THE COMPARISON OF THE EFFECTIVENESS OF RENAL REPLACEMENT THERAPIES (DIALYSIS AND TRANSPLANTATION) ON UREMIC POLYNEUROPATHY IN CHRONIC RENAL FAILURE
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Keywords (Original Language):
| Author Name | University of Author | Faculty of Author |
|---|---|---|
Abstract (2. Language):
Objective: The aim of this study was to compare the effectiveness of dialysis (dx) and transplantation (tx) on uremic
polyneuropathy.
Material and methods: Eleven dx and 22 tx recipients were included in this study. Also, there were ten healthy
persons in the control group. Electrophysiologic studies were recorded before and after six months from the onset
of dx and tx. Sensory parameters (distal latency, peak latency, amplitude, conduction velocity, and sural/radial amplitude
ratio) were measured in median, ulnar, radial, sural and superficial peroneal nerves. Motor parameters (distal
latency, amplitude, and conduction velocity) were recorded in the median, ulnar, common peroneal and tibial nerves.
Additionaly, median and tibial F wave latency and tibial H latency were measured.
Results: While sensory distal latencies and peak latencies (ms) did not change significantly in dx patients
(2.05→2.0, p>0.5 and 2.61→2.59, p>0.5, in ulnar nerve, respectively; 2.95→2.96, p>0.5 ve 3.75→3.81, p>0.5, in
sural nerve, respectively), there was a significant decrease in tx patients (1.83→1.73, p<0.5 and 2.47→2.35, p<0.5,
in ulnar nerve, respectively; 2.83→2.68, p<0.5 and 3.65→3.46, p<0.5, in sural nerve, respectively). Sensory amplitudes
(μV) and conduction velocities (m/sn) increased significantly in ulnar nerve for dx and tx patients
(13.98→16.97, p<0.01 and 48.67→51.76, p<0.01, respectively, in dx patients; 13.4→23.11, p<0.001 and
53.15→57.31, p<0.001, respectively, in tx patients), but these parameters for sural nerve increased in only tx patients
(10.91→11.08, p>0.5 and 45.39→46.14, p>0.5, respectively, in dx patients; 17.36→21.28, p<0.001 and
49.01→51.96, p<0,01, respectively, in tx patients). As motor distal latencies, amplitudes and conduction velocities
did not change in ulnar nerve for dx patients (2.76→2.61, p>0.05, 9.15→9.60, p>0.5, 55.99→56.27, p>0.5, respectively),
these parameters changed significantly in tx patients (2.45→2.05, p<0.5, 9.35→10.90, p<0.5,
61.77→64.18, p<0.01, respectively). Significant changes were found for same parameters in tibial nerve in dx and
tx patients (15.15→9.16, p<0.001, 4.12→4.96, p<0.5, 40.18→42.49, p<0.5, respectively, in dx patients;
13.61→8.30, p<0.001, 5.86→6.87, p<0.5, 43.83→45.43, p<0.5, respectively, in tx patients). Median and tibial F
wave responses and tibial H reflex latencies changed significantly in each group. But, increment of tibial H reflex
amplitudes were found in only tx patients. While sural/radial sensory amplitude ratio decreased (0.56→0.49) in dx
patients, this ratio increased (0.62→0.68) in tx patients.
Conclusion: The results of this study indicated that sensory parameters showed considerable improvement than
motor parameters in both of the dx and tx patients. The improvements in sensory and motor parameters and F wave
and H reflex latency were more prominent in tx recipients. In contrast to related literature, almost all of the parameters
were found to have improved in tx patients despite their long pretransplant uremic period. These results
suggest that renal tx is more effective than dx regarding uremic polyneuropathy outcomes.
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Abstract (Original Language):
ÖZET
Amaç: Bu çal›flman›n amac› kronik renal yetersizli¤i olan hastalarda diyaliz (dx) ve transplantasyonun (tx) üremik
polinöropatiye etkinliklerinin karfl›laflt›r›lmas›d›r.
