Nerve Conduction Studies and Prediction of Mortality in Hemodialysis Patients

Abstract

Background. The electrophysiological aspects of uremic neuropathy have been studied extensively, but never for prediction of mortality. In order to assess the parameters of nerve conduction study (NCS) as predictors of mortality in hemodialysis patients, a post hoc analysis of a prospective observation study was made. Methods. We examined conventional electrophysiological parameters (motor nerve conduction velocity [MCV], terminal latency [TL], and F wave latency of the peroneal nerve, as well as sensory nerve conduction velocity [SCV] of the sural nerve) in 75 nondiabetic patients. Hemodialysis modality (bicarbonate dialysis and biocompatible membranes), Kt/V, comorbidity (ischemic heart disease and congestive heart failure), and clinical and laboratory parameters were also evaluated. Survival was analyzed using the Cox proportional hazard model. Results. SCV was significantly higher (t-test, p < 0.01) in the group of patients treated with polysulfone compared to those using cuprophane membranes. On the other hand, MCV significantly correlated with Kt/V (Pearson, r = 0.388; p < 0.01). Multivariate Cox regression revealed only MCV as a significant predictor of mortality in this group of hemodialysis patients (HR= 0.92;; p < 0.05). Conclusion. Only MCV was a significant mortality risk predictor among NCS parameters. This parameter correlates significantly with dialysis dose. SCV was related to the use of biocompatible membranes, indicating the complexity of polyneuropathy in dialysis patients.

Impairments and comorbidities of polyneuropathy revealed by population-based analyses

“…From those studies, certain polyneuropathies have been suggested to have substantial disease burden from physical impairments 16,17 or even mortality. 18,19 However, mortality and disease burden quantification of polyneuropathies irrespective of etiology through a large population-based study has not been performed.…”

Comparative study to evaluate the effects of peritoneal and hemodialysis on peripheral nerve function

“…5,38,39 Recently, measures of neuropathy have been shown to significantly correlate with impaired quality of life in diabetic dialysis patients, 8 and with mortality in nondiabetic hemodialysis subjects. 40 The findings of this study suggest that PD may provide a beneficial option for neuropathy management in dialysis patients. Critically, larger cohort longitudinal studies would be required to establish whether early initiation of PD leads to a reduction in overall neuropathy-related disability.…”

“…Neuropathy directly contributes to patient morbidity by means of neuropathic symptoms of pain, numbness, and impaired mobility due to reduced sensory feedback and distal weakness which may lead to ulceration and amputation, especially when combined with the microvascular disease that occurs in diabetic patients . Recently, measures of neuropathy have been shown to significantly correlate with impaired quality of life in diabetic dialysis patients, and with mortality in nondiabetic hemodialysis subjects . The findings of this study suggest that PD may provide a beneficial option for neuropathy management in dialysis patients.…”

Uremic neuropathy: an overview of the current literature

“…After nerve transplantation, there is an increase in nerve conduction due to remyelination 8 . Studies have shown that motor nerve conduction (MCV) is a significant predictor of mortality 13 in hemodialysis patients and achieves statistically significant values: (HR= 0.92; CI (0.86-0.99); p < 0.05) 15 . MCV correlates significantly with dialysis dose; however, further investigation is needed in order to confirm this hypothesis 13 .…”