Arnold Ria, Pianta Timothy J, Issar Tushar, Kirby Adrienne, Scales Caoimhe M K, Kwai Natalie C G, Endre Zoltan, Krishnan Arun V
Department of Exercise Physiology, School of Medical Sciences, UNSW Sydney, Sydney, Australia.
Department of Renal Medicine, Northern Health Epping, and Northern Clinical School, University of Melbourne, Melbourne, Australia.
Nephrol Dial Transplant. 2022 Mar 25;37(4):713-719. doi: 10.1093/ndt/gfab043.
Impaired physical function drives adverse outcomes in chronic kidney disease (CKD). Peripheral neuropathy is highly prevalent in CKD, though its contribution to physical function in CKD patients is unknown. This study examined the relationships between peripheral neuropathy, walking speed and quality of life (QoL) in stages 3 and 4 CKD.
This was a prospective observational study investigating neuropathy in CKD patients with an estimated glomerular filtration rate (eGFR) 15-60 mL/min/1.73 m2. A total of 109 patients were consecutively recruited. The presence and severity of peripheral neuropathy was determined using the total neuropathy score. Walking speed was assessed at both usual and maximal speed, and QoL was assessed using the Short- Form 36 (SF-36) questionnaire.
Peripheral neuropathy was highly prevalent: 40% demonstrated mild neuropathy and 37% had moderate-severe neuropathy. Increasing neuropathy severity was the primary predictor of reduced walking speed (R2 = -0.41, P < 0.001) and remained so after multivariable analysis adjustment for diabetes. This association was evident for both usual and maximal walking speeds. Neuropathy correlated significantly with low scores on multiple domains of SF-36 including physical function (r = -0.570, P < 0.001). Subanalysis according to diabetic status revealed a high prevalence of neuropathy both with and without diabetes; relationships to walking speed remained evident in subgroup analysis. However, those with diabetes demonstrated greater severity of neuropathy, slower walking speed and lower scores in QoL.
Moderate to severe peripheral neuropathy was common in stages 3 and 4 CKD, associated with reduced walking speed independent of diabetes status and was correlated with patient-reported QoL. This suggests that neuropathy is an important contributor to declining physical function in CKD irrespective of diabetes status. Targeted diagnosis and management of peripheral neuropathy during CKD progression may improve functional outcomes and QoL.
身体功能受损会导致慢性肾脏病（CKD）出现不良后果。周围神经病变在CKD中非常普遍，但其对CKD患者身体功能的影响尚不清楚。本研究调查了3期和4期CKD患者周围神经病变、步行速度和生活质量（QoL）之间的关系。
这是一项前瞻性观察性研究，调查估算肾小球滤过率（eGFR）为15 - 60 mL/min/1.73 m²的CKD患者的神经病变情况。共连续招募了109名患者。使用总神经病变评分来确定周围神经病变的存在和严重程度。评估平时和最快速度下的步行速度，并使用简短健康调查问卷36项（SF - 36）评估生活质量。
周围神经病变非常普遍：40%表现为轻度神经病变，37%为中度至重度神经病变。神经病变严重程度增加是步行速度降低的主要预测因素（R² = -0.41，P < 0.001），在对糖尿病进行多变量分析调整后依然如此。这种关联在平时和最快步行速度下均很明显。神经病变与SF - 36多个领域的低分显著相关，包括身体功能（r = -0.570，P < 0.001）。根据糖尿病状态进行的亚组分析显示，糖尿病患者和非糖尿病患者中神经病变的患病率都很高；在亚组分析中，与步行速度的关系依然明显。然而，糖尿病患者的神经病变更严重，步行速度更慢，生活质量得分更低。
3期和4期CKD中中度至重度周围神经病变很常见，与步行速度降低有关，且与糖尿病状态无关，还与患者报告的生活质量相关。这表明，无论糖尿病状态如何，神经病变都是CKD患者身体功能下降的重要因素。在CKD进展过程中针对性地诊断和管理周围神经病变可能会改善功能结局和生活质量。
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