Skip to main content

Advertisement

SpringerLink
Log in

A neurophysiological study of large- and small-diameter nerve fibers in the hands of hemodialysis patients

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Polyneuropathy in patients with advanced clinical kidney disease is a very disabling condition. The aim of this study was to evaluate neurophysiological abnormalities of large- and small-diameter nerve fibers in the hands of hemodialysis patients.

Methods

A total of 38 hemodialysis patients and 38 healthy control subjects underwent a conventional electrophysiological examination. The function of small nerve fibers was assessed using cutaneous silent period (CSP) measurement.

Results

Slower median nerve motor conduction velocities were recorded in patients with fistula (p < 0.0001) and without fistula (p < 0.001). Sensory median and ulnar nerve conduction velocities were slower in both patient groups compared with the control group (p = 0.001). Median sensory nerve action potential amplitudes were lower in patients with fistulas (p = 0.009) and without fistulas (p = 0.005) compared with the control group. Significantly prolonged F-wave latencies of the median (p = 0.002) and ulnar nerves (p = 0.023) in patients with fistulas hands were observed. In 12/38 (32 %) patients, the onset latencies of CSPs were significantly delayed (p = 0.001). There was an inverse correlation of β2-microglobulin and decreased conduction velocities of the median nerves, while Kt/V was associated with improved sensory nerve conduction velocity of the median nerve. An inverse correlation between motor velocity of both nerves and hemodialysis duration was observed in the patient groups.

Conclusions

The measurement of CSPs provides a useful method for assessing small nerve fibers. The role of A-delta fibers is often overlooked.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Baumgaertel MW, Kraemer M, Berlit P (2014) Neurologic complications of acute and chronic renal disease. Handb Clin Neurol 119:383–393

    Article  PubMed  Google Scholar 

  2. Said G (2013) Uremic neuropathy. Handb Clin Neurol 115:607–612

    Article  PubMed  Google Scholar 

  3. Krishnan AV, Kierman MC (2007) Uremic neuropathy: clinical features and new pathophysiological insight. Muscle Nerve 35:273–290

    Article  CAS  PubMed  Google Scholar 

  4. Lacerda G, Krummel T, Hirsch E (2010) Neurologic presentations of renal diseases. Neurol Clin 28:45–59

    Article  PubMed  Google Scholar 

  5. Thomas PK (1978) Screening for peripheral neuropathy in patients treated by chronic haemodialysis. Muscle Nerve 1:396–399

    Article  CAS  PubMed  Google Scholar 

  6. Brouns R, De Deyn PP (2004) Neurological complications in renal failure: a review. Clin Neurol Neurosurg 107:1–16

    Article  CAS  PubMed  Google Scholar 

  7. Savazzi GM, Migone L, Cambi V (1980) The influence of glomerular filtration rate on uremic polyneuropathy. Clin Nephrol 13:64–72

    CAS  PubMed  Google Scholar 

  8. Said G, Boudier L, Selva J, Zingraff J, Drueke T (1983) Different patterns of uremic polyneuropathy: clinico-pathologic study. Neurology 33:567–574

    Article  CAS  PubMed  Google Scholar 

  9. Angus-Lepan H, Burke T (1992) The function of large and small nerve fibres in renal failure. Muscle Nerve 15:288–294

    Article  Google Scholar 

  10. Laaksonen S, Metsarinne K, Voipio-Pulkki LM, Falck B (2002) Neurophysiological parameters and symptoms in chronic renal failure. Muscle Nerve 25:884–890

    Article  PubMed  Google Scholar 

  11. Hojs-Fabjan T, Hojs R (2006) Polyneuropathy in haemodialysis patients: the most sensitive electrophysiological parameters and dialysis adequacy. Wien Klin Wochenschr 118(suppl 2):29–34

    Article  PubMed  Google Scholar 

  12. Inghilleri M, Cruccu G, Argenta M, Polidori L, Manfredi M (1997) Silent period in upper limb muscles after noxious cutaneous stimulation in man. Electroenecephalogr Clin Neurophysiol 105:109–115

