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Clinical |
Institute of Urology and Nephrology1 and Institute of Physical Medicine and Rehabilitation,2 Clinical Center of Serbia, Belgrade, Serbia
Correspondence to: D. Jovanovic, Akademska 8, 11080 Belgrade, Zemun, Serbia. dijanaj{at}eunet.yu
Background: It is well known that patients with uremia,
as well as patients with diabetes mellitus, develop polyneuropathy. Objectives: The signs of polyneuropathy in diabetic and
nondiabetic patients on continuous ambulatory peritoneal dialysis (CAPD) and
their relation with age, duration of dialysis, biochemical parameters,
dialysis adequacy, and health-related quality of life (HRQOL) were analyzed in
the present study. Patients and Methods: 65 CAPD patients (37 men, age 29
– 85 years, duration on dialysis 3 months to 14 years) were divided into
two groups: group 1 was comprised of 20 diabetic patients (mean age 50.1
± 13.2 years); group 2 was comprised of 45 nondiabetic patients (mean
age 62.3 ± 9.7 years). Biochemical parameters, dialysis adequacy, and
clinical signs were determined. Motor conduction velocity on the peroneal and
tibial nerves and sensitive conduction velocity on the sural nerve were
measured. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to
measure the CAPD patients' self-assessment of functioning and well-being using
4 component scores: physical component summary (PCS), mental component summary
(MCS), kidney disease target issues, and patient satisfaction. Results: Subjective symptoms were more intense in the
diabetic patients and correlated with changes in peroneal and tibial distal
motor latency (DML). Diabetic patients were significantly younger, had lower
creatinine and higher glucose levels, and all analyzed pathological
neurophysiological parameters were higher. Nondiabetic patients had prolonged
latency of the F-wave on the peroneal nerve and the tibial nerve and reduced
sensitive conduction velocity on the sural nerve. Significant correlations
were found between the analyzed neurophysiological parameters and duration of
dialysis and diabetes, glucose concentration, and dialysis adequacy in
diabetic patients, and between neurophysiological parameters and age and
dialysis adequacy in nondiabetic patients. Analysis of the 4 component scores
of the KDQOL-SF revealed that diabetic patients had significantly better
scores for PCS and MCS, which can be explained by their younger age. Patient
satisfaction was worse in diabetic patients and correlated with duration of
diabetes. In addition, significant correlations were established between PCS,
MCS, and tibial DML (late neuropathic changes) in diabetic patients, and
between MCS and tibial F-wave (early neuropathic changes) in nondiabetic
patients. Conclusion: Polyneuropathy was significantly worse in
diabetic than in nondiabetic patients on CAPD. DML on the tibial nerve
correlated with glucose concentration, dialysis adequacy, PCS, and MCS in
diabetic patients, whereas in nondiabetic patients, dialysis adequacy and
azotemia correlated with F-waves on the peroneal nerve and the tibial nerve
but MCS only with F-wave on the tibial nerve.
KEY WORDS: Polyneuropathy; diabetic patients; KDQOL; dialysis adequacy.
Received 17 August 2007; accepted 5 May 2008.
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