Neuropathy and Other Neurological Problems in Chronic Kidney Disease

Abstract

Neurological complications are highly prevalent in CKD. These complications can potentially affect all levels of the nervous system from central nervous system disorders such as cognitive dysfunction and encephalopathy, to peripheral disorders such as myopathy, autonomic and peripheral neuropathies. These conditions have a significant impact not only causing morbidity due to pain, weakness, reduced exercise capacity, and disability but also increased mortality risk. Management strategies for peripheral neuropathy include pharmacological treatment of painful symptoms, while dietary potassium restriction, glycaemic control, and exercise strategies may be beneficial. Uremic myopathy may respond to exercise programs, adequate nutritional intake, and treatment with erythropoietin. Treatment of carpal tunnel syndrome with wrist splints or corticosteroid injections may provide benefit. Patients with autonomic neuropathy may respond to sildenafil for impotence. Cognitive dysfunction and dementia may be assessed using the Montreal cognitive examination or the mini-mental state examination and should be differentiated from encephalopathy which is accompanied by tremor and asterixis. Early detection and management of chronic neurological conditions provides a window of opportunity to reduce their impact at later stages.