Danger of an Unnecessarily Prolonged Dialysis Session: Carpal Tunnel Syndrome

Abstract

Ten patients of a population of 319 on chronic intermittent treatment with Cuprophan dialyzers have undergone surgery for carpal tunnel syndrome (CTS). Since 1971 the dialysis schedule for all patients has been 4 m2/h three times per week. All patients were anuric. The operated patients represent 16% of the total population. In comparison with a dialysis population in other units described in the literature (12), 8 m2/h performed three times per week, with similar dialysis aging and a CTS incidence of 47%, it appears that the duration of the dialysis session per se increases the frequency of CTS and leads to the problem of the consequences of blood membrane interaction.

Chronic Renal Failure Treatment Duration and Mode: Their Relevance to the Late Dialysis Periarticular Syndrome

“…This steep increase of the risk must be kept in mind when incidence data are analyzed during this epoch. A recent paper by Cambi et al [4] allows us to illustrate this problem. In order to demonstrate a higher CTS risk for the patients receiving longer dialysis sessions, the authors compared their CTS data with our formerly published results [5], The 2 units used basically the same technique but with different session durations (4 h in Parma instead of 8 h in Tassin).…”

Dialysis overdose: Fact or reality?

“…The concept of overdialysis was born in 1985 when Gotch and Sargent, 3 in the Kt/V urea nomogram included in the Mechanistic Analysis of the National Cooperative Dialysis Study, described a “possible overdialysis zone.” One year later, Vincenzo Cambi and colleagues 4 suggested that excessive dialysis might be the explanation of the carpal tunnel syndrome observed frequently in the Tassin, France, unit where long dialysis was (and still is) used.…”

“…The first reported potential toxic effect of overdialysis concerned β2‐microglobulin (β2m) amyloidosis 4 . There are indeed some arguments favoring this hypothesis.…”

“…In theory, bioincompatibility is probably worse when longer or more frequent sessions are used because the patient has more exposure to foreign surfaces and substances. Cambi et al 4 speculated that long hemodialysis might cause carpal tunnel syndrome (CTS) because CTS was reported early and with a high prevalence in the patients of Tassin where long dialysis was used. But the arguments against a potential toxic effect of overdialysis on β2m amyloidosis are stronger: The possible increase in bioincompatibility is compensated for by the higher β2m removal by long/frequent dialysis.…”