Haemodialysis alters peripheral nerve morphology in end-stage kidney disease

Borire, Adeniyi A.; Arnold, Ria; Pussell, Bruce A.; Kwai, Natalie; Visser, Leo H.; Padua, Luca; Simon, Neil; Kiernan, Matthew C.; Krishnan, Arun V.

doi:10.1016/j.clinph.2016.09.010

Cited by 16 publications

(41 citation statements)

References 43 publications

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“…After a single session of dialysis, there was a significant reduction in VSc (1.4 ± 0.5 vs. 1.0 ± 0.8; P < 0.01) and MPI (1.38 ± 0.92 cm/s vs. 0.55 ± 0.58 cm/s, P < 0.01). This was accompanied by a significant reduction in the CSA postdialysis (8.5 ± 1.4 mm 2 , P < 0.01), consistent with our previous study…”

Section: Resultssupporting

confidence: 92%

“…It is, therefore, possible that the changes in nerve size led to the improvement in INBF. Our previous studies have demonstrated that dialysis can acutely alter nerve size, and it was further postulated that this may be due to removal of potassium, which is neurotoxic in this cohort . Previous studies using nerve excitability measures in ESKD demonstrated a pattern consistent with axonal membrane depolarization, with changes correlating strongly with potassium concentration .…”

Section: Discussionmentioning

confidence: 64%

“…Most of these studies have demonstrated abnormalities in nerve size, fascicular architecture, and echogenicity. More recently, studies have examined peripheral nerve morphology in ESKD patients and found that their nerves were enlarged and more hypoechoic and that the degree of enlargement correlated with clinical and electrophysiological parameters …”

mentioning

confidence: 99%

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Effects of hemodialysis on intraneural blood flow in end‐stage kidney disease

et al. 2017

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Section: Resultssupporting

confidence: 92%

Section: Discussionmentioning

confidence: 64%

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Effects of hemodialysis on intraneural blood flow in end‐stage kidney disease

et al. 2017

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“…Recent advances in ultrasound technology have demonstrated that the functional changes observed in electrophysiological studies are accompanied by structural and vascular abnormalities. One study demonstrated that the median nerve in haemodialysis patients has a greater cross‐sectional area and greater hypoechoic features, suggesting enlargement that may be caused by intraneural oedema . Ultrasound measurements using Doppler sonograms have also detected intraneural blood flow in dialysis patients, which is a pathological feature not detectable in controls .…”

Section: The Pathophysiology Of Peripheral Neuropathy In Ckdmentioning

confidence: 99%

“…In addition to the cardiovascular and disease management benefits, normalising potassium may also improve neuromuscular complications in CKD. Neuromuscular tissues are excitable, and recent studies have demonstrated that abnormal potassium homeostasis also has a detrimental effect on associated complications, such as peripheral neuropathy and skeletal muscle function, in CKD . Peripheral neuropathy is the most common neurological complication of CKD.…”

Section: Introductionmentioning

confidence: 99%

Potassium control in chronic kidney disease: implications for neuromuscular function

Arnold

Pianta

Pussell

et al. 2019

Internal Medicine Journal

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In Australia approximately 1.7million adults have evidence of chronic kidney disease (CKD). This complex disease can result in a multitude of complications, including hyperkalaemia which common and well recognised. . The advent of new therapeutics aimed at lowering serum potassium have raised the possibility of optimising potassium control to enable greater use of renin-angiotensin-aldosterone system inhibitors in the management of CKD. Recent studies suggest that hyperkalaemia also has implications for peripheral neuropathy in CKD, a complication that substantially contributes to patient morbidity. This review examines evidence of the relationship between potassium and peripheral neuropathy with discussion of clinical implications. We searched PubMed for original and review articles using prespecified key words, clinical guidelines and population data. The major findings were that contemporary CKD cohorts demonstrate a high prevalence of peripheral neuropathy, even in stage 3-4 CKD, including those without diabetes. The severity of the problem has been emphasized by an ominous rise in foot complications and amputation rates in dialysis patients, highlighting the need for increased awareness of the condition in earlier stages of CKD and targeted treatment strategies. It is likely that the pathophysiology of peripheral neuropathy in CKD is multifaceted with potential influences from potassium, vascular abnormalities, diabetes, inflammation and unknown middle molecules. Despite these complexities, the relationship between potassium and nerve function in dialysis has been well established and recent research in stage 3-4 CKD suggests that assertive potassium control may improve neuromuscular outcomes in CKD. These small studies should be confirmed in large, multicenter settings. This article is protected by copyright. All rights reserved.

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