A Clinical and Electrophysiological Study of Peripheral Neuropathies in Predialysis and Dialysis Patients: Our Experience from South India.

OBJECTIVE

To study the prevalence, clinical features, electrophysiological features and severity of peripheral neuropathy in chronic kidney disease (CKD) patients.

METHODS

Between May 2015 and December 2016, 200 CKD patients and 25 controls were assessed prospectively.

RESULTS

Prevalence of peripheral neuropathy in CKD patients was 50% based on clinical symptoms and 89% based on electrophysiological studies. Mean age of 200 CKD patients was 54.1 ± 11.9 years. 135 (67.5%) were male and 65 (32.5%) were female. Mean duration of disease was 4.2 ± 3.7 years. Positive sensory, negative sensory and autonomic symptoms were seen in 97(48.5%), 77(38.5%) and 17(8.5%) patients respectively. Symptomatic neuropathy was common in peritoneal dialysis patients. Definite and early damage was seen in 133 (66.5%) and 45 patients (22.5%) respectively, while 22 patients (11%) had no significant peripheral neuropathy. In predialysis patients (n=100); 63 (63%) had definite damage and 24(24%) had early damage. In peritoneal dialysis patients (n=50); 34(68%) had definite damage and 8(16%) had early damage. In hemodialysis patients (n=50); 36(72%) had definite damage and 13(26%) had early damage. Hemodialysis group (98%) showed more severe peripheral neuropathy. Most common nerves involved were sural, ulnar sensory, median sensory, common peroneal and posterioir tibial in CKD. Axonal and mixed sensorimotor neuropathy patterns were most common patterns in CKD.

CONCLUSION

Peripheral neuropathy is common in CKD with highest prevalence and severity in hemodialysis group. Symptomatic peripheral neuropathy is common in peritoneal dialysis group. Newer treatment modalities are required to manage uremic neuropathy in early stage.