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Tosberg JH, Mork H, Klimas R, Radermacher J, Schellinger PD, Philipps J. Nerve cross-sectional area in advanced uremic neuropathy: A nerve ultrasound pilot study. J Neuroimaging 2024; 34:486-492. [PMID: 38764165 DOI: 10.1111/jon.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/15/2024] [Accepted: 04/09/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND AND PURPOSE Uremic neuropathy (UN) is a disabling neuropathy in end-stage kidney disease (ESKD) affecting the majority of patients receiving long-term hemodialysis (HD). One previous nerve ultrasound study reported an increased cross-sectional area (CSA) of the median nerve in moderate UN, while another study found enlarged sural nerves in small-fiber polyneuropathy associated with ESKD. The present cohort study aims to analyze bilateral CSA of multiple nerves in UN. METHODS Ten nondiabetic ESKD patients with UN on HD for at least 2 years and 10 healthy age-matched controls underwent bilateral ultrasound examinations with CSA measurements in 13 arm and leg nerve sites. Nerve conduction studies (NCS) and the total neuropathy score (TNS) were recorded. Pearson's coefficient and the Mann-Whitney U-test were used to analyze correlations and compare groups. RESULTS ESKD patients presented advanced neuropathic symptoms (mean TNS 15.9). NCS showed significantly reduced motor and sensory amplitudes in the UN group compared to the control group, and a slightly reduced nerve CSA was observed in 5 of 13 nerve sites (p < .05); the other nerve sites were not enlarged. Sural nerve CSA (p < .05) and sensory amplitude (p < .01) were negatively correlated with the TNS. CONCLUSIONS Nerve enlargement was not observed in the present study in advanced UN. A reduced nerve CSA observed in the sural nerve suggests an axonal loss associated with long-term HD in ESKD. During clinical workup of an acute disease of the peripheral nervous system in ESKD patients, nerve enlargement might be attributable to other causes than chronic UN.
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Affiliation(s)
- Jan-Hendrik Tosberg
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
| | - Hannah Mork
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jörg Radermacher
- Department of Nephrology and Hemodialysis, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
| | - Peter Dieter Schellinger
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Bochum, Germany
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Cai XY, Li WL, Ge SW, Xu G. Peripheral Neuropathy Associated with Higher Mortality in Population with Chronic Kidney Disease: National Health and Nutrition Examination Surveys. KIDNEY DISEASES (BASEL, SWITZERLAND) 2024; 10:79-88. [PMID: 38751792 PMCID: PMC11095618 DOI: 10.1159/000535481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 11/18/2023] [Indexed: 05/18/2024]
Abstract
Introduction Peripheral neuropathy (PN), one of the commonest neurological complications of chronic kidney disease (CKD), was associated with physical limitation. Studies showed that a decrease in physical capability in patients with CKD is related with an increased risk of mortality. The objective of our research was to directly explore the relationship between PN and risk of mortality in patients with CKD. Method 1,836 participants with CKD and 6,036 participants without CKD, which were classified by PN based on monofilament examination in National Health and Nutrition Examination Survey (NHANES), were collected from the 1999 to 2004 National Health and Nutrition Examination Surveys. Multivariable Cox proportional hazard models were conducted to assess the relationships of PN and deaths in patients with CKD and non-CKD. Results During 14 years of a median follow-up from 1999 to 2015 and 2004 to 2015, 1,072 (58.4%) and 1,389 (23.0%) deaths were recorded in participants with CKD and without CKD, respectively. PN was related with increased all-cause mortality even after adjusting possible confounding factors in population with CKD (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.17-1.53) and without CKD (HR 1.27, 95% CI 1.12-1.43). And the adjusted HRs (95% CI) for cardiovascular mortality of the people with CKD and without CKD who suffered from PN were 1.42 (1.07, 1.90) and 1.23 (0.91, 1.67), respectively, versus those without PN. Conclusion PN was related with a higher risk of all-cause and cardiovascular death in people with CKD, which clinically suggests that the adverse prognostic impact of PN in the CKD population deserves attention and is an important target for intervention.
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Affiliation(s)
- Xiao-Yu Cai
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Lan Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sathiavageesan S, Murugan S. Accelerated neuropathy among chronic kidney disease patients undergoing hemodialysis: Analysis of an institutional cluster. Hemodial Int 2024; 28:188-197. [PMID: 38449056 DOI: 10.1111/hdi.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Accelerated neuropathy is a rare syndrome of rapidly worsening peripheral neuropathy, typically described in end-stage kidney disease (ESKD) patients undergoing dialysis. In our center, we encountered a surge in the occurrence of accelerated neuropathy among ESKD patients undergoing hemodialysis, which prompted systematic research. METHODS In this case-control study, we present the clinical features, electrophysiologic findings, and outcome of a series of patients who developed accelerated neuropathy after commencing hemodialysis for ESKD. Those who initiated hemodialysis and did not develop accelerated neuropathy were included as controls. We used logistic regression to identify predictors of accelerated neuropathy. RESULTS Among 436 ESKD patients who initiated hemodialysis over 4 years, 17 were diagnosed with accelerated neuropathy. The median-time (interquartile range) from hemodialysis initiation to presentation with accelerated neuropathy was 3 weeks (2-6). It typically presented as acute onset of unsteadiness of gait necessitating assistance for ambulation. Electrophysiology revealed length-dependent symmetric sensorimotor axonal neuropathy. Diabetes mellitus (odds ratio [OR] 4.1, 95% CI 1.2-13.9, p = 0.02), pre-existing peripheral neuropathy (OR 9.25, 95% CI 2.79-30.6, p < 0.001), and serum alkaline phosphatase (OR 1.2 for every 10 U increase, 95% CI 1.00-1.52, p = 0.04) significantly predicted accelerated neuropathy. With continued dialysis and supportive care, neurologic status improved, total-neuropathy score (summary score of peripheral nerve dysfunction incorporating clinical and electrophysiological parameters) declined from 26.5 to 18.4 (p < 0.001) and most regained unassisted ambulation. CONCLUSION This study presents the largest series of patients with accelerated neuropathy and has identified predictors. However, in view of the unusually high incidence of accelerated neuropathy we speculate that other unidentified factor(s) could be underlying its pathogenesis.
