Peripheral neuropathy: an important contributor to physical limitation and morbidity in stages 3 and 4 chronic kidney disease
Peripheral neuropathy: an important contributor to physical limitation and morbidity in stages 3 and 4 chronic kidney disease
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DOI：
10.1093/ndt/gfab043
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发表时间：
2021-03-20
影响因子：
6.1
通讯作者：
Krishnan, Arun, V
中科院分区：
文献类型：
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作者：
Arnold, Ria;Pianta, Timothy J.;Krishnan, Arun, V
背景 身体机能受损会导致慢性肾脏病 (CKD) 出现不良后果。周围神经病变在 CKD 中非常普遍，但其对 CKD 患者身体功能的影响尚不清楚。本研究探讨了 CKD 3 期和 4 期周围神经病变、步行速度和生活质量 (QoL) 之间的关系。方法 这是一项前瞻性观察性研究，调查估计肾小球滤过率 (eGFR) 15-60 mL/min/1.73 m(2) 的 CKD 患者的神经病变。连续招募了109名患者。使用总神经病变评分来确定周围神经病变的存在和严重程度。以正常速度和最大速度评估步行速度，并使用简表 36 (SF-36) 问卷评估生活质量。结果 周围神经病变非常普遍：40% 表现为轻度神经病变，37% 表现为中重度神经病变。神经病变严重程度的增加是步行速度降低的主要预测因素（R-2 = -0.41，P < 0.001），并且在对糖尿病进行多变量分析调整后仍然如此。这种关联对于正常步行速度和最大步行速度都很明显。神经病变与 SF-36 多个领域（包括身体功能）的低分显着相关（r = -0.570，P < 0.001）。根据糖尿病状况进行的亚组分析显示，无论是否患有糖尿病，神经病变的患病率都很高；在亚组分析中，与步行速度的关系仍然很明显。然而，糖尿病患者表现出更严重的神经病变、行走速度更慢以及生活质量得分更低。结论 中度至重度周围神经病变在 CKD 3 期和 4 期中很常见，与步行速度降低相关，与糖尿病状况无关，并且与患者报告的生活质量相关。这表明，无论糖尿病状况如何，神经病变都是 CKD 患者身体功能下降的重要因素。 CKD 进展期间周围神经病变的针对性诊断和治疗可能会改善功能结果和生活质量。
Background Impaired physical function drives adverse outcomes in chronic kidney disease (CKD). Peripheral neuropathy is highly prevalent in CKD, though its contribution to physical function in CKD patients is unknown. This study examined the relationships between peripheral neuropathy, walking speed and quality of life (QoL) in stages 3 and 4 CKD. Methods This was a prospective observational study investigating neuropathy in CKD patients with an estimated glomerular filtration rate (eGFR) 15-60 mL/min/1.73 m(2). A total of 109 patients were consecutively recruited. The presence and severity of peripheral neuropathy was determined using the total neuropathy score. Walking speed was assessed at both usual and maximal speed, and QoL was assessed using the Short- Form 36 (SF-36) questionnaire. Results Peripheral neuropathy was highly prevalent: 40% demonstrated mild neuropathy and 37% had moderate-severe neuropathy. Increasing neuropathy severity was the primary predictor of reduced walking speed (R-2 = -0.41, P < 0.001) and remained so after multivariable analysis adjustment for diabetes. This association was evident for both usual and maximal walking speeds. Neuropathy correlated significantly with low scores on multiple domains of SF-36 including physical function (r = -0.570, P < 0.001). Subanalysis according to diabetic status revealed a high prevalence of neuropathy both with and without diabetes; relationships to walking speed remained evident in subgroup analysis. However, those with diabetes demonstrated greater severity of neuropathy, slower walking speed and lower scores in QoL. Conclusions Moderate to severe peripheral neuropathy was common in stages 3 and 4 CKD, associated with reduced walking speed independent of diabetes status and was correlated with patient-reported QoL. This suggests that neuropathy is an important contributor to declining physical function in CKD irrespective of diabetes status. Targeted diagnosis and management of peripheral neuropathy during CKD progression may improve functional outcomes and QoL.