Electrophysiological abnormalities in upper extremities after brachiocephalic A-V fistulas construction in predialysis patients.
BACKGROUND
Peripheral neuropathy is considered a common complication in patients suffering from advanced chronic kidney disease (CKD). Superimposed peripheral multiple neuropathies may complicate arteriovenous (A-V) fistulas construction.


OBJECTIVE
To evaluate, prospectively, the influence of brachiocephalic A-V fistulas construction on the peripheral nerves of the same extremity and to characterize the patients at risk for developing ischemic and neurological complications.


METHODS
Twenty patients suffering from advanced CKD were enrolled in the study: 10 diabetic and 10 non-diabetic patients. All patients underwent electrophysiological evaluation one week before, 3 weeks and 3 months after surgery. Median, ulnar and radial nerves were studied.


RESULTS
In non-diabetic patients MNCV was normal before and after surgery, but were significantly lower and reduced progressively and significantly after surgery in diabetic patients (p< or =0.02). In both non-diabetic and diabetic patients SNCV was reduced, but were significantly lower in diabetic patients before and after surgery (p< or =0.03). In diabetic patients it reduced progressively and significantly after surgery (p<0.01). Thirty percent of patients developed local edema and significant decrease of CMAP of median nerve three weeks after surgery (p=0.02) with complete resolution at three months.


CONCLUSIONS
Diabetic uremic patients are at increased risk to develop disabling neurological complications after the construction of A-V fistulas. Diabetes was the only predictive risk factor for developing these complications. Prevention requires careful preoperative electrophysiological evaluation and postoperative follow-up.
Nephrology and Hypertension Department, Western Galilee Hospital, Nahariya, Israel. drkamalh@hotmail.com
Kamal
K
Hassan
Saab
S
Amir
Sulla
S
Michael
Waleed
W
Simri
Mahmoud
M
Haj
Shaul M
SM
Shasha
Batya
B
Kristal
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D016122:Brachiocephalic Trunk; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000628:therapy*; D004576:Electromyography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology; D011336:Probability; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D034941:Upper Extremity