Evaluation of Peripheral Neuropathy in the Feet of the Cases with Chronic Hemodialysis

Year 2020, Volume: 4 Issue: 2, 119 - 129, 30.08.2020

Ülker Özdemir , Selçuk Keser , Taner Bayraktaroğlu , Ali Borazan

https://doi.org/10.25048/tudod.610223

Abstract

Aim: In this study, we aimed to evaluation peripheral neuropathy in the feet of the cases with chronic hemodialysis.

Material and Methods: The study included in 111 hemodialysis patients. (Group-I) 35 hemodialysis patients without diabetes mellitus, (Group-II) 26 hemodialysis patients with diabetes mellitus, and (Group-III) 50 patients with type 2 diabetes mellitus without chronic kidney disease. The diagnostic criteria that, presence of subjective symptoms, Semmes Weinstein monofilament examination, vibration detection thresholds with diapasone and biotesiometer, and presence of achilles reflex, used in the diagnosis of neuropathy were recorded in the data collection form.

Results: Neuropathy percentages were detected 17.0% in Group-I cases with hemodialysis, 69.0% in Group-II cases with diabetes mellitus and hemodialysis, and 24.0% in Group-III cases with type 2 diabetes mellitus without chronic kidney diseases. The rate of neuropathy in Group II was significantly higher than Group-I and Group-III (p <0.001). There were no significant differences acording to neuropathy percentages between Group-I and Group-III (p >0.05).

Conclusion: Neuropathy is seen frequently in hemodialysis patients without diabetes mellitus, we think that regular podological foot examination and evaluation of neuropathy should be done for hemodialysis patients.

Keywords

Neuropathy, Diabetic peripheral neuropathy, Diabetes mellitus, Chronic kidney diseases, Hemodialysis

Kronik Hemodiyalizli Olguların Ayaklarında Periferik Nöropatinin Araştırılması

Abstract

Amaç: Çalışmamızda son dönem böbrek hastalığı nedeniyle hemodiyalize giren hastaların ayaklarında nöropatinin araştırılması amaçlandı.

Gereç ve Yöntemler: Çalışmaya diabetes mellitus (DM) tanısı olmayan 35 hemodiyaliz hastası (Grup-I), DM tanılı 26 hemodiyaliz hastası (Grup-II), kronik böbrek hastalığı olmayan Tip 2 DM tanılı 50 hastadan (Grup-III) oluşan toplam 111 hasta alındı. Nöropati tespitinde subjektif semptom varlığı, Semmes Weinstein monofilament incelemesi, diyapazon ve biyoteziyometrede vibrasyon algılama eşikleri ile aşil refleksinin varlığı kullanıldı. Gruplarda saptanan veriler analiz edildi.

Bulgular: Grup-I’deki hemodiyaliz olguların %17,0’sinde nöropati tespit edilirken, Grup-II’deki DM tanılı hemodiyaliz olguların %69,0’unda, Grup-III’ deki DM tanılı olguların %24,0’ünde nöropati tespit edildi. Grup II’deki nöropati oranı Grup-I ve Grup-III’e göre anlamlı yüksek bulundu (p<0,001). Grup-I ve Grup-III arasında anlamlı fark bulunmadı (p>0,05).

Sonuç: Hemodiyaliz hastalarında Diabetes Mellitus olmasa da nöropati sık görülmektedir. Bundan dolayı hemodiyalize giren hastalara düzenli podolojik ayak muayenesinin yapılmasının ve nöropati açısından değerlendirilmesinin uygun olacağını düşünmekteyiz.

Keywords

Hemodiyaliz, Nöropati, Diyabetik periferik nöropati, Diabetes mellitus, Kronik böbrek hastalığı

