Nerve dysfunction in patients with end stage renal disease and causative role of potassium-a hospital based study

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Author: 
Dr. Pinaki Mukhopadhyay, Dr. Vasudha, Dr. Shankar Prasad Saha and Dr. Nirendra Mohan Biswas
Subject Area: 
Health Sciences
Abstract: 

Introduction: Chronic kidney disease (CKD) is a critical and rapidly growing global health problem. Uremia is considered to be the second leading cause of frequent metabolic neuropathy. Neurological complications occur in almost all patients with severe CKD, potentially affecting all levels of the nervous system, from the CNS through to the PNS. Peripheral neuropathy manifests in almost all such patients, leading to weakness and disability. Aims and Objectives: To evaluate the changes of Nerve Conduction Velocity in different potassium Value in Chronic Kidney Disease stage 5 and to establish any causal relationship of potassium level with neuropathy in ESRD Patient. Methodology: Patient admitted with CKD-5 (on Hemodialysis/Not on Hemodialysis) with symptoms of tingling, numbness or feature suggestive of peripheral neuropathy will be randomly selected accordingly inclusion criteria. All epidemiological and clinical data will be recorded. Everybody will be tested for basic investigations including electrolytes in addition to potassium and NCV study. Patients will be divided into three groups- Normokalemic, hypokalemic (potassium<3.5) and hyperkalemic (potassium>5.5). The patients with positive changes of NCV will be tested for any causal relationship with potassium value. Results: A positive and a highly significant correlation between the level of potassium and neuropathic features in an ESRD patient. A positive association is seen between the NCV changes, mainly axonopathy and demyelination (in long standing cases) and raised potassium levels in ESRD patients. A positive association is seen between potassium level and the stage of neuropathy. Conclusion: The present study supports the fact that abnormalities in serum potassium constitute a transient homeostatic disturbance which if persistent can lead to more permanent damage to neurons leading to irreversible neuropathy. As far as axons are concerned, regular monitoring and strict control of potassium in the normal range goes very far in the delayed progression of peripheral neuropathy.

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