A study of patterns of peripheral neuropathy in chronic kidney disease patients on maintenance hemodialysis with and without type 2 diabetes mellitus: Our experience from tertiary care centres in South India

Objective: To study the prevalence, clinical features, electrophysiological features, and severity of peripheral neuropathy in chronic kidney disease (CKD) patients on maintenance hemodialysis and the effect of the presence of diabetes mellitus. Materials and Methods: 200 CKD patients on maintenance hemodialysis were assessed prospectively for peripheral neuropathy. Results: Prevalence of peripheral neuropathy was 45% based on clinical symptoms and 98% based on electrophysiological parameters. The mean age was 54.4 ± 10.4 years and 70% were male. 100 patients (50%) had positive symptoms and 48 patients (24%) had negative symptoms. Autonomic symptoms were seen in 8 patients (4%). Definite damage was seen in 144 patients (72%) and early damage was seen in 52 patients (26%). In hemodialysis patients with diabetes mellitus ( n = 100), 92 patients (92%) had definite damage. In hemodialysis patients without diabetes mellitus ( n = 100), 52 patients (52%) had definite damage. In CKD patients on hemodialysis, patients aged >50 years (definite damage in 77.4%) and males (definite damage in 82.9%) showed more severe peripheral neuropathy compared to patients aged ≤50 years (definite damage in 57.9%) and females (definite damage in 46.7%). The most common nerves involved were sural nerve, common peroneal nerve, and ulnar sensory nerve. The most common pattern was mixed axonal sensorimotor polyneuropathy. Conclusion: Peripheral neuropathy is common in CKD patients on hemodialysis with higher prevalence and severity in elderly males and diabetics. Early and effective management of diabetes and use of high-flux dialyzers in CKD patients on hemodialysis probably lowers the prevalence and severity of peripheral neuropathy.