    Article  CAS  Google Scholar 

  13. Leis AA, Kofler M, Ross M (1992) The silent period in pure sensory neuronopathy. Muscle Nerve 15:1345–1348

    Article  CAS  PubMed  Google Scholar 

  14. Serrao M, Parisi L, Pierelli F, Rossi P (2001) Cutaneous afferents mediating the cutaneous silent period in the upper limbs: evidence for a role of low-threshold sensory fibres. Clin Neurophysiol 112:2007–2014

    Article  CAS  PubMed  Google Scholar 

  15. Denislic M, Meh D (1997) Die quantitatieve Bestimmung der Funktion der dünnen Nervenfasern. Nervenarzt 68:509–514

    Article  CAS  PubMed  Google Scholar 

  16. Santiago S, Ferrer T, Espinosa ML (2000) Neurophysiological studies of thin myelinated (A delta) and unmyelinated (C) fibres: application to peripheral neuropathies. Neurophysiol Clin 30:27–42

    Article  CAS  PubMed  Google Scholar 

  17. Novak P, Burger H, Marincek C, Meh D (2004) Influence of foot pain on walking ability of diabetic patients. J Rehabil Med 36:249–252

    Article  PubMed  Google Scholar 

  18. Lee HJ, De Lisa JA (eds) (2005) Manual of nerve conduction study and surface anatomy for needle electromyography, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 25–55

    Google Scholar 

  19. Dyck PJ (1988) Detection, characterization and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 11:21–32

    Article  CAS  PubMed  Google Scholar 

  20. Mambelli E, Barrella M, Facchini MG, Mancini E, Sicuso C, Bainotti S, Formica M, Santoro A (2012) The prevalence of peripheral neuropathy in haemodialysis patients. Clin Nephrol 77:468–475

    Article  PubMed  Google Scholar 

  21. Krishnan AV, Phoon RK, Pussell BA, Charlesworth JA, Bostock H, Kierman MC (2005) Altered motor nerve excitability in end-stage kidney disease. Brain 128:2164–2174

    Article  PubMed  Google Scholar 

  22. Dyck PJ, Johnson WJ, Lambert EH, O’Brien PC (1971) Segmental demyelination secondary to axonal degeneration in uremic polyneuropathy. Mayo Clin Proc 46:400–431

    CAS  PubMed  Google Scholar 

  23. Deger SM, Reis KA, Guz G, Bali M, Erten Y (2011) A case of an accelerated uremic neuropathy. Ren Fail 33:371–372

    Article  PubMed  Google Scholar 

  24. Aggarwal HK, Sood S, Jain D, Kaverappa V, Yadav S (2013) Evaluation of spectrum of peripheral neuropathy in pre-dialysis patients with chronic kidney disease. Ren Fail 35:1323–1329

    Article  CAS  PubMed  Google Scholar 

  25. Al-Hayk K (2007) Neuromuscular complications in uremics: a review. Neurologist 13:188–196

    Article  PubMed  Google Scholar 

  26. Bicknell JM, Lim AC, Raroque HG Jr, Tzamalonkas AH (1991) Carpal tunnel syndrome, subclinical median mononeuropathy, and peripheral polyneuropathy: common early complications of chronic peripheral dialysis and haemodialysis. Arch Phys Med Rehabil 72:378–381

    CAS  PubMed  Google Scholar 

  27. Sivri A, Ḉeliker R, Sungur C, Kutsal YG (1994) Carpal tunnel syndrome: a major complication in haemodialysis patients. Scand J Rheumatol 23:287–290

    Article  CAS  PubMed  Google Scholar 

  28. Weiber H, Linell F (1987) Tumoral calcinosis causing acute carpal tunnel syndrome. Case report. Scand J Plast Reconstr Surg. 21:229–230

    Article  CAS  Google Scholar 

  29. Gousheh J, Iranpour A (2005) Association between carpal tunnel syndrome and arteriovenous fistula in haemodialysis patients. Plast Reconstr Surg 116:508–513