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Affiliation(s)
| | - Subramani Murugan
- Department of Medicine, Government KAPV Medical College, Trichy, India
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Ding J, Shi Q, Dong L, Su H, Du Y, Pan T, Zhong X. Association of HbA1c Variability with Vibrating Perception Threshold in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Study. Diabetes Metab Syndr Obes 2024; 17:193-202. [PMID: 38225978 PMCID: PMC10788684 DOI: 10.2147/dmso.s443917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/07/2024] [Indexed: 01/17/2024] Open
Abstract
Purpose To investigate the relationship between HbA1c variability and vibrating perception threshold (VPT) in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). Patients and Methods A total of 367 middle-aged and elderly patients with T2DM were enrolled. All patients were categorized into the control and vibration sensation deficiency group (VSD) based on VPT. Clinical data were collected. The coefficient of variation of glycated hemoglobin A1c (HbA1c-CV) and the mean glycated hemoglobin A1c(HbA1c-Mean) are considered as indexes of HbA1c variability. Multivariate logistic regression analysis, the generalized linear model and ROC curve correlation analysis were used to analyze the correlation of various factors and VPT. Results The multivariate logistic regression analysis revealed that age, systolic blood pressure (SBP), and HbA1c-CV were identified as risk factors for vibration sensation deficiency in middle-aged and elderly patients with T2DM, while estimated glomerular filtration rate (eGFR), triiodothyronine (T3), and alanine aminotransferase (ALT) were considered as protective factors. In the unadjusted generalized linear model, a significant association was observed between HbA1c-CV and VPT values. After adjusting for age, diabetic duration, SBP, homeostatic model assessment for beta-cell function (HOMA-β), ALT, eGFR, T3, 24-hour urinary protein excretion levels, and HbA1c-Mean, HbA1c-CV remained significantly correlated with VPT values on both sides. (left side, B=2.560, 95% CI 1.298~3.823; P<0.001; right side, B=2.608, 95% CI 1.498~3.718, P<0.001). The area under the curve (AUC) for HbA1c-CV and VSD prevalence was 0.723, with a sensitivity of 79.85%, specificity of 56.22%. Conclusion The risk of developing VSD increases proportionally with higher HbA1c-CV levels in middle-aged and elderly patients with T2DM. Reaching and maintaining blood glucose stability is essential to the mitigation of diabetes peripheral neuropathy occurrence.
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Affiliation(s)
- Jingcheng Ding
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Qian Shi
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Ling Dong
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Hong Su
- Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Yijun Du
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Tianrong Pan
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
| | - Xing Zhong
- Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, 230601, People’s Republic of China
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Chiu LT, Lin YL, Wang CH, Hwu CM, Liou HH, Hsu BG. Electrochemical Skin Conductance by Sudoscan in Non-Dialysis Chronic Kidney Disease Patients. J Clin Med 2023; 13:187. [PMID: 38202194 PMCID: PMC10779764 DOI: 10.3390/jcm13010187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Peripheral neuropathy is prevalent among patients with chronic kidney disease (CKD). Sudoscan non-invasively detects polyneuropathy by measuring electrochemical skin conductance (ESC). We conducted a study on sudomotor function in CKD patients across various stages based on their estimated glomerular filtration rate (eGFR). METHODS In this cross-sectional study of 700 CKD patients, all underwent Sudoscan. Pathological ESC was defined as hands < 40 μS or feet < 50 μS. Clinical neuropathy scores including Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique en 4 questionnaire (DN4) were obtained. RESULTS Among participants, 344 had diabetes and 356 did not. Hands and feet ESC decreased with CKD progression (median (IQR) in stage 1-2, 3, 4-5: 54.0 (39.0-68.0), 45.5 (30.0-63.0), 41.8 (26.5-60.5), p trend < 0.001; 64.5 (53.5-74.0), 60.5 (43.0-72.5), 55.0 (39.0-69.8), p trend < 0.001). Pathological hands and feet ESC increased in later CKD stages (stage 1-2, 3, 4-5: 26.6%, 40.9%, 45.7%, p trend < 0.001; 21.7%, 34.0%, 40.6%, p trend < 0.001). Positive hands and feet ESC-eGFR correlation existed irrespective of diabetes. Diabetic patients had lower hands and feet ESC than non-diabetics as CKD progressed. However, multivariate regression found no significant ESC-eGFR association. Sudoscan correlated with clinical neuropathy scores. CONCLUSION Pathological sudomotor function was common in non-dialysis CKD stages 4-5. Diabetic patients had worse function. Sudomotor dysfunction progressed with renal disease but eGFR was not an independent risk factor.
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Affiliation(s)
- Liang-Te Chiu
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
| | - Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (Y.-L.L.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (Y.-L.L.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chii-Min Hwu
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Medicine, Hsin-Jen Hospital, New Taipei City 242009, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (Y.-L.L.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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Ramachandran M, Subramanian V, Kuppusamy S, Parameswaran S, Chinnakali P, Vairappan B. The Burden of Peripheral Neuropathy in Nondiabetic Chronic Kidney Disease and the Role of Ghrelin Isoforms in its Development. Indian J Nephrol 2022; 32:567-573. [PMID: 36704594 PMCID: PMC9872928 DOI: 10.4103/ijn.ijn_557_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/18/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Peripheral neuropathy is one of the most common complications in chronic kidney disease (CKD). The neuroprotective role of ghrelin is being explored recently. Here we aim to determine the burden of neuropathy in nondiabetic CKD and to find the association of peripheral nerve function with plasma ghrelin levels in these patients. Methods This was a cross-sectional study conducted in nondiabetic CKD patients on conservative management to determine the magnitude of neuropathy. The association of ghrelin isoforms with nerve functions was assessed between three groups, namely CKD with neuropathy, CKD without neuropathy, and healthy volunteers, with 20 participants in each group. Results The proportion of neuropathy in nondiabetic CKD was 78% (n = 78), of which 51% (n = 40) were asymptomatic. Des acyl ghrelin (DAG) and total ghrelin (TG) levels were 1545.5 ± 487.4 and 1567.4 ± 485.3 pg/mL, respectively, in CKD patients with neuropathy and were found to be elevated compared to those without neuropathy, who had 1000.4 ± 264.2 and 1019.7 ± 264.3 pg/mL of DAG and TG, respectively (P < 0.001). Assessment of correlation between nerve conduction parameters and DAG levels showed positive correlation between DAG levels and common peroneal latency (r = 0.69; P < 0.01), median sensory latency (r = 0.45; P < 0.05), and sural latency (r = 0.51; P < 0.05). We found negative correlation between median velocity (r =-0.56; P < 0.05), common peroneal velocity (r = -0.64; P < 0.01), median sensory velocity (r =-0.49; P < 0.05), and sural velocity (r = -0.54; P < 0.05). There was no statistically significant difference in acyl ghrelin levels among the groups. Conclusion The prevalence of peripheral neuropathy in CKD is significantly higher with almost half of them being asymptomatic. Impaired renal clearance in CKD leads to the accumulation of DAG, which subsequently inhibits the neuroprotective functions of AG leading to neuropathy in CKD.
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Affiliation(s)
- Madumathy Ramachandran
- Department of Physiology, All India Institutes of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Velkumary Subramanian
- Department of Physiology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Saranya Kuppusamy
- Department of Physiology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Balasubramaniyan Vairappan
- Department of Biochemistry, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Pondicherry, India
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Khafagi AT, Yehia MA, Helmy AK, Hassan W, Abdelhakim N. Effect of Erythropoietin-stimulating agent on uremic neuropathy in hemodialysis patients: a single-center open-label prospective study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Uremic neuropathy is a distal sensorimotor polyneuropathy caused by uremic toxins; its severity is correlated with the degree of renal insufficiency. Erythropoietin (EPO) and erythropoietin receptors (EpoR) are produced in the peripheral nervous system. This is a single-center open-label prospective study was designed to investigate the possible effect of erythropoietin-stimulating agents (ESAs) on uremic neuropathy. Twenty-four newly diagnosed end-stage kidney disease (ESKD) patients were selected, clinical assessment, laboratory, and neurophysiological study were done at 1 and follow-up after 3 months. Patients were divided into two groups (group A received ESA and group B did not receive ESA).
