417-423


ISSN/ISBN: 0091-2751
PMID: 17663458
DOI: 10.1002/jcu.20411
Accession: 055853317

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To evaluate the entheseal sites of the lower extremities in patients on hemodialysis using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and to correlate the findings with the duration of hemodialysis and patient scores. Forty-nine patients who were on hemodialysis for at least 2 years were grouped according to duration of hemodialysis. Total GUESS scores; total enthesophyte, erosion, and bursitis scores; and tendon thicknesses were calculated, compared between groups, and correlated with duration of dialysis. There was a statistically significant correlation between duration of hemodialysis and total GUESS score (p < 0.001, r = 0.81) and also between the total enthesophyte and erosion scores (p < 0.001). If severe enthesitis was defined as a total GUESS score of more than 18, receiver operating characteristic (ROC) curve analysis revealed that a cutoff point of 10 years for the duration of hemodialysis would predict severe enthesal damage with 83% sensitivity and 93% specificity (area under the ROC curve, 0.92; 95% confidence interval, 0.83-1.00). Hemodialysis results in entheseal site changes that worsen with extended duration of hemodialysis, especially after 10 years.