    Article  CAS  PubMed  Google Scholar 

  30. Kwon HK, Pyun SB, Cho WY, Boo CS (2011) Carpal tunnel syndrome and peripheral polyneuropathy in patients with end-stage kidney disease. J Korean Med Sci 26:1227–1230

    Article  PubMed Central  PubMed  Google Scholar 

  31. Svilpauskaite J, Truffert A, Vaiciene N, Magistris MR (2006) Electrophysiology of small peripheral nerve fibres in man. A study using the cutaneous silent period. Medicina (Kaunas) 42:300–313

    Google Scholar 

  32. Kofler M, Fröhlich K, Saltuari L (2003) Preserved cutaneous silent periods in severe entrapment neuropathies. Muscle Nerve 28:711–714

    Article  PubMed  Google Scholar 

  33. Kofler M (2003) Functional organization of exteroceptive inhibition following nociceptive electrical fingertip stimulation in humans. Clin Neurophysiol 114:973–980

    Article  PubMed  Google Scholar 

  34. Leis AA, Stokic DS, Fuhr P, Kofler M, Kronenberg MF, Wissel J et al (2000) Nociceptive fingertip stimulation inhibits motor-neuron pools in the human upper limb. Neurology 55:1305–1309

    Article  CAS  PubMed  Google Scholar 

  35. Resende LAL, Caramori JCT, Kimaid PAT, Martin LC, Barretti P (2002) The silent period in patients with chronic renal failure undergoing hemodialysis. Electromyogr Clin Neurophysiol 42:275–279

    CAS  PubMed  Google Scholar 

  36. Kayacan SM, Ỉṣak B, Kayacan D, Mủftủoḡlu M, Karadaḡ A (2011) The importance of cutaneous silent period in uremic polyneuropathy. Nobel Med 7:89–94

    Google Scholar 

  37. Kofler M, Valls-Solé J, Vasko P, Boček V, Štetkárová I (2014) Influence of limb temperature on cutaneous silent periods. Clin Neurophysiol 125:1826–1833

    Article  PubMed  Google Scholar 

  38. Lopergolo D, Isak B, Gabriele M et al (2015) Cutaneous silent period recordings in demyelinating and axonal polyneuropathies. Clin Neurophysiol 126:1780–1789

    Article  PubMed  Google Scholar 

  39. Dyck PJ, Lais A, Karnes LJ, O’Brian P, Rizza R (1986) Fibre loss is primary and multifocal in sural nerves in diabetic polyneuropathy. Ann Neurol 50:425–439

    Article  Google Scholar 

  40. Mota IA, Fernandes JB, Cardoso MN, Sala-Blanch X, Kofler M, Valls-Solẻ J (2015) Temporal profile of the effects of regional anesthesia on the cutaneous reflexes of foot muscles. Exp Brain Res 233:2587–2596

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia

    Miro Denislic

  2. Department of Neurology, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina

    Merita Tiric-Campara

  3. Clinic for Haemodialysis, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina

    Halima Resić

  4. Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait

    Jasem Y. Al-Hashel

  5. Faculty of Chemistry and Chemical Technology, Ljubljana, Slovenia

    Rok Zorec

  6. Department of Infectology, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina

    Refet Gojak

  7. Faculty of Mathematics and Physics, Ljubljana, Slovenia

    Jan Ravnik

Authors
  1. Miro Denislic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Merita Tiric-Campara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Halima Resić
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jasem Y. Al-Hashel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rok Zorec
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Refet Gojak
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jan Ravnik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miro Denislic.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Denislic, M., Tiric-Campara, M., Resić, H. et al. A neurophysiological study of large- and small-diameter nerve fibers in the hands of hemodialysis patients. Int Urol Nephrol 47, 1879–1887 (2015). https://doi.org/10.1007/s11255-015-1117-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-015-1117-7

Keywords

Search

Navigation