Results
Eighteen patients completed the study, eight patients (44.4%) did not have symptoms but had electrophysiological findings of neuropathy (subclinical neuropathy). After 3 months of hemodialysis, patients in group A showed improvement of some electrophysiological features (ulnar MNCV; P = 0.016).
Conclusions
The use of ESA may improve uremic neuropathy in patients with newly diagnosed ESKD who have been started on hemodialysis.
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Sonbhadra A, Reddy BVC, Saini AG, Tiewsoh K, Paria P, Kesavan S, Suthar R, Dawman L, Attri S. Peripheral Neuropathy in Children With Chronic Kidney Disease: Are We Looking Enough? Ann Indian Acad Neurol 2022; 25:389-393. [PMID: 35936645 PMCID: PMC9350774 DOI: 10.4103/aian.aian_1067_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/26/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Peripheral neuropathy in chronic kidney disease (CKD) is the most common neurological complication. We aimed to look at the prevalence and patterns of neuropathy in children with CKD. Methods: This cross-sectional study was conducted over 1 year in children with CKD, stage III and above. Nerve conduction studies (NCS) were performed as per standard protocols using surface electrodes on the muscles and by supramaximal stimulation of the corresponding nerves. Presence of electrophysiological abnormalities in the absence of clinical symptoms or signs was considered as subclinical neuropathy. Results: Nearly 45 children were evaluated. The majority were males (n = 39, 86.7%). The mean age was 7.9 ± 3 years (range 2–14). The mean estimated glomerular filtration rate (GFR) at enrolment was 23.3 ± 14.6 mL/min/1.73 m2 (range 5–67). The majority of children were in stage III (n = 19, 42%), followed by stages V (n = 15, 33%) and IV (n = 11, 25%). There was no evidence of clinical neuropathy; 13 children (29%) showed subclinical neuropathy. All the nerves had an axonal pattern of involvement. Motor polyneuropathy was most common type of peripheral neuropathy. The commonest nerves involved were tibial and common peroneal nerves. There were no biochemical or clinical predictors of neuropathy in our cohort. Conclusion: The prevalence of subclinical neuropathy is high in children with CKD, stage III and above. Axonal motor polyneuropathy is the predominant pattern. Electrophysiological assessment of nerve function should be routinely done in children with advanced stages of CKD to prevent chronic complications.
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Affiliation(s)
- Ahibhushan Sonbhadra
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bandi V Chaithanya Reddy
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi G Saini
- Department of Pediatrics, Pediatric Neurology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kara Tiewsoh
- Department of Pediatrics, Pediatric Nephrology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradip Paria
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivan Kesavan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Department of Pediatrics, Pediatric Neurology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lesa Dawman
- Department of Pediatrics, Pediatric Nephrology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Severe neuropathy in a sickle cell disease patient on chronic hemodialysis (a nephro-neurology zebra). J Nephrol 2022; 35:1531-1533. [PMID: 35476299 DOI: 10.1007/s40620-022-01310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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10
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Peters J, Staff NP. Update on Toxic Neuropathies. Curr Treat Options Neurol 2022; 24:203-216. [PMID: 36186669 PMCID: PMC9518699 DOI: 10.1007/s11940-022-00716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Toxic neuropathies are an important preventable and treatable form of peripheral neuropathy. While many forms of toxic neuropathies have been recognized for decades, an updated review is provided to increase vigilant in this area of neurology. A literature review was conducted to gather recent information about toxic neuropathies, which included the causes, clinical findings, and treatment options in these conditions. Recent Findings Toxic neuropathies continue to cause significant morbidity throughout the world and the causative agents, particularly with regards to medications, do not appear to be diminishing. A wide variety of causes of toxic neuropathies exist, which include alcohol, industrial chemicals, biotoxins, and medications. Unfortunately, no breakthrough treatments have been developed and prevention and symptom management remain the standard of care. Summary A detailed medication, occupational and hobby exposure history is critical to identifying toxic neuropathies. Increased research is warranted to identify mechanisms of neurotoxic susceptibility and potential common pathomechanistic pathways for treatment across diverse toxic neuropathies.
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Affiliation(s)
- Jannik Peters
- Department of Neurology, Mayo Clinic Rochester, MN USA
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Gollie JM, Patel SS, Harris-Love MO, Cohen SD, Blackman MR. Fatigability and the Role of Neuromuscular Impairments in Chronic Kidney Disease. Am J Nephrol 2022; 53:253-263. [PMID: 35344954 PMCID: PMC9871956 DOI: 10.1159/000523714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/16/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The combination of neuromuscular impairments plus psychosocial aspects of chronic kidney disease (CKD) may predispose these patients to greater risk for experiencing increased levels of fatigability. There has been extensive clinical and scientific interest in the problem of fatigue in CKD and end-stage kidney disease (ESKD) patients, whereas less attention has been directed to understanding fatigability. Accordingly, the primary purposes of this review are to (1) discuss fatigue and fatigability and their potential interactions in patients with CKD and ESKD, (2) provide evidence for increased fatigability in CKD and ESKD patients, (3) examine how commonly experienced neuromuscular impairments in CKD and ESKD patients may contribute to the severity of performance fatigability, and (4) highlight preliminary evidence on the effects of exercise as a potential clinical treatment for targeting fatigability in this population. SUMMARY Fatigue is broadly defined as a multidimensional construct encompassing a subjective lack of physical and/or mental energy that is perceived by the individual to interfere with usual or desired activities. In contrast, fatigability is conceptualized within the context of physical activity and is quantified as the interactions between reductions in objective measures of performance (i.e., performance fatigability) and perceptual adjustments regulating activity performance (i.e., perceived fatigability). We propose herein a conceptual model to extend current understandings of fatigability by considering the interactions among fatigue, perceived fatigability, and performance fatigability. Neuromuscular impairments reported in patients with CKD and ESKD, including reductions in force capacity, skeletal muscle atrophy, mitochondrial dysfunction, abnormal skeletal muscle excitability, and neurological complications, may each contribute to the greater performance fatigability observed in these patients. KEY MESSAGES Considering the interactions among fatigue, perceived fatigability, and performance fatigability provides a novel conceptual framework to advance the understanding of fatigability in CKD and ESKD patients. Measures of fatigability may provide valuable clinical insights into the overall health status of CKD and ESKD patients. Existing data suggest that CKD and ESKD patients are at greater risk of experiencing increased fatigability, partly due to neuromuscular impairments associated with reduced kidney function. Further investigations are warranted to determine the potential clinical role fatigability measures can play in monitoring the health of CKD and ESKD patients, and in identifying potential treatments targeting fatigability in this patient population.
