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Abstract: PO1182

Relationship of Peripheral Nerve Function with Mobility in ESKD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Doshi, Simit, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Cranor, Alissa Ann, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Avin, Keith G., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Moorthi, Ranjani N., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

Mobility limitation is widely prevalent in patients undergoing dialysis and is associated with frailty, disability, hospitalizations and mortality. Motor and sensory nerve impairments are reported in ESKD but their relationship with mobility is poorly studied. We tested the hypothesis that objective measures of nerve function in the lower extremity are associated with mobility limitation.

Methods

Twenty-five subjects with ESKD underwent nerve testing after their routine dialysis session. Nerve testing was done using the Natus Viking Quest NSC system and vibration detection threshold (VDT) was measures with a Medoc VSA-3000 analyzer. Predictors were nerve action potentials (amplitude) and nerve conduction velocity (NCV) in motor (peroneal) and sensory (sural) nerves as well as VDT quantitatively measured at the pulp of the big toe. Gait speed (mobility outcome) was measured over 4 meters and the better of 2 attempts used. Leg extensor strength, a covariate was measured by a dynamometer. Patient symptoms were assessed using the Neuropathic Pain Questionnaire.

Results

Subjects were 23-74 y, 14 male, 23 black, 14 diabetic, median dialysis vintage 4.5 yrs. Median gait speed was 0.70 m/s (IQR 0.61-0.86). Neuropathic pain was noted in ~57% patients, but did not correlate with objective measures of nerve function or gait speed. Median vibration detection threshold was 51μ (IQR 26-104) and showed significant negative correlation with gait speed (p < 0.01). Higher sensory (sural) nerve onset and peak latency and lower sensory conduction velocity were correlated with lower gait speed (all p < 0.01). Higher peroneal motor nerve amplitude was positively correlated with gait speed (p < 0.05). Higher VDT remained significantly associated with gait speed in multivariable regression model adjusted for demographics, diabetes, dialysis vintage and muscle strength (model R2=0.74).

Conclusion

In patients with ESKD, objective measures of nerve function are associated with mobility dysfunction regardless of diabetes, muscle strength and dialysis vintage. In contrast, subjective assessment of neuropathy is not associated with mobility dysfunction. These results demonstrate that the neuropathy of ESKD is a contributing factor to the widespread impairment in mobility observed in patients undergoing dialysis and that objective testing is required for diagnosis.

Funding

  • Private Foundation Support