Surreal illustration linking dialysis, spine, and destructive change.

Dialysis and Your Spine: Understanding and Managing Neck Pain

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"A 9-Year Study Reveals How Long-Term Hemodialysis Impacts Cervical Spine Health"

For individuals with chronic renal failure, hemodialysis serves as a crucial lifeline, extending both survival rates and opportunities for social engagement. However, this life-sustaining treatment also brings potential complications, including bone and joint disorders. Among these, destructive spondyloarthropathy (DSA) stands out as a significant spinal condition linked to long-term hemodialysis.

Destructive spondyloarthropathy (DSA) can lead to severe neck pain and neurological deficits, sometimes requiring surgical intervention. While understanding the progression of DSA is vital for effective treatment, longitudinal studies tracking its natural course remain limited.

This article explores the radiological changes occurring in the cervical spine over a 9-year period in patients undergoing long-term hemodialysis. By analyzing these changes and associated clinical symptoms, we aim to shed light on the factors contributing to DSA and inform better management strategies.

What Causes Neck Pain and Spinal Issues in Long-Term Dialysis?

Surreal illustration linking dialysis, spine, and destructive change.

Research suggests that the primary culprit behind DSA is the accumulation of β2-microglobulin. In individuals with chronic renal failure undergoing long-term hemodialysis, this substance deposits in articular, periarticular, and perineural tissues due to the kidneys' and dialysis columns' inability to filter it effectively.

The presence of advanced glycation end products (AGEs) further exacerbates the issue. AGEs not only modify β2-microglobulin but also trigger the production of TNF alpha and IL-1β. These inflammatory cytokines then activate osteoclasts and chondroclasts, leading to bone resorption and the destructive changes characteristic of DSA.

β2-microglobulin deposits in joints and tissues.
AGEs modify β2-microglobulin, increasing inflammation.
TNF alpha and IL-1β activate bone-destroying cells.

While the deposition of AGEs and β2-microglobulin is a key factor, it doesn't fully explain DSA's pathogenesis. Interestingly, a patient's age at the onset of hemodialysis appears to play a significant role in the progression of destructive changes. This suggests that aging itself contributes to the development of DSA, making older individuals more vulnerable to these complications.

Key Takeaways: Managing Spinal Health During Long-Term Dialysis

A 9-year study highlights the progression of destructive changes in the cervical spine of long-term hemodialysis patients. While the duration of dialysis may not directly correlate with these changes, older patients at the onset of hemodialysis are more susceptible.

Destructive changes commonly occur in the lower cervical spine, often limited to one or two disc levels. Although clinical symptoms may vary, they don't always align with the severity of radiological findings.

Given the potential for complications and high mortality rates associated with surgery, careful patient selection based on disability, general condition, and prognosis is crucial. Regular monitoring and proactive management can help mitigate the risks of spinal issues in individuals undergoing long-term hemodialysis.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2152/jmi.64.68, Alternate LINK

Title: Radiographic Changes Of Cervical Destructive Spondyloarthropathy In Long-Term Hemodialysis Patients: A 9-Year Longitudinal Observational Study

Subject: General Biochemistry, Genetics and Molecular Biology

Journal: The Journal of Medical Investigation

Publisher: University of Tokushima Faculty of Medicine

Authors: Akihiro Nagamachi, Mitsuhiko Takahashi, Noriaki Mima, Keisuke Adachi, Kazumasa Inoue, Subash C. Jha, Akihiro Nitta, Masatoshi Morimoto, Tomoya Takasago, Toshiyuki Iwame, Keizo Wada, Fumitake Tezuka, Kazuta Yamashita, Humio Hayashi, Ryo Miyagi, Toshihiko Nishisyo, Ichiro Tonogai, Tomohiro Goto, Yoichiro Takata, Toshinori Sakai, Kosaku Higashino, Takashi Chikawa, Koichi Sairyo

Published: 2017-01-01

Everything You Need To Know

Why do people on long-term dialysis often experience neck pain and spinal problems?

Long-term hemodialysis can lead to spinal issues like destructive spondyloarthropathy (DSA). This is primarily due to the accumulation of β2-microglobulin in joints and tissues because the kidneys and dialysis columns can't effectively filter it. Additionally, advanced glycation end products (AGEs) modify β2-microglobulin, increasing inflammation by triggering TNF alpha and IL-1β, which then activate osteoclasts and chondroclasts, leading to bone destruction. Patient's age at the onset of hemodialysis also plays a significant role.

What is destructive spondyloarthropathy (DSA), and how does it impact the cervical spine?

Destructive spondyloarthropathy (DSA) can cause severe neck pain and neurological deficits, potentially requiring surgery. The progression of DSA involves radiological changes in the cervical spine, including bone resorption and destructive changes due to the activation of osteoclasts and chondroclasts. These changes are often observed over time in patients undergoing long-term hemodialysis. The role of longitudinal studies is vital in understanding the natural course of DSA.

What exactly causes the destructive changes in the spine for individuals undergoing hemodialysis?

Research indicates that the accumulation of β2-microglobulin is a primary factor in DSA. This substance deposits in articular, periarticular, and perineural tissues. Additionally, advanced glycation end products (AGEs) modify β2-microglobulin, triggering the production of TNF alpha and IL-1β, inflammatory cytokines that activate osteoclasts and chondroclasts, leading to bone destruction. While these depositions are key, a patient's age at the onset of hemodialysis also plays a significant role in DSA's progression.

What did the 9-year study reveal about spinal health in patients undergoing long-term hemodialysis?

The 9-year study highlighted that while the duration of dialysis may not directly correlate with destructive changes in the cervical spine, older patients at the onset of hemodialysis are more susceptible to these changes. Factors such as β2-microglobulin accumulation and the presence of advanced glycation end products (AGEs) exacerbate the issue, leading to increased inflammation and bone destruction. Managing spinal health during long-term dialysis requires careful monitoring and consideration of these factors.

Besides managing β2-microglobulin, what other management strategies are vital for spinal health during long-term dialysis, and what is missing?

While the study emphasizes the impact of β2-microglobulin, advanced glycation end products (AGEs), and inflammatory cytokines like TNF alpha and IL-1β, it only touches upon potential management strategies. Comprehensive spinal health management during long-term dialysis would ideally involve interventions to reduce β2-microglobulin accumulation, manage AGEs, and control inflammation. Further research and clinical guidelines are needed to address these areas more effectively.