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Affiliation(s)
- Jared M. Gollie
- Research Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Health, Human Function and Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Samir S. Patel
- Renal Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA
| | - Michael O. Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA;,Geriatric Research Education and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Scott D. Cohen
- Renal Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA
| | - Marc R. Blackman
- Research Service, Washington DC VA Medical Center, Washington, DC, USA;,Department of Medicine, George Washington University, Washington, DC, USA;,Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, USA
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Bonnet JB, Sultan A. Narrative Review of the Relationship Between CKD and Diabetic Foot Ulcer. Kidney Int Rep 2021; 7:381-388. [PMID: 35257052 PMCID: PMC8897302 DOI: 10.1016/j.ekir.2021.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 01/22/2023] Open
Abstract
Diabetic foot ulcer (DFU) and chronic kidney disease (CKD) are 2 significant complications of diabetes mellitus (DM). Up to 40% of patients with DM are expected to also develop CKD, and 19% to 34% will suffer from DFU during their lifetimes. However, data on the link between podiatric risk and the extent of CKD are scarce. Neuropathy, a key element of the International Working Group on the Diabetic Foot (IWGDF) classification, nevertheless appears to be related to the CKD stage. The incidence of DFU and its poor evolution also appear to be linked to the stage of CKD, with mortality reaching its peak in patients with end-stage renal disease (ESRD). Whatever, the decrease in the rate of diabetic foot amputation observed worldwide, especially for major amputations, is also observed in patients with ESRD. Specific actions taken for patients undergoing dialysis seems to improve the DFU prognosis. CKD and DFU share a number of elements of pathophysiology, the first of which is peripheral arterial disease (PAD). Uremic neuropathy and nutritional status also seem to create a link between the development of the 2 complications. This literature review provides an update on the complex and dynamic relationship between DFU and CKD. It examines the epidemiologic link between CKD and diabetic foot risk, CKD and DFU occurrence, and CKD and DFU prognosis. It focuses on the pathophysiological links between these 2 complications. Finally, it highlights the actions taken to improve management in the ESRD population that have reduced the rate of major amputations in this population by more than half.
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13
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Yang Z, Lou X, Zhang J, Nie R, Liu J, Tu P, Duan P. Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021; 14:4391-4397. [PMID: 34744444 PMCID: PMC8565989 DOI: 10.2147/dmso.s335283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN. METHODS Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m2. RESULTS DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN. CONCLUSION When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.
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Affiliation(s)
- Zhi Yang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People’s Republic of China
| | - Jie Zhang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People’s Republic of China
| | - Jiang Liu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People’s Republic of China
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14
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Gollie JM, Harris-Love MO, Patel SS, Shara NM, Blackman MR. Rate of Force Development Is Related to Maximal Force and Sit-to-Stand Performance in Men With Stages 3b and 4 Chronic Kidney Disease. FRONTIERS IN REHABILITATION SCIENCES 2021; 2. [PMID: 34708217 PMCID: PMC8547335 DOI: 10.3389/fresc.2021.734705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: The primary aims of the present study were to assess the relationships of early (0–50 ms) and late (100–200 ms) knee extensor rate of force development (RFD) with maximal voluntary force (MVF) and sit-to-stand (STS) performance in participants with chronic kidney disease (CKD) not requiring dialysis. Methods: Thirteen men with CKD (eGFR = 35.17 ±.5 ml/min per 1.73 m2, age = 70.56 ±.4 years) and 12 non-CKD men (REF) (eGFR = 80.31 ± 4.8 ml/min per 1.73 m2, age = 70.22 ±.9 years) performed maximal voluntary isometric contractions to determine MVF and RFD of the knee extensors. RFD was measured at time intervals 0–50 ms (RFD0−50) and 100–200 ms (RFD100−200). STS was measured as the time to complete five repetitions. Measures of rectus femoris grayscale (RF GSL) and muscle thickness (RF MT) were obtained via ultrasonography in the CKD group only. Standardized mean differences (SMD) were used to examine differences between groups. Bivariate relationships were assessed by Pearson's product moment correlation. Results: Knee extensor MVF adjusted for body weight (CKD=17.14 ±.1 N·kg0.67, REF=21.55 ±.3 N·kg0.67, SMD = 0.79) and STS time (CKD = 15.93 ±.4 s, REF = 12.23 ±.7 s, SMD = 1.03) were lower in the CKD group than the REF group. Absolute RFD100−200 was significantly directly related to adjusted MVF in CKD (r = 0.56, p = 0.049) and REF (r = 0.70, p = 0.012), respectively. STS time was significantly inversely related to absolute (r = −0.75, p = 0.008) and relative RFD0−50 (r = −0.65, p = 0.030) in CKD but not REF (r = 0.08, p = 0.797; r = 0.004, p = 0.991). Significant inverse relationships between RF GSL adjusted for adipose tissue thickness and absolute RFD100−200 (r =−0.59, p = 0.042) in CKD were observed. Conclusion: The results of the current study highlight the declines in strength and physical function that occur in older men with CKD stages 3b and 4 not requiring dialysis. Moreover, early RFD was associated with STS time in CKD while late RFD was associated MVF in both CKD and REF. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT03160326 and NCT02277236.
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Affiliation(s)
- Jared M Gollie
- Skeletal Muscle Laboratory, Research Service, Washington, DC, United States.,George Washington University, Health, Human Function, and Rehabilitation Sciences, Washington, DC, United States.,George Mason University, Rehabilitation Science, Fairfax, VA, United States
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Muscle Morphology, Mechanics and Performance Laboratory, Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO, United States
| | - Samir S Patel
- Renal Service, Washington DC VAMC, Washington, DC, United States.,Department of Medicine, George Washington University, Washington, DC, United States
| | - Nawar M Shara
- Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Washington, DC, United States
| | - Marc R Blackman
- Department of Medicine, George Washington University, Washington, DC, United States.,Research Service, Washington DC VAMC, Washington, DC, United States.,Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, United States
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15
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Park SY, Park CH. Diagnosis of Muscle Fatigue Using Surface Electromyography and Analysis of Associated Factors in Type 2 Diabetic Patients with Neuropathy: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9635. [PMID: 34574559 PMCID: PMC8469078 DOI: 10.3390/ijerph18189635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
Diabetic neuropathy (DN) is a major complication associated with diabetes mellitus (DM) and results in fatigue. We investigated whether type 2 diabetic patients with or without neuropathy experienced muscle fatigue and determined the most influencing factor on muscle fatigue. Overall, 15 out of 25 patients with type 2 DM were diagnosed with DN using a nerve conduction study in the upper and lower extremities, and the composite score (CS) was calculated. We obtained the duration of DM and body mass index (BMI) from subjects, and they underwent a series of laboratory tests including HbA1c, fasting plasma glucose, triglycerides, and high- and low-density lipoprotein. To qualify muscle fatigue, this study used surface electromyography (sEMG). Anode and cathode electrodes were attached to the medial gastrocnemius. After 100% isometric maximal voluntary contracture of plantarflexion, the root mean square, median frequency (MDF), and mean power frequency (MNF) were obtained. We showed a correlation among laboratory results, duration of DM, BMI, CS, and parameters of muscle fatigue. The duration of DM was related to fatigue of the muscle and CS (p < 0.05). However, CS was not related to fatigue. The MDF and MNF of muscle parameters were positively correlated with HbA1c and fasting plasma glucose (p < 0.05). In conclusion, we suggest that the duration of DM and glycemic control play important roles in muscle fatigue in patients with DN. Additionally, sEMG is useful for diagnosing muscle fatigue in patients with DN.