Gereç ve yöntem: Çal›flmam›za 11 diyaliz (9’u hemodiyaliz, 2’si kronik periton diyalizli) ve 22 renal transplantl›
olmak üzere toplam 33 hasta al›nd›. Kontrol grubunda 10 sa¤l›kl› birey vard›. Renal replasman tedavisi yani dx veya
tx yap›lmadan önce ve tedavinin bafllamas›ndan 6 ay sonra elektrofizyolojik incelemeler yap›ld›. Duysal iletiler
olarak medyan, ulnar, radyal, sural ve superfisyel peroneal sinirlerde bafllang›ç (distal) latans›, tepe latans›, amplitüd,
ileti h›z› ve sural/radyal duysal cevap amplitüd oran›; motor iletiler olarak ise medyan, ulnar, peroneal ve tibial
sinirlerde, distal latans, amplitüd ve ileti h›z› hesapland›. Ayr›ca medyan ve tibial F dalga ile tibial H refleks latanslar›
da incelendi.
Bulgular: Duysal cevap bafllang›ç (distal) latanslar› ve tepe latanslar›nda (ms) dx hastalar›nda anlaml› bir de¤ifliklik
olmazken (örne¤in, ulnar sinirde s›ras›yla 2,05→2,0, p>0,5 ve 2,61→2,59, p>0,5; sural sinirde s›ras›yla
2,95→2,96, p>0,5 ve 3,75→3,81, p>0,5), tx hastalar›nda anlaml› azalma saptand› (örne¤in, ulnar sinirde s›ras›yla
1,83→1,73, p<0,5 ve 2,47→2,35, p<0,5; sural sinirde s›ras›yla 2,83→2,68, p<0,5 ve 3,65→3,46, p<0,5). Duysal
cevap amplitüdleri (μV) ve ileti h›zlar›nda (m/sn) da ulnar sinirde dx ve tx hastalar›nda anlaml› art›fl olurken (dx
hastalar›nda s›ras›yla 13,98→16,97, p<0,01 ve 48,67→51,76, p<0,01; tx hastalar›nda s›ras›yla 13,4→23,11,
p<0,001 ve 53,15→57,31, p<0,001) sural sinirde sadece tx hastalar›nda anlaml› art›fl bulundu (dx hastalar›nda s›-
ras›yla 10,91→11,08, p>0,5 ve 45,39→46,14, p>0,5; tx hastalar›nda s›ras›yla 17,36→21,28, p<0,001 ve
49,01→51,96, p<0,01). Ulnar sinirdeki motor cevap bafllang›ç (distal) latanslar›, amplitüdleri ve ileti h›zlar› diyaliz
hastalar›nda de¤iflmezken (s›ras›yla 2,76→2,61, p>0,5, 9,15→9,60, p>0,5, 55,99→56,27, p>0,5), tx hastalar›nda
anlaml› olarak de¤iflmifltir (s›ras›yla 2,45→2,05, p<0,5, 9,35→10,90, p<0,5, 61,77→64,18, p<0,01). Ayn› de¤erlerin
tibial sinirdeki ölçümlerinde dx ve tx grubunda anlaml› de¤ifliklikler bulunmufltur (dx grubunda s›ras›yla
15,15→9,16, p<0,001, 4,12→4,96, p<0,5, 40,18→42,49, p<0,5 ve tx grubunda s›ras›yla 13,61→8,30, p<0,001,
5,86→6,87, p<0,5, 43,83→45,43, p<0,5). Her iki grup hastada da medyan ve tibial F dalga yan›tlar› ile tibial H refleks
latanslar›nda anlaml› de¤ifliklikler olmufltur. Tibial H refleks amplitüdleri ise sadece tx grubunda anlaml› art›fl
göstermifltir. Sural/radyal duysal amplitüd oran›nda ise dx grubunda azalma olurken (0,56→0,49) tx grubunda art›
fl (0,62→0,68) gözlendi.
Sonuç: Hem diyaliz ve hem de tx hastalar›nda duysal parametrelerin motor parametrelerden daha belirgin olarak
düzeldi¤i; duysal, motor iletilerde ve F dalga yan›t› ile H refleksindeki düzelmenin transplantl› hastalarda daha belirgin
oldu¤u dikkati çekmifltir. Literatürde belirtildi¤inin aksine, transplantl› hastalar›m›zda preop üremik dönemin
uzunlu¤una ra¤men posttx tüm iletilerde anlaml› düzelmeler dikkati çekmifltir. Bu sonuçlar üremik polinöropatinin
tedavisinde renal tx’in diyaliz tedavisine üstünlü¤ünü göstermifltir.
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