The Relationship Between Duration of Dialysis and Carpal Tunnel Release Outcomes: A Systematic Review

Abstract Purpose Carpal tunnel syndrome (CTS) is a common compressive neuropathy that can become more severe in patients undergoing long-term hemodialysis (HD). Although carpal tunnel release (CTR) is the standard surgical treatment for CTS, outcomes may worsen among patients undergoing long-term HD. The aim of this systematic review is to evaluate the relationship between CTR and HD. Methods A systematic review was conducted by screening 569 studies. Variables included duration of HD prior to CTS diagnosis, duration of symptomatic CTS, and total duration of HD therapy prior to surgical intervention. Postoperative symptom relief and complications were also collected. Studies including patients receiving peritoneal dialysis, preexisting non-HD associated CTS, or case series with n < 10 were excluded. Results Four studies were included, consisting of 199 HD patients (271 hands). Minimum follow-up was 1 year. At 1 year, post-CTR complications were seen in 31 hands (11.4%), with the most common being persistent CTS in 25 hands (9.2%). Individuals with >10 years on HD prior to CTS diagnosis had significantly less symptomatic relief and were associated with higher rates of persistent CTS and revision when compared with those with <10 years on HD. Conclusions CTR generally improves symptoms in HD patients with CTS. However, we demonstrated a significant inverse relationship between HD duration and symptom improvement, with higher persistence of symptoms in the long-term HD cohort. These findings underscore the importance of timely diagnosis tailored to HD duration to optimize clinical outcomes. Type of study/level of evidence Prognostic III