肾脏病学与治疗学杂志

Why does Carpal Tunnel Syndrome Still Occur in our Chronic Hemodialysis Patients?

Abstract

Intissar Haddiya, Hicham Yacoubi and Yassamine Bentata

Despite the numerous advances in hemodialysis practice, cases of CTS are still observed in our patients. The aim of this study was to assess the prevalence of CTS and factors associated to its occurrence in our chronic HD patients.
Methods: We performed a cross-sectional study in December 2017, including consenting chronic hemodialysis patients, with a dialysis vintage of at least three months, in a reference state center in Oujda- Eastern Morocco. Diagnosis was based on signs and symptoms reported by the patient, and manoeuvres of Tinel and Phalen. Symptomatic patients underwent electromyography (EMG) on non-dialysis days, by the same neurologist in the same conditions.
Results: Our study included 112 chronic HD patients, who met the inclusion criteria. CTS was diagnosed and verified using nerve conduction examination in 8.04% of the patients. Diabetic nephropathy was the most observed initial nephropathy in CTS patients in 36.3% of the cases. Patients with CTS were older (mean age: 52.99 ± 11.32 vs. 48.4 ± 12.6; p=0.002), mainly males (63.6% vs. 55.4%; p=0.03), active smokers in 18.5% of the cases. They also had a longer HD duration (95.8 ± 15.75 vs. 82.11 ± 17.22 months; P<0.001). Moreover, CTS patients had higher diabetes mellitus prevalence (36.3% vs. 13.8%; p<0.001), higher HCV prevalence (18.18% vs. 2.97%; p=0.02), and were less likely to have a urine output >100 ml/day (27.2% vs. 3.98%; P=0.003). Multivariate logistic regression showed that HCV (OR: 1.45, 95% confidence interval (CI): 1.17-1.87, p=0.034), HD vintage [OR: 1.95, 95% CI: 1.89-3.65, P<0.001] and urin output <100ml/day (OR:1.72, 95% CI: 1.03-2.57, P=0.01) were positively associated with CTS.
Conclusion: In this cross-sectional study, we observed that a long dialysis vintage, positive HCV and loss of residual renal function were associated with CTS in chronic HD patients. However, additional studies are required for further clarification of the pathogenesis of CTS in chronic HD patients.