Clinical and electrophysiological investigation of uremic neuropathy in haemodialysis patients

ABSTRACT

Uremic neuropathy is a distal sensorimotor polyneuropathy caused by uremic toxins. The severity of neuropathy is correlated strongly with the severity of the renal insufficiency. The electrophysiological study is a sensitive test for diagnosis of neuropathy in patients with uremia. Objectives: (1) To assess the clinical characteristics and (2) to describe the electrodiagnostic abnormalities of neuropathy during the haemodialysis. Patients and method: Clinical examination, motor and sensory nerve conduction measurements and an H reflex study (via the Nicolet EMG machine) were performed in 32 non-diabetic uremic patients (16 men and 16 women, mean age 43.5+2.29), who were all treated with chronic maintenance haemodialysis. Results: The incidence of neuropathy in haemodialysis patients was 68.8% on clinical examination and was 96.9% on electrophysiological study. The abnormalities in clinical findings were altered motor-sensory function in 62.8%, predominantly impaired sensibility in 50%, loss of tendon reflexes in 37.5%, symptom of restless legs in 46.9% and carpal tunel syndrome in 9.4% of patients. In the electrophysiological parameters, compared with Vietnamese healthy index, the nerve conduction velocity of all tested nerves was decreased significantly (p<0.05), the highest abnormal rates was the sural nerve (75%), the tibial nerve (71%) and the peroneal nerve (69.4%); H-reflex was also significantly prolonged in 42.9%. Conclusion: The most haemodialysis patients showed clinical and electrophysiological evidence of uremic neuropathy. Electrophysiological findings showed more abnormalities than clinical examination for neuropathy showed on hemodialysis patients.