Clinical course of uremic neuropathy in long-term hemodialysis

Jurčić, Dragan and Bilić, Ante and Schwarz, Dragan and Oršanić, Dubravka and Gabrić, Maruška and Špoljarić, Ljubica and Mihanović, Mate (2008) Clinical course of uremic neuropathy in long-term hemodialysis. Collegium Antropologicum, 32 (3). pp. 771-775. ISSN 0350-6134

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Abstract

One hundred and thirty-one patients on long-term hemodialysis were examined for the presence of clinical symptoms and signs, and for the effects of dialytic age, age and sex on uremic neuropathy. According to dialysis age, the patients were divided into three subgroups: low dialysis age, < 5 years of dialysis (n = 58); intermediate dialysis age, 5-10 years of hemodialysis (n = 39); and high dialysis age, > 10 years of dialysis (n = 34). Two patient subgroups were differentiated according to mean age of 53.2 years: younger (n = 57) and older (n = 74). Clinical grading of uremic neuropathy was based on Nielsen's criteria. The most common symptoms were restless legs syndrome (47%) and cramps (51%). Sensory symptoms were less common in patients on long-term hemodialysis, most common of them being paresthesia (29%) and burning feet syndrome (28%). Abnormal Achilles reflex (53%) and impaired vibration sense (59%) were the most common clinical signs. Clinically manifested uremic neuropathy was present in more than 80% of all study patients, i.e. mild in 41%, and moderate to severe forms of uremic neuropathy according to Nielsen's criteria in 39%. There was no evident effect of dialytic age and sex on the clinical course of uremic neuropathy, however, there was a clear impact of age. It is concluded that long-term hemodialysis does not influence the clinical course of uremic neuropathy unlike evident deterioration of electroneurophysiologic findings.

Abstract in Croatian

U 131 bolesnika na dugotrajnoj hemodijalizi ispitivana je prisutnost kliničkih simptoma i znakova uremijske neuropatije kao i utjecaj dijalizne i životne dobi te spola na istu. Prema dužini dijalize bolesnici su podijeljeni u 3 podskupine: kratka dijalizna dob, <5 godina dijalize (n=58); srednja dijalizna dob, 5–10 godina dijalize (n=39); visoka dijalizna dob, >10 godina dijalize (n=34). U odnosu na srednju životnu dob ispitanika koja je iznosila 53,2 godine, bolesnici su podijeljeni u dvije dobne skupine: mlađe (n=57) i starije (n=74). Kliničko stupnjevanje uremijske neuropatije izvršeno je na temelju Nielsenovih kriterija. Najučestaliji simptomi u bolesnika bili su sindrom nemirnih nogu (47%) i grčevi (51%). Senzorički poremećaji imali su nižu prevalenciju, a najčešće su bile prisutne parestezije (29%) i sindrom užarenih stopala (28%). Promijenjen refleks Ahilove tetive (53%) i poremećaj osjeta vibracije (59%) bili su najčešći klinički znaci neuropatije. Klinički manifestna uremijska neuropatija zabilježena je u 80% ispitanika: blaga forma u 41%, umjerena do teška, prema Nielsenovim kriterijima, u 39% bolesnika. Nije zabilježen jasan utjecaj dijalizne dobi i spola na klinički tijek uremijske neuropatije, a evidentan je utjecaj životne dobi. Možemo zaključiti da dugotrajna hemodijaliza ne utječe na klinički tijek uremijske neuropatije, dok je taj utjecaj jasan kod ispitivanja elektrofizioloških parametara.

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