title: Haemodialysis alters peripheral nerve morphology in end-stage kidney disease.
abstract: OBJECTIVE
  We explored the nerve ultrasound (US) characteristics of 15 patients with end-stage kidney disease (ESKD) and correlated these findings with clinical severity and electrophysiological parameters of neuropathy.
  
  
  METHODS
  15 ESKD patients on thrice-weekly high-flux haemodialysis and 15 healthy controls were enrolled. Sonographic and electrophysiologic studies were conducted before and after a single session of haemodialysis. Serial measurements of median nerve cross-sectional area (CSA) and hypoechoic fraction (HF) were performed at the same non-entrapment site in the mid-forearm. Neuropathy severity was quantified using the total neuropathy score (TNS).
  
  
  RESULTS
  86.7% of the ESKD cohort had neuropathy (TNS>1). ESKD patients had significantly higher baseline CSA (8.9±1.2mm2vs 7.5±1.0mm2, p<0.05) and HF (56.0±1.0% vs 54.0±1.1%, p<0.05) compared with the control group. The CSA correlated significantly with TNS (r=0.826; p<0.0001) and other electrophysiological parameters. There was a reduction in both the CSA (8.3±1.4mm2; p<0.01) and HF (55.0±1.6%; p<0.05) after a single session of HD. A significant relationship was also found between the change in CSA and change in serum K+after dialysis (r=0.782, p<0.01).
  
  
  CONCLUSIONS
  This study shows that peripheral nerves in ESKD patients are larger and more hypoechoic and that these morphological abnormalities may be reversed by dialysis.
  
  
  CONCLUSIONS
  US may be useful as an early marker of neuropathy in ESKD.
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Adeniyi A
authors.initials: AA
authors.lastname: Borire
authors.affiliation: School of Medical Sciences, University of New South Wales, Sydney, Australia.
authors.forename: Ria
authors.initials: R
authors.lastname: Arnold
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Pussell
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Kwai
authors.affiliation: St Elisabeth Ziekenhuis, Tilburg, The Netherlands.
authors.forename: Leo H
authors.initials: LH
authors.lastname: Visser
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Don Gnocchi Foundation, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Padua
authors.affiliation: St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Simon
authors.affiliation: Brain and Mind Centre, University of Sydney, Sydney, Australia.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kiernan
authors.affiliation: Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. Electronic address: arun.krishnan@unsw.edu.au.
authors.forename: Arun V
authors.initials: AV
authors.lastname: Krishnan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging; D008875:Middle Aged; D010525:Peripheral Nerves / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000639:trends; D014463:Ultrasonography
keywords: Cross-sectional area; End stage kidney disease; Hypoechoic fraction; Nerve ultrasound; Neuropathy; Total neuropathy score