Neuropathy and Other Neurological Problems in Chronic Kidney Disease

Abstract

Neurological complications are highly prevalent in patients with CKD. These complications can potentially affect all levels of the nervous system from central nervous system disorders, such as encephalopathy and cognitive dysfunction, to peripheral disorders such as myopathy and autonomic and peripheral neuropathies. These conditions have significant impacts not only on patient morbidity due to pain, weakness, reduced exercise capacity and disability but also increased mortality risk. Management strategies for neuropathy include pharmacological treatment of painful symptoms, while dietary potassium restriction, glycemic control and exercise strategies may be beneficial. Uremic myopathy may respond to exercise programmes, adequate nutritional intake and treatment with erythropoietin. Treatment of carpal tunnel syndrome with wrist splints or corticosteriod injections may provide benefit. Patients with autonomic neuropathy may respond to phosphodiesterase type 5 inhibitors, such as sildenafil, for impotence. Cognitive dysfunction and dementia may be assessed using the mini-mental state examination or formal neuropsychological testing. Detection and management of these conditions in earlier stages of CKD may provide a window of opportunity to reduce their impact at later stages.