J Korean Med Sci.  2011 Sep;26(9):1227-1230. 10.3346/jkms.2011.26.9.1227.

Carpal Tunnel Syndrome and Peripheral Polyneuropathy in Patients with End Stage Kidney Disease

• Kwon HK
• Pyun SB
• Cho WY
• Boo CS

• KMID: 1779399
• DOI: http://doi.org/10.3346/jkms.2011.26.9.1227

Abstract

This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.

Keyword

Uremia; Carpal Tunnel Syndrome; Electrodiagnosis; Amyloidosis; Arteriovenous Fistula

MeSH Terms

Adult
Aged
Amyloidosis/complications
Arteriovenous Fistula/complications
Blood Urea Nitrogen
Carpal Tunnel Syndrome/*complications/*diagnosis
Creatinine/blood
Electrophysiological Phenomena
Female
Humans
Kidney Failure, Chronic/*complications/*therapy
Male
Middle Aged
Peritoneal Dialysis/adverse effects
Polyneuropathies/*complications/*diagnosis
Renal Dialysis/adverse effects
beta 2-Microglobulin/blood

Reference

1. Krishnan AV, Kiernan MC. Uremic neuropathy: clinical features and new pathophysiological insights. Muscle Nerve. 2007. 35:273–290.

2. Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. 2004. 107:1–16.

3. Hirasawa Y, Ogura T. Carpal tunnel syndrome in patients on long-term haemodialysis. Scand J Plast Reconstr Surg Hand Surg. 2000. 34:373–381.

4. Bicknell JM, Lim AC, Raroque HG Jr, Tzamaloukas AH. Carpal tunnel syndrome, subclinical median mononeuropathy, and peripheral polyneuropathy: common early complications of chronic peritoneal dialysis and hemodialysis. Arch Phys Med Rehabil. 1991. 72:378–381.

5. Gejyo F, Narita I. Current clinical and pathogenetic understanding of beta2-m amyloidosis in long-term haemodialysis patients. Nephrology (Carlton). 2003. 8:Suppl. S45–S49.

6. Cofan F, Garcia S, Combalia A, Segur JM, Oppenheimer F. Carpal tunnel syndrome secondary to uraemic tumoral calcinosis. Rheumatology (Oxford). 2002. 41:701–703.

7. Harding AE, Le Fanu J. Carpal tunnel syndrome related to antebrachial Cimino-Brescia fistula. J Neurol Neurosurg Psychiatry. 1977. 40:511–513.

8. Kumar S, Trivedi HL, Smith EK. Carpal tunnel syndrome: a complication of arteriovenous fistula in hemodialysis patients. Can Med Assoc J. 1975. 113:1070–1072.

9. Gousheh J, Iranpour A. Association between carpal tunnel syndrome and arteriovenous fistula in hemodialysis patients. Plast Reconstr Surg. 2005. 116:508–513.

10. Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995. 122:561–568.

11. Jebsen RH, Tenckhoff H, Honet JC. Natural history of uremic polyneuropathy and effects of dialysis. N Engl J Med. 1967. 277:327–333.

12. Delmez JA, Holtmann B, Sicard GA, Goldberg AP, Harter HR. Peripheral nerve entrapment syndromes in chronic hemodialysis patients. Nephron. 1982. 30:118–123.

13. Namazi H, Majd Z. Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis. Arch Orthop Trauma Surg. 2007. 127:725–728.

14. Benz RL, Siegfried JW, Teehan BP. Carpal tunnel syndrome in dialysis patients: comparison between continuous ambulatory peritoneal dialysis and hemodialysis populations. Am J Kidney Dis. 1988. 11:473–476.

15. Kuntz D, Naveau B, Bardin T, Drueke T, Treves R, Dryll A. Destructive spondylarthropathy in hemodialyzed patients: a new syndrome. Arthritis Rheum. 1984. 27:369–375.

16. Jain VK, Cestero RV, Baum J. Carpal tunnel syndrome in patients undergoing maintenance hemodialysis. JAMA. 1979. 242:2868–2869.