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Affiliation(s)
- So Young Park
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul 02447, Korea;
| | - Chan Hyuk Park
- Department of Physical & Rehabilitation Medicine, Inha University Hospital, Incheon 22332, Korea
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16
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Livshits L, Barshtein G, Arbell D, Gural A, Levin C, Guizouarn H. Do We Store Packed Red Blood Cells under "Quasi-Diabetic" Conditions? Biomolecules 2021; 11:biom11070992. [PMID: 34356616 PMCID: PMC8301930 DOI: 10.3390/biom11070992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023] Open
Abstract
Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells’ ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as “quasi-diabetic”. Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells’ functional properties during storage.
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Affiliation(s)
- Leonid Livshits
- Red Blood Cell Research Group, Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zürich, CH-8057 Zurich, Switzerland;
| | - Gregory Barshtein
- Biochemistry Department, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Correspondence: ; Tel.: +972-2-6758309
| | - Dan Arbell
- Pediatric Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Alexander Gural
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Center, Afula 1834111, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Hélène Guizouarn
- Institut de Biologie Valrose, Université Côte d’Azur, CNRS, Inserm, 28 Av. Valrose, 06100 Nice, France;
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17
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Ferdousi M, Azmi S, Kalteniece A, Khan SU, Petropoulos IN, Ponirakis G, Alam U, Asghar O, Marshall A, Soran H, Boulton AJM, Augustine T, Malik RA. No evidence of improvement in neuropathy after renal transplantation in patients with end stage kidney disease. J Peripher Nerv Syst 2021; 26:269-275. [PMID: 34085731 DOI: 10.1111/jns.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
To assess the impact of renal transplantation on peripheral nerve damage in patients with chronic kidney disease (CKD). Fifteen patients with CKD (eGFR <15 mL/min/1.73 m2 ) underwent longitudinal assessment after renal transplantation (age: 56.88 ± 2.53 years, eGFR: 46.82 ± 4.86) and were compared with 15 age-matched controls (age: 58.25 ± 2.18 years, eGFR: 86.0 ± 2.0). The neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration perception threshold (VPT), cold and warm sensation threshold (CST and WST), cold and heat induced pain (CIP and HIP), deep breathing heart rate variability (DB-HRV), nerve conduction studies and corneal confocal microscopy (CCM) to quantify small nerve fibre pathology, were undertaken within 1-month of renal transplantation (baseline) and at 6, 12 and 24 months of follow up. There was no significant difference in NSP (P = .1), NDS (P = .3), VPT (P = .6), CST (P = .2), CIP (P = .08), HIP (P = .1), DB-HRV (P = .9) and sural (P = .4) and peroneal (P = .1) nerve amplitude between patients with CKD and controls at baseline. However, sural (P = .04), peroneal (P = .002) and tibial (P = .007) nerve conduction velocity and tibial nerve amplitude (P = .03) were significantly lower, WST (P = .02) was significantly higher and corneal nerve fibre density (P = .004) was significantly lower in patients with CKD compared with controls. There was no significant change in NSP, NDS, quantitative sensory testing, DB-HRV, nerve conduction or CCM parameters 24 months after renal transplantation. There is evidence of small and large fibre neuropathy in patients with CKD, but no change up to 24 months after successful renal transplantation.
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Affiliation(s)
- Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Saif Ullah Khan
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Doha, Qatar
| | - Uazman Alam
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Omar Asghar
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Andrew Marshall
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Handrean Soran
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Andrew J M Boulton
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Titus Augustine
- Department of Transplant and Endocrine Surgery, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.,Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Doha, Qatar
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18
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Arnold R, Pianta TJ, Issar T, Kirby A, Scales C, Kwai N, Endre Z, Krishnan AV. Peripheral Neuropathy: An Important Contributor To Physical Limitation And Morbidity In Stage 3-4 Chronic Kidney Disease. Nephrol Dial Transplant 2021; 37:713-719. [PMID: 33576810 DOI: 10.1093/ndt/gfab043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 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 neuropathy, walking speed and quality of life (QoL) in CKD. METHODS This was a prospective observational study investigating neuropathy in CKD patients with an eGFR 15-60ml/kg/min-1. A total of 109 patients were consecutively recruited. The presence and severity of neuropathy was determined using the Total Neuropathy Score (TNS). Walking speed was assessed at both usual and maximal speed, and QoL was assessed using the SF-36 questionnaire. RESULTS 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 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. CONCLUSIONS Moderate to severe peripheral neuropathy was common in stage 3-4 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.
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Affiliation(s)
- Ria Arnold
- Department of Exercise Physiology, School of Medical Sciences, UNSW Sydney, Australia
| | - Timothy J Pianta
- Department Renal Medicine, Northern Health; and Northern Clinical School, University of Melbourne, Australia
| | - Tushar Issar
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Adrienne Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Caoimhe Scales
- Department of Exercise Physiology, School of Medical Sciences, UNSW Sydney, Australia
| | - Natalie Kwai
- Department of Exercise Physiology, School of Medical Sciences, UNSW Sydney, Australia
| | - Zoltan Endre
- Department of Nephrology, Prince of Wales Hospital Randwick, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Australia
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19
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Lin SY, Lin CL, Hsu WH, Lin CC, Lo SF, Kao CH. Risk of idiopathic peripheral neuropathy in end-stage renal disease: A population-based cohort study. Int J Clin Pract 2021; 75:e13641. [PMID: 32750233 DOI: 10.1111/ijcp.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/24/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Whether patients with end-stage renal disease (ESRD) have a higher risk of idiopathic polyneuropathy (IPN) than those without ESRD remains unclear. We hypothesised that carpal tunnel syndrome (CTS) is a prodrome of IPN in patients with ESRD. METHODS Data were collected from the Taiwan National Health Insurance research database (NHIRD) for the 2000-2011 period. Two matching strategies, age- and sex-matching and propensity matching, were used, which yielded 2596 age- and sex-matched patients with ESRD and 2210 propensity-matched patients with ESRD. The comparison cohort was chosen in a 1:4 ratio for the age- and sex-matched method and in a 1:1 ratio for the propensity-matching method. The primary outcome was the incidence of IPN. Cox proportional hazards modelling was used. RESULTS In the age- and sex-matched cohort, the IPN incidence was 7.64 and 2.88 per 1000 person-years for the ESRD and controls cohorts, respectively. After we adjusted for age, sex, comorbidities and medications relative to controls, having ESRD was significantly associated with increased risk of IPN (hazard ratio [HR] = 2.45, 95% confidence interval [CI] = 1.76-3.41). Competing risk of death as sensitivity analysis revealed that having ESRD with CTS was still associated with higher risk of IPN than having CTS without ESRD (HR = 2.85, 95% CI = 1.87-4.34). CONCLUSION Patients with ESRD with CTS had higher incidences of idiopathic peripheral neuropathy than those without ESRD with CTS.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sui-Foon Lo
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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20
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Yang Z, Lou X, Zhang J, Nie R, Liu J, Tu P, Duan P. Association Between Early Markers of Renal Injury and Type 2 Diabetic Peripheral Neuropathy. Diabetes Metab Syndr Obes 2021. [PMID: 34744444 DOI: 10.2147/dmso.s335283:] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Diabetic kidney disease (DKD) and diabetic peripheral neuropathy (DPN) are both common chronic complications of type 2 diabetes mellitus (T2DM). The aim of this study was to examine whether some markers of early renal injury were associated with DPN. METHODS Retrospective hospitalization data from 471 patients with T2DM were analyzed. Subjects were divided into DPN group and non-DPN group according to clinical history, symptoms, signs and nerve conduction study. Markers of glomerular injury [urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR)] and tubular injury [urinary N-acetyl-β-D-glucosaminidase/creatinine ratio (NAG/Cr) and urinary β2 microglobulin (β2-MG)] were innovatively combined to assess the association with DPN. Staging of chronic kidney disease (CKD) was classified as G1, G2, G3a, G3b, G4 based on eGFR categories of ≥90, 60-89, 45-59, 30-44, 15-29 mL/min/1.73m2. RESULTS DPN was detected in 71.1% of our population. Subjects in DPN group suffered from older age, longer duration of diabetes and worse blood glucose control compared with non-DPN group. The levels of UACR, NAG/Cr and β2-MG were significantly increased in DPN group than those in non-DPN group, while eGFR was decreased. The prevalence of DPN increased gradually in G1, G2 and G3-4 of CKD, which were 66.3%, 73.2% and 82.7% (P = 0.014). After adjusting for confounding factors, NAG/Cr >1.41 U/mmol (the highest tertile) was a consistently independent risk factor for DPN [odds ratio, OR (95% confidence interval, CI) = 1.86 (1.04-3.33)]. However, UACR, eGFR and β2-MG did not significantly affect the risk of DPN. CONCLUSION When T2DM patients suffer from CKD, DPN will be more likely to appear, accelerate or deteriorate. Some easily available urinary markers of glomerular and tubular damage can be used for early prediction of DPN, in which increased NAG/Cr is an independent risk factor for DPN.
