To investigate the relationship between severity of peripheral polyneuropathy (PPN) and degree of depression and quality of life in chronic renal failure (CRF) patients on hemodialysis (HD).
Forty seven chronic renal failure patients on hemodialysis were recruited (22 male, 25 female, mean age of 63.17±12.52) and etiology, disease duration, hemodialysis duration, creatinine and hemoglobin were recorded. Motor and sensory nerve conduction studies were carried out on bilateral median, ulnar, tibial and peroneal nerves for diagnosis of polyneuropathy according to our laboratory criteria. The Korean version of Beck depression inventory (BDI) questionnaire translated into Korean for diagnosis of depression, and Korean version of Short Form 36 health survey (SF-36) questionnaire for measurement of general health level were measured in those diagnosed with uremic PPN.
Out of 52 patients, 47 were diagnosed with polyneuropathy and mean score for BDI was 18.49±9.18. Mean scores for each of Mental Component Summary (MCS) and Physical Component Summary (PCS) of SF-36 were 50.84±15.42 and 47.41±18.68. The correlation between the scores and polyneuropathy were analyzed by Pearson coefficient. The MCS score was the significant (p<0.05) correlation parameter with depression (R=-0.635) and the PCS score was the only parameter with a significant (p<0.05) correlation with polyneuropathy (R=-0.340).
Uremic polyneuropathy is commonly observed in chronic renal failure patients on hemodialysis. Depression in CRF with uremic PPN is affected by psychological factors other than the PPN itself.
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Cefepime is a fourth-generation cephalosporin that is active against both gram-positive and gram-negative organisms. It is administered parenterally for the treatment of severe infections. Approximately 85% of the drug is excreted unchanged by the kidneys. Neurotoxicity in patients with renal failure who are treated with cefepime has been reported sporadically. We report on two senile patients with renal impairment who developed neurotoxicity including lethal outcome after treatment with cefepime.
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Objective: The sympathetic skin response (SSR) was measured in patients with chronic renal failure (CRF) for diagnosis of uremic polyneuropathy and its correlations with nerve conduction study (NCS) and clinical autonomic symptoms were investigated.
Method: The SSR was measured in 15 patients with CRF on regular hemodialysis, aged 26 to 67 years. With median nerve stimulation at the wrist using the extremity without arteriovenous fistula, the SSR was recorded from both palm and sole simultaneously. The responses were interpreted as normal (presence) or abnormal (absence). Routine nerve conduction study was also performed in the same extremities and clinical autonomic symptoms were investigated.
Results: Nine of fifteen patients (60.0%) had symptoms suggestive of autonomic dysfunction: the most frequent findings were orthostatic dizziness and sweating problem. The SSR was absent in four of fifteen patients (26.7%). There is no significant relationship between SSR and autonomic symptoms (P＞0.05). The nerve conduction study was abnormal in eight of fifteen patients (53.3%), and the SSR was absent in two of seven patients with normal NCS. There is no significant relationship between NCS and SSR (P＞0.05).
Conclusion: Although the proportion of abnormal SSR was small, it may be a valuable method in the assessment of uremic polyneuropathy in conjunction with routine nerve conduction study in CRF patients.
Method: Subjects were 22 patients with AVF in patients with CRF and 10 controls without AVF in patients with CRF. We studied nerve conductions, and compared the findings in the arms with fistula and without fistula, and the arms in controls.
Results: In ulnar motor nerve conduction study, the amplitude in fistula side was lower than non-fistula side, but the conduction velocity in non-fistula side was lower than fistula side. In radial motor nerve conduction study, the distal latency in non-fistula side was more delayed than that in fistula side. There were no statistical significancies between fistula side and non-fistula side in the other nerve conduction study parameters in arms. And there was no statistically different incidences of carpal tunnel syndrome in both sides. Comparing with controls, conduction velocities of ulnar and radial motor nerves and peak latencies of ulnar and radial sensory nerves were more delayed in both sides.
Conclusion: There were no significant local effects of arteriovenous fistula on nerve conductions in patients with chronic renal failure. (J Korean Acad Rehab Med 2003; 27: 912-916)
Objective: The purpose of this study is to evaluate the relationship between cognitive function and findings of evoked potential study in chronic renal failure patients.
Method: Thirty chronic renal failure patients with cognitive dysfunction were recruited, whose mini-mental state examination (MMSE) scores were less than 24 points. According to the underlying diseases of chronic renal failure, we categorized thirty patients into diabetic group (11 patients) and non-diabetic group (19 patients), and the control-group was composed of 15 normal volunteers. Somatosensory evoked potential (SEP) on stimulating median and posterior tibial nerves, and cortical and spinal conduction time of the motor pathways were valuated.
