말기 신질환 환자들에서 발생한 말초신경병증
Peripheral Neuropathy in Patients with End-Stage Renal Disease
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Objective: To investigate and analyze prevalence and characteristics of peripheral neuropathy in patients with end-stage renal disease (ESRD) according to the cause of ESRD. Methods: Cross sectional study was conducted in 112 patients who had undergone hemodialysis (n= 64) or peritoneal dialysis (n= 48). The medical records were reviewed. Standard motor and sensory nerve conduction studies, F waves, and H reflexes were performed. Peripheral neuropathy (PN) was diagnosed and classified into 4 grades. Results: PN was diagnosed in 58 patients (51.8%): 34 in hemodialysis (HD) group and 24 in peritoneal dialysis (PD) group. Forty two out of 47 patient with diabetes mellitus developed PN whereas 16 out of 65 did in non-diabetic patients (p<0.01). The severity of PN was as follows: Grade I, 12; Grade II, 11; Grade III, 26; Grade IV, 9. The duration of ESRD according to the severity of PN was not significant (p=0.056) in all the patients, but showed moderate correlation in non-diabetic patients (r=0.287, p<0.05). Conclusion: The diabetic patients may develop severe degree of PN compared to those with other etiology of ESRD because the peripheral nerve could be affected from both diabetes mellitus and uremia.
Abstract
Objective: To investigate and analyze prevalence and characteristics of peripheral neuropathy in patients with end-stage renal disease (ESRD) according to the cause of ESRD. Methods: Cross sectional study was conducted in 112 patients who had undergone hemodialysis (n= 64) or peritoneal dialysis (n= 48). The medical records were reviewed. Standard motor and sensory nerve conduction studies, F waves, and H reflexes were performed. Peripheral neuropathy (PN) was diagnosed and classified into 4 grades. Results: PN was diagnosed in 58 patients (51.8%): 34 in hemodialysis (HD) group and 24 in peritoneal dialysis (PD) group. Forty two out of 47 patient with diabetes mellitus developed PN whereas 16 out of 65 did in non-diabetic patients (p<0.01). The severity of PN was as follows: Grade I, 12; Grade II, 11; Grade III, 26; Grade IV, 9. The duration of ESRD according to the severity of PN was not significant (p=0.056) in all the patients, but showed moderate correlation in non-diabetic patients (r=0.287, p<0.05). Conclusion: The diabetic patients may develop severe degree of PN compared to those with other etiology of ESRD because the peripheral nerve could be affected from both diabetes mellitus and uremia.
참고문헌 (29)
- Raskin NH, "Neurologic disorders in renal failure (first of two parts)", N Engl J Med, 294, pp.143~148 (1976)
- Hegstrom RM, "Two year’'s experience with periodic hemodialysis in the treatment of chronic uremia", Trans Am Soc Artif Intern Organs, 8, pp.266~280 (1962)
- Asbury A, "Uremic polyneuropathy", Trans Am Neurol Assoc, 87, pp.100~103 (1962)
- Dyck PJ, "Segmental demyelination secondary to axonal degeneration in uremic neuropathy", Mayo Clin Proc, 46, pp.400~431 (1971)
- 정태두, "만성 신부전 환자에서 동정맥루가 말초신경에 미치는 영향", Annals of Rehabilitation Medicine, 27(1), pp.15~89 (2003), 대한재활의학회
- Jebsen RH, "Natural history of uremic polyneuropathy and effects of dialysis", N Engl J Med, 277, pp.327~333 (1967)
- Nielsen VK, "The peripheral nerve function in chronic renal failure. V. Sensory and motor conduction velocity", Acta Med Scand, 194, pp.445~454 (1973)
- Preswick G, "Subclinical Polyneuropathy in Renal Insufficiency", Lancet, 2, pp.731~732 (1964)
- Halar EM, "H-reflex latency in uremic neuropathy: correlation with NCV and clinical findings", Arch Phys Med Rehabil, 60, pp.174~177 (1979)
- Bolton CF, "Letter to editor", N Engl J Med, 302, pp.744~ (1980)
- Bolton CF, "Electrophysiologic changes in uremic neuropathy after successful renal transplantation", Neurology, 26, pp.152~161 (1976)
- Mitz M, "Motor nerve conduction indicators in uremic neuropathy", Arch Phys Med Rehabil, 61, pp.45~48 (1980)
- Ackil AA, "Late response and sural conduction studies. Usefulness in patients with chronic renal failure", Arch Neurol, 38, pp.482~485 (1981)
- Nielsen VK, "The peripheral nerve function in chronic renal failure. VII. in :Longitudinal course during terminal renal failure and regular hemodialysis", Acta Med Scand, 195, pp.155~162 (1974)
- Caccia MR, "Effects of hemodialytic treatment on uremic polyneuropathy. A clinical and electrophysiological follow-up study", J Neurol, 217, pp.123~131 (1977)
- Di Paolo B, "Electrophysiological aspects of nervous conduction in uremia", Clin Nephrol, 29, pp.253~260 (1988)
- 김진호, "만성 신부전 환자의 근전도 소견", 대한재활의학회지, 13, pp.139~143 (1989)
- "The effect of intensive diabetes therapy on the development and progression of neuropathy. in :The Diabetes Control and Complications Trial Research Group", Ann Intern Med, 122, pp.561~568 (1995)
- Winegrad AI, "Diabetic polyneuropathy: the importance of insulin deficiency, hyperglycemia and alterations in myoinositol metabolism in its pathogenesis", N Engl J Med, 295, pp.1416~1421 (1976)
- Dyck PJ, "Diabetic Neuropathy, 2nd edition", pp.286~288 (1999), W.B. Saunders
- Finegold D, "Polyol pathway activity and myo-inositol metabolism. A suggested relationship in the pathogenesis of diabetic neuropathy", Diabetes, 32, pp.988~992 (1983)
- Sima AA, "Axoglial dysjunction. A novel structural lesion that accounts for poorly reversible slowing of nerve conduction in the spontaneously diabetic bio-breeding rat", J Clin Invest, 77, pp.474~484 (1986)
- Mayer RF, "Conduction Velocity in Peripheral Nerve during Experimental Demyelination in the Cat", Neurology, 14, pp.714~726 (1964)
- Bricker NS, "A humoral inhibitor of sodium transport in uremic serum. in :A potential toxin", Arch Intern Med, 126, pp.860~864 (1970)
- Man NK, "An approach to “"middle molecules”" identification in artificial kidney dialysate, with reference to neuropathy prevention", Trans Am Soc Artif Intern Organs, 19, pp.320~324 (1973)
- Blumberg A, "Myoinositol--a uremic neurotoxin", Nephron, 21, pp.186~191 (1978)
- Di Giulio S, "Parathormone as a nerve poison in uremia", N Engl J Med, 299, pp.1134~1135 (1978)
- 김준석, "당뇨병 환자에서 신병증 진행정도에 따른 말초신경 전도에 관한 연구", 대한내과학회지, 44, pp.28~36 (1993)
- Bazzi C, "Uremic polyneuropathy: a clinical and electrophysiological study in 135 short- and long-term hemodialyzed patients", Clin Nephrol, 35, pp.176~181 (1991)
