title: Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients.
abstract: Carpal tunnel syndrome (CTS) is the most common mononeuropathy in patients with end-stage renal disease (ESRD). The association between chronic inflammation and CTS in hemodialysis (HD) patients has rarely been investigated. HD patients with a high normalized protein catabolic rate (nPCR) and low serum albumin level likely have adequate nutrition and inflammation. In this study, we assume that a low serum albumin level and high nPCR is associated with CTS in HD patients. We recruited 866 maintenance hemodialysis (MHD) patients and divided them into 4 groups according to their nPCR and serum albumin levels: (1) nPCR <1.2 g/kg/d and serum albumin level <4 g/dL; (2) nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL; (3) nPCR <1.2 g/kg/d and serum albumin level ≥4 g/dL; and (4) nPCR ≥1.2 g/kg/d and serum albumin level ≥4 g/dL. After adjustment for related variables, HD duration and nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL were positively correlated with CTS. By calculating the area under the receiver-operating characteristic curve, we calculated that the nPCR and HD duration cut-off points for obtaining the most favorable Youden index were 1.29 g/kg/d and 7.5 years, respectively. Advance multivariate logistic regression analysis revealed that in MHD patients, nPCR ≥1.29 g/kg/d and serum albumin <4 g/dL, and also HD duration >7.5 years were associated with CTS. A high nPCR and low serum albumin level, which likely reflect adequate nutrition and inflammation, were associated with CTS in MHD patients.
authors.affiliation: aDepartment of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center bChang Gung University College of Medicine cDivision of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan dGraduate Institute of Clinical Medicine, Taipei Medical University eDepartment of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan, R.O.C.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Jui-Hsiang
authors.initials: JH
authors.lastname: Lin
authors.forename: Meng
authors.initials: M
authors.lastname: Lee
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000097:blood / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin