Abstract
Background Peripheral neuropathy is a common neurological complication in uremic patients, and quantitative sensory testing (QST) is effective for diagnosis of small fiber neuropathy. Malnutrition and arterial stiffness are prevalent in patients undergoing hemodialysis (HD). The associations of small fiber neuropathy with nutritional status and arterial stiffness remain uncertain in maintenance HD patients. Methods A total of 152 HD patients were included. Geriatric nutritional risk index (GNRI), an indicator of nutritional status, was calculated by serum albumin and actual and ideal body weight. Arterial stiffness was defined as brachial-ankle pulse wave velocity (baPWV) > 1400 cm/s. Small fiber neuropathy was assessed by an abnormal QST threshold of cold and warm sensation in patients' hands or feet. Multivariate forward logistic regression analysis was performed to examine the associations among abnormal QST threshold, GNRI, and arterial stiffness. Results baPWV and prevalence of abnormal QST threshold were significantly higher in diabetic patients. Multivariate logistic analyses revealed that older age (OR, 1.081; 95% CI, 1.026–1.139, p = 0.003) and male gender (OR, 4.450; 95% CI, 1.250–15.836, p = 0.021) were associated with abnormal warm threshold of hands. Furthermore, diabetes (OR, 3.966; 95% CI, 1.351–11.819, p = 0.012) and lower GNRI (per 1 unit increase, OR, 0.935, 95% CI, 0.887–0.985, p = 0.012) were associated with abnormal cold threshold of feet. Arterial stiffness (OR, 5.479, 95% CI, 1.132–22.870, p = 0.020) and higher calcium-phosphorus product (OR, 1.071, 95% CI, 1.013–1.132, p = 0.015) were associated with abnormal warm threshold of feet. Conclusions Lower GNRI and arterial stiffness were significantly associated with small fiber neuropathy in patients undergoing HD. Malnutrition risk and vascular factors might play important roles in small fiber neuropathy among patients undergoing HD.
Highlights
Patients with end-stage renal disease (ESRD) often suffer from neurological complications, thereby contributing to morbidity and mortality [1,2,3]
Diabetic patients were more likely to be older in age and had shorter duration of dialysis, higher brachial-ankle pulse wave velocity (baPWV), lower cold threshold, and higher warm threshold among the quantitative sensory testing (QST) of both hands and feet
We found that the prevalence of abnormal QST threshold and baPWV were significantly higher in diabetic HD patients
Summary
Patients with end-stage renal disease (ESRD) often suffer from neurological complications, thereby contributing to morbidity and mortality [1,2,3]. Peripheral neuropathy is the most commonly reported neurological complication associated with chronic renal failure [4], with an incidence rate of more than 60% in patients on dialysis. It can affect sensory, motor, and cranial nerves and is characterized by axonal degeneration and demyelination [5]. Small fiber neuropathy was assessed by an abnormal QST threshold of cold and warm sensation in patients’ hands or feet. Multivariate forward logistic regression analysis was performed to examine the associations among abnormal QST threshold, GNRI, and arterial stiffness. Lower GNRI and arterial stiffness were significantly associated with small fiber neuropathy in patients undergoing HD.
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