Hyaluronic Acid to treat arthritis in dialysis patients

Hello Dr. Agar,

I have been diagnosed with Grade 2 Osteoarthritis. This is causing me a lot of pain in my left knee. I was put on NSAIDS for a while but the pain keeps coming back. The Orthopedician has now suggested a shot of Hyaluronic Acid in my left knee. With regard to this:

  1. Are you aware of any side effects of Hyaluronic acid in dialysis patients (both the orthopedician and my nephrologist say they are not aware of any but they are not sure)?

  2. Do I need to do a heparin-free dialysis before or after taking the shot? (my nephrologist suggested that I do but the ortho feels it is not required)

Thanks in advance for your help!

  • Kamal

To be honest, Kamal, I have no experience of this option. I can’t see it being at all problematic from a renal/dialysis aspect, but I don’t know that for certain - it is just my best guess (bolstered by a brief literature search). Will it work? … no idea, but it clearly HAS been used - some reports suggesting with benefit. But, as best I can find out, it shouldn’t be a problem. As for needing to do a heparin-free dialysis preceding the procedure, I find myself agreeing with your orthopaedic surgeon, as I see no issue there. The procedure is pretty atraumatic, is unlikely to be associated with any bleeding, and as the half-life of heparin is short, by the time you are off dialysis and have made it to the surgeon, the effects of heparin will have largely dissipated anyway. I would do your dialysis as planned.