Uremic Neuropathy Treatment & Management

Updated: Aug 27, 2018
  • Author: Yi Pan, MD, PhD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Treatment

Approach Considerations

Available therapies for uremic neuropathy, including dialysis and vitamin supplementation, are not satisfactory. Erythropoietin has showed improvement in motor nerve conduction velocity in predialysis patients. [32] Renal transplantation in early stage uremic neuropathy has achieved a favorable outcome.

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Medical Care

Different dialyzer membranes have been investigated for treatment of uremic neuropathy. Djukanovic's group found that hemodialysis using membranes with high permeability to molecules of middle molecular weight (ie, 300–2000 Daltons) prevented excessive accumulation of these molecules in plasma and significantly improved neuropathy in patients with high levels of mid-weight molecules. High-flux membranes can remove mid-weight molecules. [33]

Bolton et al reported improvement of polyneuropathy with high-flux hemodialysis. They indicated that modern methods of managing renal failure have decreased the incidence of uremic neuropathy. [34]

Chronic hemodialysis may stabilize neuropathy in most patients. However, the course of neuropathy cannot be improved with certainty simply by manipulating the hemodialysis schedule. [35, 36] Paresthesia may improve rapidly once hemodialysis is started, but other symptoms persist. [37]

In the past, peritoneal dialysis was associated with a lower incidence of uremic neuropathy than hemodialysis because peritoneal dialysis often was characterized by better removal of mid-weight molecules. [38] No significant differences have been demonstrated in the effects of peritoneal dialysis and current high-flux membrane hemodialysis on peripheral nerve function. Uremic neuropathy was reported in 73.9% of the patients who had peritoneal dialysis between 5 and 10 years. [39]

Biotin is a low molecular weight coenzyme loosely bound to serum proteins, which likely would be lost during dialysis. Yatzidis et al recommended a 10 mg dose of biotin 3 times a day. In a small group study, they found that all 9 patients experienced improved mental function, sensory symptoms, and walking after 3 months of treatment. In addition, they found that biotin counteracts the inhibitory effect of uremic plasma on microtubule formation in vitro. [40, 41]

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Surgical Care

Numerous case reports exist on the beneficial effect of renal transplantation. Nielsen reported that all patients who underwent successful transplantation showed definite improvement. Paresthesia disappeared within 1-3 months in mild uremic neuropathy. The remission after transplantation had 2 phases, with an early rapid phase and a late slow phase in moderate-to-severe neuropathy. Rapid improvement in nerve conduction velocity was noted shortly after successful transplantation. Renal transplantation reverses sympathetic and parasympathetic autonomic dysfunction in as little as 3-6 months after the procedure. [5, 42, 43]

Patients with diabetes do not show improvement with their neuropathy, which suggests that the underlying cause of the neuropathy is mainly the diabetes mellitus and not the renal insufficiency.

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Consultations

Consultation with the following may prove helpful:

  • Nephrologist for hemodialysis

  • Transplant team for renal transplantation

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Diet

A low-protein diet is recommended; this requires periodic assessment of dietary compliance and nutritional status. [44]

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Activity

If the patient has significant weakness, devices such as ankle/foot orthosis, cane, walker, or wheelchair may help mobility.

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Prevention

Chronic dialysis may prevent neuropathy in some patients if it begins early. Renal transplantation should be considered to prevent uremic neuropathy. The occurrence of neuropathy is highly correlated with the severity and duration of renal failure. [45, 46]

 

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Long-Term Monitoring

Uremic neuropathy is a chronic disease. Long-term monitoring includes patient’s sensory symptoms, pain control, depression/anxiety, motor function, risk of fall, and utilization of devices.

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