Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment
Jerzy Kopec, Artur Gadek, Maciej Drozdz, Krzysztof Miskowiec, Julian Dutka, Antoni Sydor, Eve Chowaniec, Wladyslaw Sulowicz
Med Sci Monit 2011; 17(9): CR505-509
Background: Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment.
Material/Methods: The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken.
Results: Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20–30 years), 100% required surgical release procedures, while 66.66% of those treated for 15–19 years, 42.1% of those treated for 10–14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula.
Conclusions: Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS.
Keywords: Middle Aged, Median Nerve - pathology, Incidence, Humans, Hepacivirus - immunology, Carpal Tunnel Syndrome - surgery, Antibodies, Viral - immunology, Amyloidosis - surgery, Aged, 80 and over, Aged, Adult, Adolescent, Poland - epidemiology, Renal Dialysis - adverse effects, Risk Factors, young adult