A Study on the prevalence of peripheral neuropathy in patients with chronic kidney disease in GVMCH

BACKGROUND: The incidence and prevalence of Chronic Kidney Disease is increasing slowly. The affected groups are predominantly elderly individuals, diabetics and patients with systemic hypertension. Peripheral Neuropathy among CKD patients is the most common neurological complication of uremia, but still it is an under estimated problem adversely affecting the patient’s quality of life. It is more often a silent burden for the patient, progressively affecting his/her quality of life. It is sometimes overlooked as the treating physicians are occupied with other uremia related complications and also there is a dearth of literature regarding the diagnostic criteria and management of this condition. It is further amplified by the lack of availability of a simple screening tool for peripheral neuropathy in CKD. Hence this study aims to establish the prevalence of peripheral neuropathy among patients with CKD in our Hospital. AIMS AND OBJECTIVES: 1. To study the prevalence of peripheral neuropathy in patients with chronic kidney disease in GVMCH. 2. To determine the prevalence of Peripheral Neuropathy and associated factors in relation to the stage of CKD. METHODOLOGY: This study was carried out in chronic kidney disease patients attending hemodialysis unit and patients admitted as in-patients in our medical wards in the department of General medicine, Government Vellore Medical College and Hospital. A total sample of 100 patients were studied using meticulously prepared proforma over a period of one year starting from October 2016 to September 2017. After prior Institutional Ethical clearance and obtaining informed consent, the participants satisfying the inclusion criteria were asked detailed history and clinical examination was performed according to the well-designed proforma cited below. The presence of neuropathy was assessed using Michigan Neuropathy Screening Instrument (MNSI) Scores with Semmes-Weinstein monofilament(10g) and Diabetic neuropathy symptom score (DNS).Weight, height and waist of the individual patients were measured and BMI was calculated and recorded in all the cases. RESULTS: The mean age of the study subjects was 47.87 years. Most of the patients belonged to the age group 40-70years.Out of 100 cases, there were 58 (58.0%) males and 42(42.0%) females. The Male to Female sex ratio was 1.38:1.Sixty patients out of 100 patients were on Hemodialysis whereas 40 patients belonged to the non-HD group. The prevalence of peripheral neuropathy in CKD patients in GVMCH assessed by MNSI was 64%.The prevalence of clinical Uremic distal symmetrical sensory-motor peripheral neuropathy assessed by MNSI in the CKD on HD population was 71.66%. Whereas the prevalence for the same for CKD patients not on HD was 73.68%.Of the non-HD patients 6 out of 17 CKD stage 4 patients (35.29% prevalence) and 1 out of 4 CKD stage 3 patients (25% prevalence) were affected by peripheral neuropathy.The average height of the study population was 162.77cm. The average weight of the study population was 61.60kg.The average BMI of the study population was 23.05.The average eGFR of the study population was 13.05ml/min/1.73m2BSA. The average serum creatinine of the study group was 5.33mgs%. CONCLUSION: Uremic neuropathy is the most common neurological complication in patients with uraemia. The condition is not restricted to patients with ESRD,but it is more prevalent in patients with stage V CKD. MNSI physical assessment could be used as a simple bed side examination to determine the presence or absence of uremic peripheral neuropathy