Comparison of Gait Speed and Peripheral Nerve Function Between Chronic Kidney Disease Patients With and Without Diabetes

OBJECTIVE: To compare overall physical function, including gait speed and peripheral nerve function, between diabetic chronic kidney disease (CKD) patients and nondiabetic CKD patients and to investigate the association between gait speed and peripheral nerve function in CKD patients. METHODS: Sixty adult CKD patients (35 with and 25 without diabetes), who received maintenance hemodialysis (HD), were included in this study. Demographic data, past medical history, current medical condition and functional data—usual gait speed, vibration perception threshold for the index finger (VPT-F) and the great toe (VPT-T), activity of daily living (ADL) difficulty, and peripheral neuropathy (PN) along with the degree of its severity—were collected and compared between the two groups. Correlations between the severity of PN and the impairment of other functions were identified. RESULTS: Diabetic CKD patients showed significantly slower gait speed (p=0.029), impaired sensory function (VPT-F, p=0.011; VPT-T, p=0.023), and more frequent and severe PN (number of PN, p<0.001; severity of PN, p<0.001) as compared to those without diabetes. Usual gait speed had a significant negative correlation with the severity of PN (rho=−0.249, p=0.013). By contrast, VPT-F (rho=0.286, p=0.014) and VPT-T (rho=0.332, p=0.035) were positively correlated with the severity of PN. ADL difficulty was comparatively more frequent in the patients with more severe PN (p=0.031). CONCLUSION: In CKD patients with maintenance HD, their gait speed, sensory functions, and peripheral nerve functions were all significantly impaired when they have diabetes, and the severity of PN was negatively correlated with their gait speed, sensory function, and ADL function. Adverse effects of diabetes impacted physical performance of CKD patients. The physical disability of those patients might be attributable to PN and its severity.

Randomized Controlled Trial for Efficacy of Capsular Distension for Adhesive Capsulitis: Fluoroscopy-Guided Anterior Versus Ultrasonography-Guided Posterolateral Approach

OBJECTIVE: To find the most effective procedure to treat adhesive capsulitis of the shoulder, we evaluated the clinical effects of an ultrasonographic-guided anterior approach capsular distension and a fluoroscopy-guided posterolateral approach capsular distension. We expected the anterior approach to be better than the posterolateral approach because the rotator interval, a triangular anatomic area in the anterosuperior aspect of the shoulder, which is considered an important component of the pathology of adhesive capsulitis. METHODS: Participants were randomly assigned to two groups: 27 patients in group A were injected by an anterior approach with 2% lidocaine (5 mL), contrast dye (5 mL), triamcinolone (40 mg), and normal saline (9 mL) under fluoroscopic guidance in the operating room. Twenty-seven patients in group B were injected using a posterolateral approach with 2% lidocaine (5 mL), triamcinolone (40 mg), and normal saline (14 mL) under ultrasonographic guidance. After injection, all patients received physiotherapy four times in the first postoperative week and then two times each week for eight more weeks. Treatment effects were assessed using the shoulder pain and disability index (SPADI), visual numeric scale (VNS), passive range of motion (PROM), hand power (grip and pinch) at baseline and at one week, five and nine weeks after injection. RESULTS: SPADI, VNS, PROM, and hand power improved in one week, five and nine weeks in both groups. Statistically significant differences were not observed in SPADI, VNS, PROM, or hand power between groups. CONCLUSION: Ultrasonography-guided capsular distension by a posterolateral approach has similar effects to fluoroscopy-guided capsular distension by an anterior approach.