Polyneuropathy associated with chronic hemodialysis: Clinical and electrophysiological study

AIM

To estimate the frequency and pattern of peripheral polyneuropathy (PNP) that may affect patients maintained on hemodialysis.

PATIENTS AND METHODS

The study was carried out on 60 middle-aged male patients attending the Internal Medicine Department for maintenance hemodialysis. All were subjected to a complete neurological examination. Motor and sensory nerve conduction studies of both lower limbs (the tibial, peroneal and sural nerves) and both upper limbs (median and ulnar nerves), as well as F-wave measurements of both tibial and median nerves, were done. The patients were subdivided clinically into two groups, clinically apparent neuropathy and inapparent groups. Then they were divided according to the types of peripheral neuropathy detected by electrophysiological studies into axonal, demyelinated and mixed polyneuropathy. In addition, they were divided into motor, sensory and sensorimotor groups.

RESULTS

Polyneuropathy was found clinically presented in 33 (55%) cases, while evident by electrophysiological examination in 100% of the clinically apparent group (33 patients) and evident in 92.5% of the clinically inapparent group (27 patients). The frequency of pathologic electrophysiological parameters was significantly higher in patients with longer duration of hemodialysis. Axonal polyneuropathy is the most prevalent type in those patients.

CONCLUSION

Peripheral polyneuropathy is a common presentation in patients maintained on hemodialysis. The longer the duration of hemodialysis, the more liability to develop PNP that can be detected earlier by electrodiagnostic studies in the subclinical cases.

Inhibitory factors of serum opsonic activity in serum from patients with chronic renal failure

We investigated the mechanism of impaired serum opsonic activity in patients suffering from chronic renal failure (CRF). Prehemodialysis pooled serum from CRF patients was fractionated using Sephadex G-50 gel chromatography, and the effects of the obtained fractions on serum opsonic activity were examined using luminol-dependent chemiluminescence responses. Number 25-30 fractions in the prehemodialysis serum contained factors that may inhibit serum opsonic activity. The presumed molecular weight of these fractions is between 300 and 2800 daltons. These findings indicate that the inhibitory factors of serum opsonic activity may belong to middle molecules.

Follow-up of nerve conduction in chronic uremic patients during hemodialysis

We studied to evolution of nerve conduction during hemodialysis following 21 patients with chronic renal failure. Mean motor nerve conduction velocity (MCV) was significantly different at hemodialysis onset and 3 years later for both common peroneal nerve (44.5 and 41.0 m./sec.) and ulnar nerve (52.5 and 47.1 m./sec.). MCV decreased more in patients with low Kt/V (a depuration index) than in those with high Kt/V.