Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients With End-Stage Renal Disease

Abstract

Prognostic level III, comparative study.

A case of bilateral Achilles tendon spontaneous rupture in a hemodialysis patient: Who is the real culprit? Acidosis? Or hyperparathyroidism?

“…In patients with chronic renal failure, the tendon rupture occurred at a younger age as compared to patients with other etiologies [5]. The average age of patients from one series was 52 years [9]. The most frequently affected tendon was the quadriceps tendon followed by the patellar tendon and the Achilles tendon [4].…”

“…The spontaneous ATR in hemodialysis patients is a rare complication. The majority of these patients have additional predisposing factors, such as secondary hyperparathyroidism (HPTH), diabetes mellitus, obesity, rheumatoid arthritis, gout, statins, steroids, fluoroquinolones, and the presence of B and/or C hepatitis virus [9].…”

Common Questions and Misconceptions in the Management of Renal Transplant Patients: A Guide for Health Care Providers in the Posttransplant Setting

“…Although the prevalence of fluoroquinolone-associated tendinopathy is estimated to be only 0.14% to 0.4 % in the general population, 60 factors such as age of 60 years and older and concomitant use of systemic corticosteroids may increase this risk. 62,65-68 In one population-based case-control study, the adjusted odds ratio for Achilles tendon rupture within 30 days of fluoroquinolone exposure increased from 4.3 (95% CI = 2.4-7.8) in the overall population to 6.4 (95% CI = 3.0-13.7) and 20.4 (95% CI = 4.6-90.1) in patients aged 60 to 79 years and 80 years or older, respectively. 62 In patients with concomitant oral corticosteroid use, the adjusted odds ratio increased to 17.5 (95% CI = 5.0-60.9).…”

“…62 Other potential risk factors include renal failure and diabetes mellitus. 60,67,68 Many renal transplant recipients have one or more of the aforementioned risk factors for fluoroquinolone-associated tendinopathy. This is important to consider when deciding between antimicrobial alternatives.…”

Short-Term Exposure to Ciprofloxacin Reduces Proteoglycan Loss in Tendon Explants

“…However, their use is associated with an increased risk of tendinopathy and rupture [ 2 ], particularly of the Achilles tendon (~90% of all cases [ 3 , 4 ]); a condition now commonly referred to as FQ-associated tendinopathy [ 5 ]. The risk is compounded in populations with an already elevated risk of developing tendinopathy such as those on concurrent systemic corticosteroid therapy [ 6 ], the elderly [ 7 ], and those with renal pathology [ 8 , 9 ]. Multiple FQs have been associated with development of tendinopathies however ciprofloxacin (CPX) has been implicated as one of the most common causative agents in the literature [ 3 , 7 , 10 ].…”