Results: In tibial nerve SEP, N22-P38 interpeak latencies (IPL) were 18.1⁑4.2 msec in the patient group and 15.7⁑1.9 msec in the control group, respectively. In MEP, cortico-lumbar central motor conduction times (CMCT) were 19.5⁑2.7 and 16.5⁑3.0 msec, respectively. CMCT were prolonged in patients than controls (p＜0.05). There was significant correlation between serum creatinine concentration and N22-P38 IPL (r=0.64, p＜0.05), but, there were no correlations between the underlying diseases of chronic renal failure, duration of disease, MMSE score and cortico-lumbar CMCT, N22-P38 IPL (p＞0.05).
Conclusion: Evoked potentials will be helpful in evaluating the patients with cognitive dysfunction in chronic renal failure.
Objective: To investigate the prevalance of carpal tunnel syndrome (CTS) and polyneuropathy (PNP) in chronic hemodialysis patients, and to know the relationships between the clinical symptoms and electrophysiological evidence of CTS, the edema of the hand and CTS, and the shunt side and CTS.
Method: We carried out a standardized nerve conduction study on 30 patients who had undergone a chronic dialysis for varying lengths of time. Differential diagnosis between CTS and PNP was done on the basis of difference of the median-ulnar motor and sensory latencies in the patients with a prolonged distal median motor or sensory latency.
Results: Sixteen (54%) had a combined PNP with the CTS; Seven (23%) patients had a PNP only; Two (7%) patients had a CTS only. There was no definite findings of peripheral neuropathy in five (17%) patients. Among eighteen patients with the CTS, sixteen were subclinical and two were overt CTS. Presence of edema and shunt was not crucial for the development of CTS.
Conclusion: Prevalence of CTS in chronic hemodialysis patients was 60%. Subclinical CTS was more frequent compared to the overt CTS. Dialysis patients need a frequent nerve conduction study for the early identification of carpal tunnel syndrome and to avoid the irreversible nerve damage.
Objective: To evaluate the autonomic nervous system function in chronic renal failure patients compared to normal control and to assess the effect of dialysis method and underlying diseases such as diabetes mellitus and hypertension, on autonomic nervous system function in chronic renal failure patients.
Method: We checked palm and sole skin temperature with digital thermometer, sympathetic skin responses and heart rate variability in chronic renal failure patients (77 persons) and normal control group (77 persons).
Results: The amplitude of sympathetic skin response (SSR) and heart rate variability (RRIV) of patients group showed statistically significant difference compared to control group (p＜0.05). The diabetic patient group with chronic renal failure showed prolonged latency of SSR in sole but significant differences were shown in amplitude and RRIV (p＜0.05). The hypertensive group with chronic renal failure showed prolonged latency of SSR in both palm and sole (p＜0.05) but the amplitude and RRIV of those didn,t show statistical difference (p＞0.05). CRF without diabetes mellitus and hypertension showed significant difference on amplitude of SSR and RRIV (p＜0.05) but autonomic nervous system function tests showed no difference (p＞0.05) between hemodialysis and peritoneal dialysis groups.
Conclusion: SSR test and RRIV could be valuable measure to evaluate autonomic nervous system functions in the patients with chronic renal failure.
Method: Nerve conduction studies were performed in 23 patients with chronic renal failure. We not only measured distal latencies, amplitudes, and conduction velocities of median and ulnar motor nerves but also measured same parameters of radial sensory nerves at both upper limbs. In case of pateints with suspected peripheral polyneuropathy, we checked peripheral nerves at one lower limb. The results of nerve conduction studies and the frequency of cubital tunnel syndrome or carpal tunnel syndrome were compared between arteiovenous fistula side and non-arteiovenous fistula side.
Results: The amplitudes of median motor, ulnar motor nerves and radial sensory nerve in arteiovenous fisula side are statistically lower than those in non-arteiovenous fisula side (p＜0.05). In the 14 patients with peripheral polyneuropathy, the difference is also statistically significant between two sides (p＜0.05). Compared arteiovenous fisula side with non-arteiovenous fisula side, the frequency of cubital tunnel syndrome or carpal tunnel syndrome was not different between two sides.
Conclusion: Arteiovenous fisula may damage to the peripheral nerve in patients with chronic renal failure. (J Korean Acad Rehab Med 2003; 27: 85-89)
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