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Affiliation(s)
- Zhi Yang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Xiaoyang Lou
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Jie Zhang
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People's Republic of China
| | - Ronghui Nie
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
- Jiangxi Medical College of Nanchang University, Nanchang, 330036, Jiangxi, People's Republic of China
| | - Jiang Liu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Ping Tu
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Peng Duan
- Department of Endocrinology and Metabolism, The Third Hospital of Nanchang, Nanchang, 330000, Jiangxi, People's Republic of China
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Chronic kidney disease as a risk factor for peripheral nerve impairment in older adults: A longitudinal analysis of Health, Aging and Body Composition (Health ABC) study. PLoS One 2020; 15:e0242406. [PMID: 33320861 PMCID: PMC7737903 DOI: 10.1371/journal.pone.0242406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction 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. Materials and methods 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. Results 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. Conclusions Pre-existing CKD leads to new and worsening sensorimotor nerve impairments over a 7-year time period in community-dwelling older adults.
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Arnold R, Pianta TJ, Pussell BA, Endre Z, Kiernan MC, Krishnan AV. Potassium control in chronic kidney disease: implications for neuromuscular function. Intern Med J 2020; 49:817-825. [PMID: 30230667 DOI: 10.1111/imj.14114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022]
Abstract
In Australia, approximately 1.7 million adults have evidence of chronic kidney disease (CKD). This complex disease can result in a multitude of complications, including hyperkalaemia, which is common and well recognised. The advent of new therapeutics aimed at lowering serum potassium has raised the possibility of optimising potassium control to enable greater use of renin-angiotensin-aldosterone system inhibitors in the management of CKD. Recent studies suggest that hyperkalaemia also has implications for peripheral neuropathy in CKD, a complication that substantially contributes to patient morbidity. This review examines evidence of the relationship between potassium and peripheral neuropathy, with a discussion of clinical implications. We searched PubMed for original and review articles using pre-specified key words, clinical guidelines and population data. The major findings were that contemporary CKD cohorts demonstrate a high prevalence of peripheral neuropathy, even in stage 3-4 CKD, including those without diabetes. The severity of the problem has been emphasised by an ominous rise in foot complications and amputation rates in dialysis patients, highlighting the need for increased awareness of the condition in earlier stages of CKD and targeted treatment strategies. It is likely that the pathophysiology of peripheral neuropathy in CKD is multifaceted, with potential influences from potassium, vascular abnormalities, diabetes, inflammation and unknown middle molecules. Despite these complexities, the relationship between potassium and nerve function in dialysis has been well established, and recent research in stage 3-4 CKD suggests that assertive potassium control may improve neuromuscular outcomes in CKD. These small studies should be confirmed in large, multicentre settings.
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Affiliation(s)
- Ria Arnold
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy J Pianta
- Northern Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce A Pussell
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Zoltan Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Mayeda L, Katz R, Ahmad I, Bansal N, Batacchi Z, Hirsch IB, Robinson N, Trence DL, Zelnick L, de Boer IH. Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease. BMJ Open Diabetes Res Care 2020; 8:8/1/e000991. [PMID: 31958307 PMCID: PMC7039577 DOI: 10.1136/bmjdrc-2019-000991] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/27/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE: Compared with hemoglobin A1c (HbA1c), continuous glucose monitoring (CGM) may better capture risk of diabetes complications in patients with chronic kidney disease (CKD), including diabetic peripheral neuropathy (DPN). We hypothesized that glucose time in range (TIR), measured by CGM, is associated with DPN symptoms among participants with type 2 diabetes mellitus (type 2 DM) and moderate-to-severe CKD. RESEARCH DESIGN AND METHODS: We enrolled 105 people with type 2 DM treated with insulin or sulfonylurea, 81 participants with CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2) and 24 matched control participants with eGFR ≥60 mL/min/1.73 m2. Each participant wore a CGM for two 6-day periods. Calculated glycemic measures included TIR (glucose 70-180 mg/dL) and glucose management indicator (GMI). DPN symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI) questionnaire, with a positive MNSI score defined as ≥2 symptoms. RESULTS: Participants with CKD had a mean age of 68 years, diabetes duration 20 years, eGFR 38 mL/min/1.73 m2 and HbA1c 7.8%, 61 mmol/mol. Sixty-two participants reported ≥2 DPN symptoms, 51 (63%) with CKD and 11 (46%) controls. Less TIR and higher GMI were associated with higher risk of MNSI questionnaire score ≥2 (OR 1.25 (95% CI 1.02 to 1.52) per 10% lower TIR, and OR 1.79 (95% CI 1.05 to 3.04) per 1% higher GMI, adjusting for age, gender and race). Similar results were observed when analyses were restricted to participants with CKD. In contrast, there was no significant association of HbA1c with DPN symptoms. CONCLUSIONS: Symptoms of DPN were common among participants with long-standing type 2 DM and CKD. Lower TIR and higher GMI were associated with DPN symptoms.
