Electrophysiological Abnormalities in Upper Extremities After Brachiocephalic A‐V Fistulas Construction in Predialysis Patients

Abstract

Background: Peripheral neuropathy is considered a common complication in patients suffering from advanced chronic kidney disease (CKD). Superimposed peripheral multiple neuropathies may complicate arteriovenous (A-V) fistulas construction. Aim: To evaluate, prospectively, the influence of brachiocephalic A-V fistulas construction on the peripheral nerves of the same extremity and to characterize the patients at risk for developing ischemic and neurological complications. Patients and Methods: Twenty patients suffering from advanced CKD were enrolled in the study: 10 diabetic and 10 non-diabetic patients. All patients underwent electrophysiological evaluation one week before, 3 weeks and 3 months after surgery. Median, ulnar and radial nerves were studied. Results: In non-diabetic patients MNCV was normal before and after surgery, but were significantly lower and reduced progressively and significantly after surgery in diabetic patients ( p 0.02). In both non-diabetic and diabetic patients SNCV was reduced, but were significantly lower in diabetic patients before and after surgery ( p 0.03). In diabetic patients it reduced progressively and significantly after surgery ( p < 0.01). Thirty percent of patients developed local edema and significant decrease of CMAP of median nerve three weeks after surgery ( p = 0.02) with complete resolution at three months. Conclusion: Diabetic uremic patients are at increased risk to develop disabling neurological complications after the construction of A-V fistulas. ORDER REPRINTSDiabetes was the only predictive risk factor for developing these complications. Prevention requires careful preoperative electrophysiological evaluation and postoperative follow-up.

Neuropathy in the Hemodialysis Population: A Review of Neurophysiology Referrals in a Tertiary Center

“…An ischemic steal effect has been proposed as a result of fistula formation. 18 Diabetes mellitus is recognized as the predominant risk factor for the development of upper limb neuropathy and ischemia post vascular access due presumably to preexisting neuropathy or calcific atherosclerosis but we found it in only 4 of the 15 (26.6%) patients with mononeuropathies following arterio-venous fistula formation in our study. Ischemic monomelic mononeuropathy, identified in three patients, is a rare complication affecting a fistula limb requiring urgent closure of the fistula for recovery.…”