Phrenic neuropathy in comparison with peripheral neuropathy in patients with chronic renal failure on hemodialysis

Abstract

Background Uremia-induced phrenic neuropathy may account for diaphragmatic involvement in patients with end-stage renal disease who are on dialysis. Objective The aim of this study was to assess the occurrence of phrenic neuropathy and its relationship with hyperkalemia and frequency of dialysis in patients with chronic renal failure on dialysis. Patients and methods The study included 27 patients with chronic renal failure on dialysis and 27 controls. All patients and controls were subjected to history taking, neurological examination, laboratory tests, neurophysiological study of phrenic and peripheral nerves, and scales to assess the severity of symptoms and disability caused by peripheral neuropathy. Results Of the 27 patients, 70.4% had phrenic motor neuropathy, 33.4% had median motor neuropathy, 48.2% had median sensory neuropathy, 40.8% had peroneal motor neuropathy, and 66.7% had peroneal sensory neuropathy with highly statistically significant difference in neuropathy between patients and controls. Infrequent dialysis was the cause of bilateral mixed (44.4%) and axonal (33.3%) phrenic motor neuropathy. Bilateral mixed phrenic motor neuropathy was more frequent in the hyperkalemia group (31.2%). Conclusion Phrenic neuropathy is a frequent complication in chronic renal failure patients on dialysis, especially in those with hyperkalemia and undergoing infrequent dialysis.