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Affiliation(s)
- Laura Mayeda
- Virginia Mason Medical Center, Seattle, Washington, USA
| | - Ronit Katz
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Iram Ahmad
- Division of Endocrinology, Banner-MD Anderson Health System, Gilbert, Arizona, USA
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Zona Batacchi
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA
| | - Nicole Robinson
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Dace L Trence
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington, USA
| | - Leila Zelnick
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
| | - Ian H de Boer
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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Soylemez C, Emre U, Köse S, Tekesin A. Evaluation of the presence of neuropathy and pruritus in predialysis patients. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Jasti DB, Mallipeddi S, Apparao A, Vengamma B, Sivakumar V, Kolli S. A Clinical and Electrophysiological Study of Peripheral Neuropathies in Predialysis Chronic Kidney Disease Patients and Relation of Severity of Peripheral Neuropathy with Degree of Renal Failure. J Neurosci Rural Pract 2019; 8:516-524. [PMID: 29204008 PMCID: PMC5709871 DOI: 10.4103/jnrp.jnrp_186_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: To study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in predialysis chronic kidney disease (CKD) patients with respect to severity of renal failure and presence of diabetes mellitus. Materials and Methods: Between May 2015 and December 2016, 200 predialysis CKD patients were assessed prospectively. Results: The prevalence of peripheral neuropathy in predialysis CKD patients in the present study was 45% based on clinical symptoms and 90% electrophysiologically. Mean age of 200 predialysis CKD patients who participated in the study was 53.2 ± 13.2 years. One hundred and thirty-six (68%) patients were male and 64 (32%) patients were female. Mean duration of disease was 2.2 ± 1.6 years. Nearly 45% patients of patients had asymptomatic peripheral neuropathy in the present study, which was more common in mild-to-moderate renal failure group. One hundred twenty-six patients (63%) had definite damage and 54 patients (27%) had early damage. In mild-to-moderate renal failure (n = 100) and severe renal failure patients (n = 100), 88% and 92% had significant peripheral neuropathy, respectively. Most common nerves involved were sural nerve, median sensory nerve, and ulnar sensory nerve. Diabetic patients (97%) showed more severe and high prevalence of peripheral neuropathy when compared to nondiabetic patients (83%). Most common patterns were pure axonal sensorimotor neuropathy and mixed sensorimotor neuropathy. Conclusion: Peripheral neuropathy is common in predialysis patients, prevalence and severity of which increases as renal failure worsens. Predialysis patients with diabetes show higher prevalence and severity of peripheral neuropathy when compared with nondiabetics.
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Affiliation(s)
| | | | - A Apparao
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
| | - B Vengamma
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, SVIMS, Tirupati, Andhra Pradesh, India
| | - Satyarao Kolli
- Department of Neurology, SVIMS, Tirupati, Andhra Pradesh, India
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Issar T, Arnold R, Kwai NCG, Walker S, Yan A, Borire AA, Poynten AM, Pussell BA, Endre ZH, Kiernan MC, Krishnan AV. Relative contributions of diabetes and chronic kidney disease to neuropathy development in diabetic nephropathy patients. Clin Neurophysiol 2019; 130:2088-2095. [PMID: 31541986 DOI: 10.1016/j.clinph.2019.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/04/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) caused by diabetes is known as diabetic kidney disease (DKD). The present study aimed to examine the underlying mechanisms of axonal dysfunction and features of neuropathy in DKD compared to CKD and type 2 diabetes (T2DM) alone. METHODS Patients with DKD (n = 30), CKD (n = 28) or T2DM (n = 40) and healthy controls (n = 41) underwent nerve excitability assessments to examine axonal function. Neuropathy was assessed using the Total Neuropathy Score. A validated mathematical model of human axons was utilised to provide an indication of the underlying causes of nerve pathophysiology. RESULTS Total neuropathy score was significantly higher in patients with DKD compared to those with either CKD or T2DM (p < 0.05). In DKD, nerve excitability measures (S2 accommodation and superexcitability, p < 0.05) were more severely affected compared to both CKD and T2DM and worsened with increasing serum K+ (p < 0.01). Mathematical modelling indicated the basis for nerve dysfunction in DKD was an elevation of extracellular K+ and reductions in Na+ permeability and the hyperpolarisation-activated cation current, which was similar to CKD. CONCLUSIONS Patients with DKD manifested a more severe neuropathy phenotype and shared features of nerve dysfunction to that of CKD. SIGNIFICANCE The CKD, and not diabetes component, appears to underlie axonal pathophysiology in DKD.
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Affiliation(s)
- Tushar Issar
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia
| | - Ria Arnold
- School of Medical Sciences, UNSW Sydney, NSW 2052, Australia
| | - Natalie C G Kwai
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia; Department of Exercise Physiology, UNSW Sydney, NSW 2052, Australia
| | - Susan Walker
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia
| | - Aimy Yan
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia
| | - Adeniyi A Borire
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia
| | - Ann M Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Bruce A Pussell
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Zoltan H Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, UNSW Sydney, NSW 2031, Australia.
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Issar T, Arnold R, Kwai NC, Pussell BA, Endre ZH, Poynten AM, Kiernan MC, Krishnan AV. The utility of the Total Neuropathy Score as an instrument to assess neuropathy severity in chronic kidney disease: A validation study. Clin Neurophysiol 2018; 129:889-894. [DOI: 10.1016/j.clinph.2018.02.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/14/2018] [Accepted: 02/04/2018] [Indexed: 10/17/2022]
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Silver EM, Ochoa W. Glucocorticoid-Induced Myopathy in a Patient with Systemic Lupus Erythematosus (SLE): A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018. [PMID: 29525810 PMCID: PMC5865408 DOI: 10.12659/ajcr.906377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Female, 35 Final Diagnosis: Glucocorticoid-induced myopathy Symptoms: Generalized weakness Medication: Prednisone Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Elliot M Silver
- School of Medicine, University of California Riverside, Riverside, CA, USA
| | - William Ochoa
- Department of Internal Medicine, Riverside University Health System, Moreno Valley, CA, USA
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Cabrera VJ, Hansson J, Kliger AS, Finkelstein FO. Symptom Management of the Patient with CKD: The Role of Dialysis. Clin J Am Soc Nephrol 2017; 12:687-693. [PMID: 28148557 PMCID: PMC5383375 DOI: 10.2215/cjn.01650216] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
As kidney disease progresses, patients often experience a variety of symptoms. A challenge for the nephrologist is to help determine if these symptoms are related to advancing CKD or the effect of various comorbidities and/or medications prescribed. The clinician also must decide the timing of dialysis initiation. The initiation of dialysis can have a variable effect on quality of life measures and the alleviation of uremic signs and symptoms, such as anorexia, fatigue, cognitive impairment, depressive symptoms, pruritus, and sleep disturbances. Thus, the initiation of dialysis should be a shared decision-making process among the patient, the family and the nephrology team; information should be provided, in an ongoing dialogue, to patients and their families concerning the benefits, risks, and effect of dialysis therapies on their lives.
