Haemodialysis alters peripheral nerve morphology in end-stage kidney disease

Adeniyi A. Borire, Ria Arnold, Bruce A. Pussell, Natalie C. Kwai, Leo H. Visser, Luca Padua, Neil G. Simon, Matthew C. Kiernan, Arun V. Krishnan

Research output: Contribution to journalArticlepeer-review


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 ± 1.2 mm2 vs 7.5 ± 1.0 mm2, 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 ± 1.4 mm2; 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. Significance US may be useful as an early marker of neuropathy in ESKD.

Original languageEnglish
Pages (from-to)281-286
Number of pages6
JournalClinical Neurophysiology
Issue number1
Publication statusPublished - Jan 1 2017


  • Cross-sectional area
  • End stage kidney disease
  • Hypoechoic fraction
  • Nerve ultrasound
  • Neuropathy
  • Total neuropathy score

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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