Division of Nephrology, Indiana University, Indianapolis, IN, United States of America.
University of Pittsburgh, Pittsburgh, PA, United States of America.
PLoS One. 2020 Dec 15;15(12):e0242406. doi: 10.1371/journal.pone.0242406. eCollection 2020.
Sensory and motor nerve deficits are prevalent in older adults and are associated with loss of functional independence. We hypothesize that chronic kidney disease predisposes to worsening sensorimotor nerve function over time.
Participants were from the Health, Aging and Body Composition Study (N = 1121) with longitudinal data between 2000-01 (initial visit) and 2007-08 (follow-up visit). Only participants with non-impaired nerve function at the initial visit were included. The predictor was presence of CKD (estimated GFR ≤ 60 ml/min/1.73m2) from the 1999-2000 visit. Peripheral nerve function outcomes at 7-year follow-up were 1) Motor: "new" impairments in motor parameters (nerve conduction velocity NCV < 40 m/s or peroneal compound motor action potential < 1 mv) at follow-up, and 2) Sensory: "new" impairment defined as insensitivity to standard 10-g monofilament or light 1.4-g monofilament at the great toe and "worsening" as a change from light to standard touch insensitivity over time. The association between CKD and "new" or "worsening" peripheral nerve impairment was studied using logistic regression.
The study population was 45.9% male, 34.3% Black and median age 75 y. CKD participants (15.6%) were older, more hypertensive, higher in BMI and had 2.37 (95% CI 1.30-4.34) fold higher adjusted odds of developing new motor nerve impairments in NCV. CKD was associated with a 2.02 (95% CI 1.01-4.03) fold higher odds of worsening monofilament insensitivity. CKD was not associated with development of new monofilament insensitivity.
Pre-existing CKD leads to new and worsening sensorimotor nerve impairments over a 7-year time period in community-dwelling older adults.
感觉和运动神经缺陷在老年人中很常见，并且与功能独立性丧失有关。我们假设慢性肾脏病随着时间的推移会导致感觉运动神经功能恶化。
参与者来自健康、衰老和身体成分研究（N=1121），在 2000-01 年（初始访视）和 2007-08 年（随访访视）之间有纵向数据。只有在初始访视时神经功能无损伤的参与者才被包括在内。预测因子是 1999-2000 年访视时存在 CKD（估算肾小球滤过率≤60ml/min/1.73m2）。7 年随访时的周围神经功能结果为：1）运动：在随访时出现新的运动参数（神经传导速度<40m/s 或腓总复合运动动作电位<1mv）的损害，2）感觉：新的损害定义为对标准 10g 单丝或轻 1.4g 单丝在大脚趾处不敏感，“恶化”定义为随着时间的推移从轻触不敏感到标准触不敏感的变化。使用逻辑回归研究 CKD 与“新”或“恶化”周围神经损伤之间的关系。
研究人群中 45.9%为男性，34.3%为黑人，中位年龄为 75 岁。CKD 参与者（15.6%）年龄较大，更多的高血压，BMI 较高，调整后的新运动神经损伤的 NCV 新发病率的优势比为 2.37（95%CI 1.30-4.34）倍。CKD 与轻触不敏感向标准触不敏感恶化的优势比为 2.02（95%CI 1.01-4.03）倍。CKD 与新发单丝不敏感无关。
在社区居住的老年人中，预先存在的 CKD 会导致新的和恶化的感觉运动神经损伤，在 7 年的时间内。