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Affiliation(s)
- Valerie Jorge Cabrera
- Department of Medicine, Section of Nephrology, Yale University, New Haven, Connecticut; and
| | - Joni Hansson
- Department of Medicine, Section of Nephrology, Yale University, New Haven, Connecticut; and
| | - Alan S. Kliger
- Yale New Haven Health System–Performance Management, New Haven, Connecticut
| | - Fredric O. Finkelstein
- Department of Medicine, Section of Nephrology, Yale University, New Haven, Connecticut; and
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Koseoglu S, Derin S, Huddam B, Sahan M. The effect of non-diabetic chronic renal failure on olfactory function. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:161-164. [PMID: 27988196 DOI: 10.1016/j.anorl.2016.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES In chronic renal failure (CRF), deterioration of glomerular filtration results in accumulation of metabolites in the body which affect all organs. This study was performed to investigate the olfactory functions, and determine if hemodialysis or peritoneal dialysis improves olfactory function in non-diabetic CRF patients. MATERIALS AND METHODS The olfactory functions were analyzed in CRF patients not on a dialysis program and had a creatinine level≥2mg/dL, in CRF patients on hemodialysis or peritoneal dialysis, and in healthy controls. Diabetic patients were excluded since diabetes alone is a cause of olfactory dysfunction. The study group consisted of a total of 107 individuals including 38CRF patients on a hemodialysis program, 15 CRF patients on peritoneal dialysis, 30 patients with a creatinine level ≥ 2mg/dL without any need for dialysis, and 24 healthy controls with normal renal functions. Olfactory functions were analyzed with "Sniffin' sticks" test, and the groups were compared for the test results. RESULTS All test parameters were impaired in patients with CRF. The median TDI scores of the patients with CRF and the healthy subjects were 24.75 (13-36) and 32.5 (27.75-37.75), respectively, with a statistically significant difference in between (P<0.001). The olfactory functions for the dialysis patients were better than those for the CRF patients not on a dialysis program (P=0.020). CONCLUSION Non-diabetic CRF affects olfactory functions negatively. Dialysis improves olfactory functions in those patients.
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Affiliation(s)
- S Koseoglu
- Department of Otolaryngology, Mugla Sıtkı Kocman University, School of Medicine, Mugla, Turkey
| | - S Derin
- Department of Otolaryngology, Mugla Sıtkı Kocman University, School of Medicine, Mugla, Turkey.
| | - B Huddam
- Department of Nephrology, Mugla Sıtkı Kocman University, School of Medicine, Mugla, Turkey
| | - M Sahan
- Department of Otolaryngology, Mugla Sıtkı Kocman University, School of Medicine, Mugla, Turkey
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Denislic M, Tiric-Campara M, Resić H, Al-Hashel JY, Zorec R, Gojak R, Ravnik J. A neurophysiological study of large- and small-diameter nerve fibers in the hands of hemodialysis patients. Int Urol Nephrol 2015; 47:1879-87. [DOI: 10.1007/s11255-015-1117-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
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Ghazan-Shahi S, Koh TJK, Chan CT. Impact of nocturnal hemodialysis on peripheral uremic neuropathy. BMC Nephrol 2015; 16:134. [PMID: 26264143 PMCID: PMC4534055 DOI: 10.1186/s12882-015-0133-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uremic neuropathy is a common complication in patients with end stage kidney disease. Its pathogenesis has been attributed to accumulation of uremic toxins. Kidney transplantation has been the best therapeutic option. CASE PRESENTATION We describe a case of severe uremic peripheral neuropathy, which improved after conversion from a conventional renal replacement therapy to nocturnal hemodialysis. CONCLUSION Enhanced uremic control by intensive hemodialysis may contribute at least in part to clinical and neurophysiological improvements of uremic neuropathy.
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Affiliation(s)
- Sassan Ghazan-Shahi
- Department of Internal Medicine, Division of Nephrology, University Health Network Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
| | - Timothy Jee Kam Koh
- Department of Internal Medicine, Division of Nephrology, University Health Network Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
| | - Christopher T Chan
- Department of Internal Medicine, Division of Nephrology, University Health Network Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
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Witzel II, Jelinek HF, Khalaf K, Lee S, Khandoker AH, Alsafar H. Identifying Common Genetic Risk Factors of Diabetic Neuropathies. Front Endocrinol (Lausanne) 2015; 6:88. [PMID: 26074879 PMCID: PMC4447004 DOI: 10.3389/fendo.2015.00088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/13/2015] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a global public health problem of epidemic proportions, with 60-70% of affected individuals suffering from associated neurovascular complications that act on multiple organ systems. The most common and clinically significant neuropathies of T2DM include uremic neuropathy, peripheral neuropathy, and cardiac autonomic neuropathy. These conditions seriously impact an individual's quality of life and significantly increase the risk of morbidity and mortality. Although advances in gene sequencing technologies have identified several genetic variants that may regulate the development and progression of T2DM, little is known about whether or not the variants are involved in disease progression and how these genetic variants are associated with diabetic neuropathy specifically. Significant missing heritability data and complex disease etiologies remain to be explained. This article is the first to provide a review of the genetic risk variants implicated in the diabetic neuropathies and to highlight potential commonalities. We thereby aim to contribute to the creation of a genetic-metabolic model that will help to elucidate the cause of diabetic neuropathies, evaluate a patient's risk profile, and ultimately facilitate preventative and targeted treatment for the individual.
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Affiliation(s)
- Ini-Isabée Witzel
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Herbert F. Jelinek
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
- Centre for Research in Complex Systems, School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Sungmun Lee
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
| | - Ahsan H. Khandoker
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
- Electrical and Electronic Engineering Department, The University of Melbourne, Parkville, VIC, Australia
| | - Habiba Alsafar
- Biomedical Engineering Department, Khalifa University of Science, Technology and Research, Abu Dhabi, United Arab Emirates
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Oyetola EO, Owotade FJ, Agbelusi GA, Fatusi O, Sanusi A, Adesina OM. Salivary Flow Rates of Nigerian Patients with Chronic Kidney Disease: A Case-control Study. J Contemp Dent Pract 2015; 16:264-9. [PMID: 26067727 DOI: 10.5005/jp-journals-10024-1673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND OBJECTIVES The study determined the relationship between chronic kidney disease (CKD) and changes in salivary flow and the complications of reduced salivary flow among African subjects with CKD compared with the controls. MATERIALS AND METHODS One hundred and eighty patients, 90 C KD and 90 controls were recruited, interviewed and examined. Stimulated and unstimulated saliva collection was done with standardized spitting method. Urinalysis and blood creatinine levels were determined and glomerular filtration rate (GFR) of each patient was calculated from the blood creatinine using Cockcroft and Gault formula. Statistical analysis was done using STATA 11 software. RESULTS The mean stimulated and unstimulated whole salivary flow rate among CKD subjects were 4.07 ± 1.91 and 2.34 ± 0.99 ml/5 min respectively and is significantly lower than that of the controls which were 8.05 ± 3.95 ml/5 min and 3.82 ± 2.27 ml/5 min for stimulated and unstimulated flow rates. Oral signs of reduced salivary flow were found in 80% of CKD patients. The commonest oral finding was taste abnormalities others are burning sensation, halitosis and difficulty in mastication. CONCLUSION Patients with CKD had reduced stimulated and unstimulated salivary flow rate. Reduced salivary flow was associated with oral lesions in majority (80%) of CKD patients, the commonest finding being taste abnormalities.
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Affiliation(s)
- Elijah Olufemi Oyetola
- Lecturer and Consultant, Department of Preventive and Community Dentistry, Obafemi Awolowo University, Osun State, Nigeria Phone: 08035375713, e-mail:
| | - Foluso John Owotade
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Ile Ife, Osun State Nigeria
| | | | - Olawumi Fatusi
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Ile Ife, Osun State Nigeria
| | - Abubakar Sanusi
- Department of Internal Medicine, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Olufunlola M Adesina
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Ile Ife, Osun State Nigeria
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