References

• KAYNAKLAR1. Tanrıverdi MH, Karadağ A, Hatipoğlu EŞ. Kronik böbrek yetmezliği. Konuralp Tıp Dergisi. 2010;2:27-32.
• 2. Benbir G, Tursun İ. Kronik böbrek yetmezliği olan ve olmayan diyabetik hastalarda nörofizyolojik değerlendirme. New Symposium Journal. 2013;51(2):101-4.
• 3. Doğukan A. Kronik böbrek yetmezliğinde nörolojik bozukluklar. Turkiye Klinikleri Journal of Internal Medical Sciences. 2005;1:28-32.
• 4. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Reviews Endocrinology. 2011;8:228.
• 5. Kaminski MR, Raspovic A, McMahon LP, Strippoli GF, Palmer SC, Ruospo M, et al. Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis. Nephrology Dialysis Transplantation. 2015;30(10):1747-66.
• 6. Otte J, van Netten JJ, Woittiez A-JJ. The association of chronic kidney disease and dialysis treatment with foot ulceration and major amputation. Journal of vascular surgery. 2015;62(2):406-11.
• 7. Association AD. Clinical practice recommendations 1996. Diabetic neuropathy. American Diabetes Association; 1996. Contract No.: 19 (1).
• 8. Dyck PJ, Davies JL, Litchy WJ, O'brien P. Longitudinal assessment of diabetic polyneuropathy using a composite score in the Rochester Diabetic Neuropathy Study cohort. Neurology. 1997;49(1):229-39.
• 9. Perkins BA, Bril V. Diabetic neuropathy: a review emphasizing diagnostic methods. Clinical Neurophysiology. 2003;114(7):1167-75.
• 10. Dyck PJ, Larson T, O'Brien P, Velosa J. Patterns of quantitative sensation testing of hypoesthesia and hyperalgesia are predictive of diabetic polyneuropathy: a study of three cohorts. Nerve growth factor study group. Diabetes Care. 2000;23(4):510-7.
• 11. Lunetta M, Le Moli R, Grasso G, Sangiorgio L. A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy. Diabetes Research And Clinical Practice. 1998;39(3):165-72.
• 12. Valk G, Grootenhuis P, Van Eijk JTM, Bouter L, Bertelsmann F. Methods for assessing diabetic polyneuropathy: validity and reproducibility of the measurement of sensory symptom severity and nerve function tests. Diabetes Research And Clinical Practice. 2000;47(2):87-95.
• 13. McGill M, Molyneux L. Spencer R, Heng LF, Yue DK. Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of lnsensate foot and workload requirements. Diabetes Care. 1999;22:598-602.
• 14. Abbott CA, Carrington AL, Ashe H, Bath S, Every L, Griffiths J, et al. The North‐West Diabetes Foot Care Study: incidence of and risk factors for new diabetic foot ulceration in a community‐based patient cohort. Diabetic Medicine. 2002;19(5):377-84.
• 15. Kumar S, Fernando DJS, Veves A, Knowles EA, Young MJ, Boulton AJM. Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Research And Clinical Practice. 1991;13(1-2):63-7.
• 16. Mcgill M, Molyneaux L, Spencer R, Heng LF, Yue DK. Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of insensate foot and workload requirements. Diabetes Care. 1999;22(4):598-602.
• 17. Rahman M, Griffin S, Rathmann W, Wareham N. How should peripheral neuropathy be assessed in people with diabetes in primary care? A population‐based comparison of four measures. Diabetic Medicine. 2003;20(5):368-74.
• 18. Kamei N, Yamane K, Nakanishi S, Yamashita Y, Tamura T, Ohshita K, et al. Effectiveness of Semmes–Weinstein monofilament examination for diabetic peripheral neuropathy screening. Journal of Diabetes and its Complications. 2005;19(1):47-53.
• 19. Vinik AI, Suwanwalaikorn S, Stansberry KB, Holland MT, McNitt PM, Colen LE. Quantitative measurement of cutaneous perception in diabetic neuropathy. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 1995;18(6):574-84.
• 20. Aaberg ML, Burch DM, Hud ZR, Zacharias MP. Gender differences in the onset of diabetic neuropathy. Journal of Diabetes and its Complications. 2008;22(2):83-7.
• 21. Baraz S, Zarea K, Shahbazian HB, Latifi SM. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. Journal of Diabetes & Metabolic Disorders. 2014;13(1):19.
• 22. Jones NJ, Chess J, Cawley S, Phillips AO, Riley SG. Prevalence of risk factors for foot ulceration in a general haemodialysis population. International wound journal. 2013;10(6):683-8.
• 23. Geetha P, Shanmugasundaram P. Assessment of diabetic peripheral neuropathy in type 2 diabetes patients by Biothesiometer. Drug Invention Today. 2019;12(3).
• 24. Cheng W-Y, Jiang Y-D, Chuang L-M, Huang C-N, Heng L-T, Wu H-P, et al. Quantitative sensory testing and risk factors of diabetic sensory neuropathy. Journal of Neurology. 1999;246(5):394-8.
• 25. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Research and Clinical Practice. 2018;138:271-81.
• 26. Dimitrakoudis D, Bril V. Comparison of sensory testing on different toe surfaces: implications for neuropathy screening. Neurology. 2002;59(4):611-3.
• 27. Jirkovská A, Bouček P, Wosková V, Bartoš Vr, Skibová J. Identification of patients at risk for diabetic foot: a comparison of standardized noninvasive testing with routine practice at community diabetes clinics. Journal of Diabetes and Its Complications. 2001;15(2):63-8.
• 28. Olaleye D, Perkins BA, Bril V. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Research and Clinical Practice. 2001;54(2):115-28.
• 29. Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes care. 2001;24(2):250-6.
• 30. Biçer EK, Çelik S. Diyabetli hastalar için kapsamlı ayak muayenesi ve risk değerlendirmesi. Turkiye Klinikleri Journal of Nursing Sciences. 2016;8(1):62-70.
• 31. Rizzo MA, Frediani F, Granata A, Ravasi B, Cusi D, Gallieni M. Neurological complications of hemodialysis: state of the art. Through Critical Appraisal. 2012;25(02):170-82.
• 32. Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia. 1996;39(11):1377-84.
• 33. Freeman A, May K, Frescos N, Wraight P. Frequency of risk factors for foot ulceration in individuals with chronic kidney disease. Internal medicine journal. 2008;38(5):314-20.