Hemodialysis fistula-related ischemic neuropathy in ESRD: an electrophysiological study

• Arteriovenous fistulas (AVFs) cause subclinical sensorimotor neuropathy in the ipsilateral median and ulnar nerves. • Forearm AVFs and high flow enhance neuropathic changes and distal ischemic injury risk. • Early electrophysiological screening enables timely detection and intervention for AVF neuropathy. Hemodialysis access (HA) may induce distal ischemia and impair peripheral nerve function in the ipsilateral limb. Peripheral neuropathy is common in end-stage renal disease (ESRD) and may remain subclinical without electrophysiological testing. This study evaluated the effect of arteriovenous fistula (AVF) on electrophysiological parameters of the median (MN) and ulnar (UN) nerves and examined the impact of HA localization and flow. Ninety ESRD patients with functioning AVF underwent bilateral nerve conduction studies (DML, CMAP, CSAP, MCV, SCV) one hour before dialysis. HA flow was measured by Doppler sonography. Sensory symptoms and clinical tests (Phalen, Tinel) were recorded. Compared to the contralateral arm, the HA arm showed longer DML and reduced CMAP, CSAP, MCV, and SCV in both MN and UN. CSAP and MCV reductions were significant in both nerves, CMAP in UN. Electrophysiological impairment was greater with forearm HA and high flow (>979 ml/min). Patients with sensory complaints exhibited significantly worse parameters than asymptomatic patients. AVF is associated with mixed axonal sensory-motor neuropathy, likely due to chronic distal ischemia. Sensory fibers are particularly vulnerable. Forearm location and high flow exacerbate deficits. Early electrophysiological screening may enable timely detection and intervention.