Silent Suffering: Clinical and Electrophysiological Profiling of Peripheral Neuropathy in Hemodialysis Patients in Nepal

Background and objective Peripheral neuropathy (PN) is a common and debilitating complication of chronic kidney disease (CKD), particularly in patients undergoing hemodialysis (CKD stage 5 on dialysis, CKD5D). This study aimed to determine the prevalence of PN among CKD5D patients at a tertiary care center in Nepal and to characterize its clinical and electrophysiological features. Methodology A single-center, observational, cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH) from November 2020 to October 2021. Adult patients (≥18 years) with CKD5D undergoing maintenance hemodialysis were included. Patients with a prior renal transplant or known neurological disorders were excluded. Peripheral PN was assessed by using the Michigan Neuropathy Screening Instrument (MNSI) questionnaire and physical examination, and confirmed by nerve conduction studies (NCS). Data were analyzed using SPSS® Statistics version 25 (IBM Corp., Armonk, NY), and ethical approval was obtained from the Institutional Review Board. Results Among the 116 enrolled patients, 80 were male (68.9%), with a mean age of 44.9 ± 15.47 years. The etiology of CKD was undetermined in 76 patients (65.5%), followed by diabetic kidney disease in 32 patients (27.6%). The mean duration of hemodialysis was 14 months, and 91 patients (78.4%) received eight hours of dialysis per week. PN was detected in 106 patients (91.4%), including all 35 diabetic participants (100%) and 71 out of 81 non-diabetic patients (87.7%). Based on the MNSI questionnaire, 14 patients (12.1%) reported neuropathic symptoms, while 60 (51.7%) had signs of PN on physical examination. Distal sensorimotor axonal neuropathy was the predominant pattern observed. The most frequently affected nerves were the common peroneal nerve (motor) and the sural nerve (sensory). Notably, lower serum albumin levels were significantly associated with the presence of PN (p=0.017). Conclusions PN is highly prevalent in CKD5D patients in Nepal, including among non-diabetics. Routine screening using clinical tools such as the MNSI, complemented by electrodiagnostic testing, may facilitate early detection and guide management strategies.